Developments in clinical neuropsychology: Implications for school psychological services - Cleary et. al. - 2011 - Article

It is well known that there is a disparity between the mental health needs of school age children and the availability of mental health and social services. 16 to 22% of children and adolescents have emotional or behavioural problems serious enough to fit a mental health diagnosis. Also, research shows that 15% of children and adolescents suffer from a mental disorder severe enough to cause a certain level of functional impairment. The President’s New Freedom Commission was put up in 2002 and this tries to counterbalance the gap between mental health problems and available services. This programme enabled children and adults with mental health problems to participate fully in their communities. There are also two other programmes that support cognitive and behavioural development in children and adolescents, especially those with learning problems. These two programmes are The No Child Left Behind Act of 2001 and the Individuals WITH Disabilities Education Improvement Act of 2004 (IDEA). This article will look at the growing neuropsychological evidence for numerous behavioural and learning disorders (LD), the developments supporting neuropsychological testing in schools and the growing interest in school neuropsychology. The writers will also make suggestions regarding how school psychologists and clinical neuropsychologists can interface effectively on behalf of children and parents.

The history of clinical neuropsychology

After the 1975 passage of the Education for All Handicapped Children Act, school psychologists had to carry out psychological assessments of children for special education services. Around this time, researchers began examining the neurological bases of behavioural disorders and learning disabilities. Nowadays we have solid neurobiological evidence for attention-deficit hyperactivity disorder (ADHD), disorders of reading, calculating and persuasive developmental disorders such as Asperger’s syndrome. There is also information about neuropsychological abnormalities, like schizophrenia, obsessive-compulsive disorder and unipolar depression. Biological underpinnings of behaviour is becoming more relevant to the current health practitioners. There has been much work published recently about the application of neuropsychological principles in school settings. There are many school psychologists who want to bring together brain-behaviour research and neuropsychological principles into practice and they start to identify themselves as school neuropsychologists.

To better understand the trend for neuropsychology, it is important to look at the history of clinical neuropsychology. Researchers in the mid-19th century focused on global brain function and dysfunction and they relied upon performance on one single test to detect the presence of brain damage. From the 1940s to the 1970s multiple test batteries were developed to measure different neuropsychological constructs, like spatial abilities and memory. This was done in order to determine the source of possible brain dysfunction.

The Russian neuropsychologist Luria was the one who suggested that capacities (like language and attention) are comprised of interacting subcomponents and mediated by interactive neural networks. Because of his approach, researchers did not just look at test batteries to determine the components of impaired performance, but also looked at behavioural observations. Paediatric neuropsychologists started making test batteries for neuropsychological assessments of children. The modern paediatric neuropsychological evaluation consists of:

• An interview and observations of the child

• A parent conference

• A look at the child’s school and medical records

• A neuropsychological test

By looking at the brain-related strengths and weaknesses, neuropsychological test help explain why a student struggles. The clinical neuropsychologist is seen as a specialist in the diagnostic assessment and treatment of patients with brain injury or deficits. Neuropsychology is one of the fastest growing specialties within clinical psychology.

School neuropsychology

Many fields are interested in school neuropsychology. This is because of large number of children are affected by neurological conditions. Some are affected because they survived neonatal risk factors. Children with low birth weight are at risk for cognitive, behavioural and academic difficulties. 40% of the chronically ill children have school-related problems. Children with head injuries return to school shortly after they have been medically stabilized and the burden falls upon the teachers and families to support these children to reach their potential. Some researchers have suggested to children with traumatic brain injuries (TBI) be routinely monitored for changes in behavioural, social and academic functioning. However, due to outdated reporting protocols the prevalence of TBIs are greatly underestimated. Also, the growing use of medication is another factor which shapes school neuropsychology. Most medication to school children is prescribed for disruptive behavioural disorders. Sometimes medications are prescribed without knowing how they affect school performance. School psychologists also see an increase in the prevalence of behavioural and social-emotional problems. Many of which are the result of neuropsychological deficiencies. The school neuropsychologist can interpret the results of neuropsychological testing and make a right diagnosis.

Neuropsychological testing in school

The National Association of School Psychologists (NASP) made a service delivery system. Tier 1 services include educative and behavioural support for all students without a precise classification of what the student needs. Tier 2 services are for students who show a lack of academic progress and academic skills are directly assessed. The students who fail to respond to Tier 1 and Tier 2 interventions are categorized as Tier 3.

There is not much agreement about what needs to happen in Tier 3 before a diagnosis is made for special education services. Some scientists argue that only minimal assessment is necessary while others want a more detailed evaluation and the use of neurological tests. The writers believe that neuropsychological assessment must be seen as an essential component of the neurodiagnostic evaluation. The need for neuropsychological assessments in school is relatively high, but the access to a clinical neuropsychologist is sometimes difficult. There are many neuropsychologists that work only with adults while the majority of pediatric clinical neuropsychologists work in hospital settings with severely brain-injured children. The school psychologist needs to be trained in neuropsychology and he or she will be perfect for the school setting. He or she can interface with the clinical neuropsychologist to identify needed services. The American Board of School Neuropsychology was founded in 1999 to set standards of practice for school psychologists who claim to be school neuropsychologists.

Implications

The school psychologist and the community clinical psychologist must help other school-based professional become familiar with developments in neuropsychological assessment. This can be done with workshops and in-service presentations. School psychologists need to translate neuroscience research findings into language that social workers, parents, administrators and the school board can understand. When making websites about school neuropsychology, there needs to be a frequently asked questions section in which the most common definitions are explained. Models for the utilization of neuropsychological testing must be explored. School psychologists and clinical neuropsychologists need to work together to develop interprofessional assessment protocols which will result into more effective intervention services for students with neuropsychological conditions. School psychologists with training in neuropsychology could administer or interpret some of the test batteries employed by clinical neuropsychologists.