Published onHI Hope
If Leela Morrow, PsyD, the psychologist for the Congenital Hyperinsulinism Center at Children’s Hospital of Philadelphia, gives your child a referral for a neuropsychology evaluation it’s nothing to be afraid of. In fact, it may give your child a roadmap to success.
“A great way to think of a neuropsychology evaluation is taking a microscope to your child’s brain,” Morrow says. “The neuropsychologist will take a good look at your child’s attention, memory, language function and any emotional concerns to see if there are issues that need support. It’s much more than just an educational evaluation.”
It’s unknown exactly why children with hyperinsulinism (HI) may have behavioral, learning and executive function problems. It may have to do with periods of extremely low or wildly fluctuating blood sugar levels or be a trait of the genetic mutation that led to the HI in the first place. There are no definitive answers.
But neuropsychological or academic problems are common enough that the HI Center has entered into a formal relationship with Neuropsychology, which is part of the Department of Child and Adolescent Psychiatry and Behavioral Science at CHOP, to have a neuropsychologist join the HI Center team this fall.
What prompts a neuropsychology evaluation
When Morrow sees a child as part of a follow-up visit to the HI Clinic, she will ask the parents if the child is showing any signs of attention or memory problems, if the child has received services through the family’s local Early Intervention provider, or if the child’s pre-school or school has created an individualized education plan (IEP) or indicated the child should be evaluated for learning issues.
“Any of those are consideration points for referrals to Neuropsychology,” Morrow says. “The neuropsychologist does an extensive evaluation, and the results inform my treatment and recommendations.”
The purpose of a neuropsychological evaluation is to understand how medical conditions, like HI, or treatments involving the brain or central nervous system affect the person’s development, including impacts on cognitive, emotional and behavioral functioning.
Time evaluation to start of school
It’s helpful to have the initial neuropsychological evaluation done about the time the child is ready for kindergarten. That evaluation serves as a baseline.
“Not every child will end up needing extra assistance with learning support,” Morrow says, “but if they do, we would want to start it earlier rather than later.”
Currently, there is a considerable wait for an evaluation appointment at CHOP. That will improve when the neuropsychologist joins the HI Center team. For HI families that live outside of the region, it might make sense to work with a local neuropsychologist. CHOP social workers are available to work with families to find a neuropsychologist near them who takes the family’s insurance.
What to expect
Families should plan for a full-day evaluation, especially for younger children who get more frequent breaks. The intake, which can be handled virtually via telehealth for CHOP families, gathers detailed information and background, including an IEP, if applicable. The neuropsychologist won’t repeat testing that was already completed as part of preparing a child’s IEP. The evaluation will focus on tests that will give more specifics on potential neuro-cognitive challenges.
When the evaluation report is completed, the family will have a feedback session (which can be done virtually) with the neuropsychologist, who will explain the findings and what they mean for a child’s learning a functioning.
Morrow also receives a copy and is available to families to further drill down into the results and give recommendations for how to help the child.
“I talk to parents about what supports can be put in place in the school, in the home and through outside therapy services or continuation of our sessions,” Morrow says. “For example, a child may have received a diagnosis of attention deficit/hyperactivity disorder (ADHD) since we see hyperactivity in some children with HI. So, it might be helpful for the child to use fidgets or stress balls, sit on a bouncy chair, and get frequent breaks during school to compensate. Our goal is for them to learn optimally, given some of the challenges they have.”
Supports may change as child grows
Once needs are identified, children can learn tools to aid with memory, organization and processing issues to help them succeed.
The initial evaluation serves as a baseline. Morrow recommends that children be re-evaluated near the time of the transition to middle school and the transition to high school — as academics become more difficult.
“After a second or third evaluation, the recommendations may change, but it’s important for parents to know their child’s intellectual functioning or IQ doesn’t change,” Morrow says. “That will be relatively stable over time. But academic functioning my change. For example, they may have more challenges with math in middle school compared to elementary school, which leads to a recommendation of extended time for tests, shorter assignments or math support.”
Including a neuropsychological evaluation is one other example of how the HI Center relies on its multidisciplinary structure to ensure each child achieves the best possible outcome.