Is Your Child with a Medical Condition Misunderstood?
It’s common for parents to request a neuropsychological evaluation after they’ve worked with many professionals. Families express confusion and frustration. They just want answers, and they want to know how to help their child!
Here is a fictitious example that is common for a child with a medical condition:
Bobby was born with cerebral palsy but has been medically stable since he was born. He only sees a pediatrician and is a healthy boy. Due to early speech and motor delays, Bobby required Early Intervention Services (with Babies Can’t Wait) before the age of 3 years. He then showed a slow rate of learning in kindergarten. Bobby worked with a neighborhood tutor for a couple years. By 3rd grade, teachers were calling home about disruptive behavior, social conflict, and his grades were dropping.
Bobby was referred to the school psychologist at his elementary school for an evaluation. The results of this evaluation determined various areas that were weaker than same age students, but Bobby “was not eligible” for special education services at school. Although the school psychologist noted elevated attention problems, the school cannot give a child a diagnosis. The school suggested that Bobby see a child psychologist.
Bobby’s family consulted with a child psychologist in the community. Bobby was diagnosed with ADHD. He did not meet criteria for any other diagnoses but the psychologist confirmed the same weaknesses from the school evaluation.
Bobby’s pediatrician prescribed medication for ADHD symptoms. This helped somewhat, but Bobby’s grades were not getting better and he was becoming more socially isolated.
Bobby’s family has already worked with speech, physical and occupational therapists, a tutor, school psychologist, child psychologist, and the pediatrician. Each of these professionals has an expertise to support specific areas of developmental concern.
So why has it been so difficult to get Bobby the help he needs? Let me explain what happened.
After Bobby was diagnosed with cerebral palsy as an infant, he got exactly what he needed at the time. Early Intervention Services are a state funded program from infancy to age 3 following a diagnosis of developmental delay. Bobby made definite progress in his motor and communication skills.
But when Bobby began school, new developmental challenges emerged and worsened. His parents thought that he would eventually catch up over time, especially if they gave him a lot of support.
As school progressed, Bobby’s family did everything they could. They attended every parent-teacher conference. His parents reviewed school lessons at home, and they checked his homework. They helped him practice reading. And when they were unsure what to do next (especially in math), they paid a tutor.
Bobby just couldn’t keep up. His low grades became a signal to the school that it was time to do something. Only after these red flags did the school realize he needed an evaluation with the school psychologist.
The school psychologist completed all the typical tests. Bobby seemed to have weaknesses scattered across multiple areas. These weaknesses didn’t fit in a category to qualify for special education services. Luckily, his attention problems were clearly identified. Here are the eligibility categories for special education services in the public schools of Georgia (these can vary by state):
Autism, Deaf/Hard of Hearing, Visual Impairment/Blindness, Emotional or Behavioral Disorder, Intellectual Disability, Orthopedic Impairment, Other Health Impaired, Significant Developmental Delay, Specific Learning Disability, Speech/Language Impairment, Traumatic Brain Injury.
Visit the GA Dept of Education to learn more: www.gadoe.org
Bobby didn’t fit in a category understood by the school. What happened next?
Bobby’s family met with the pediatrician because his medication for ADHD was only somewhat helpful. This is when the pediatrician explained to his family that cerebral palsy is associated with neurodevelopmental delays, including ADHD, and that it may take time and patience to figure out the right medication. The pediatrician reminded the family of Bobby’s abnormal brain MRI when he was an infant. This MRI showed lesions in the basal ganglia and white matter regions of the brain. The pediatrician referred Bobby’s family to a neuropsychologist.
A neuropsychological evaluation showed scattered weaknesses in attention, executive skills, processing speed, rote memory, fine motor speed, math, and reading comprehension. His diagnosis of ADHD was also accurate. This pattern of findings was consistent with his diagnosis of cerebral palsy and abnormalities on brain imaging.
After putting all the pieces together, Bobby does meet criteria for special education services under the category of Other Health Impaired (OHI). This is a category commonly used for children with developmental challenges due to a neurological condition. His new Individualized Education Program (IEP) included supports such as occupational therapy for handwriting challenges, small group help for math, audiobooks for reading comprehension, extra time on testing, and social skills groups.
It took a while to figure out how to make sense of Bobby’s neurodevelopmental profile. The only “category” that made sense was related to his medical history. Cerebral palsy (and abnormal brain imaging) are certainly associated with neurodevelopmental weaknesses. This information helped his family, school, and medical team come together and create a plan for how to support his progress.
If you believe it could be helpful to work with a neuropsychologist to understand your child, call us for a free consultation at 404-721-2644. More information on how to contact us here: https://pedneurocenter.com/contact/
