Unpacking the School Neuropsychology Evaluation Report (e.g., What the heck does all of this mean for the classroom teacher?)

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Unpacking the School Neuropsychology Evaluation Report (e.g., What the heck does all of this mean for the classroom teacher?)

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Title: Unpacking the School Neuropsychology Evaluation Report (e.g., What the heck does all of this mean for the classroom teacher?)

1
Unpacking the School Neuropsychology Evaluation
Report(e.g., What the heck does all of this mean
for the classroom teacher?)

Presented by
Phyllis G. Paro, MA, ABSNP
Vermont Licensed School Psychologist
Diplomate, American Board of School
Neuropsychology

2
Topics

TBI Stats (from the CDC)
Pictorial Overview of Brain
The School Neuropsychology Evaluation Report
Cognitive Processes Sensorimotor
Cognitive Processes Visuospatial
Cognitive Processes Auditory/Phonological
Cognitive Processes Learning/Memory
Cognitive Processes Executive Functions
Facilitators/Inhibitors Allocating and
Maintaining Attention

Facilitators/Inhibitors Working Memory
Facilitators/Inhibitors Speed, Fluency, and
Efficiency of Processing
Acquired Knowledge Acculturation Knowledge
Acquired Knowledge Language Abilities
Acquired Knowledge Reading Achievement
Acquired Knowledge Written Language Achievement
Acquired Knowledge Mathematics Achievement
Social-Emotional Functioning and Adaptive
Behaviors

4
TBI Statistics(From the Centers for Disease
Control)

TBI in the United States
An estimated 1.7 million people sustain a TBI
annually. Of them 52,000 die, 275,000 are
hospitalized, and 1.365 million, nearly 80,
are treated and released from an emergency
department.

TBI is a contributing factor to a third (30.5)
of all injury-related deaths in the United States
About 75 of TBIs that occur each year are
concussions or other forms of mild traumatic
brain injury (MTBI)
During the last decade, emergency department
visits for sports and recreation related
TBIs, including concussions, among children
and adolescents increased by 60
Overall, the activities associated with the
greatest number of TBI-related emergency
department visits included bicycling,
football, playground activities, basketball,
and soccer

National surveillance in 9 high school
sports
TBI represents almost 9 of all injuries
reported in the 9 sports. Numbers and
rates are highest in football (55,007
0.47 per 1000 athlete exposures) and girls
soccer (29,167 0.36 per 1000 athlete
exposures)

7
Picture copied from Brain Injury A Manual for
Educators, Colorado Department of Educations
8
Basic Sensorimotor Functions

Sensory functions encompass our ability to
process visual, auditory, kinesthetic, and
olfactory information. Dysfunctions in any single
sensory system can have a dramatic effect on a
childs learning capabilities and behavioral
regulation. Motor functions encompass both fine
motor skills (e.g., picking up or manipulating
small objects, holding a pencil correctly,

buttoning a button) and gross motor skills (e.g.,
walking in a balanced and coordinated manner,
running, jumping, riding a bike, etc.).

10
Basic Sensorimotor Functions Specific Skills
Measured

Lateral Preference Measures the degree of
handedness or preference of which side of the
body used for fine motor activities.
Sensory Functions Measures of auditory and
visual acuity (how well can the student hear and
see) and measures of tactile sensation and
perception (how well the student can respond to
touch).
Fine Motor Functions Measures the students
ability to movement fingers and hands in a
coordinated manner.

11
Basic Sensorimotor Functions Specific Skills
Measured

Visual - Motor Integration Skills Measures the
students ability to copy objects on paper.
Visual Scanning Skills Measures the students
ability to visually scan a horizontal line for
information.
Gross Motor Functions Measures a students
ability to use his/her large muscles in their
body in a coordinated manner.

12
What it might look like in the classroom

Behavior Implications for Sensory Issues
May appear to be overwhelmed
May emotionally melt down
May be irritable or have a short fuse
May be fidgety
May bump into others when in line
May become overly excited on the playground
May become more tactile (touching people or
things)
May tune out due to being over stimulated

Academic Implications
Messy papers, poor organized of school work
Incomplete work
Poor handwriting
Excessive erasing, crossing out of words
Difficulties completing worksheets with cluttered
visual fields
Difficulties shifting from workbook/textbook to
writing on an answer sheet/paper
Difficulties reading due to visual stimuli

Difficulties with group work and/or group
discussion
Difficulties with seat work
Becoming overwhelmed in crowded environments

