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Child NeuropsychologyReview - Child Neuropsychology
Concepts, Theory, and Practice
by Jonathan Reed and Jody Warner-Rogers (Editors)
Wiley-Blackwell, 2008
Review by R.A. Goodrich, Ph.D.
Aug 18th 2009 (Volume 13, Issue 34)

To consult a textbook as a practitioner or a student can be radically different from the task of critiquing it.  The student or practitioner seeks answers; the reviewer, questions.  The first kind of reader often focuses upon his or her lack of knowledge; the second kind, upon the text's apparent lack.  In what follows, we shall adopt both roles when critically assessing the main goal outlined by the editors of Child Neuropsychology, Jonathan Reed and Jody Warner-Rogers, two clinical psychologists who were jointly in charge of the at Guy's Hospital in London for several years.

The principal goal defining paediatric neuropsychology is generally taken to be an analysis of the developmental relationships between the brain and the behaviour of children where the "process of change is key" (1).  The more specific aim of this volume is to gain "a thorough understanding," "to define what a comprehensive theory...should encompass" (1).  And that aim seems realisable because, as its editors claim, "textbooks can provide the conceptual framework within which newly acquired knowledge can be organized, understood, and integrated" (1)--though whether readers' or researchers' knowledge remains unsaid.  Or, as Ian Frampton writing from the perspective of mental health contexts expresses it, "there is nothing as practical as a good theory" (393).  Whether this anthology realises its aim of imparting an appropriate conceptual framework by which its readers can fulfil their practical concerns is the focus of what follows.


The distinctive scope and purpose of Child Neuropsychology shows itself in the wider context of recent publications.  The anthology follows fast upon the third edition of the 2008 The Neuropsychology Handbook (co-edited by Arthur Horton, a contributor to whom we shall return) and within a few years of the 2002 Blackwell Handbook of Childhood Cognitive Development (edited by Usha Goswami, another contributor).  The first-mentioned handbook is overtly pitched at clinical practitioners and other professionals relying upon neuropsychological data and opinions whereas the second handbook more implicitly targets postgraduates and researchers seeking surveys of classic, current, and anticipated research in developmental psychology.  The contrast with these recent anthologies and the explicit rationale of the shorter Child Neuropsychology is clear.  Its twenty predominantly Anglo-American contributions--each aiming to maintain a balance between compression of information and clarity of exposition--are distributed into three parts, "Key Concepts" (comprising six chapters, 7-135), "Theory of Neuropsychological Development" (nine chapters, 139-374), and "Practice" (five chapters, 377-449) respectively. The twenty chapters collectively manifest its editors' attempt both to bridge recent scientific research and clinical practice and to reflect a developmental focus rather than one based solely upon disorders.

Having sketched the context, let us begin a closer analysis with the seventh chapter.  Its author, Michael Anderson, immediately confronts readers with the need to reckon with the often disregarded concept of general intellectual ability in the context of the co-occurrence or "comorbidity of developmental disorders" (112).  More crucially, argues Anderson, it is manifested in a dual manner, "one related to individual differences and the other to developmental change" (112).  The need to account for  general intelligence is not merely an empirical or statistical issue, one tied to the fact that "[m]ost developmental disorders are diagnosed with reference to a discrepancy in levels of performance from that predicted by the general intellectual functioning of the child" (112).  It is also "theoretically necessary," Anderson contends, because general intelligence and developmental disorders are "functionally...linked" (113) in so far as tests and criteria for the former are "developmentally normed" (131).  After countering typical objections to general intelligence--that it is little more than an artefact constructed by its tests or that it is an artefact reflecting socio-cultural bias (114-115)--Anderson next synthesizes two hypotheses separately formulated in the 'seventies and the 'nineties respectively.  In short, he construes general intelligence as fundamentally based upon both the speed of processing perceptual "information" and the capacity for solving problematic tasks.  Behavioural self-regulation or inhibition as much as cognitive attention and monitoring of the goals hierarchically sorted during such tasks is, as Anderson reminds us, typically termed "executive functioning."  In turn, both individual variation and cognitive development--the two dimensions of intelligence mentioned at the outset--are hypothesized as corresponding to two cortical "processing routes" in acquiring knowledge (120ff.).  For readers familiar with his work since the early 'nineties, these are the two avenues by which Anderson aims to explicate the complex matrix characterising developmental disorders.  His chapter ends with at least two possibilities framing future directions readers may be driven to pursue.  Firstly, whilst contrasting those with dyslexia and those with autism, Anderson entertains that the latter's "specific deficit in theory of mind" may not just be concomitant with impaired general intelligence, but may actually be its cause (126).  Secondly, agreeing with Dorothy Bishop, he, too, proposes that research not only needs to disclose "crucial instances of dissociation" marking developmental disorders, but also the presence of "associations between different types of impairments" where time and again comorbidity prevails (130).

