Clinical neuropsychology is the application of knowledge of brain-behavior relationships for assessment and treatment of a wide range of disorders. In children these disorders include outright neurological disease or injury, as well as conditions of presumed constitutional origin, such as learning disabilities, attention deficit hyperactivity disorder (ADHD), and speech and language impairment. Childhood apraxia of speech falls within the latter category of neurodevelopmental disorders. Neuropsychologists have a special interest in research on the neurological and genetic causes of these disorders. Their most unique clinical role is to examine childrens cognitive strengths and weaknesses. Although cognitive testing includes IQ, such global scores can hide important patterns of abilities and disabilities. For this reason, neuropsychologists evaluate a number of more specific abilities in the domains of language, perceptual-motor and spatial skills, memory, attention and executive functions, and problem solving. To determine how childrens cognitive abilities contribute to their learning and behavior, neuropsychological assessment also includes measures of academic achievement, behavior, and social adjustment.
Comprehensive neuropsychological assessment is useful in recognizing the deficiencies, as well as capabilities, that accompany apraxia. The pattern of childrens abilities, in turn, can help to account for the types of academic or behavior problems that children display at home and school. This information is valuable in fully appreciating the nature of childrens developmental problems, the reasons for these problems, and the types of interventions that will be needed to optimize childrens learning and day-to-day functioning. For example, children with apraxia frequently have weaknesses in academic achievement, attention, and organizational (executive) skills. By identifying these weaknesses, as well as strengths, and by examining behavioral and social adjustment, neuropsychological assessments provide a more complete picture of the childrens abilities and disabilities, as well as their efforts to cope with their limitations.
Because cognitive deficiencies identified earlier in development often forecast later learning difficulties, neuropsychological assessment is also useful in helping parents and teachers to anticipate future problems and establish longer-term educational plans. For example, deficits in remembering and manipulating phonological representations (as required, for example, to blend or segment spoken words or to rhyme) can lead to later difficulties in learning how to read. Similarly, early childhood problems in attention or executive functions can be manifest as poor study skills during adolescence, even in children who have functioned well in a structured elementary school program. Test findings that document such problems can make parents and schools aware of the need for preventative steps to reduce the impact of childrens deficiencies on future learning. Examples of these steps include additional academic instruction, efforts to teach the child organization skills, and accommodations that minimize frustration and encourage the development of compensatory strategies. At the least, anticipatory guidance can assist parents in monitoring development and in recognizing the signs of emerging problems, helping to insure that the problems can be managed in a more immediate and constructive fashion. Period neuropsychological follow-up may assist parents in tracking childrens development, but ongoing monitoring by parents and teachers is essential. The most critical times to be proactive are during transitions between educational settings, such as between elementary and junior or senior high, and between high school and entrance to post-secondary programs.
(Dr. Taylor is Professor of Pediatrics at Case Western University and in the Department of Pediatrics, Rainbow Babies & Childrens Hospital, University Hospitals of Cleveland in Cleveland, Ohio. His interests include both clinical neuropsychological assessments of children and research on the developmental outcomes of early brain insults. He is a Diplomate in Clinical Neuropsychology, American Board of Professional Psychology. He is supported by the National Institutes of Health to conduct research on the developmental consequences of childhood traumatic brain injury and low birth weight. He also collaborates with speech/language pathologist Dr. Barbara Lewis on an NIH-supported study of genetic influences on speech-sound disorders, including childhood apraxia of speech. Dr. Taylor is a member of CASANAs Professional Advisory Board.)