A Mystery of Perplexing Symptoms: Neuropsychological Assessment in a Case of Dysautonomia
Poor misunderstood Laura! Preschool staff filled out referral forms about her struggle with “physical and verbal control when with others” and “swaying attention.” Her kindergarten teacher felt that she actually enjoyed disturbing others, although Laura's parents suspected that this teacher's status as the oldest and most dominant in the traditional culture at her small rural school might have been coloring her view of students who did not sit and do their work quietly. Were her periods of apparent fatigue really signs of becoming less interested in the work? Elementary grade staff debated if she might be a “tactile/visual learner” rather than an “auditory learner.” Things became particularly perplexing when she started showing quirky medical features, such as rapid weight shifts, losing her sense of smell at age 6, and being diagnosed with asthma and then unexpectedly never having asthma symptoms again after a 10-day course of steroids.
Pediatric neuropsychologists occasionally see such confusing symptom patterns, often combining physical and behavioral features, often for year after year, that are eventually discovered to have a low-prevalence neurological disorder that helps knit things together. Laura's break came at age 8, when careful neurological evaluation uncovered a diagnosis of dysautonomia. Laura's main neurological issues at that time included headaches, dizziness, intermittent vomiting, chronic constipation, fatigue, and weight changes. The cause of these symptoms was not initially apparent, so the neurologist began with a detailed medical history.
KeywordsObstructive Sleep Apnea Complex Regional Pain Syndrome Kindergarten Teacher Angelman Syndrome Teacher Report Form
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Resources for Clinicians
- Boyce, W. T., Quas, J., Smider, N. A., Essex, M. J., Kupfer, D. J., & the MacArthur Assessment Battery Working Group of the MacArthur Foundation Research Network on Psychopathology and Development. (2001). Autonomic reactivity and psychopathology in middle childhood. British Journal of Psychiatry, 179, 144–150.CrossRefPubMedGoogle Scholar
- Menkes, J. H., Sarnat, H. B., & Maria, B. L. (Eds.) (2006). Child Neurology (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.Google Scholar
Resources for Families
- Dysautonomia Foundation, 315 W. 39th Street, Suite 701, New York, NY 10018.Google Scholar
- Familial Dysautonomia Hope Foundation, Inc. (FD Hope), 110 Deerwood Court, Chapel Hill, NC 27517, firstname.lastname@example.org, http://www.fdhope.org, Tel: 828-238-3149.
- National Dysautonomia Research Foundation, http://www.ndrf.org/