Journal of Child & Adolescent Trauma

, Volume 1, Issue 2, pp 163–178 | Cite as

Neuropsychological Assessment in Clinical Evaluation of Children and Adolescents with Complex Trauma



Complex trauma (i.e., exposure to chronic, interpersonal trauma in childhood) has been associated with structural and functional alterations in brain development, which in turn can result in cognitive and neuropsychological deficits. The goal of combining neuropsychological assessment with standard trauma specialty evaluation is to gain a comprehensive understanding of each child’s unique set of cognitive strengths and weaknesses and associated behavioral manifestations within a trauma-informed framework. This process can be a vital aide in diagnosing, conceptualizing, and designing effective interventions for traumatized youth and avoiding the common misdiagnoses that lead to ineffective treatment. This paper presents a trauma-informed approach to neuropsychological assessment, using two case studies to illustrate the process of integrating neuropsychological testing with trauma specialty evaluation.


trauma neuropsychological assessment children adolescents 


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  1. Allen, R. E., & Oliver, J. M. (1982). The effects of child maltreatment on language development. Child Abuse and Neglect, 6, 299–305.PubMedCrossRefGoogle Scholar
  2. Beers, S. R., & De Bellis, M. D. (2002). Neuropsychological function in children with maltreatment-related posttraumatic stress disorder. American Journal of Psychiatry, 159, 483–486.PubMedCrossRefGoogle Scholar
  3. Benton, A. L., Varney, N. R., & Hamsher, K. (1978). Visuospatial judgment: A clinical test. Archives of Neurology, 35, 364–367.PubMedCrossRefGoogle Scholar
  4. Carrion, V. G., Weems, C. F., Eliez, S., Patwardhan, A., Brown, W., Ray, R. D., et al. (2001). Attenuation of frontal asymmetry in pediatric posttraumatic stress disorder. Biological Psychiatry, 50, 943–951.PubMedCrossRefGoogle Scholar
  5. Children’s Advocacy Center of Suffolk County. (2003, October). Conducting trauma and sexual abuse evaluations. Training presented in Boston, MA.Google Scholar
  6. Conners, C. K., & MHS Staff. (2004). Conners’ Continuous Performance Test (CPT-II) computer programs for windows technical guide and software manual. North Tonawanda, NY: Multi-Health Systems.Google Scholar
  7. Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. (Eds.) (2003). Complex trauma in children and adolescents. National Child Traumatic Stress Network, Complex Trauma Taskforce. Retrieved April 12, 2007, from Google Scholar
  8. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.Google Scholar
  9. Crozier, J. C., & Barth, R. P. (2005). Cognitive and academic functioning in maltreated children. Children & Schools, 27, 197–206.CrossRefGoogle Scholar
  10. De Bellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., et al. (1999). Developmental traumatology Part II: Brain development. Biological Psychiatry, 45, 1259–1270.PubMedCrossRefGoogle Scholar
  11. De Bellis, M. D., Keshavan, M. S., Shifflett, H., Iyengar, S., Beers, S., Hall, J., et al. (2002). Brain structures in pediatric maltreatment-related posttraumatic stress disorder: A sociodemographically matched study. Biological Psychiatry, 52, 1066–1078.PubMedCrossRefGoogle Scholar
  12. Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan Executive Function System. San Antonio, TX: Psychological Corporation.Google Scholar
  13. Drake, E. B., Bush, S. F., & van Gorp, W. G. (2001). Evaluation and assessment of PTSD in children and adolescents. In S. Eth (Ed.), PTSD in children and adolescents (pp. 1–31). Washington, DC: American Psychiatric Association.Google Scholar
  14. Eth, S., & Pynoos, K. (1985). Developmental perspectives on psychiatric trauma in childhood. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of posttraumatic stress disorder (pp. 36–52). New York: Brunner/Mazel.Google Scholar
