Diagnostic Categories and Assessment
When dealing with neuropsychological diagnoses in childhood, there are generally no “litmus tests”. Diagnoses emerge from an overall analysis of test data, history, and observations.
Here are some considerations when looking at testing for children with different diagnoses:
Language Based Learning Disability
LBLD is a broad category referring to language deficits which prevent a child from effectively accessing their intelligence in the service of learning. Typically, testing should include assessment of both expressive and receive language, and should also assess subtle aspects of language processing which are critical for building reading skills. The latter include skills such as phonological awareness, or the ability to discern the sound-structure of words, and rapid sound-symbol association. When a child presents with challenges only in these latter areas, and oral language skills are typical, the diagnosis of dyslexia will sometimes be used.
An integral part of any assessment of a child with LBLD will be examination of literacy skills. This will include assessment of various dimensions of reading (speed, accuracy, decoding, comprehension) and writing (motor, spelling, sentence structure and use of language, overall organization).
Finally, it will be important to assess nonverbal problem solving skills to contrast with verbal skills, and also to assess attention and executive functioning skills as many children with LBLD also have ADD/ADHD.
Nonverbal Learning Disability
NLD is another broad category of neuropsychological disorder. Children with NLD typically struggle with nonverbal information processing, and more generally with gestalt (or “big picture”) thinking.
Children with NLD experience difficulty with social skills. They may be motivated to connect socially with other children, but are prone to miss out on nonverbal social cues (facial expression, body language). Challenges are often apparent as well in organization and in aspects of academics which require organization and spatial processing, such as writing and math.
Assessment of NLD should include contrasting measures of verbal and nonverbal cognitive skills; measures of organization; assessment of social processing and social skills; and assessment of vulnerable academic areas such as writing. In addition, because children with NLD are prone to depression and anxiety, assessment of mood should be included.
Autism/PDD refers to a well defined but broad spectrum of presentations. Overall level of cognitive functioning may range from advanced to significantly delayed. In order to establish an intellectual baseline, it is important to use a nonverbal measure of cognitive functioning which circumvents the language deficits representing an inevitable element of the syndrome.
Additional assessment depends on overall level of functioning. For higher functioning children, assessment may encompass executive functioning, academic skills, and social skills. For children who are more delayed, assessment may focus on more functional skills such as activities of daily living and fundamental communication skills.
Children with Asperger’s Syndrome are considered to occupy part of the high functioning end of the autism spectrum. Unlike children with autism, children with Asperger’s are not delayed with regard to language. Instead, verbal skills often represent a strength, and the majority of children who need behavioral criteria for Asperger’s will display a NLD profile on neuropsychological testing. The assessment will therefore need to encompass the components of an NLD evaluation (see above).
Like autism and Asperger’s, ADD/ADHD is a behavioral diagnosis based on observations of issues with focus and impulsivity in multiple settings. Most children with these diagnoses, however, will present with learning challenges. These may include learning disabilities such as discussed above, but may also include general deficits in executive functioning.
Executive functioning is a term referring to higher level cognitive skills such as planning, organization, and self-regulation. Assessment of ADHD must therefore include not only behavioral indicators (e.g., questionnaires) but formal assessment of executive functioning and of the academic skills which are dependent on it (chiefly expository writing).