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Файл:Развитие навыков переводческой деятельности на английском языке по теме «Нейропсихология». Учебно-методическое пособие
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explanation is sufficient, provide some examples tailored to the child’s
chronological age, and indicate that discussion about why their
child is being tested will also occur directly with the child before
formal assessment begins to ensure optimal cooperation. Parents
may be encouraged to emphasize in their description to the child
the play aspect of testing for a young child. For an older child or
adolescent, who likely will be more cognizant of the reasons for such
an evaluation, they can take the opportunity to emphasize the test
session will examine both strengths and overall competencies, along
with any potential weaknesses.
(Baron I. S. Neuropsychological Evaluation of the Child)
Text 12
History Taking
The critical importance of a thorough history taking cannot
be overstated. Information revealed in history taking inevitably
influences the final interpretive conclusions. It serves as a doublecheck on the history taken by others and as an opportunity to obtain
information not previously reported to the child’s pediatrician,
teacher, or others involved in the child’s care. Parents do not always
appreciate the extent of their knowledge about their child and,
therefore, might omit critical information, thinking it unimportant
unless there is direct and focused inquiry. What they recall about
early risk factors, deviations from normal development, relevant
family history, or prior illness, injury, or treatment regimens that can
result in late cognitive or behavioral effects needs to be systematically
reviewed. The neuropsychologist’s facility for listening is essential
in reviewing the important topics in a child history taking: pregnancy
and delivery, peri-and neonatal course, language, motor, and social
development, medical history, family history, educational history,
prior consultations, and extracurricular interests.
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Special attention should be given to the medically unsophisticated
parent who might not understand medical terminology and, therefore,
unintentionally omits important information. For example, one father
of a child with a seizure disorder said “no” when asked whether
anyone else in the family had a history of seizures. But with further
questioning, he revealed that three family members would say,
“Here it comes!” He then began to shake his limbs to indicate what
occurred next, having obviously witnessed their seizures. In another
example, a mother denied anyone in the family had a “neurological
problem.” But when then asked, “Does anyone have a problem with
their brain?” she replied, “Oh yes, my mother and her sister both
have something called a Chiari malformation, and my mother had
brain surgery last year.”
A parent’s reluctance, unwillingness, or inability to comply can
also complicate history taking. For example, the parent of a child
involved in a custody battle might be unwilling to divulge information
freely, a parent suspected of neglect might withhold information,
or a parent of a hospitalized child may be at work and unavailable
for interview. A more complete history occurs with a combination
of questionnaire, parent interview, child interview and/or records
review with signed authorization. The reader is also referred
to discussion of informed consent in neuropsychological practice.
(Baron I. S. Neuropsychological Evaluation of the Child)
Text 13
Test of Nonverbal Intelligence–3
The Test of Nonverbal Intelligence–3 is a relatively brief,
language-free measure of intelligence, aptitude, abstract reasoning,
and problem solving for ages 6 to 89. The TONI was first published
in 1982 as a nonverbal 50-item test for those 5 to 85 years old (Brown,
Sherbenou, & Johnsen, 1982). It was normed on 1,929 individuals
in 28 states. It was revised in 1990 and 835 new individuals were
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added to the original normative data base for a new sample of 2,764.
Five items were added to the upper end. The current TONI–3 was
shortened to 45 items and all new normative data were collected
on 3,451 individuals matched to the 1990 U.S. census results,
including 2,118 children between 6 and 18 years. New picture plates
were also designed. Bias on the basis of demographic variables
and item bias was insignificant. This test should be considered
when the child cannot comprehend language well or respond
well through verbal expression. It is recommended for screening
in the early recovery stages of traumatic brain injury. This test has
applicability for a number of profoundly impairing conditions. It may
also be useful when English is not the first language. Instructions
are pantomimed, and the child responds either by pointing or
in response to the examiner’s pointing to as many as 45 items
arranged in ascending order of difficulty. There are two equivalent
forms for test-retest circumstances.
(Baron I. S. Neuropsychological Evaluation of the Child)
Tексты на пересказ
Цель пересказа текстов — закрепить лексику и актуализировать
грамматические конструкции, потренировать речевой аппарат для
общения, отработать навыки грамотного формулирования мыслей
на английском языке.
Для выполнения подробного пересказа текста рекомендуется
следующий алгоритм:
• Внимательно прочитайте текст. Постарайтесь понять не толь-
ко основную идею, но и важные детали.
• Разберите новую лексику и грамматику. Незнакомые слова
и фразы необходимо выписать и перевести, ориентируясь на контекст. Уточните по словарю произношение новых слов.
• Выделите для себя самое главное, основные мысли или события. Их можно выписать или выделить маркером.
• Составьте план пересказа.
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Text 1
Parent Education
A major goal of the interpretive session is to provide the parents
with information that will make them even more effective advocates
for their child than they currently are. Extensive objective, qualitative,
and collateral data are collected in a neuropsychological evaluation,
which then must be summarized succinctly if the lay person is going
to understand and apply the information in a practical and meaningful
way. Parents must first understand what is being communicated.
