Here’s What You Can Expect from a Neuropsychological Evaluation

A child may be referred for a neuropsychological evaluation when there are concerns about one or more areas of development. This can include cognition, academics, attention, memory, language, socialization, emotional, behavioral, motor, visual-spatial, and adaptive functioning. Blog-Neuropsychological-Evaluation-Main-Landscape

A neuropsychological evaluation aids the psychologist in determining an appropriate diagnosis, such as Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Specific Learning Disorder, Language Disorder, and emotional and behavioral disorders. An evaluation can also be recommended if your child has been diagnosed with a medical condition such as Down syndrome, epilepsy, or a traumatic brain injury (TBI). The purpose of the evaluation would be to identify your child’s strengths and weaknesses in order to provide appropriate treatment recommendations, determine progress and response to intervention, and monitor functioning.

After your pediatrician has made a referral for a neuropsychological evaluation, you will need to schedule an intake appointment, which is typically an hour long.

What to Expect During the Neuropsychological Intake:

  • Inform the psychologist about your areas of concern
  • Provide information about your child’s history
    • Including medical, developmental, academic, attention, behavior, motor, and social history
  • Inform the psychologist of any current, or past, services your child receives (e.g., speech language therapy, occupational therapy, physical therapy, individual therapy, academic tutoring)

What to Bring to the Neuropsychological Intake:

  • Completed intake paperwork
  • Any prior psychological/neuropsychological evaluation (if applicable)
  • Your child’s most recent 504 Plan or IEP (if applicable)
  • Any recent private intervention evaluation (e.g., speech language therapy, occupational therapy)
  • Your child’s most recent report card or standardized exam scores
  • Any relevant medical information (e.g., EEG report, CT/MRI scan report)

After the intake, you will schedule the testing session for your child.  Most of the time, testing is completed in one day (5 hours of testing), but occasionally the testing will need to be completed over two days.  The psychologist will create a neuropsychological battery based on the areas of concern; however, the battery could be adjusted on the day of testing.  Typically, this occurs if another area of concern arises during the testing session.

What to Bring on the Day of the Neuropsychological Test:

  • Plenty of snacks and lunch
  • Completed paperwork and rating forms
  • Any prior evaluations that were not brought to the intake

After testing is complete, you will return for a one hour feedback session approximately two weeks later, with the clinician to review the testing data, any diagnoses determined based on your child’s profile, recommendations for home and school, and any intervention services to foster your child’s development.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

Meet-With-A-Neuropsychologist

What Comes After the ADHD Diagnosis?

Many times parents leave a doctor’s office with more questions than when they came in. This is true for medical doctors as well as for clinical psychologists. After a parent is informed that his or her child has Attention Deficit Hyperactivity Disorder (ADHD) the next phase is to start to develop a treatment plan to help the child reach his or her potential. Treatment of ADHD should be thought of as a possible three tier system: medication, therapy, and school based accommodations. Blog-ADHD-Diagnosis-Main-Landscape

Medication for ADHD

Research indicates that stimulant medication is one of the primary treatments of choice for ADHD. Many parents are very cautious and scared about putting their child on medication. One of my first pieces of advice for parents is to stay away from doing their own on-line literature search. Anyone who has access to a computer and the internet is capable of creating their own website. A website that I refer parents to all the time is www.chadd.org which is the national resource on ADHD. The literature this website provides is empirically supported and often times created by some of the biggest names in ADHD research. The other piece of advice I give to parents is to schedule a meeting with the child’s pediatrician and have a discussion regarding medication; from how the medication works to what possible side effects to look out for.

Therapy for ADHD

Children and families often get referred for therapy when the child is diagnosed with ADHD. I am a proponent of therapy that is done correctly. There first needs to be a focus on what the targets of the therapy are as well as what specific goals will be worked on in the sessions. The therapy goals need to be specific and measureable. There needs to be some metric implemented to assess for change in the child’s behavior. Finally, parents must be active participants in the therapy. There needs to be homework assignments to work on during the week as well as specific strategies that parents can implement in the moment to help modify behavior.

