Play-Based Neuropsychological Assessment of Toddlers.

Standardized psychological assessment provides a precise yet limited view of the neuropsychological status of preschool toddlers, whose brain functioning is only beginning to develop localized functioning. Yet, referrals for preschool evaluation of these early-age children often request a wide variety of information about brain-behavior relationships, i.e., cognition, attention, object permanence-memory, pre-language and language skills, visual-spatial perception, executive functioning as well as pre-academic skills. A play-based model of assessment provides a promising method of assessing the neuropsychological status of toddlers referred for preschool evaluation of their special needs. ********** Of IDEA (2004) calls for a multidisciplinary assessment of preschool children with potentially identifiable developmental needs to determine their eligibility for school-based services. Many of these children are referred through state-sponsored early intervention systems during their toddler years prior to age three to receive multidisciplinary assessments, and referrals for early-age assessments often request information addressing the neuropsychological status of these toddlers, i.e., cognition, attention, object permanence and memory, pre-language and language skills, visual-spatial perception, executive functioning as well as pre-academic skills. As such, preschool, early-age multidisciplinary assessment often involves neuropsychological correlates relevant to a number of presenting disorders commonly identified during these evaluations (e.g., Attention Deficit Disorder, Pervasive Developmental Disorder, Dyslexia, Tourette's syndrome, Neurofibromatosis, and Sensory Integration Disorder). Observational measures of children's neuropsychological status. Although the traditional neuropsychological assessment batteries for children offer precise and reliable measures, they do not address the age range of children commonly referred for the early age assessment. Examples of these measures include the Halstead Neuropsychological Battery for Children (HRNB; Reitan & Davison, 1974a),the Reitan-Indiana Neuropsychological Battery (RINB; Reitan & Davison, 1974b), and the Luria-Nebraska Neuropsychological Batter--Children's Revised (LNNB-CR; Golden, 1984). The HRND is standardized for children ages 9-14,and the RINB is standardized for children 5-8, while the LNNB-CR is standardized for children ages 8-12. Given the importance of early age assessment and the types of questions presented at preschool evaluations, efforts to extend neuropsychological assessment downward to an early age population have been made through formal and informal methods. Many of the formal and traditional neuropsychological assessment batteries are standardized on children above the age of three and allow for the direct observation of performance. For instance, the NEPSY is a standardized, individually administered procedure that provides information about attention and executive functioning, language, sensorimotor functioning, visuospatial processing, and memory and learning for children ages 3 to 12 (Korkman, Kirk & Kemp, 1998). The Cognitive Assessment System (CAS) is a standardized, individually administered procedure that provides a full scale estimate of cognitive functioning as well as subscale measurements of planning, attention, successive processing and simultaneous processing (e.g., PASS scales) for children and adolescents ages 5 to 17 years. PASS subscales allow for the identification of cognitive strengths and weakness (Naglieri, 1999). Early age neuropsychological assessments with the NEPSY and CAS are based upon a Luria (1973) model of brain development. Brain functioning is looked upon as a complex functional system that combines in concert with many working brain structures, each of which contributes separately to a holistic functional system. Each specific brain structure introduces its own particular factor essential for performance, with removal of this factor making the total performance impossible. …