15
Suggested Classroom Accommodations

Allow the student to use a computer for written
work
Allow the student to dictate the first draft of a
written assignment rather than write it
Break down written work into chunks
Use color overlays
Reduce visual and auditory distractions
Reduce the number of problems on a page
Use a guide to assist with visual tracking

Allow the student to have preferential seating in
order to reduce auditory and visual stimulation
Make use of study carrels

17
What it might look like in the classroom

Behavior Implications for Fine Motor Issues
May have shaky hands/tremors
May have difficulties with fasteners
May have difficulties holding a pencil correctly
May have difficulties using small manipulatives
Academic Implications
May have poor handwriting
May have difficulties with drawing
May have difficulties with cutting

May take extra time to produce written work
May avoid tasks that require writing
Behavior Implications for Gross Motor Issues
May stumble and/or bump into things
May be clumsy and/or fall
May avoid sports (even those they had previously
engaged in)
May have difficulty carrying lunch tray without
spilling things
May be unsteady on the stairs, on playground
equipment, or in crowds of people

Academic Implications
May have difficulties with or demonstrate an
avoidance of Physical Education
May avoid recess
May have difficulties sitting upright

20
Suggested Classroom Accommodations

Allow student to use the computer for written
work
Develop pre-prepared materials (i.e., shapes
already cut out, etc.) so that the student can
focus on content rather than fine motor skills
Provide the student with notes (can be copied
from another student or taken by an adult)
Provide the student with guiding notes and/or an
outline

21
Cognitive Processes VisuospatialSpecific
Skills Measured

Visuospatial Perception Measures a students
ability to make visual discriminations, locate
objects in space, and construct objects.
Visuospatial Reasoning Measures the students
ability to recognize spatial configurations,
identify objects with missing parts, and match
similar visual patterns.

22
What it might look like in the classroom

Behavioral Implications
Student may have difficulties organizing
materials
Student may experience behavioral difficulties
due to his/her inability to understand visual
materials
Academic Implications
Reading difficulties
Difficulties organizing written work
Issues with handwriting
Difficulties with math

Difficulties with depth perception
Spatial perception and orientation difficulties
Difficulties with mental rotation
Difficulties with object construction
Distance perception difficulties
Difficulties visualizing mental maps

24
Suggested Classroom Accommodations

Provide verbal directions
Check-in frequently to ensure understanding
Enlarge written materials
Reduce visual clutter at the students desk
(and also within the classroom)
Provide support in aligning math problems (e.g.,
use graph paper)
Provide support in organizing writing from left
to right and organizing/expressing thoughts

25
Cognitive Processes Memoryand Learning

Memory is a significant contributor to the
learning process. Memory is comprised of multiple
interactive systems immediate memory, working
memory, and long-term retrieval.

26
Memory and LearningSpecific Skills Measured

Overall Memory Indices overall indicators of
memory and learning
Rate of Learning measures the students ability
to learn new information over repeated trials
Immediate Memory measures the students ability
to immediately recall information presented
either verbally or visually in a variety of
formats

Delayed Memory Recall versus Recognition
measures the students ability to recall or
recognize information that was presented verbally
or visually after a 20-30 minute delay
Verbal Visual Associative Learning and Recall
measures the students ability to learn and
recall information that requires verbal and
visual associations

28
What it might look like in the classroom

Behavioral Implications
May become easily frustrated
May seem spacey forgetful
May make things up in order to save face
May seem defiant
May be seen as lazy or unmotivated
May copy others behaviors or work
May demonstrate angry outbursts or meltdowns
May not remember more than one things at a time

May not remember recent events
May be disorganized
May develop an attitude
May appear to be manipulative
May get lost frequently and easily
Academic Implications
Has difficulties re-telling a story
Forgets assignments, people and names, events,
etc.
May fail tests in spite of studying
Experiences difficulties with spelling

Has difficulty retaining new skills
May demonstrate inconsistent performance
May not remember information they have been
taught
May put in a lot of effort and still get poor
results
May be able to memorize, but seems unable to
apply this information
Fails to see the big picture

31
Suggested Classroom Accommodations

Repeat instructions out loud
Have the student repeat back instructions in
order to demonstrate he/she understands
Use multi-modal teaching
Practice instructions out loud
Use pictures or visual cues
When introducing new skills, provide the student
with concrete pictures to look at, hands-on
activities, or other ways to visualize and form
associations regarding what is being learned

Tie learning tasks to the students areas of high
interest as this will maximize its storage into
long-term memory
Keep oral requests short and simple and pair with
visual cues whenever possible
Provide intensive repetition, practice, and
review in learning activities. To promote
retention, provide activities to reinforce the
skills or content at frequent and regular
intervals, gradually increasing the intervals to
less frequent and intermittent
Teach to learning style strengths and reinforce
with different types of learning methods

Teach the student specific memory strategies and
how to recognize which strategy may be most
useful in a variety of situations, such as taking
notes versus memorizing rote information for a
test. Examples include using verbal rehearsal,
chunking, making ridiculous visual images
composed of items that one has to remember, and
reading first-letter mnemonic strategies
Present all types of verbal information
accompanied by visual stimuli that clearly
illustrates the concepts being taught. Examples
are pictures, charts, graphs, semantic maps,
etc.

