NYC Pediatric Neuropsychologist

Are you worried that your child has a potential learning disability, ADHD, Depression, Anxiety, Asperger’s Disorder, Autism, or PDD? Are you concerned about developmental delays? Do you think your child needs extra time in order to perform well on standardized tests (i.e. SAT)?

A comprehensive neuropsychological evaluation will help your child achieve his or her potential. Following the evaluation, you will receive a report detailing the diagnosis and any further weaknesses that your child may be experiencing. Most importantly, clear solutions regarding how to correct the problem will be explained. Additionally, pertinent recommendations for home and school will be provided.

Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder

Essential features:
A. Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.
B. Some hyperactive-impulsive or inattentive symptoms must have been present before seven years of age.
C. Some impairment from the symptoms must be present in at least two settings.
D. There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder.

Three Subtypes:
Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type: This subtype is used if six (or more) symptoms of inattention (but fewer than six symptoms of hyperactivity-impulsivity) have persisted for at least six months.

Attention-Deficit/Hyperactivity Disorder Predominantly Hyperactive-Impulsive Type: This subtype should be used if six (or more) symptoms of hyperactivity-impulsivity (but fewer than six of inattention) have persisted for at least six months.

Attention-Deficit/Hyperactivity Disorder Combined Type: This subtype should be used if six (or more) symptoms of inattention and six (or more) symptoms of hyperactivity-impulsivity have persisted for at least six months.

Diagnostic Criteria for the three subtypes of Attention-Deficit/Hyperactivity Disorder according to DSM-IV:

A. “Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.” Individual must meet criteria for either (1) or (2):

(1) Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

Inattention
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
(b) often has difficulty sustaining attention in tasks or play activity
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often looses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities

(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms must have been present before age 7 years.
C. Some impairment from the symptoms is present in at least two settings (e.g., at school [or work] and at home).
D. There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Prevalence

• Estimated 3%-7% in school –age children
• Rates dependent on population sampled and method of ascertainment
• Data on prevalence in adolescence and adulthood is limited

Anxiety Disorders

Anxiety is a natural response and a necessary warning adaptation in humans. Anxiety can become a pathologic disorder when it is excessive and uncontrollable, requires no specific external stimulus, and manifests with a wide range of physical and affective symptoms as well as changes in behavior and cognition.

As outlined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR), anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder (also known as social phobia), specific phobia, panic disorder with and without agoraphobia, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), anxiety secondary to medical condition, acute stress disorder (ASD), and substance-induced anxiety disorder.

Diagnostic Criteria for Autistic Disorder

Diagnostic Criteria for Autistic Disorder – 299.00 The following criterion are from the 2000 Revision of the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR).Â

A. A total of Six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3).

  1. Qualitative impairment in social interaction, as manifested by at least two of the following:
    • marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
    • failure to develop peer relationships appropriate to development level
    • a lack of spontaneous seeking to share enjoyment, interest, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
    • lack of social or emotional reciprocity
  2. Qualitative impairments in communication as manifested by at least one of the following:
    • delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alterative modes of communication such as gesture or mine)
    • in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
    • stereotyped and repetitive use of language or idiosyncratic language
    • lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
  3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
    • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
    • apparently inflexible adherence to specific, nonfunctional routines or rituals
    • stereotypes and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
    • persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintergrative Disorder.

American Psychiatric Association. (2000). Diagnostic criteria for autistic disorder. In Diagnostic and statistical manual of mental disorders (Fourth edition—text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 75.

What is Pediatric Neuropsychology?

Pediatric neuropsychology deals with the relationship of children’s learning and behavior to their brain structures and systems. A learning disability does not mean your child is incapable of gaining knowledge and growing; instead it means a different method of teaching must be applied.

Pediatric or child neuropsychology is a field of study involving the relationship of abilities, behaviors and mental skills (cognitive functions) in children. Clinical, pediatric or child neuropsychology (neuropsych) involves the application of this field to diagnostic assessment and clinical treatment of normal and abnormal child developmental, medical, psychiatric, and neurological conditions or problems. The field shares a knowledge base with other professions. A child or pediatric neuropsychologist may work with other pediatric specialists in behavioral neurology, developmental pediatrics, pediatric neurology, child psychiatry, pediatricians, occupational therapists and speech and language therapists.

How does a neuropsychological evaluation differ from a school psychological assessment?

School assessments are usually performed to determine whether a child qualifies for special education programs or therapies to enhance school performance. They focus on achievement and skills needed for academic success. Generally they do not diagnose learning or behavior disorders caused by altered brain function or development.

Why are children referred for neuropsychological assessment?

Children are referred by a doctor, teacher, school psychologist, or other professional because of one or more problems, such as:

Difficulty in learning, attention, behavior, socialization, or emotional control;a disease or inborn developmental problem that affects the brain in some way; or a brain injury from an accident, birth trauma, or other physical stress.

A neuropsychological evaluation assists in better understanding your child’s functioning in areas such as memory, attention, perception, coordination, language, and personality. This information will help you and your child’s teacher, therapists, and physician provide treatments and interventions for your child that will meet his or her unique needs.

Pediatric Neuropsychologists are licensed as psychologists or in some states neuropsychologists. By definition, in almost all states, these individuals have doctoral degrees from accredited programs by the American Psychological Association usually in clinical psychology or neuropsychology. To be considered a neuropsychologist one must have formal graduate level training and clinically supervised experience in neuropsychology.

Pediatric and NYC child neuropsychologists often assess memory and learning. Information from such evaluations are often helpful in determing how your child or adolescent learns best.

Pediatric or child neuropsychologists commonly assess children for attention problems such as Attention-deficit Hyperactivity Disorder (ADHD), learning disorders such as dyslexia or math difficulties, disorders of language and/or coordination difficulties. Evaluations are often more detailed than simply involving ability assessment and assumptions are made about brain-behavior relationships. Evaluations may also involve assessments of Autism Spectrum Disorders which inclue autism, Asperger’s Disorder, and Pervasive Developmental Disorder (PDD). Assessments are aso performed to evaluate neurological conditions such as effects of a tumor, anoxia, birth complications, Cerebral Palsy, toxic exposures, head injuries or concussions. They may involve subtle or not so subtle deficits which may be involved with anemia, kidney disease or other metabolic diseases, and the effects of treatments or interventions which may impact on neurological or neuropsychological functions.

When choosing a clinic or neuropsychologist to conduct a neuropsychological evaluation on your child, it is wise to ensure the individual providing or supervising the services is a licensed psychologist with training involving both neuropsychological assessment and with children and adolescents.

Asperger syndrome

Asperger syndrome, also known as Asperger’s disorder, is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical use of language are frequently reported.

The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy. The modern conception of Asperger syndrome came into existence in 1981 and went through a period of popularization, becoming standardized as a diagnosis in the early 1990s. Many questions remain about aspects of the disorder. For example, there is doubt about whether it is distinct from high-functioning autism (HFA); partly because of this, its prevalence is not firmly established. It has been proposed that the diagnosis of Asperger’s be eliminated, to be replaced by a diagnosis of autism spectrum disorder on a severity scale.

The exact cause is unknown. Although research suggests the likelihood of a genetic basis, there is no known genetic etiology and brain imaging techniques have not identified a clear common pathology. There is no single treatment, and the effectiveness of particular interventions is supported by only limited data. Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most children improve as they mature to adulthood, but social and communication difficulties may persist. Some researchers and people with Asperger’s have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured.

If you believe your child is displaying Asperger syndrome contact me today.

Evaluations are available by appointment only.