          Now, consider the case of a reader wishing to pursue concepts raised by Anderson such as executive functioning or theory-of-mind within this anthology.  When Claire Hughes and Andrew Graham deal with executive functions and development in the twelfth chapter of the same name, they expand upon problematic tasks in terms of "a complex cognitive construct" which underpin "goal-directed responses to novel or difficult situations" and which correlates with the prefrontal cortex (264).  However, Hughes and Graham make no reference to the concept of intelligence.  Instead, they pursue the loss or absence of executive function in those with prefrontal lesions which result in "impairments in...abstract thinking," a contention influentially associated with the far earlier work of Adhémar Gelb and Kurt Goldstein (neither of whom figure in the index).  Nor are the difficulties perceived by Hughes and Graham in pinpointing an operational definition of executive function (266ff.) ever re-conceptualised by questioning what Goldstein and Gelb actually understood, let alone assumed, by "abstract" or so-called "categorial" thinking.  To that extent, it seems, our hypothetical reader is left stranded.

If, to take another example, a reader intrigued by Anderson's claim about the causal connections with theory-of-mind mentioned above, he or she will ultimately find the problem of other minds appearing in two otherwise unrelated passages. Here, the extensive index of this anthology (450-472) is not simply the last resort, it is the only resort if chapter titles prove unhelpful since neither a glossary nor an annotated bibliography is provided.   The first occurs in Hughes and Graham, who define "theory of the ability to attribute mental states to oneself and others" (278), where they contend that there is "converging evidence for a functional link" between executive functioning and theory-of-mind both of which betray "pronounced impairments...among children with autism" (278-279).  However, in the end, Hughes and Graham look to improving "our conceptual understanding" here by our capacity to handle the "methodological challenges" besetting researchers to date (279).  And, to note in passing, were our hypothetical reader tempted to explore executive functions in light of possible preconditions such as attention and self-regulation, the respective contributions by Maxine Sinclair and Eric Taylor (235ff.) and by Rebecca Todd and Marc Lewis (285ff.) provide little illumination. 

So, the next occurrence of theory-of-mind for our reader figures in the fourteenth chapter by Simon Baron-Cohen and Bhismadev Chakrabarti under the heading of the development of empathy, a precondition of which is "shared attention" (318ff.). The authors take an act of empathy not only "to identify another person's emotions and thoughts," a cognitive skill or set of skills, but also "to respond to these with an appropriate emotion" at an affective level (316).  If states of mind or feeling are not "matched" but nonetheless "concern" for the other is present, then we purportedly have a "third component" of empathy "also termed 'sympathy'" (317).  Once again, without entering the complexities of Baron-Cohen's second revised model of his 1994 mindreading system here, readers are not introduced to the contested conceptions of empathy in circulation.  For instance, Lauren Wispé in her 1991 monograph, The Psychology of Sympathy, distinguishes empathy and sympathy quite sharply on the grounds that they operate in reverse: "In empathy one substitutes oneself for the other person; in sympathy one substitutes others for oneself" such that, ultimately, "empathy is a way of knowing; sympathy is a way of relating."