School Accommodations for ADHD

The final domain that needs to be considered after a child was diagnosed with ADHD is accommodations in the classroom setting to help alleviate symptoms of inattention and impulse control which have a negative impact on the child’s academic performance. Many times after I diagnosis a child with ADHD, I discuss with the parents about creating a 504 Plan in the academic setting. A 504 Plan consists of a variety of classroom and testing based accommodations to help address academic symptoms of ADHD. The plan is always individually tailored based upon the specific concerns that a child exhibits.

The diagnosis of Attention Deficit Hyperactivity Disorder is only the first step of helping the child. Parents frequently will have to seek out outside resources such as pharmacological intervention, therapy, and school based accommodations in order for their child to reach his or her potential.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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What Are Disorders of the Corpus Callosum?

This guest blog post was written by Amy Connolly, RN, BSN, PCCN of a community hospital in Chicago.

The corpus callosum is the large bundle of nerve fibers that serve as a pathway, connecting the right andCorpus Callosum left hemispheres of the brain together. Disorders of the corpus callosum, or DCC’s, are “conditions in which the corpus callosum does not develop in a typical manner.” This important brain superhighway is usually formed by 12 to 16 weeks after conception. However, there are some people born without a corpus callosum at all, this is otherwise known as agenesis of the corpus callosum. My 4 year old son has hypoplasia of the corpus callosum, which means that his corpus callosum is thin and therefore may be less efficient. A few other included disorders are partial agenesis, as in partially absent, and dysgenesis, or malformation, of the corpus callosum.

DCC’s, like Autism, are a spectrum disorder, where there is no textbook answer to how happy or healthy someone will be just based off of diagnosis. Many parents are finding out during pregnancy due to the advancement in technology and equipment. Unfortunately, they are not always getting the best advice or support, due to the lack of knowledge on provider’s part. My best advice to them is to be proactive with recommended testing and therapies, but not to stress over the diagnosis itself. Having a disorder of the corpus callosum is nothing to fear in itself.

Every individual with a DCC, will have their own paths and abilities. The diagnosis should not define them or stop them from reaching their true potential, whatever that may be. There are plenty of people who found their diagnosis after a MRI or CT scan was done due to headaches or some type of accident. Someone with a DCC may live a pretty ordinary life and you would never have even been able to tell that they had a “special” brain, if they did not have a diagnostic test for some reason or another. Many people with a DCC have trouble keeping up with their peers when they get closer to their teen years. They may be socially awkward and they may not get the punchline of jokes right away.

For others with a DCC, a lot of therapy and repetition will help them to tell their story. Many of those with a DCC may also be diagnosed with ADHD, Autism, depression, anxiety, and so forth. Some who haven’t had an MRI or CT scan may only be diagnosed with one or more of the other things and do not even know that they have this disorder. Many people with the disorder may also have seizures, low muscle tone, and sensory disorders. Other midline defects can also be common such as eye or vision problems, heart problems, thyroid or growth disorders, and the list goes on. Some people with a DCC may also have feeding tubes as children and they may or may not still need them as they get older.  There is a lot we still do not know about disorders of the corpus callosum, but what we do know is that people with them are pretty awesome! They may usually have to work harder to make those important brain connections, but they always continue to put smiles on our faces no matter how big or small their accomplishment may be in someone else’s eyes!

The National Organization for Disorders of the Corpus Callosum, NODCC, is a nonprofit organization that strives to find out more about people like my son and to spread awareness about the disorder. The NODCC holds a conference every other year in a different U.S. location for individuals living with a DCC, families, professionals, and anyone else who would like to attend. There are multiple sessions on different tracks going on at the same time. This year approximately 600 people are expected to attend. Attendees will be from all over the U.S., with some even flying in from abroad. The conference is at the Marriott O’Hare in Chicago from July 22-24, 2016. For many with the disorder, and their families, conference is like a home away from home. A place where everybody gets each other without having to say a word. High functioning, low functioning, we are all functioning. Together.

To learn more about disorders of the corpus callosum, please go to www.nodcc.org.

