The Watson Institute

1. The Watson Institute A Family Based Model of Neuropsychological Assessment Christy Emmons Basista, Psy.D., Julie Knapp, Ph.D., Sharon Arffa, Ph.D., and Lindsy Yarger, M.A. MODEL INTRODUCTION CONCLUSIONS Research has shown that family structure and family relationships are impacted by the behavioral and affective changes seen in a child following a medical or neurological illness Junque, Bruna and Mataro (1997) . Similarly, a child’s rehabilitation course can be affected by the family’s ability to successfully adapt to and to cope with the chronic stressor. By fully assessing family and environmental factors within the context of a neuropsychological evaluation, treatment can target not only the behavioral and emotional changes secondary to cognitive deficits, but may also assist in improving the known family factors that play a role in the child’s recovery. Research has demonstrated that psychosocial factors influence the behavioral development and rehabilitation course of children with neurological impairments and CNS disorders. When families undergo times of crises and transitions, it is important to determine the family processes and to help identify the factors that enable the family members and the family system to adapt successfully. Neuropsychological assessments, however, often fail to fully assess family and environmental factors as a routine part of the evaluation. We propose a family-based model of neuropsychological assessment with an emphasis on evidence based measures of family and child functioning to assist in a differential diagnosis and treatment planning. Initial Evaluation ●Family’s presentation of behavioral and emotional concerns. ●Medical history, including current treatment regimen. ●Assessment of the amount of information the family has received regarding the medical illness/injury. ●Evaluation of family factors, including: -Financial stressors and situation of the family. -Overall family dynamics and relationships. -Sources of social support for the family. -Current coping mechanisms. • Neuropsychological Evaluation • ●Objective assessment of cognitive factors contributing to behavioral and emotional sequelae. • ●Standardized assessment of child’s behavioral and emotional symptoms across environments: • -Child Behavior Checklist and Teacher Report Forms • -Children’s Depression Inventory • -Revised Children’s Manifest Anxiety Scale • -Conners’ Parent and Teacher Rating Scales • ●Standardized assessment of family factors: • -Parenting Stress Index • -The Life Stressors and Social Resources Inventory • -The Family Burden of Injury interview • . BACKGROUND Taylor and colleagues (1995) emphasized a link between child behavior problems and family stress, negative life events, and parental psychological symptoms. Research has also shown that the three main variables that play a role in the successful adaptation of families following a pediatric TBI include amount of social support, the financial situation of the family and the amount of information and education the family has received about the TBI (Ergh et al., 2003; Martin 1998; Newacheck and Kim, 2005). • Collaborative Family Feedback Session • ●Describe relationship of cognitive deficits to behavioral and emotional symptoms. • ●Provide information and training for the family regarding the child’s illness or injury, including expected course and changing symptoms. • ●Propose targets and methods of intervention, including intensity and rationale of treatment.