34
Cognitive ProcessesExecutive Functions

Executive Functioning can be conceptualized into
two broad areas cognitive and behavioral/emotiona
l control. The cognitive aspects of executive
functioning include concept generation and
problem solving. The behavioral/emotional aspects
of executive functioning relate to the inhibitory
controls of behavior (e.g., impulsivity,
regulation of emotional tone, etc.)

35
Executive FunctionsSpecific Skills Measured

Cognitive Flexibility (Set Shifting) measures
the students ability to stop focusing on one
activity and start focusing on another activity
Concept Recognition and Generation measures the
students abilities to recognize or generate
multiple ways of classifying or categorizing
objects, pictures, or words
Problem Solving, Fluid Reasoning Planning
measures the students ability to solve problems,
apply reasoning skills, and use planning
strategies

Response Inhibition (Impulse Control) measures
the students ability to learn and demonstrate a
new response to a stimuli instead of producing a
typical response
Behavioral/Emotional Regulation measures the
students ability to shift cognitive set and
modulate emotions and behavior via appropriate
inhibitory control. Additionally, it looks at
the students ability to cognitively self-manage
tasks and to monitor his/her performance

37
What it might look like in the classroom

Behavioral Implications for Cognitive
Flexibility
May be concrete and have rigid thinking
May demonstrate difficulties with transitions
May perseverate
May have difficulty taking feedback
May be stubborn and argumentative
May not like to try new things
May demonstrate difficulties making friends
May lack empathy

Academic Implications
May have difficulties with abstract thinking
May have difficulties deviating from the
classroom schedule
May have difficulties coming up with more than
one solution to a problem
May have difficulty switching gears
May not do what has been asked of him appears
to be noncompliant
May not learn from his/her mistakes
May not think well on his/her feet

39
Suggested Classroom Accommodations

Develop routines for the student to follow
Plan for situations that will require the use of
cognitive flexibility
Teach coping strategies
Reduce novelty by pre-teaching or allowing the
student to preview the materials to be presented
providing cuing in advance of transitions (e.g.,
you have 5 minutes left, etc.) providing gradual
exposure to new situations

Modify tasks by breaking them down into their
component parts providing the student with
templates or rubrics to follow decreasing the
complexity of information presented
Increasing the level of support around tasks by
offering frequent reassurance or reinforcement
providing step-by-step assistance in working
through difficult problems being nearby during
transition times

41
What it might look like in the classroom

Behavioral Implications for Problem Solving,
Fluid Reasoning Planning
May make poor behavioral and social choices
May not follow through with requests to complete
tasks
Lacks common sense
Doesnt think well on his/her feet
May be stubborn and/or oppositional
May demonstrate poor social judgment

May act without thinking of the consequences
May appear to be depressed
May not make plans with friends
May have difficulties problem-solving
Demonstrates rigid thinking
Academic Implications
May not get the broader concepts (but should be
able to do rote learning)
May demonstrate difficulties with math
problem-solving

May have difficulties responding to essay
questions
May do better on multiple choice tests
May not generalize information appropriately
May lack insight
May not get the big picture
May experience difficulties with comprehension
(e.g., reading, math written expression)
May have difficulties brainstorming
May be late for class and come unprepared
May demonstrate difficulties with time management
May have difficulties with sequential tasks

44
Suggested Classroom Accommodations

Avoid the use of sarcasm
Use multiple choice instead of essay test formats
Use scaffolding
Anticipate transitions
Provide frequent cues/reminders to keep working
Provide graphic organizers for writing
Break larger assignments into smaller, more
manageable parts

45
What it might look like in the classroom

Behavioral Implications for Response Inhibition
(Impulse Control)
May say or do things the he/she quickly regrets
May say or do things that cause embarrassment to
others
May deny his/her behavior even when caught in
the act
May have difficulty explaining why he/she chose
to do something

