218 Practice Issues in School Neuropsychology

that a comprehensive battery is not likely to yield substantive educa­tionally relevant recommendations. However, caution in these cases should be taken to ensure that subtle deficits are not ignored. Second, in cases where there are very severe residuals, formal neuropsychological assessment may not be helpful. For example, if a child has experienced I very severe general cognitive loss and now functions in the lower ranges I of intellectual disability, standard neuropsychological assessment may I not yield meaningful information. Similarly, if there are severe physical I or sensory residuals, testing may not be feasible.

• Where comprehensive assessment is indicated, the recommendation is that Miller's (2007) conceptual model be followed. This model is also described in other sections of this volume. This model dictates an orderly progression of assessment through sensory-motor, attentional, visual- spatial, language, memory and learning, executive, cognitive speed and efficiency, intellectual, and academic functions and processes. Based on medical information and information from parents, teachers, and others, the neuropsychological assessment should be individually planned to focus on apparent residuals from the illness or injury and the possible I educational impact. The Neuropsychological Processing Concerns Checklist for School-Aged Children and Youth (Miller, 2007) would be useful in planning the formal assessment. Also, since many of these children and adolescents may have social-emotional residuals related to their injury or illness, assessment of both internalizing and externalizing behavioral and emotional concerns should be considered to supplement the model.

• The assessment and related educational plans should delineate the various accommodations and related services. In many cases, the child with neurocognitive residuals will need an interdisciplinary approach involving occupational therapy, physical therapy, and speech and language services. Professionals from these disciplines often assess and intervene in areas related to Miller's (2007) conceptual model.

• In many cases, children with neurological disorders may warrant more frequent evaluations of status. While special education laws and regu­ lations typically indicate a three-year evaluation cycle, this may I be too infrequent for these children. The first twelve to eighteen months after return to school may be an appropriate time for additional reevaluation.

• Last, children who have experienced neurologically related illness or injury may present atypical patterns after their return to school. Some data suggests there may be "late-emerging" problems even several years after the illness or injury. Some children may appear to have had minimal, educationally related residuals when they were younger,

School Reentry for Children Recovering from Neurological Conditions 219

but problems may emerge with additional development and/or chang­ing demands of the school curriculum. Children with significant history of neurological illness or injury may need evaluation and/or services later in their educational career.

SUMMARY

Children and adolescents returning to school after experiencing a serious neurological condition or injury present special challenges for the school neuropsychologist and other educational professionals. The disorders cov­ered in this chapter share some commonalities in terms of the residuals, but also yield unique impairments related to their condition. It is important to know the specific residuals of the condition and collaboration with medical personnel is important in planning a successful reintegration pro­gram. Dealing with reintegration issues often requires the school to be able to quickly develop a plan for the child's return. The school neuro­psychologist is often the ideal individual to coordinate a reintegration team. A variety of activities may include assessment, consultation with and education for other school personnel, developing accommodations, monitoring progress of school readjustment, and dealing with associated social-emotional or behavioral issues.

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