Resources:

http://nodcc.org/corpus-callosum-disorders/faq/

Amy CAmy Connolly RN, BSN, PCCN lives in Franklin Park, Illinois.  Amy is a registered nurse at a community hospital in Chicago.  Amy is also stepmom to Patrick (16), mom to Jesse (6), Jake (4), and Marcey (2).  Jake, now age 4, was diagnosed with hypoplasia of the corpus callosum at ten months of age, after a MRI was done due to delayed developmental milestones and a lazy eye.  Amy’s nursing experience did not prepare her to navigate the world with a child with special needs.  She has learned a lot over the last four years and enjoys sharing and learning more with other families.  Amy is also actively involved as a volunteer for the National Organization for Disorders of the Corpus Callosum due to her strong belief in their mission and values.

‘Act First, Think Never’ – Warning Signs That A Child May Have ADHD

In the United States, attention-deficit/hyperactivity disorder (ADHD) has become a very common Blog-ADHD-Red-Flags-Main-Landscapechildhood diagnosis (NIMH, 2015). Parents and teachers may often wonder if their child or student fits the criteria for this diagnosis. There are several common indicative signs and symptoms of ADHD; however, the best way to be sure is to get a proper assessment by a psychologist/neuropsychologist. There are various factors that may influence a child’s behavior, causing them to appear as though they have ADHD. Additionally, anxiety and depression are common mood disorders that resemble ADHD symptoms. Because, ADHD is more complex than inattention and restlessness, it is imperative that an assessment is conducted.

Some red flags that may warrant concern and need for an ADHD assessment are:

  1. Behaviors are frequent and negatively impact quality of life
  2. Behaviors impact school performance and everyday life
  3. Inability to regulate emotions- seeming impulsive and “over reacts”
  4. Short attention span
  5. Talkative
  6. Always moving, running, jumping, and fidgeting
  7. Forgetful- “where?” “What?” Uh?”
  8. Disorganized
  9. Curious- interested in a lot of things but has poor follow through
  10. Cannot wait turn- very impatient
  11. Often loud and struggle to play quietly
  12. Avoids tasks that require mental effort
  13. Makes careless mistakes, and does not seem to work to potential
  14. Difficulty following multiple step directions
  15. Often unaware of time and gets lost easily

It is important to distinguish what is normal childhood behavior from behaviors that are impairing developmental growth and academic performance. There are also gender differences in symptoms. Boys and girls often do not display symptoms in the same manner; boys tend to be more impulsive than girls and equally inattentive.

A standard rule of thumb is that children with ADHD display symptoms three times as much as their peers (NIMH, 2015). If you suspect that a child may have ADHD, it is best to refer for assessment from a qualified professional. Remember to be aware that the child’s behavior can be caused by a host of influential factors, i.e. neurological, psychological, and environmental. Nonetheless, if the behaviors persist and are worsening, thus essentially negatively impacting their quality of life, socially, academically, emotionally, and physically, then it is time to seek help.

References

Hasson, R. & Goldenring Fine, J. (2012). Gender differences among children with ADHD on Continuous Performance Tests A Meta-Analytic Review. Journal of Attention Disorders, 16(3), 190-198.

The National Institute of Mental Health (NIMH). (2015). Attention Deficit Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Find-Out-More-About-ADHD

Reasons to Seek a Neuropsychological Evaluation for Your Child

Neuropsychology is a field of psychology that focuses on the relationship between learning, behavior, and brain functioning. A child may be referred for a Blog-Neuropsychological-Evaluation-Main-Landscapeneuropsychological evaluation when there are concerns about one or more areas of their development. This can include a child’s cognitive, academic, memory, language, social, self-regulatory, emotional, behavioral, motor, visual-spatial, and adaptive functioning.

This type of evaluation can help rule out diagnoses such as Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Specific Learning Disorder, Language Disorder, as well as various emotional and behavioral disorders. A neuropsychological evaluation can also be helpful if your child has been diagnosed with a medical condition such as Down Syndrome or other genetic disorders, Traumatic Brain Injury, or Epilepsy. The purpose of the evaluation is to identify a child’s patterns of strengths and challenges in order to provide parents, schools, and other providers with strategies to help them succeed across contexts. It can also be used to track a child’s progress and response to targeted interventions.