  15. Friedrich, W. N., Einbender, A. J., & Luecke, W. J. (1983). Cognitive and behavioral characteristics of physically abused children. Journal of Consulting and Clinical Psychology, 51, 313–314.PubMedCrossRefGoogle Scholar
  16. Garbarino, J., Dubrow, N., Kostelny, K., & Pardo, C. (1992). Children in danger: Coping with the consequences of community violence. San Francisco: Jossey-Bass.Google Scholar
  17. Glaser, D. (2000). Child abuse and neglect and the brain—A review. Journal of Child Psychology and Psychiatry, 41, 97–116.PubMedCrossRefGoogle Scholar
  18. Heaton, R. K. (1981). Wisconsin Card Sorting Test manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  19. Hoffman-Plotkin, D., & Twentyman, C. T. (1984). A multimodal assessment of behavioral and cognitive deficits in abused and neglected preschoolers. Child Development, 55, 794–802.PubMedCrossRefGoogle Scholar
  20. Hooper, H. E. (1958). The Hooper Visual Organization Test: Manual. Beverly Hills, CA: Western Psychological Services.Google Scholar
  21. Ito, Y., Teicher, M., Glod, C., & Ackerman, E. (1998). Preliminary evidence for aberrant cortical development in abused children: A quantitative EEG study. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 298–307.PubMedGoogle Scholar
  22. Ito, Y., Teicher, M., Glod, C., Harper, D., Magnus, E., & Gelbard, H. (1993). Increased prevalence of electrophysiological abnormalities in children with psychological, physical and sexual abuse. Journal of Neuropsychiatry, 5, 401–408.Google Scholar
  23. Kaplan, E. (1990). The process approach to neuropsychological assessment of psychiatric patients. Journal of Neuropsychology, 2(1), 72–87.Google Scholar
  24. Kendall-Tackett, K. A., & Eckenrode, J. (1996). The effects of neglect on academic achievement and disciplinary problems: A developmental perspective. Child Abuse and Neglect, 20, 161–169.PubMedCrossRefGoogle Scholar
  25. Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review of recent empirical studies. Psychological Bulletin, 113, 164–180.PubMedCrossRefGoogle Scholar
  26. Koenan, K., Moffitt, T. E., Caspi, A., Taylor, A., & Purcell, S. (2003). Domestic violence is associated with environmental suppression of IQ in young children. Development and Psychopathology, 15, 297–311.Google Scholar
  27. Lezak, M. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.Google Scholar
  28. Luria, A. R. (1980). Higher cortical functions in man. New York: Basic Books.CrossRefGoogle Scholar
  29. Mezzacappa, E., Kindlon, D., & Earls, F. (2001). Child abuse and performance task assessments of executive functions in boys. Journal of Child Psychology and Psychiatry, 42, 1041–1048.PubMedCrossRefGoogle Scholar
  30. Moradi, A. R., Doost, H. T. N., Taghavi, M. R., Yule, W., & Dalgleish, T. (1999). Everyday memory deficits in children and adolescents with PTSD: Performance on the Rivermead Behavioural Memory Test. Journal of Child Psychology and Psychiatry, 40, 357–361.PubMedCrossRefGoogle Scholar
  31. Palmer, L. K., Frantz, C. E., Armsworth, M. W., Swank, P., Copley, J. V., & Bush, G. A. (1999). Neuropsychological sequelae of chronically psychologically traumatized children: Specific findings in memory and higher cognitive functions. In V. L. Banyard (Ed.), Trauma and memory (pp. 229–244). Thousand Oaks, CA: Sage Publications.Google Scholar
  32. Perez, C., & Widom, C. (1994). Childhood victimization and long-term intellectual and academic outcomes. Child Abuse and Neglect, 18, 617–633.PubMedCrossRefGoogle Scholar
  33. Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky, & E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221–238). Washington, DC: American Psychiatric Press.Google Scholar
  34. Prasad, M. R., Kramer, L. A., & Ewing-Cobbs, L. (2005). Cognitive and neuroimaging findings in physically abused preschoolers. Archives of Disease in Childhood, 90, 82–85.PubMedCrossRefGoogle Scholar
  35. The Psychological Corporation. (2002). WAIS-III/WMS-III: Updated technical manual. San Antonio, TX: Author.Google Scholar
