School Neuropsychology: A Practitioner's Handbook
328
School Neuropsychology: A Practitioner's Handbook
328eBook
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Overview
Product Details
| ISBN-13: | 9781462532377 |
|---|---|
| Publisher: | Guilford Publications, Inc. |
| Publication date: | 03/13/2017 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 328 |
| File size: | 2 MB |
About the Author
Catherine A. Fiorello, PhD, is Associate Professor of School Psychology at Temple University, where she currently serves as program coordinator for school psychology. Prior to completing her doctorate, she worked as a certified school psychologist, and she continues to maintain a private practice in diagnostic assessment.
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School Neuropsychology
A Practitioner's HandbookBy James B. Hale Catherine A. Fiorello
The Guilford Press
ISBN: 1-59385-011-5
Chapter One
Linking Assessment to InterventionTHE COGNITIVE HYPOTHESIS-TESTING MODEL
Prereferral Issues
In our cognitive hypothesis-testing (CHT) model, emphasis is placed on helping a majority of children through systematic prereferral services. As a psychologist, you must intervene to assess: You must develop an effective prereferral intervention program, using a team approach such as an intervention assistance team (see Ross, 1995) and problem-solving consultation, to reduce the number of referrals for formal evaluation. A large majority of children can be helped via an indirect service delivery model, and consultative approaches can effectively reduce the number of referrals for formal standardized evaluation. This is the only way in which the comprehensive CHT evaluations we argue for will be feasible; reducing referrals means gaining more time to conduct both interventions and more comprehensive evaluations.
Of course, there have been calls for more emphasis on prereferral interventions, or a move to interventions instead of referrals, for many years. Since Public Law 94-142 originally mandated serving children with disabilities rather than excluding them, school psychology has tried to emphasize interventions. The National Association of School Psychologists issued a volume titledAlternative Educational Delivery Systems (Graden, Zins, & Curtis, 1988), which called for more consultation, more teacher assistance teams, and more interventions. The 25th-anniversary issue of the School Psychology Review (Harrison, 1996) called for the same, as did Best Practices in School Psychology IV (Thomas & Grimes, 2002). Despite these numerous calls for professional change, however, school psychologists continue to spend the majority of their time in determining eligibility for special education (Hosp & Reschly, 2002). Why is this? There are probably several reasons. Intervention resources often depend on special education eligibility. Also, the funding to pay school psychologists may come from special education money. High student-psychologist ratios, as well as a high number of required assessments, may contribute to a lack of time to spend in alternative roles (e.g., Wilczynski, Mandal, & Fusilier, 2000). How can we increase the perceived value of interventions? In many schools, special education is seen as the only way to get help for a child who is experiencing difficulties. Systems change efforts must include resource allocation for supporting children in general education. Then the school psychologist's ability to help design and monitor those interventions will be seen as a valuable role, and the consultation role can increase. And when evaluations are truly useful for intervention design, rather than focusing entirely on eligibility, they will be valued as well. Only with a mix of both these roles can school psychologists completely fulfill the promise of their training.
As noted earlier, a child's behavior and his or her environment are inextricably related. The environment-including teachers, peers, the curriculum, and the classroom structure and routine-exerts a great influence on the child's behavior. But the child's characteristics-biological constraints, temperament, past learning history, and current skills-also influence both the child's behavior and, in turn, the environment. Practitioners can use information about both parts of the cycle to intervene and develop individualized interventions that will work with the environment to meet the child's unique needs. We suggest paying attention to both sides of the equation, since we feel that an exclusive focus either on external, environmental factors or on within-child factors neglects half the picture. This approach combines the two most powerful strands of the school psychology profession: individual psychoeducational assessment (e.g., Kamphaus, 2001; Sattler, 2001), and intervention development and monitoring from the behavioral intervention and problem-solving consultation models (e.g., Erchul & Martens, 2002; Thomas & Grimes, 2002).