In order to assess whether a neuropsychological evaluation may be helpful for a child, a family may identify concerns in the following areas:

  • Cognitive
    • Difficulties with verbal and nonverbal reasoning and problem solving
    • Requiring a significant amount of repetition and/or additional time when learning
    • Delays in adaptive functioning
  • Academic
    • Grades below peers
    • Concerns with reading (phonetic development, fluency, comprehension), mathematics (calculation, word problems), or writing (spelling, content, organization)
    • Needing additional time to complete schoolwork, homework, or tests
    • Frustration with academic work
  • Language
    • Expressive (output of language) or receptive (understanding of language) difficulties
    • Challenges initiating or maintaining a conversation
    • Difficulties with sarcasm or non-literal language (e.g, “It’s raining cats and dogs”)
    • Repetitive or odd language usage (e.g., repeating lengthy scripts heard from television or news programs)
    • Pronoun reversals or odd use of language
  • Self-Regulation
    • Difficulty paying attention or sitting still
    • Needing frequent prompts or reminders to complete tasks
    • Difficulty with multiple-step commands
    • Losing or misplacing items
    • Forgetting to turn in completed assignments
  • Social
    • Poor peer relations
    • Inappropriate response when approached by peers
    • Difficulty with imaginative, functional, or reciprocal play
    • Limited interest in peers or preference for solitary play
  • Repetitive Behaviors
    • Repetitive vocalizations
    • Repetitive motor mannerisms (e.g., hand flapping, finger flicking, body rocking)
    • Lining up toys, spinning wheels of cars, sorting objects for prolonged periods of time
  • Behavioral Dysregulation
    • Physical or verbal aggression
    • Defiance or non-compliance
    • Difficulties with transitions or changes in routine
    • Self-injury (e.g., head banging)
  • Emotional
    • Poor frustration tolerance
    • Irritability or easily upset
    • Eating or sleeping difficulties
    • Somatic complaints
    • Negative self-statements
    • Lack of interest in things he/she used to enjoy
  • Visual-Spatial, Visual-Motor, and Motor
    • Poor handwriting
    • Trouble with fine motor tasks (e.g., unwrapping small items, buttoning or zipping clothing, tying shoe laces)
    • Difficulty transferring information from the classroom board to a notepad, or transferring information from a test booklet to a scantron/bubble sheet
    • Difficulty with overwhelming visual displays (e.g., computer screen with several icons; homework with several problems on one sheet; a book with several colors and pictures)

Should a child demonstrate difficulties in some of the areas listed above, he/she may benefit from further consultation or a subsequent neuropsychological evaluation. Through this process, areas of difficulty can be identified, and targeted interventions will be suggested to enhance a child’s development.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Meet-With-A-Neuropsychologist

10 Steps to Diagnosing A Learning Disability

If your child has difficulty with reading, writing, math or other school learning-related BlogLearningDisabilityDiagnosis-Main-Landscapetasks, this does not necessarily mean that they have a learning disability. Lots of children struggle at times with school.

Common signs of a learning disability:

  • Difficulty with reading, writing or math skills
  • Short attention span or difficulty staying on task (easily distracted)
  • Difficulty with memory
  • Trouble following directions
  • Poor hand-eye coordination
  • Difficulty with time management
  • Problems staying organized
  • Inability to discriminate between or among letters, numerals, or sounds
  • Difficulty with paying attention
  • Inconsistent school performance

Each learning disability has its own signs and not every person with a particular disability will have all of the signs. These signs alone are not enough to diagnose a learning disability, so a professional assessment is necessary to diagnose a learning disability.