  36. Pynoos, R. S. (1990). Post-traumatic stress disorder in children and adolescents. In B. D. Garfinkel, G. A. Carlson, & E. B. Weller (Eds.), Psychiatric disorders in children and adolescents (pp. 48–63). Philadelphia: W. B. Saunders.Google Scholar
  37. Semel, E., Wiig, E. H., & Secord, W. A. (2003). Clinical evaluation of language fundamentals (4th ed.). Toronto: The Psychological Corporation/Harcourt Assessment Company.Google Scholar
  38. Shahinfar, A., & Fox, N. A. (1997). The effects of trauma on children: Conceptual and methodological issues. In D. Cicchetti & S. L. Toth (Eds.), Developmental perspectives on trauma: Theory, research, and intervention (Vol. 8, pp. 115–139). Rochester, NY: University of Rochester Press.Google Scholar
  39. Sheslow, D. & Adams, W. (2003). Wide Range Assessment of Memory and Learning: Second edition administration and technical manual. Wilmington DE: Wide Range.Google Scholar
  40. Shonk, S., & Cicchetti, D. (2001). Maltreatment, competency deficits, and risk for academic and behavioral maladjustment. Developmental Psychology, 37, 3–17.PubMedCrossRefGoogle Scholar
  41. Stern, R. A., Javorsky, D. J., Singer, E. A., Harris, N. G., Somerville, J. A., Duke, L. M., et al. (1999). The Boston Qualitative Scoring System for the Rey-Osterrieth Complex Figure. Odessa, FL: Psychological Assessment Resources.Google Scholar
  42. Strauss, E., Sherman, E. M., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). New York: Oxford University Press.Google Scholar
  43. Stuss, D. T., & Benson, D. F. (1986). The frontal lobes. New York: Raven Press.Google Scholar
  44. Sweet, J. J., Moberg, P. J., & Sucy, Y. (2000). Ten-year follow-up survey of clinical neuropsychologists: Part 1. practices and beliefs. The Clinical Neuropsychologist, 14, 18–37.PubMedCrossRefGoogle Scholar
  45. Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., & Navalta, C. P. (2002). Developmental neurobiology of childhood stress and trauma. Psychiatric Clinics of North America, 25, 397–426.PubMedCrossRefGoogle Scholar
  46. Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M. (2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience and Behavioral Reviews, 27, 33–44.CrossRefGoogle Scholar
  47. Teicher, M. H., Dumont, N. L., Ito, Y., Vaituzis, C., Giedd, J. N., & Andersen, S. L. (2004). Childhood neglect is associated with reduced corpus callosum area. Biological Psychiatry, 56, 80–85.PubMedCrossRefGoogle Scholar
  48. Teicher, M. H., Ito, Y., Glod, C. A., Andersen, S. L., Dumont, N., & Ackerman, E. (1997). Preliminary evidence for abnormal cortical development in physically and sexually abused children using EEG coherence and MRI. Annals of the New York Academy of Sciences, 821, 160–175.PubMedCrossRefGoogle Scholar
  49. Twamley, E. W., Hami, S., & Stein, M. B. (2004). Neuropsychological function in college students with and without posttraumatic stress disorder. Psychiatry Research, 126, 265–274.PubMedCrossRefGoogle Scholar
  50. van der Kolk, B. A. (1996). The body keeps the score: Approaches to the psychobiology of Posttrau-matic Stress Disorder. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 214–241). New York: Guilford Press.Google Scholar
  51. Watts-English, T., Fortson, B. L., Gibler, N., Hooper, S. R., & De Bellis, M. D. (2006). The psychobiology of maltreatment in childhood. Journal of Social Issues, 62, 717–736.CrossRefGoogle Scholar
  52. Wechsler, D. (2003). Wechsler Intelligence Scale for Children (4th ed.). San Antonio, TX: The Psychological Corporation.Google Scholar
  53. Wolfe, J., & Charney, D. S. (1991). Use of neuropsychological assessment in posttraumatic stress disorder. Psychological Assessment, 3, 573–580.CrossRefGoogle Scholar

Copyright information

© The Haworth Press 2008

Authors and Affiliations

  1. 1.Trauma CenterJustice Resource InstituteBrooklineUSA

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