Neuropsychological Evaluation of Children

Abstract

The major approaches to child clinical neuropsychology have used an adult model of neuropsychological functioning as an initial framework for analysis of cognitive dysfunction in childhood.^1-4 While this strategy seemed logical and initially proved useful as a model for the organization of ideas about brain-behavior relationships in childhood, the limitations of this approach, well articulated by Rudel,⁵ have become increasingly apparent as brain-damaged children are evaluated more systematically in observational or experimental studies. Thus, child neuropsychologists began to accumulate evidence that countered the assumption that the developing organism suffers the same fate (both biologically and psychologically) following brain damage as does the mature adult. We know, from postnatal and prenatal studies of nonhuman primates and children, that focal brain damage produces different kinds of cognitive deficits and different degrees of recovery of function depending on the developmental stage or age at which the damage occurred.^6-13 Child neuropsychologists have also had to consider the logic of the assumption that abnormal development of a cognitive ability reflected pathology in the same brain structures that were determined from adult lesion studies to be necessary for the intact expression of that ability in adulthood.¹⁴ In fact, Rudel⁵ rejected that notion, stating, “Adult brain trauma studies shed light on what is essential for the performance of a function but not for its development” (p. 10). That is, during the acquisition of a skill, many parts of the brain may be involved; as proficiency increases, some structures may no longer participate in the mediation of this behavior. Thus, these brain structures, while crucial for the development of a function, may not be necessary for its expression once complete competency has been achieved.