CHT in Assessment and Intervention
Initially, standard problem-solving consultation is used in CHT to develop data-based interventions at the prereferral level. But a child who does not benefit from these initial interventions is referred for a formal CHT evaluation. The referral question, history, and previous interventions are examined to develop a theory of the problem (see #1 under "Theory" in Figure 4.1). If cognitive functioning is thought to be related to the academic or behavioral deficit areas in question (see #2 under "Hypothesis" in Figure 4.1), the intelligence/cognitive test is used as one of the first-level assessment tools (see #3 under "Data Collection/Analysis"). Via demands analysis, the findings are interpreted (see #4 under "Data Interpretation") to determine possible cognitive strengths and weaknesses (#5 under "Theory"). This is where many psychologists stop the process. Because of time demands, psychologists in the schools typically write their reports and present their findings in a team meeting; they have little contact with the child, parents, or teacher thereafter (unless individual therapy is offered). But our CHT model goes beyond this to choose additional measures (#6 under "Hypothesis") to confirm or refute the intellectual test data (#7 under "Data Collection/Analysis"). The results are examined in light of the record review/history, systematic observations, behavior ratings, and parent/teacher interviews to gain a good understanding of the child (#8 under "Data Interpretation").
Completing the initial assessment is where the CHT process begins, not ends. Interventions are subsequently developed using the understanding of the child and the environment during collaborative consultative follow-up meetings with teachers and/or parents. Possible intervention strategies are explored in consultation with the teacher (#9 under "Theory"), and an intervention plan likely to succeed is developed (#10 under "Hypothesis"). The systematic intervention is then undertaken (#11 under "Data Collection/Analysis") and evaluated to determine intervention efficacy (#12 under "Data Interpretation"). If the intervention does not appear to be effective, it is revised or recycled until beneficial results are obtained (#13 under "Theory"). Like brief experimental analysis (Chafouleas, Riley-Tillman, & McGrath, 2002), the CHT model we describe uses a problem-solving approach and single-subject methodology to examine child performance over time. We are strong advocates for behavioral technology and single-subject methodology. The difference between our model and other behavioral approaches is that we use information about cognitive functioning in developing our interventions.
Conducting Demands Analysis
Demands analysis is a core component of the CHT model. It is the key both to accurate identification of childhood disorders and to development of interventions that are sensitive to individual needs. The demands analysis process that we present here is derived from two assessment traditions. The first tradition is the "intelligent testing" approach, which examines global, factor, and subtest scores based on clinical, psychometric, and quantitative research (e.g., Flanagan & Ortiz, 2001; Kamphaus, 2001; Kaufman, 1994; McGrew & Flanagan, 1998; Sattler, 2001). When formulating your clinical demands analysis, you must be careful to examine all relevant technical and cross-battery subtest information. Heavily influenced by the Luria (1973) approach to neuropsychological assessment, the second tradition consists of the developmental and processoriented neuropsychological assessment approaches (e.g., Bernstein, 2000; Kaplan, 1988; Lezak, 1995). Although demands analysis may seem similar to other versions of profile analysis (e.g., Kaufman, 1994), the major difference is the emphasis on the neuropsychological and cognitive processes necessary for task completion. We have noted previously that the input and output demands are straightforward; they are the observable and measurable test stimuli and behavioral responses. However, research is clearly demonstrating that the underlying neuropsychological processing demands are essential for understanding and helping many children with their learning and behavior problems.
For many children and most tests/subtests, a brief demands analysis should be sufficient to examine and test hypotheses about brain-behavior relationships. We have provided you with two forms (Appendix 4.1 and Appendix 4.2) to guide you in interpretative efforts. The form in Appendix 4.2 may even be more helpful as you become more accustomed to demands analysis, because this allows you to add constructs as necessary to reflect the neuropsychological processes underlying a particular subtest or if a child responds in an idiosyncratic manner. To conduct the demands analysis, identify tests/subtests that represent the child's strengths and weaknesses. Enter them in the appropriate spaces in Appendix 4.2, and for each measure conduct a task analysis of the input, processing, and output demands. Input refers to the stimulus materials as well as the directions, demonstrations, and teaching items. Think about what modality or modalities are needed for the input-for example, whether there are pictures or verbal directions, whether the content is meaningful or abstract, and what other aspects of the content are relevant (e.g., level of English language used or amount of cultural knowledge required). Processing refers to the actual neuropsychological processing demands of the task, as discussed in Chapters 2 and 3. Think about the primary requirement (often suggested by the test's developers), but also secondary requirements, such as the executive and working memory skills needed to keep a stimulus in mind while processing it. Output refers to the modalities and skills required for responding to the task. Is the output a complex verbal response, a simple pointing response, or a complex motoric response? If oral expression is needed, is syntax important, and is word choice an issue? These are some of the questions you must answer in demands analysis. The form we provide in Appendix 4.1 is merely a tool for you to begin thinking about underlying psychological processes. We have included blanks in the last column for you to provide additional subtest input, processing, and output demands. Once you have listed the input, processing, and output demands for all of the child's strengths and weaknesses, it is important to look for commonalities and contradictions among the data.