Academic Implications
May call out frequently in class
In reading, may have a tendency to guess
impulsively at words based on the first letter or
may have the tendency to insert words that are
not actually in the text
May have a tendency to respond quickly to
questions and/or problems without stopping to
think or problem solve

47
Suggested Classroom Accommodations

Increase external controls by restricting access
to settings or situations in which the student
can get into trouble
Increase supervision
Reduce the opportunity for the student to act
impulsively by limiting decision making
Provide the student with clear, simply stated
explanations, instructions, and directions so
that he/she knows exactly what is expected

Do not leave a lot of unstructured time for the
student
Teach the student decision-making steps (a)
think about how other persons may be influenced,
(b) think about the consequences, (c) carefully
consider the unique situation, (d) think of
different courses of action which are possible,
and (e) think about what is ultimately best for
him/her
Teach the student to think before acting (e.g.,
ask him/herself What is happening? What am I
doing? What should I do? What is best for
me?)

49
What it might look like in the classroom

Behavioral Implications for Behavioral/Emotional
Regulation
May over/under react to situations
May experience difficulties with anger management
May present as being emotionally labile
May appear lazy, unmotivated, or spacey
May be able to tell you what they are supposed to
be doing, but cannot get started
May require constant cuing

May get overlooked because they are not causing
problems within the classroom
May appear to be aloof or disinterested in peers
May lose things easily
May be disorganized
May be easily frustrated
Academic Implications
May have difficulties with group learning
May have trouble focusing
May experience emotional difficulties that
interfere with academics

May not complete homework or classwork
May appear to be passive/resistant
May have difficulties starting schoolwork
May turn in poor quality work
May have difficulties managing long-range
projects
May not turn in homework
May be forgetful
Work may be messy

52
Suggested Classroom Accommodations

Provide assistance to the student with getting
started on his/her work
Provide more frequent check-ins to ensure that
he/she is completing assignments
Provide a written/visual cue to assist him/her
with beginning work
Teach/support organization skills/systems (e.g.,
folders, planners, etc.)
Provide student with step-by-step instructions

Home and school should work together to implement
an organization system that works for the student
Color code subjects
Provide a space within the classroom that the
student can go to if they need to calm down
Anticipating problem situations and preparing the
student for them
Teaching coping strategies
Structuring the environment in order to avoid
problem situations or to allow you to intervene
early
Allowing for breaks if tasks appear to be
frustrating

54
Facilitators/Inhibitors Allocating and
Maintaining Attention

Attention is a complex and multifaceted construct
used when an individual must focus on certain
stimuli for information processing. In order to
regulate thinking and to complete tasks of daily
living such as schoolwork, it is necessary to be
able to attend to both auditory and visual
stimuli in the environment. Attention can be
viewed as the foundation of all other
higher-order processing. In other words, if
attention is compromised it can

adversely affect other cognitive processes of
language, memory, visuospatial skills, etc.
Attention can be divided into three subareas
selective/focused attention, sustained attention,
and attentional capacity.

56
Allocating and Maintaining AttentionSpecific
Skills Measured

Selective/Focused Attention refers to the ability
to pay attention to relevant information while
ignoring irrelevant information. An example of
selective/focused attention would be the childs
ability to pay attention to only the classroom
teacher when there is the noise and the visual
distracters of the classroom to ignore.
Sustained Attention refers to the ability to
maintain an attention span over a prolonged
period of time.

Attentional Capacity refers to the childs
ability to recall information ranging from small
chunks (e.g., a string of numbers or letters), to
larger chunks of information (e.g., list of
unrelated words or sentences of increasing length
and complexity), and to even larger semantically
complex chunks of information (e.g., memory for
stories).

58
What it might look like in the classroom

Behavioral Implications of Attentional
Difficulties
May have difficulties sustaining attention to
non-preferred tasks
May be easily distracted by external and/or
internal stimuli
May have a low frustration/tolerance level
May lose things necessary for tasks
May seem spacey or forgetful

Academic Implications
Fluency may be negatively impacted as students
mind wanders
Quality of work may be impacted by careless
errors
May have difficulties following directions
May not follow through with directions/instruction
s and tasks
May not complete assignments
May appear to have memory issues

60
Suggested Classroom Accommodations

Providing the student with opportunities to move
to a quiet place in the classroom any time the
auditory and visual stimuli interfere with
his/her ability to function successfully
Providing the student with shorter tasks that do
not require extended attention in order to be
successful. Gradually increasing the length of
the tasks as he/she demonstrates success
Providing the student with a predetermined signal
(e.g., hand signal, verbal cue, etc.) when he/she
begins to display off-task behavior