If some of these symptoms sound familiar, below are 10 steps to take:

  1. Talk to your child about the areas they are struggling in order to understand the symptoms.
  2. Provide empathy and emotional support for your child. Let them know that lots of people struggle at times with school related tasks.
  3. Get specific feedback from teachers regarding problem areas or grades.
  4. Set up an initial intake session with a Psychologist/Neuropsychologist to discuss symptoms and background information.
  5. Have the child tested in specific areas:
    1. Intellectual/IQ
    2. Achievement/Academic
    3. Language/Communication
    4. Memory
    5. Attention
    6. Visual/Motor
    7. Problem Solving
    8. Social, Emotional, Behavioral
  6. Get feedback from teachers with specific forms regarding behaviors
  7. Discuss with Psychologist/Neuropsychologist the results of the testing and recommendations.
  8. Talk to the child’s school about accommodations and services.
  9. Follow up with teachers about effectiveness and gains of accommodations.
  10. Follow up Neuropsychological testing in 6 months to 1 years’ time.

References:

https://www.nichd.nih.gov/health/topics/learning/conditioninfo/Pages/symptoms.aspx

http://ldaamerica.org/symptoms-of-learning-disabilities

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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How is Torticollis Diagnosed?

Congenital muscular Torticollis should be a suspected diagnosis if your infant demonstrates a preferred head position or posture. Infants will present with reduced cervical range of motion, a potential palpable mass in the sternocleidomasoid muscle and/or craniofacial asymmetry.BlogTorticollisDiagnosis-Main-Landscape

A diagnosis is made by your pediatrician and can usually be done based on a simple history and physical examination. Physical examination findings may include:

  • Head tilt to one side
  • Reduced range of motion
  • Palpable SCM tightness
  • Absence of findings associated with non-muscular causes of congenital Torticollis

[1] Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants–a study of 1,086 cases. J Pediatric Surg 2000; 35:1091.

[2] Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Chronic Pain In Children

How To Handle Chronic Pain In Children

Have you ever heard the saying, “If you change the way you look at things, the things you look at change?” This is an approach that is also effective when dealing with chronic pain. Chronic pain is defined as persistent and/or recurrent pain that lasts greater than 3-6 months. In the United States, the number of pediatric patients who were admitted to a hospital as a result of chronic pain increased by 831% from 2004 to 2010.

The main reason these children are heading to the emergency room is because they are experiencing headaches, abdominal pain or musculoskeletal pain. Additional symptoms include chronic fatigue, heat/cold intolerance and may other symptoms. Some kids may be in such pain that they begin using an assistive devices as a means of mobility and start missing school. In turn, their grades can begin to slip and it may become harder to maintain their friendships.

How To Help Chronic Pain in Children:

Unfortunately, clinicians don’t always have a clear picture as to what is causing this chronic pain. As a result, theseChronic Pain in Children patients seek multiple opinions from various practitioners in hopes of finding a definitive answer to the cause of their pain. This can be especially frustrating for kids and their parents because without a definitive diagnosis, it may feel like the pain they are experiencing is psychological in nature or does not truly exist.

This is where a change in perspective is needed. More research is indicating that it is more beneficial to look at improving functionality by eliminating the disability associated from chronic pain than to first focus on eliminating pain. It is hypothesized that returning to function should be the first goal in treatment, and a decrease in pain will follow. This can only be done only after any potentially harmful cause of pain has been ruled out. Adolescents and children, along with their parents, should avoid seeking out further medical attention to find the root cause of their underlying chronic pain.

Treatment for Chronic Pain In Children:

Since chronic pain is a complex topic, treatment should be approached through multiple angles by a multidisciplinary team. Physical Therapists play an integral role in the management and treatment of pediatric chronic pain. When a child is experiencing chronic pain, their central nervous system is most likely experiencing central sensitization. This is when the nervous system is functioning at a high state of reactivity. Intense physical activity and an individualized exercise prescription given by a physical therapist can help desensitize these nerves and reduce hypersensitivity.

During this process, it is crucial to eliminate any pain behaviors to facilitate functionality. A pain behavior is anything that communicates that the child is experiencing pain such as grimacing, guarding and asking for unnecessary assistance. Drawing attention to a painful body part by wearing braces or utilizing an assistive device is another type of pain behavior. A licensed physical therapist can appropriately determine when it is safe to no longer use these devices.

