Neuropsychological Assessment in Clinical Evaluation of Children and Adolescents with Complex Trauma

Abstract

Complex trauma (i.e., exposure to chronic, interpersonal trauma in childhood) has been associated with structural and functional alterations in brain development, which in turn can result in cognitive and neuropsychological deficits. The goal of combining neuropsychological assessment with standard trauma specialty evaluation is to gain a comprehensive understanding of each child's unique set of cognitive strengths and weaknesses and associated behavioral manifestations within a trauma-informed framework. This process can be a vital aide in diagnosing, conceptualizing, and designing effective interventions for traumatized youth and avoiding the common misdiagnoses that lead to ineffective treatment. This paper presents a trauma-informed approach to neuropsychological assessment, using two case studies to illustrate the process of integrating neuropsychological testing with trauma specialty evaluation.Complex trauma refers to the dual problem of children's exposure to traumatic events and the impact of such exposures on their development and long-term outcomes (Cook, Blaustein, Spinazzola, & van der Kolk, 2003;Cook et al., 2005). Complex trauma exposure is the experience in early childhood of chronic, developmentally adverse traumatic events, typically of an interpersonal nature, occurring within the child's caregiving system. These exposures include sexual, emotional, and physical abuse; neglect; loss; and witnessing domestic and community violence. Research and clinical observation have demonstrated impairment in the regulatory capacities of children with complex trauma exposure in the affective, cognitive, behavioral, physiological/ biological, relational/interpersonal,

Life History Interviews with 11 Boys Diagnosed with Attention-Deficit/Hyperactivity Disorder Who Had Sexually Offended: A Sad Storyline

“…The boys' difficulties must be approached in a holistic way, with the aim of helping them to understand themselves and their life histories. Other studies have stressed the importance examining the child's surrounding environment (Weinstein, Steffelbach, & Biaggio, 2009) and conducting the psychiatric assessment in a way that does not damage the child's understanding of self or identity (Gabowitz, Zucker, & Cook, 2009). In this study, the assessments seem to have focused on the boys themselves and their behavior rather than on their environments and histories.…”

Meditative Dialogue: Cultivating Compassion and Empathy with Survivors of Complex Childhood Trauma

“…Mindfulness researchers have begun examining effects of meditation practices on specific areas of the brain through neuroimaging studies Engstrom & Soderfeldt, 2010;Fuchs, 2004;Gabowitz et al, 2008;Holzel et al, 2011;Krasner, 2004;Light et al, 2009;Lutz et al, 2008;Preston et al, 2007;Slagter, Davidson, & Lutz, 2011). Their findings hold promise for survivors of CCT as they work to develop alternative ways of negotiating their lives and relationships.…”

Projective aspects on cognitive performance: distortions in emotional perception correlate with personality

“…In the field of neuropsychology, it is possible to find projective techniques being recommended, especially as ways of evaluating neurological trauma (Gabowitz et al 2008;Spreen and Strauss 1998) due to their ability to measure perceptual organization, processing and stimuli integration (Acklin & Wu-Holt, 1996;Lezak et al 2004). …”