After completing the sheets for each subtest, you attempt to identify patterns in the child's performance. If you find that one particular processing demand is required on all low-score tests, and it is not needed for the high-score tasks, you would hypothesize that this demand is a weakness for the child. Information from your observations of the child during testing, as well as information provided by the teacher, should also be consistent with any hypotheses. The weakness may be a cognitive processing weakness, but it may also be a sensory or motor weakness, a result of emotional interference, or a consequence of limited exposure or background. Enter this information on the worksheet provided in Appendix 4.3. Although these sheets and interpretive texts (e.g., Groth-Marnat, Gallagher, Hale, & Kaplan, 2000; Kamphaus, 1993; Kaufman, 1994; McGrew & Flanagan, 1998; Sattler, 2001) can be helpful in conducting demands analysis, you should not be lulled into a "cookbook" approach when interpreting subtest data-a tendency that often results in erroneous interpretation. To guard against this and to foster accurate interpretation, we have provided a checklist in Appendix 4.4. This checklist is primarily for you to complete to aid in clinical judgment, but it could possibly be used as an informant rating scale as well.
Let's walk through a demands analysis of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Block Design subtest to see what the process looks like. First, consider the input. The task has oral directions, and the task is modeled for younger children and those who have difficulty on the first item. The stimulus materials (booklet with visual model and two-color blocks) are abstract colored shapes, so that verbal encoding is difficult. The task will be novel for most children (although perhaps not on reevaluation or as the testing progresses). The processing demands are quite complex and involve both hemispheres and executive/frontal demands. Primarily, Block Design is a right-hemisphere task, since it is visual-spatial (i.e., involves the dorsal stream), is novel, and does not depend on crystallized prior knowledge. However, there is some bilateral processing because of the bimanual sensory and motor coordination, as well as the part (directional orientation of the blocks-left parietal) and whole (gestalt/spatial-right parietal) coordination (see Kaplan, 1988). There is a heavy frontal component, due to the executive and motor requirements of the task. The frontal demands include planning and organization, self-monitoring and evaluation of the response, inhibition of impulsive responding, and fine motor and bimanual coordination. This is particularly true if the child uses a trial-and-error approach. Note particularly if the child has more difficulty after the lines are removed from the stimulus book, as this may suggest right posterior (i.e. configuration problem) or frontal (delayed responding due to novelty) difficulties. Considering the output, Block Design requires fine motor and bilateral motor coordination, and adequate processing speed. Bilateral sensory-motor coordination requires the corpus callosum, so look for midline problems or a tendency to use just one hand. Slow responding may be due to difficulties in frontal-subcortical circuits (i.e., prefrontal-basal ganglia-cingulate) or the sensory-motor system (constructional praxis)-inattention/disorganization (symptoms resembling attention-deficit/hyperactivity disorder [ADHD]), low cortical tone or lethargy (motivation problems or depression-like symptoms), or perfectionistic tendencies (symptoms resembling obsessive-compulsive disorder [OCD] or other anxiety disorders).
Although conducting demands analysis may be helpful in understanding patterns of performance, remember that multifactorial tasks can be solved in more than one way, so that the demands analysis may differ from child to child. For instance, a child who uses good executive and psychomotor skills to compensate for a right posterior spatial problem may still do well on Block Design, but you would err if you concluded that the child had adequate visual-spatial-holistic processing skills.
Continues...
Excerpted from School Neuropsychology by James B. Hale Catherine A. Fiorello Excerpted by permission.
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Table of Contents
Introduction to School Neuropsychology1. Assessment and Intervention Practices in Educational Settings
2. A Model of Brain Functioning
3. Neuropsychological Approaches to Assessment Interpretation
4. Linking Assessment to Intervention
5. The Neuropsychology of Reading Disorders
6. The Neuropsychology of Mathematics Disorders
7. The Neuropsychology of Written Language Disorders
8. Neuropsychological Principles and Psychopathology
Interviews
School psychologists and special educators; other practitioners involved in child psychological assessment; advanced students and trainees. Serves as a text in neuropsychology courses within graduate programs in school psychology.