Modeling appropriate behavior in the presence of
auditory and visual stimuli (e.g., continuing to
work, asking for quiet, moving to quieter part of
the classroom, etc.)
Providing the student with a timer to be used to
increase the amount of time during which he/she
maintains attention (e.g., have the student work
on the activity until the timer goes off)
Following a less desirable task with a more
desirable task making the completion of the
first necessary to perform the second

62
Facilitators/Inhibitors Working Memory

Working Memory is the ability to hold on to
information while performing complex tasks for
example, solving a mental math problem

63
What it might look like in the classroom

Behavioral Implications Refer to earlier section
on Learning and Memory
Academic Implications
May forget or be unable to follow multi-step
directions
May forget what he/she was talking about
May forget the details of reading (while still
reading)
May forget what he/she is looking for

May be able to answer factual questions, but has
difficulties with recalling complex details,
making predictions, or making inferences (e.g.,
can see the individual trees, but not be able to
see the forest)
May forget ideas or sequences of thoughts after a
writing task has been started

65
Suggested Classroom Accommodations

Keep oral directions short and simple and
supplement with visual cues when possible.
Provide intensive repetition, practice, and
review in learning activities. To promote
retention, provide activities to reinforce the
skills or content at frequent and regular
intervals, gradually increasing the intervals to
less frequent and intermittent.

When introducing new skills, provide the student
with concrete pictures to look at, hands-on
activities, or other ways to visualize and form
associations regarding what is being learned.
Given the students limitations with working
memory, he/she may benefit from verbal rehearsal
strategies (i.e., talking cues) to keep
information in memory for a longer time.
Teaching him/her to talk his/her way through
multi-step or multi-sequential tasks, such as
division, might be helpful as well

67
Facilitators/Inhibitors Speed, Fluency, and
Efficiency of Processing

The facilitators/inhibitors of speed, fluency,
and efficiency of processing are conceptualized
to be composed of four second sub-classifications
performance fluency, retrieval fluency, acquired
knowledge fluency, and fluency and accuracy.

68
Speed, Fluency Efficiency of Processing
Specific Skills Measured

Performance Fluency Measures the students
ability to quickly perform simple repetitive
tasks
Retrieval Fluency Measures the students ability
to quickly assess information from long-term
memory
Acquired Knowledge Fluency Measures the degree
to which reading, writing, and math is fairly
automatic for a student

Assessing Fluency with Accuracy Measures the
interaction between completion time on a task and
accuracy. Some students slow down on tasks to be
more accurate. Other students are very fast but
make many errors. Ideally, students have average
completion times with good accuracy

70
What it might look like in the classroom

Behavioral Implications
May become easily frustrated
May get tired easily
May appear to be inattentive
May act like he/she doesnt understand
May experience delays in responding

Academic Implications
Delays in responding to questions
May be slow at doing work
May have difficulties taking time tests
May not be able to complete assignments during
class time
May have difficulties following a lecture
May have difficulties multi-tasking
May get poor grades despite high levels of effort
Does not appear to remember information (forgets
the question while attempting to process the
information)

72
Suggested Classroom Accommodations

Repeat instructions
Student may want to tape lectures
Give instructions one at a time
Be brief and concise
Allow for a delay in the students response
Give the student extra time
Replace timed tests with alternative assessment
procedures

73
Additional Areas Assessed

Cognitive Processes Auditory/Phonological
Sound Discrimination and Auditory/Phonological
Processes Measures the students ability to
discriminate differences in sounds and speech and
to apply basic auditory and phonological
processing skills
Acquired Knowledge Acculturation Knowledge
Semantic Memory Measures the students knowledge
of basic information retrieved from memory.

Acquired Knowledge Language Abilities
The language domain is categorized into oral
expression and listening comprehension (receptive
language)
Acquired Knowledge Reading Achievement
Acquired Knowledge Written Language Achievement
Acquired Knowledge Mathematics Achievement
Social-Emotional Functioning and Adaptive
Behaviors

75
Sources

www.cdc.gov/concussion
http//www.cdc.gov/concussion/HeadsUp/schools.html
www.cokidswithbraininjury.com
Brain Injury A Manual for Educators, Colorado
Department of Education
Executive Function in the Classroom Practical
Strategies for Improving Performance and
Enhancing Skills for All Students Christopher
Kaufman, Ph.D

Executive Skills in Children and Adolescents A
Practical Guide to Assessment and Intervention
Peg Dawson Richard Guare
Helping Students Remember Exercises and
Strategies to Strengthen Memory Milton J. Dehn

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