Then, they must make the necessary intellectual and emotional
adjustments to accommodate to the results. This then allows them
to take positive steps in their child’s best interest. Accomplishing
these objectives within the interpretive session’s time constraints is
not always easy, but always necessary.
Professional terminology and unfamiliar concepts complicate
communication in the interpretive session. Therefore, a practitioner
should avoid technical jargon that is not clearly explained and should
use simple language to convey complex information. The strategy
of repeating the same information in different ways, and with
different examples, is often especially useful. Some parents are
reluctant to ask questions of the “doctor,” and it is imperative that
their questions be accepted, anticipated, and addressed. Asking
a parent to “tell me what you have learned so far in this meeting”
is revealing of the parent’s acquisition of the new information and
associated gaps. It is also useful to have one parent restate conclusions
for the other, or for the child, to gain a better appreciation of what
information has been integrated well and where there are lacunae
in understanding or agreement.
In one of my interpretive sessions, the parents had widely divergent
viewpoints. The father considered the child to be unmotivated but
perfectly normal and had been unwilling to pursue neuropsychological
evaluation. In contrast, his wife had a sensitive and knowledgeable
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appreciation of her son’s deficits. She attributed their differences
of opinion to the father’s absence from the home, due to long work
days and late returns home, sometimes when their son was already
asleep. The mother, who was home when her son returned from
school, saw directly her son’s struggle with homework assignments
and his consistently poor results. To explain the seriousness of his
son’s neurocognitive weaknesses and break the pattern of denial,
the father was asked to pretend he was going to his job as he does
every day, but to think aloud about how his son’s identified specific
problem areas would affect his on-the-job performance. Only in this
context could the father relent and acknowledge that he might have
failed to recognize the significance of his son’s problems and that
he might have contributed to the significant family stress as a result.
Concrete examples may be particularly helpful to parents. For
example, a parent might focus on the Intelligence Quotient (IQ)
to the exclusion of the other considerable neuropsychological data,
thinking it a sufficient measure of their child’s future success or failure.
In such instances, the range of their child’s strengths and weaknesses
requires clarification to delimit the emphasis on an unitary global
score to which they ascribe too much importance. Pointing out
the profile of high and low scores, and stronger and weaker cognitive
domains, and the specific implications of such scores for real-world
experiences can make the “numbers” that much more meaningful
to those with limited appreciation for test generalization and criterionvalidity.
One score or one test result does not generally define a child’s
deficit and a multiplicity of factors typically influences the observed
behavior. The importance of deriving a profile according
to convergence profile analysis, based on qualitative and quantitative
information, is relevant to further helping the parent understand his
child’s neuropsychological functioning.
(Baron I. S. Neuropsychological Evaluation of the Child)
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Text 2
The Written Report
The written report combines all relevant observations into a succinct
clinical analysis and interpretation of the child’s neuropsychological
functioning. The written report’s form is influenced by the clinician’s
training, the target reader(s), and the purpose of the evaluation,
and these are subject to modification by the individual practitioner.
The report is also influenced by the practice setting. Despite varying
report preferences, there are certain commonalities in report
preparation. Survey data suggests that most neuropsychologists will
routinely include the referral source and reason for referral, a summary
of the individual’s clinical description obtained personally and through
records, a list of tests administered, and a qualification of performance
in descriptive terms, as often recommended.
The parents of a child seen in the outpatient setting may forget
essential information once the interpretive session is concluded.
The written report will serve as their tangible reminder and as
an explicit explanation of the interpretive session discussion.
It summarizes the test results and conclusions jointly reached
by the neuropsychologist and the parents, including recommendations.
It also specifies for the reader how the child may demonstrate deficit
in real-world situations and describes in what ways the child can be
expected to succeed or excel. As noted earlier, a child’s strengths
often receive less conference time than do the child’s weaknesses.
Parents naturally focus on deficits, wanting to understand them better
as they seek advice about opportunities for remediation. The written
report allows for an elaboration on the observed strengths, as well
as for a clear restatement of the documented deficits.
My preference is to complete the written report after the interpretive
session. This has the advantage of providing the lay reader — parents —
with explanations that will enable a more sophisticated reading than
if the report is prepared and provided without an opportunity for
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discussion and clarification. This order is also advantageous because
final conclusions and recommendations may often be amended
once the interpretive session is held and new information revealed.
Of course, in some settings, the communication of results may need
to be more immediate. This is likely when the child is hospitalized
or in a rehabilitation facility. In such cases, the neuropsychologist is
obligated to respond to the referral questions rapidly and without such
additional communication, perhaps noting the initial summation as
a preliminary impression in anticipation that a parent meeting will occur.
(Baron I. S. Neuropsychological Evaluation of the Child)
Text 3
Inpatient Notes
Before writing a note into the medical chart or preparing a full
report, it is very helpful to read the existing medical chart carefully
to review the impressions of other personnel in contact with
the child. Nursing notes can often contain valuable documentation
of behavioral observations about the inpatient. Such notes
may offer clues to relevant diagnostic considerations, including
observations whose neuropsychological significance may be missed
by the nonpsychologist staff. For example, notes about “immature
speech” or “refusal to talk” in a head-injured adolescent may be
the unrecognized signs of the presence of aphasia. These data may
also provide an opportunity to highlight the neuropsychological
significance of a patient’s behavior and to educate the staff further
about the significance of complete neuropsychological data.