Unfortunately, children aren’t the only ones who demonstrate pain behaviors. Parents can be guilty of showing pain behaviors by displaying overly protective responses to their child’s complaint of pain. Parents always want to do what is best for their child. Sometimes it is hard to avoid doing these behaviors.

Participating in a multidisciplinary approach to the treatment of chronic pain can help you and your child address all of these concerns. If your child is suffering from chronic pain, schedule a physical therapy evaluation at NSPT.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Resources:

  1. American Pain Society. Assessment and Management of Children with Chronic Pain. 2012. Available at: http://americanpainsociety.org/uploads/get-involved/pediatric-chronic-pain-statement.pdf. Accessed October 16, 2015.
  1. Coffelt T, Bauer B, Carroll A. Inpatient Characteristics of the Child Admitted With Chronic Pain. PEDIATRICS. 2013;132(2):e422-e429. doi:10.1542/peds.2012-1739.
  1. org. Central Sensitization. 2015. Available at: http://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization. Accessed October 16, 2015.
  1. Kizilbash SJ e. Adolescent fatigue, POTS, and recovery: a guide for clinicians. – PubMed – NCBI. Ncbinlmnihgov. 2015. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24819031. Accessed October 16, 2015.
  1. Odell S, Logan D. Pediatric pain management: the multidisciplinary approach. JPR. 2013;6:785. doi:10.2147/jpr.s37434.

 

the WISC-V

Understanding the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V)

In the world of psychological assessment, the Wechsler Intelligence Scales are considered to be the gold standard measures of intellectual functioning.  The assessments represent over 70 years of research and subsequent revisions that reflect advancements in neurodevelopmental and neurocognitive research, psychology, technology, and changes in population. (Wechsler, 2014).

The Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V):

One of the most commonly used assessments for school-aged children is the Wechslerchilds-brain-Portrait Intelligence Scale for Children, Fifth Edition (WISC-V). The assessment generates five composite score indices:

  • Verbal Comprehension (VCI)
  • Visual Spatial Index (VSI)
  • Fluid Reasoning Index (FRI)
  • Working Memory Index (WMI)
  • Processing Speed Index (PSI)

Together, a Full Scale Intelligent Quotient (FSIQ) is developed.  When large discrepancies are identified between the indices which comprise a child’s FSIQ, alternative scores can be calculated to best capture a child’s cognitive profile.  Alternative scores may be considered when deficits in language, attention, or motivation appear to have negatively impacted a child’s overall performance. Through the analysis of the general and specific domains of cognitive functioning, clinicians are better able to make informed decisions regarding diagnostic conceptualization and treatment recommendations.

WISC-V Composite Score Indices:

