Neuropsychology

Cognitive neuropsychology studies the way in which changes in the brain (traumatic or developmental) can affect behaviour and cognitive abilities (e.g., memory, language, arithmetic operations, attention, visual-perceptive skills, executive functioning, strategic planning, manual dexterity, abstract reasoning, etc.).

The cognitive neuropsychology department provides assessment or rehabilitation sessions with children or adults. With the use of a large number of neuropsychological tests and tasks  it aims to describe in a complete way personal cognitive functioning.

In order to perform a complete neuropsychological assessment, including a full written report, 3 or 4 sessions are necessary. A brief assessment with a summarized report can be accomplished in 2 sessions. These sessions include a medical history and  psychological and neuropsychological tests. The full report can be handed over during a session with a detailed explanation on the results of each test or  the report can be collected from  reception..

On the day of the session, the patient should come well rested, well fed and should avoid intense physical exercise or the consumption of alcoholic drinks immediately before.

COMMON SITUATIONS IN WHICH A NEUROPSYCHOLOGICAL SESSION IS ADVISED

Assessment

• Adults

  • General cognitive functioning assessment (e.g., needed for a medical or legal report);
  • Cognitive functioning after traumatic brain injury or stroke;
  • Differential diagnosis between mental decline within what is expected for the age group or resulting from mental disease or emotional distress;
  • Detection of cognitive deficits resulting from epilepsy;
  • confusional states;

• Children

  • Suspicion of dyslexia;
  • Suspicion of attention and hyperactivity disorder;
  • Early detection of developmental disorders;
  • Non-specific learning disabilities;
  • Cognitive deficits associated with epilepsy;

Rehabilitation

• Adults

  • Cognitive training (memory, attention, language, planning).

• Children

  • Dyslexia rehabilitation with phonological training;
  • Behavioural planning in Attention Deficit and Hyperactivity Disorder.

MAIN PATHOLOGIES / DISEASES 

Specific Learning Disabilities

Specific Learning Disabilities (SLD) consist in learning difficulties and difficulty in using academic skills such as reading, writing and mathematical calculation.

SLD are the most common cause of school failure and result from a specific deficit in the brain’s ability to receive, process and communicate information.  These difficulties should not result from a lack of practice, teaching methods, anxiety and depression, behavioural disorders or from  perceptive peripheral deficits (vision or hearing). 

The most significant signs of SLD are a significant difference between the expectations deposited on the child’s school performance (taking into account its intellectual capacity, its behaviour, family and emotional well-being) and the actual school results of the child.  A child with SLD shows an adequate level of reasoning and capacity for understanding and for carrying our various tasks but fails when it comes to learning and especially in school test results.

It is nevertheless important to distinguish between general learning difficulties, for example due to a delay in cognitive development or an autism disorder from Specific Learning Disabilities (SLD).

The most frequent SLD are:

• Dyslexia: difficulty in learning to read, very slow reading with mistakes, and difficulty in comprehending what is being read. This is the most common SLD, affecting 5% of the population;
• Dysgraphia /Dysorthographia – literacy difficulties (writing, spelling or grammar);
• Dyscalculia – difficulty in learning calculations, mathematical calculations or judging quantities. 
• Dyspraxia – difficulties in fine motor / motor coordination;
• Vision or Hearing Difficulties – difficulty in organizing or understanding visual or auditory projects, in the absence of a peripheral deficit.

An attention deficit, with or without hyperactivity, may also be present together with SLD (difficulty in orientation, paying attention, planning difficulties). 

SLD are a permanent affliction and the child needs monitoring and support during the rehabilitation period. Frequently adequate support measures need to be taken also at school, in order to minimise the impact that these difficulties might cause on the child´s school career.

It is also important to emphasize that that SLD are independent to the child’s intellectual development; the best indicator is the gap between the child’s obvious intellectual capacity and his school performance.

COMMON SYMPTOMS

There may be a large number of manifestations:

• Reading with many errors and word replacement;
• Slow reader with effort, difficulty in understanding the text;
• Spelling errors (substituting letter with similar sounds, omission of letters);
• Illegible handwriting, even to the child himself;
• Difficulty in the construction of sentences, paragraphs and the use of punctuation;
• Difficulty in expressing ideas in writing;
• Difficulty in mastering the concept of numbers, mathematical calculations. 

NECESSARY EXAMINATIONS

For an evaluation it is necessary to gather information from various sources; the parents, teachers and to observe the child.  Various cognitive tests must also be carried out.

Early detection will allow for the establishment of interventions in order to address the child’s difficulties,  targeted at improving performance and reducing the child’s academic frustration. 

ADVANTAGES OF THIS CONSULTATION AVAILABLE AT THE HPA HEALTH GROUP

The HPA Health Group has a specialised consultation in Neuropsychology for Children where it is possible to evaluate and intervene:

• Evaluation of the mental development level of the child at a preschool age (3-6 years of age);
• Low academic performance in children of school going age;
• Diagnosis and rehabilitation of SLD:
•  
  • Differential diagnosis for reading and writing disorders (dyslexia and/or dysorthography);
  • Multimodal metalinguistic rehabilitation for dyslexia;
  • Training of handwriting and spelling;
  • Differential diagnosis of calculation disorders (dyscalculia);
     
• Diagnosis of Attention Deficit Hyperactivity Disorders (ADHD), identifying the different subtypes;  identifying  a mixture of both, lack of attention or impulsive hyperactive;
• Parental counselling in order to adopt strategies in behavioural changes specifically directed to concentration difficulties and training sessions in concentration to try and  avoid medication;
• Suspicion of cognitive deficits associated with prematurity, neonatal hypoxia, epilepsy, traumatic brain injury.

Dyslexia

Dyslexia is a specific learning disability where learning to read is impaired. This difficulty in learning to read is independent from the general intellectual ability, in a child with adequate reasoning and comprehension. These difficulties in reading and writing cannot be explained by visual or auditory deficits.

A dyslexic child shows difficulties in school, reads slowly and with errors and also produces a significant percentage of errors in writing. They show difficulties in interpreting texts and a low ability to produce written texts. School performance is lower than what you would expect taking into account the child’s intellectual ability. These children withdraw from school and school related work, usually being labelled as lazy or distracted.

An early diagnosis allows for a faster and significant rehabilitation of  reading and writing abilities. It also allows the child to understand the origin of his difficulties, boosting self-esteem and has a stimulating effort in school work. These children should have a differentiated treatment at school, with regards to  reading and writing difficulties, in order to  further their  linguistic abilities.

Frequent symptoms found in dyslexic children:

• Start to speak later than usual, also learn new words and building of simple sentences later than what is expected;
• Frequent otitis around 2 years of age;
• Intellectual abilities are within what is expected for the age group but show significant difficulties in learning to read and write;
• Doesn’t like to read or write, its necessary a lot of encouragement to perform school works involving reading or writing;
• Is considered lazy or distract in the school room;
• Oral language is much better than written language production;
• Low self-esteem, sometimes the child refers to itself as “dumb”;
• Low understanding of what he/she reads;
• Confuses some letters and their sounds (F-V, B-D-P);
• Omits or changes some letters in the word;
• Irregular calligraphy, where sometimes the child isn’t able to read what she writes;
• Difficulties learning a foreign language;
• Family history of reading and writing difficulties;
• Normal ability to perform mathematical operations, although, when there is a need to read shows difficulties in solving mathematical problems.