An inpatient note in the progress section of a child’s medical
record may precede the formal written report, or it may be the only
report of the neuropsychologist’s contact with the child. Staff may
improve their attention to the child’s specific situation if the range
of capabilities that are preserved or compromised are better
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appreciated. The neuropsychologist may suggest practical guidelines
for nursing personnel and others involved in the moment-tomoment
care of a child. For example, suggestions about how to interact
may be made for a child with receptive language problems. Such
a child may need to have directions presented in brief but concrete
phrases. An emotionally distressed child may not integrate well any
information about what procedure he is being prepared for until
calmed and instructed age appropriately.
A hemifield visual impairment may also go undetected. Once
recognized, suggestions may be made that staff present themselves
and visual material on the side of space to which the child is more
attentive, that they encourage the child to monitor the full visual
range, and that they use verbal and visual prompts to ensure full
scanning to the neglected side of space, for instance, a colorful
margin or bright stickers to which the child must refer when reading.
The neuropsychologist may suggest positioning the child so that
the busy hall or TV is not placed on the neglected side.
(Baron I. S. Neuropsychological Evaluation of the Child)
Text 4
Screening as a Substitude for Full Evaluation
Screening assessment in child neuropsychology is hotly debated
when it is considered to be a substitute for a more lengthy and
comprehensive evaluation. The substitution of a brief sampling
of a range of behaviors for a more thorough investigation has
the potential downside that a practitioner will miss highly relevant
clinical information. This risk is especially the case when screening
depends on only a single instrument sampling a restricted
behavioral repertoire (Murphy, 2001). Screening is often considered
inappropriate since in most cases the child’s diagnosis is already
known, and a referral is generated as a request for greater detail
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about neurocognitive functioning, thus making the referral a request
for more, rather than less, information. Some would argue that only
with a complete evaluation does a clinician conscientiously examine
the extended range of strengths and weaknesses necessary to offer
the most appropriate treatment recommendations and intervention
strategies. Further, circumstances and qualitative behavioral
observations during the actual test session often highlight additional
functions a neuropsychologist might wish to explore further to better
understand underlying cognitive structure. This exploration may
not be possible if only a partial assessment is planned. In general,
a screening evaluation is limiting and, therefore, ultimately
inconclusive with respect to the full range of etiological factors that
may explain the behaviors of concern.
Further complicating matters, there may be external pressures
on the neuropsychologist that support considering and proceeding
with a screening assessment. These pressures are often generated
because of an economic issue or expressed as a preference by a referral
source to which the neuropsychologist is responsible. Such influences
must be placed in proper perspective. The neuropsychologist’s
ethical obligations to the child need to be kept foremost in mind,
along with appropriate concern for providing the high quality
of service that the child deserves. Such external pressures may present
themselves, for example, when a forensic examination is requested,
and the referral source requests a screening of particular cognitive
functions, although a more thorough evaluation may better address
the child’s functioning and lead to better identifying the child’s
full range of neurocognitive strengths and weaknesses. It is also
inadvisable to adapt one’s typical neuropsychological procedures
to include a screening assessment in response to pressures from
external oversight parties, such as third party payers, who seek
to reduce billable clinical hours and lessen the expense of the more
appropriate full evaluation.
(Baron I. S. Neuropsychological Evaluation of the Child)
79
Text 5
Cognitive Function, Intelligence,
and Neurological Insult
In earlier years it was believed that the younger the child at the time
of neurological insult, the greater the opportunity for recovery to normal
afterwards. It is now clearly acknowledged that early brain insult may
have more profound consequences on IQ than insult in later childhood.
One focus in child neuropsychology is data collection for outcome
study to determine whether a child reaches full recovery or whether
intellectual and/or cognitive functioning are compromised as a result
of an insult. The interest in determining whether there is recovery
to the premorbid intellectual level, or whether a discrepancy from
expected cognitive functioning exists as a result of the neurological
insult, may be seriously confounded by developmental factors.
One possible outcome is that an acquired skill is lost consequent
to the insult. For example, a child may stop speaking or experience
profound motor dysfunction after normal development.
A second possibility is that there is observable immediate loss
of function, but the child regains full mastery with elapsed time,
in which case there is presumed to be a full and successful recovery.
However, this may not be an accurate conclusion since a third
possibility is that there is no loss of function observed, but there is
a failure to progress from the time of the neurological insult on, which
lasts long after the responsible acute factors have otherwise resolved.
As a result, a desired later-onset behavior may fail to appear. This will
not be known until the child has matured sufficiently to be expected
to demonstrate the behavior. An alternative outcome is that the behavior
will emerge, but late or incompletely since the contributory insult
occurred at a time in development before the function or behavior
was expected to emerge and before it could be assessed.
In such instances, it is only at a later chronological age that the deficit
becomes evident. This possibility may be apparent in diverse ways,
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