  • VCI: The VCI measures verbal reasoning, understanding, concept formation, in addition to a child’s fund of knowledge and crystallized intelligence.  Crystallized intelligence is the knowledge a child has acquired over his or her lifespan through experiences and learning.  The core subtests which comprise the VCI require youth to define pictures or vocabulary words, and describe how words are conceptually related.  Children with expressive and/or receptive language deficits often exhibit poorer performance on the VCI.  Studies have also indicated that a child’s vocabulary knowledge is related to the development of reading abilities, and as such, weaker performance on tasks involving vocabulary may signal an academic area of difficulty.
  • VSI:  The VSI measures a child’s nonverbal reasoning and concept formation, visual perception and organization, visual-motor coordination, ability to analyze and synthesize abstract information, and distinguish figure-ground in visual stimuli.  Specifically, the core subtests of the VSI require that a child use mental rotation and visualization in order to build a geometric design to match a model with and without the presence of blocks.  Children with visual-spatial deficits may exhibit difficulty on tasks involving mathematics, building a model from an instruction sheet, or differentiating visual stimuli and figure ground on a computer screen.
  • FRI: The FRI assesses a child’s quantitative reasoning, classification and spatial ability, knowledge of part to whole relationships.  It also evaluates a child’s fluid reasoning abilities, which is the ability to solve novel problems independent of previous knowledge.    The core tasks which make up the FRI require that a child choose an option to complete an incomplete matrix or series, and view a scale with missing weight(s) in order to select an option that would keep the scale balanced.  A child with fluid reasoning deficits may have difficulty understanding relationships between concepts, and as such, may generalize concepts learned.  They may also struggle when asked to solve a problem after the content has changed, or when question is expressed differently from how a child was taught (e.g., setting up a math problem by using information in a word problem).  Difficulties with inductive reasoning can also manifest as challenges identifying an underlying rule or procedure.
  • WMI: The WMI evaluates a child’s ability to sustain auditory attention, concentrate, and exert mental control.  Children are asked to repeat numbers read aloud by the evaluator in a particular order, and have memory for pictures previously presented.  Deficits in working memory often suggest that children will require repetition when learning new information, as they exhibit difficulties taking information in short-term memory, manipulating it, and producing a response at a level comparable to their same age peers.  It is also not uncommon for youth with self-regulatory challenges, as observed in Attention-Deficit/Hyperactivity Disorder (ADHD) to present with difficulties in working memory and processing speed (noted below).
  • PSI: The PSI estimates how quickly and accurately a child is able to process information. Youth are asked to engage in tasks involving motor coordination, visual processing, and search skills under time constraints.  Assuming processing speed difficulties are not related to delays in visual-motor functioning, weaker performance on the tasks which comprise the core subtests of the PSI indicate that a child will require additional time to process information and complete their work.  In the academic context, school-based accommodations may include allowing a child to take unfinished assignments home, focusing on the quality of work over quantity, shortening tasks, and allowing extended time.

In summary, IQ is more than one aspect of functioning and encapsulates several factors described above.  As a result, it is often more helpful to assess the indices which comprise a child’s FSIQ separately in order to best inform treatment and intervention.

Neuropsychology testing IL
NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!


using stairs to assess functional strength

How to Use a Staricase to Assess Functional Strength

We as physical therapist use functional measures of strength to assess strength in a child. Parents can use these same measures to assess whether their child is on track with gross motor skills, or to see if there is an underlying weakness. I have broken down the milestones for stair ascent and descent during the first 4 years of life, along with possible weaknesses and impairments associated with delayed skill.

Functional Strength Assessment Using a Staircase:

  • 18 months – Children should be able to walk up and down 1 set of stairs in home or at the park, How to Use Stairs to Assess Functional Strengthusing one railing or one hand held assistance, and demonstrating any type of form. Children will usually place both feet on each step at this phase. Be aware of children who always lead with the same foot; this may be a sign of opposite side weakness. Delays to this milestone may indicate core weakness, lower extremity weakness, or balance impairments.
  • 2 years – As children continue to practice this skill and strengthening their legs, their stair skills dramatically improve. First children will begin testing their stair skills by carrying objects up or down stairs and taking steps without holding onto the railing or holding a hand. Initially, they will place both feet on each step. By 2½ years old, children will begin using a more mature reciprocal form (one foot on each step), when going up stairs while using one handrail. Delays to reciprocal gait while going up stairs usually indicates weakness in the leg that does not step up.
  • 3 years – A 3-year old should be able to ascend 1 set of stairs demonstrating reciprocal gait, without handrail support. This milestone may be delayed due to short stature, and subsequent shortened tibia length (shin bones) which make it harder to reach the stairs, but will be achieved prior to their 4th birthday. Delays to reciprocal gait without handrail support indicates lower extremity weakness in non-leading leg.
  • <4 years – Prior to their 4th birthday, children should have mastered stairs. This includes walking up a set of stairs using reciprocal stepping, both with and without handrail use, as well as walking down a set of stairs using reciprocal stepping, both with and without handrail use. While handrail use will be dependent on situation, reciprocal gait will be the norm, used regardless. Delays to reciprocal gait while going down stairs may indicate eccentric weakness of quadriceps (inability to control limb with slow descent), impaired single limb balance, or core weakness.

Any child over the age of 4 who is unable to walk up and down 1 set of stairs without support, demonstrating a mature one-foot-one-each –step form, should come into NSPT for a free physical therapy screen to assess leg strength and balance.

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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!