Sense and Sensibility: Relating Behavior Control Issues with Self-Regulation of Sensory Input

Abstract

Jennifer was referred for a neuropsychological evaluation as a supplement to a psychological evaluation for behavior problems and a previous history of academic difficulties. Her prenatal development, birth, and early infancy were normal. Early developmental milestones were attained at the normal rate for both motor and language functions. There were no significant head injuries and no other neurological insults. Since 5 years of age, during times of stress, she has gone through episodes lasting up to a month of often closing her eyes and shaking her head. Her primary care physician had ruled out Tourette's disorder, but she had not had a neurological evaluation. Jennifer's parents reported in interview that she has always shown very high sensitivity to sound, touch, and smell. Vision and hearing screening tests were normal.

Jennifer was home-schooled for kindergarten through second grade, when her father was working for an international corporation in Thailand. She then repeated second grade when the family returned to the United States, so she was older than typical students in fourth grade at the time of her neuropsychological assessment. Questions arose during the early elementary years about her performances in all academic areas, although her reading had improved since and she was said to be successful in math “if she figured it out her own way.” Individually administered achievement testing by her school when she started her repeat year of second grade was below average, but both group-administered standardized achievement testing of all students and individually administered achievement tests at school during fourth grade had risen to the average or above average range in all areas. Intelligence testing by a private psychologist 1 month prior to the neuropsychological evaluation was in the average range, with equivalent verbal reasoning skills and visual-spatial problem-solving skills (Table 28.1). Among core verbal subskills, Jennifer showed high average vocabulary knowledge, average common-sense social reasoning, and above average word comparison skills, or abstract verbal conceptualization. She was well above average on a cluster of subtests sensitive to verbal working memory. Among core visual-spatial subskills, she was average in abstract visual construction when copying block design patterns, average in discerning concepts in pictures, and average in visual analogies. She was mildly impaired on a cluster of subtests that reflected visual-perceptual processing speed. These findings were virtually identical to previous testing at school in second grade.