The study that focuses on the fundamental mechanisms that underlie disorders and diseases of the

Samenvatting CA&T Clinical child neuroscience The study that focuses on the fundamental mechanisms that underlie disorders and diseases of the brain and the central nervous system (CNS) to understand behaviour and behaviour problems (study of brain-behaviour pathways). To develop new ways of conceptualizing and diagnosing and develop novel treatments for the disorders and diseases. The brain and CNS have a direct impact on the behavioural, cognitive and psychosocial adjustment of individuals.Neurocognitive functions Cognitive functions are closely linked to the function of brain areas, neural pathways or cortical networks in the brain. All cognition is the result of neurological activity. There is a developmental pathway in the cognitive functions.Neuropsychological assessment and treatment Trying to find answers in fundamental brain mechanisms that underlie the behaviour. One way to look at behaviour is the brain-behaviour pathway model. Genes and brain (dys)functions drive neurocognitive (dys)functions and they drive behaviour or behaviour problems. The interplay with the environment is really important.There are three very important things to keep in mind when

doing np assessment with children:

-Development Children are developing. The brain is also in development. The development is not only drive by genes, it is developing in interaction with the environment. So the way that a child develops their brain and neurocognitive functions is in interplay with the environment. With assessment you also deal with the brain in development and not only with the brain at hand.This gives certain difficulties, but also opportunities in np assessment.-Adulthood Some children already have neurocognitive dysfunctions and they continue to develop. They have either way to deal with the impaired neurocognitive functions. Some children have a genetic disorder, which predisposes them to certain np difficulties.-Definition of normal Need to know what is defined as normal. We do not know a large part of things about np functions. You need to set a threshold to the child’s capabilities themselves.

Np assessment is relevant when:

-The question at hand should be answerable and useful.-The motivation for the question is clear.For example when there are concerns or complaints of the child or the environment.-The objective of the question should be clear.A certain set goals based on the np strength and weakness profile of the child.-The timing is appropriate For example stable and assessable. The child should be able to be tested and the situation should be positive and not stressful. 1 / 4

• / 4

Indications (reasons) for np assessment in children:

-Developmental disorders Anything that deals with problems with the development. For example motor difficulties, disturbance during pregnancy, somatic problems, diseases that affect the CNS, eating disorders or ADHD.-Brain damage For example tumor, epilepsy, traumatic brain injury or lack of conscious.-Evaluation of treatment For example after cognitive behaviour therapy or beside chemotherapy.-Evaluation of development A way to track the development and be able to take prevented action.For example children with gene disorders, who will growing into deficits, what will result in a different development.-Supporting choice for education, parenting or profession For example the choice for regular or special education or fitting parenting style to the np profile of the child The way structures in the developing brain are related to changes in psychological and cognitive development is of interest to clinical child neuropsychologists. The diagnostic assessment-treatment cycle is one way to find out what is going on, how you can help and threat the child or the family.Assessment is a small part from the assessment-treatment cycle. There are a lot of steps that need to be taken with regards to np assessment and treatment. Other steps also help to form the

explanatory theory:

-Problem inventory Listening to all the difficulties/issues that the child, parents, school or other important caregivers may experience. Ask yourself if you expect these difficulties in normal development. You have to care at much info as possible and then you will decide if it is a problem based on your knowledge about typical and np development.-Developmental history Check all the things step by step that happened from pregnancy till now. Early development of the brain has impact on the development throughout life. See how and where things might have been a marker, whether development problems arose early or whether something has triggered them.-Hypotheses on dysfunctions and disorders Based in the info from the previous to steps, you form hypotheses about which dysfunctions or disorders may think are going to happen or are present. Hypotheses about how you can understand the behaviour. You decide which of those functions you go to asses.-Assessment Testing to find out what are the strengths and weaknesses in np functioning. Np assessment is not only the tasks, but also the questionnaires and observations. Both in the situation itself, but also in school and parenting situations. Questionnaires can with regards to complaint, np functions or about the self (such as emotional well-being, personality, self- image). Intelligence, perception, processing speed, language/speech, motor skills, time and place orientation, attention, memory, EF, social cognition and emotion regulation are all the np functions that one may or may not assess. Intelligence tests are often include more than one np function, for example WM and info processing speed. 3 / 4

-Profile with strengths and weaknesses Based on the info from the previous steps and the test performance, you form a profile with the np functions that are developed appropriately and the np functions that are developed poorly.-Explanatory theory Based on the profile, you set up an explanatory theory about the coherence of the strengths and weaknesses, the developmental problems that are experienced in everyday life, and the influence of the environmental factors. A theory about what the neuropsychologist understand about the behaviour. It is a descriptive diagnosis and not a classifying diagnoses.For example saying that a child has a developmental disorder is a classifying diagnoses and saying that a child has difficulty with social cognition and that leads to difficulties understanding one another is an descriptive diagnosis. After the explanatory theory the assessment cycle is finished.-Prognosis The start of the treatment cycle. Make an judgement about what is natural development.You look at the severity and degree of the dysfunction and if you need to do something. You estimate the etiology of the disorder. Sometimes you know with a certain amount of certainty that the etiology of the dysfunction is based on something, but sometime you don’t know. For example when there are info processing speed difficulties and you know that there is a genetic disorder that is linked to these impairments or it is a good possibility that the difficulties are linked to a traumatic brain injury, but it might also be that it is not. It can also be based on/linked to a certain amount of events. You say what the opportunities are for recovery or is it a dysfunction for life. Should you bother to try and threat the dysfunctions or should you try to limit the impact on the behaviour. You will see whether you be able to stimulate or train the weaker functions, can compensate the weaker functions (strategy training) or influence the development of the child in a positive way by making adaptions to the environment. Prognosis can also lead to go back to the problem inventory, when things are not fully explained yet.-Treatment plan A plan about what you will do with the child and the environment.-Treatment Treatment is usually individual and most often in a multidisciplinary treatment-setting. You incorporate the child and the whole environment in the treatment.-Evaluation Beforehand, you need to set goals of treatment. Through the goals you know when you will evaluate the treatment, evaluate it in a properly way and know what you will do when the goals are not met. Evaluation of treatment by means of tracking symptoms or complaints with np assessment. It is very important to incorporate info from all part of the system.The question is: Has the child enough tools to deal with the np dysfunctions and can he/she continue on with their life? When this is not the case, you can go back to the problem inventory, prognosis or explanatory theory.

Np interventions from brain level to environment:

-Medication There are certain types of medication that can be prescribed to enhance certain neurocognitive functions, such as methylphenidate in ADHD to enhance neurological communication that enhance info processing in the brain.

• / 4