Newsletter: The Neuropsychological Evaluation for Preemies

April 2014

Past newsletters are posted at www.isbaron.com. Questions/comments should be emailed to ida@isbaron.com

Thank You Preemies Today!

Dr. Baron is honored to accept an invitation to join the Preemies Today Board of Directors. I look forward to actively contributing to the continued success of Preemies Today. I am also pleased to announce that Preemies Today has asked to have these newsletters become a monthly blog. As well, all prior newsletters are archived and available for review at www.isbaron.com, under “PETIT Study”, where you will also find an up-to-date listing of our research publications.

How can only one day of testing lead to valid decisions about my child’s brain functioning?

Neuropsychological tests differ from other psychological tests in how they are designed and therefore how they can be interpreted. These tests have an evidence-base that makes decisions about brain integrity possible. There are many neuropsychological tests and selecting the right tests for your child is best determined on an individual basis during the testing session.

Unlike tests that compare your child to other children of the same age, (e.g., IQ tests, academic achievement tests) some neuropsychological tests assess function in a specific brain region and it will not matter how other children might perform on the test.
Some tests elicit specific errors or responses that, if demonstrated, are highly significant of brain dysfunction no matter what the other test results show. No normative data are necessary when these signs are shown. The neuropsychologist’s clinical experience and judgment make a difference in understanding their significance.
Some tests directly compare the right and left sides of the body, thus comparing your child to him/herself, and the right and left sides of the brain due to crossed limb-brain control.
Some tests measure integrity of the surface of the brain (cortex), while others measure functioning in deeper (subcortical) brain regions involved in, for example, coordination, balance, and memory.
Some tests indicate efficiency of the front portions of the brain while others assess how well rear brain areas function.

After testing is completed what should I expect in the interpretive meeting?

At an interpretive session with the neuropsychologist you should receive a clear explanation about 1) which cognitive abilities were examined, and 2) what the overall profile of results indicates about your child’s strengths as well as weaknesses. This meeting should not be a time when you are only provided test scores (these belong in the final written report). Instead, this valuable time with the neuropsychologist is when you can discuss your concerns that resulted in this referral related to your child’s actual performance. You should leave this session with a better understanding about how your child processes information. This is best accomplished in context with an integration of additional information obtained, e.g., about early development, home life, and academic performance. When the interpretive session concludes you should have a much better understanding about your child’s competencies and clear and appropriate recommendations for what to do about any weaknesses. Your signature on a release of information document will permit a copy of the forthcoming written report to also be sent to others involved in your child’s care, e.g., your pediatrician.

How do parents of preterm children first find out about the PETIT Study?

While your baby is at Inova Fairfax Hospital for Children’s NICU staffed by Fairfax Neonatal Associates you will be given a letter from the Research division (usually by the nursing staff). If you are eligible for the study but did not receive a letter, you can call Ms. Hopp, Research Coordinator, at 703-752-2759. Your signature and contact information allows the research team to contact you and enroll your family in the study around your child’s first birthday. Additional forms will be sent to you when your child is 1 year old, corrected age.

What is a corrected age?

A preterm preschooler’s development is best not compared to that of children born at term. The American Academy of Pediatrics recommended in the 1990s that age correction continue up to 3 years of age. However, it is now recommended by others that correction continue longer for children born very early. To age correct a child born at 28 weeks (3 months early), for example, chronological age will be reduced by 3 months and scores obtained from normative data of children three months younger. Our PETIT Study written reports use corrected scores at age 3. If your young preterm child has a psychological evaluation and age correction is not considered you might want to discuss this further with the psychologist evaluating your child.

What if I have concerns about my child’s development and school performance but he/she is not eligible to be a research participant?

Our Pediatric Neuropsychology division provides comprehensive neuropsychological evaluations to toddlers, older children, and adolescents. You can find out more at www.fnapc.com/neuropsychology and www.isbaron.com.

PETIT Study research neuropsychological evaluations are conducted at no-charge but will insurance cover the costs of a clinical neuropsychological evaluation?

Yes, the neuropsychological evaluation is a covered service using a special Neurology procedure code. Typically, insurance companies reimburse you for about 60-70% of the fee.

Be aware that many local insurance companies have no provider who completed a two-year residency/postdoctoral fellowship in Clinical Neuropsychology, and will instead refer you to other psychologists. You should be sure that the person to whom you are referred has had appropriate training. When an insurance company has no qualified provider they approve us out-of-plan. We can help you negotiate the process.

Introducing A PETIT STUDY Research Team Member!

Crista Hopp, M.A., Research Coordinator of the PETIT (Prematurity’s Effects on Toddlers, Infants and Teens) Study

“I have a Masters of Arts in Counseling Psychology from Bowie University in Maryland and a Bachelor of Arts in Sociology from Rowan University in New Jersey. A majority of my career has been spent working with both adults and children with developmental disabilities. Working with psychologists and completing my own training in tests and measurements, I quickly realized that I wanted to pursue a career in psychological assessments. I became a student research volunteer with the PETIT Study in 2008 and then in 2010 I joined the staff as the Research Coordinator.

I have enjoyed seeing the study flourish in last six years. I strive to not only support research that will benefit the physicians treating the children in the NICU but also the families of premature children. Movement development is an area of functioning that particularly interests me and I believe that the Movement Assessment Battery for Children – 2nd Edition (MABC-2) has been an important addition to our battery of tests. With this assessment, we are able to document how your children are progressing in fine and gross motor skills, and in motor planning. It is very rewarding to hear how our families use our results to acquire services through schools and the community. As the Aunt of a preemie born at 26 weeks, I believe that I am not only able to add to this study in a professional manner, but also to understand the journey our families have been on.”

Scientific Paper and Abstract Acceptances:

A paper authored by Gerner, G. & Baron, I. S. entitled “Pregnancy Complications and Neuropsychological Outcomes: A Review” was accepted for publication in the journal Child Neuropsychology.

A PETIT Study abstract entitled “Phonological Processing and Rapid Naming Differences in Late-Preterm Children at Age 6” first-authored by one of our research student volunteers, Kaitlin Riegler and with B. A. Weiss, C. Hopp, & I. S. Baron was accepted for presentation as a poster at the June 2014 American Academy of Clinical Neuropsychology conference in NYC.