TNP

Preschool Neuropsychological Test

G. Cossu and E. Paris
Child Neuropsychiatry, University of Parma

GENERAL OVERVIEW

The TNP is an originally-conceived diagnostic tool that analyses the linguistic and cognitive functions in children aged between 4 and 6 and a half, enabling an articulated neuropsychological assessment of children with neurological pathologies or psychopathological problems, in both hospital and outpatient environments.
As well as the linguistic abilities, the TNP also investigates protomathematical, praxical and visuoperceptive skills. In view of the analytic layout and the rigorous selection of the items, it combines the convenience of a screening test with the semiotic detail of more articulated diagnostic tests which are however difficult to use because of the attention commitment demanded from the child and the lengthy administration times. The guiding concept behind the TNP is that the linguistic and cognitive disturbances of the child are the clinical expression of damage to the central nervous system, that is they are neurocognitive disturbances. Consequently, the tests have been conceived to enable a structural analysis of the neuropsychological systems, the deciphering of the functional mechanisms and the monitoring of the evolution trajectory over time.

One of the primary features of the TNP is therefore the specific structural analysis of each test, which permits an articulated investigation of the components of each of the investigated functions. A second, crucial aspect is the functional selectivity of the tests, which makes it possible to solicit in a targeted manner the neurofunctional mechanisms of the neurocognitive system under investigation. All the tests of the TNP conform to this type of methodological restriction, so that the strategies adopted by the child in responding to each test provide an accurate reflection of the state of the target functional system.
The primary objective of the TNP continues to be the qualitative analysis of the investigated functions. Consequently, the administration of the test is not aimed solely at the determination of the child’s levels of performance, but also at deciphering the functional mechanisms of the neuropsychological systems investigated and their evolution over time. Only in this way will the examiner be in a position to construct a functional map for tracing out the rehabilitation paths of the child.

KEY FEATURES

• First test in Europe that assesses morphosyntactic production and operations of implicit calculation in preschool age.
• First test in Europe that uses a pragmatic interactive context (including handling of toys) to assess production, morphosyntactic comprehension and implicit calculation.
• Analytic assessment of the structural components of the linguistic system.
• Assessment of the protomathematical skills and praxical and visuoperceptive functions.
• Rapid administration: ideal for screening.
• Longitudinal clinical screening for children with suspected linguistic and neuropsychological deficits.
• Clinical appraisal even in children older than the scheduled age.
• Single version for all age brackets.

STRUCTURE

The TNP consists of 10 tests, which can be administered globally – with a collaborative child and an expert examiner – in approximately half an hour. The specific administration procedures for the various tests make it possible to keep the child’s attention permanently engaged.

The tests
The TNP consists of 10 tests for the assessment of the following functions:

• Verbal functions:
  • Lexical comprehension
  • Lexical production
  • Morphosyntactic comprehension
  • Morphosyntactic production
  • Nonword repetition.
• Praxical functions: two tests of Copy the figure (a house and a clock).
• Visuoperceptive functions: test of gnosic synthesis with enforced recognition of 12 fragmented figures.
• Protomathematical functions:
  • Counting in random order, with assessments of cardinal value
  • Implicit calculation.

Calibration
The choice of the preschool period (age 4-6.6), as a normative target enables an early identification of linguistic and neuropsychological deficits before they produce negative effects that cannot subsequently be reversed in school-age children. With early diagnosis, the rehabilitation can produce positive results in view of the elevated adaptability of the neurocognitive system deriving from cerebral plasticity. For these reasons, with the availability of a reliable diagnostic tool, the prevention of neurocognitive disturbances becomes a goal that can be concretely achieved through the concerted action of family paediatricians and the school. The TNP offers this possibility because it is based on a broad normative range of case studies – a total of 1235 children divided into 5 age brackets – in addition to systematic verification in clinical practice

Subjects with cognitive retardation
The lack of correlation between CPM and the neuropsychological tests of the TNP illustrates the selectivity of the tests used, as well as their specificity and independence, since this demonstrates that the control of the skills investigated is not influenced by the general intelligence. This means that the TNP also has full validity in the assessment of children who may suffer from intellectual retardation, and hence that its use is not restricted to children whose intelligence is within the normal parameters.

THE MATERIAL

The administration of the various tests entails the use of toys, coloured cards, panels etc., all of which are provided in a special case. The variability of the proposed situations, the shortness of the tests and above all the use of attractive pragmatic contexts (exploiting toys) enhances the engagement of the child and captures his or her attention through the play solution.

UTILISATION

The analytical features and the brevity of the TNP hence make it an ideal tool for clinical screening. In view of the nature of the functions investigated and the time span considered, the utilisation of the TNP can usefully be extended to neuropsychological assessment in the logopedic and psychomotor ambits, as well as in paediatrics for preschool screening for learning disturbances.

The test also enables longitudinal monitoring of the level of linguistic and neuropsychological development in children with neurocognitive disturbances or suspected cognitive retardation.
Finally, the TNP can be utilised to monitor the neuropsychological evolution of children in rehabilitation, to gauge the efficacy of the intervention.