          Baron-Cohen and Chakrabarti are not alone in stipulating how key concepts ought to be defined.   Arthur Horton and Henry Soper on the neuropsychology of children's memory in the tenth chapter are another case in point.  Given the multiplicity of forms of memory, Horton and Soper categorise these forms in terms of temporal duration and the extent to which they raise problems of encoding, storage, and retrieval (218-219).  Nowhere is the reader made privy to the possibility that their underpinning metaphors of "encoding, storage, and retrieval" (230) have been seriously questioned by, for instance, the alternative neural Darwinist framework for construing memory and perception developed by Gerald Edelman, Israel Rosenfield, and William Clancey over the last two decades.  Whereas Horton and Soper explicitly draw upon the "interactive" framework of Alexander Luria on higher cortical functions in an effort to sketch the neuropsychological organisation and development of memory and patterns of its impairment (221-225), no explanation is given for relying upon the first 1966 edition in preference to the richly expanded second 1980 edition.  Luria is extolled by Horton and Soper for providing a "unique, elegant, and efficient method" for framing the development of "language, memory, and executive functioning" (224 & 223); indeed, he is also praised by Hughes and Graham for realising that the onset of executive functioning was far earlier than previously thought (271).  Yet, the neurological debates and applications of his generation are largely neglected in this anthology.  Indeed, passing references to Luria's dependence upon Lev Vygotsky (223 & 224), not unlike that of Frampton (393), give readers little detailed sense of why, let alone how, Luria and Vygotsky were driven to uphold one conceptual framework for comprehending the patterns of the hierarchical development of attention, memory, perception, volition, and cognition in preference to others nor the central role of speech both men discerned in such development. 


          We began by commenting upon different kinds of readers of textbooks.  Let us conclude by briefly returning to that very issue and the demands they can make upon textbook anthologies.  Readers of Child Neuropsychology will notice how different an approach Horton and Soper take by contrast with most of its contributors. For example, whereas the final chapter by the editors themselves adheres to a formal, impersonal address ("Of course, one would never expect..."; "How does one go about collecting and interpreting..."; and "This chapter aims to answer..." to cite its introduction (432)), Horton and Soper address readers directly in the second-person  ("you").  More pointedly, they engage their readers colloquially. For instance, when elaborating upon relevance of recollected details tied to the infero-temporal areas of the "fully functioning...cortex," Horton and Soper write: "This goes with the trash heap, with the back of stop lights and everything else.  All the stuff I do not need is thrown out because I can only pack so much into my memory" (228).  Ironically, we almost immediately face the comment, "It might be mentioned that the research program of Roger Sperry was so successful and produced findings of such importance that he later received the Nobel Prize in Medicine for his contributions" (229).  The point here is not simply a stylistic issue.  Rather, it lies in the ambitions of a textbook aiming "to stimulate" its readers--"our colleagues"--into "the next stage of research and practice" (3).

          Basically, students and practitioners, seeking theoretical and practical knowledge, focus upon a set of concepts or topics and the key issues they raise.  What should the entries or chapters they encounter minimally provide them?  At least five features are required: the formal or working definition(s); the key issues, debates, or problems; the characteristic examples or evidence; the related entries, fields, or concepts ("keywords"); and the major writing(s) on the topic or concept.  The strengths of the anthology under review are largely in the domain of neuropsychological assessment.  Its aim to bridge "cutting-edge science and clinical practice" whilst conceding it "can never reflect the most contemporary research findings" (1) is arguably the bane of all textbooks with such goals.  Perhaps that is a salutary reminder that the pursuit of current research needs to convey not only its conceptual frameworks but also the past debates out of which it emerged.


© 2009 R.A. Goodrich


R.A. Goodrich teaches in the School of Communication & Creative Arts, Deakin University, Melbourne, Australia, co-edits the online refereed arts-practice journal, Double Dialogues, and currently co-ordinates with Maryrose Hall a pilot study of a number of children within the autistic spectrum of disorders.


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