PGR – 3 Neuropsychological Evaluation to Aid with New Onset of Behavioral Symptoms with a Child with Myelomeningocele with Hydrocephalus

Abstract Objective Those with a history of myelomeningocele with hydrocephalus are often at risk for neurocognitive deficits that include attention, executive functioning, visual memory deficits, verbal fluency, as well as fine motor and gross motor challenges (Foss et al., 2019). Those with hydrocephalus s/p ventriculoperitoneal (VP) shunt are at greater risk for malfunction, which can include headaches, onset of vomiting, and behavioral changes. In addition, to imaging, neuropsychological evaluation can provide functional impairment and help with further diagnostic clarification of these symptoms. Method Presenting case includes an 11-year-old, Hispanic female, with myelomeningocele of lumbar region with shunted hydrocephalus; Chiari malformation, Type II as well as neurogenic bladder and bowel. Previous diagnoses include anxiety and provisional diagnosis of intellectual disability. Current concerns include new onset of irritability, throwing objects as well as hitting, and yelling at others. Brain MRI was stable two week prior to the neuropsychological evaluation. Results The results of the evaluation were consistent with an intellectual disability as well as challenges with attention, executive functioning, and motor functioning. During the evaluation, the patient disclosed an adverse childhood experience (ACE) that coincided with the onset of new behavioral concerns. Increased challenges with emotional regulation and attention are thought to be related to ACE. Conclusion The results show that it is important to take a biopsychosocial perspective when evaluating children with medical complexities. It can often be challenging to differentiate neurodevelopmental differences as well as ACE. While is important to consider the medical sequalae associated with hydrocephalus, it is important to consider the day-to-day functioning.