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This page intentionally left blank
Principles and Practice of Lifespan
Developmental Neuropsychology
Principles
and Practice of Lifespan
Developmental
Neuropsychology
Jacobus Donders
Scott J. Hunter
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore,
São Paulo, Delhi, Dubai, Tokyo

Cambridge University Press

The Edinburgh Building, Cambridge CB2 8RU, UK

Published in the United States of America by Cambridge University Press, New York

www.cambridge.org
Information on this title: www.cambridge.org/9780521896221
© Cambridge University Press 2010

This publication is in copyright. Subject to statutory exception and to the

provision of relevant collective licensing agreements, no reproduction of any part
may take place without the written permission of Cambridge University Press.
First published in print format 2010

ISBN-13 978-0-511-67360-3 eBook (EBL)

ISBN-13 978-0-521-89622-1 Hardback

Cambridge University Press has no responsibility for the persistence or accuracy

of urls for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Contents
Contact information for authors page vii
Biography for Jacobus Donders and Scott J. Hunter xi

Introduction 6c Synthesis of chapters on learning disabilities:

Jacobus Donders and Scott J. Hunter 1 overview and additional perspectives
H. Lee Swanson 163
Section I: Theory and models 3
7a Infants and children with spina bifida
1 A lifespan review of developmental Heather B. Taylor, Susan H. Landry, Lianne
neuroanatomy English and Marcia Barnes 169
John Williamson 3
7b Adolescence and emerging adulthood in
2a Developmental models in pediatric individuals with spina bifida: a developmental
neuropsychology neuropsychological perspective
Jane Holmes Bernstein 17 Kathy Zebracki, Michael Zaccariello, Frank
Zelko and Grayson N. Holmbeck 183
2b Models of developmental neuropsychology:
adult and geriatric 7c Spina bifida/myelomeningocele and
Tyler J. Story and Deborah K. Attix 41 hydrocephalus across the lifespan:
a developmental synthesis
3 Multicultural considerations in lifespan
Ilana Gonik, Scott J. Hunter and Jamila
neuropsychological assessment
Cunningham 195
Thomas Farmer and Clemente Vega 55
8 Cerebral palsy across the lifespan
4 Structural and functional neuroimaging
Seth Warchausky, Desiree White and Marie
throughout the lifespan
Van Tubbergen 205
Brenna C. McDonald and Andrew J. Saykin 69
9a Intellectual disability across the lifespan
Section II: Disorders 83 Bonnie Klein-Tasman and Kelly Janke 221
5a Attention deficit hyperactivity disorder 9b Lifespan aspects of PDD/autism spectrum
in children and adolescents disorders (ASD)
David Marks, Joey Trampush and Anil Chacko 83 Julie M. Wolf and Sarah J. Paterson 239
5b Attention deficit hyperactivity disorder 9c Autism spectrum disorders and intellectual
in adults disability: common themes and points
Margaret Semrud-Clikeman and Jodene of divergence
Goldenring Fine 97 Marianne Barton, Colby Chlebowski and
Deborah Fein 251
5c Attention deficit hyperactivity disorder:
a lifespan synthesis 10a Hearing loss across the lifespan:
Jeffrey M. Halperin, Anne-Claude V. Bedard and neuropsychological perspectives
Olga G. Berwid 113 Betsy Kammerer, Amy Szarkowski and Peter
Isquith 257
6a Learning disorders in children and adolescents
Gregory M. Stasi and Lori G. Tall 127 10b Visual impairment across the lifespan:
neuropsychological perspectives
6b Learning disorders in adults
Lisa M. Noll and Lana L. Harder 277
Elizabeth P. Sparrow 143
 Contents

11a Traumatic brain injury in childhood 13b Lifespan aspects of brain tumors
Michael W. Kirkwood, Keith Owen Yeates and Celiane Rey-Casserly 393
Jane Holmes Bernstein 299
14 Lifespan aspects of endocrine disorders
11b Adult outcomes of pediatric traumatic Geoffrey Tremont, Jennifer Duncan Davis and
brain injury Christine Trask 409
Miriam Beauchamp, Julian Dooley and Vicki
Anderson 315 15 Metabolic and neurodegenerative disorders
across the lifespan
11c Neurobehavioral aspects of traumatic brain Richard Ziegler and Elsa Shapiro 427
injury sustained in adulthood
Tresa Roebuck-Spencer, James Baños, Mark 16a Psychopathological conditions in children
Sherer and Thomas Novack 329 and adolescents
Abigail B. Sivan 449
11d Traumatic brain injury in older
adults 16b Psychopathological conditions in adults
Felicia C. Goldstein and Harvey Anthony C. Ruocco, Elizabeth Kunchandy
S. Levin 345 and Maureen Lacy 455

11e Traumatic brain injury across the 16c Neuropsychological aspects of

lifespan: a long-term developmental psychopathology across the lifespan:
perspective a synthesis
Jacobus Donders 357 Alexandra Zagoloff and Scott J. Hunter 469

12a Pediatric aspects of epilepsy

Lindsey Felix and Scott J. Hunter 359
12b A lifespan perspective of cognition in Index 477
epilepsy
Michael Seidenberg and Bruce Hermann 371 The color plates are to be found between pp. 276
and 277
13a Leukemia and lymphoma across the lifespan
Kevin R. Krull and Neelam Jain 379

vi
Contact information for authors
Vicki Anderson, Ph.D. Anil Chako, Ph.D.
Department of Psychology Department of Psychiatry
Royal Children’s Hospital Mount Sinai Medical Center
Parkville, Victoria, Australia New York, NY
Deborah K. Attix, Ph.D. Colby Chlebowski, M.A.
Department of Psychiatry and Behavioral Sciences Department of Psychology
Duke University Medical Center University of Connecticut
Durham, NC Storrs, CT
James Baños, Ph.D., ABPP-Cn Jamila Cunningham, M.A.
Department of Physical Medicine & Rehabilitation Department of Psychology
University of Alabama, Birmingham Loyola University
Birmingham, AL Chicago, IL
Marcia Barnes, Ph.D. Jennifer Duncan Davis, Ph.D.
Children’s Learning Institute Department of Psychiatry and Human Behavior
University of Texas Health Science Center at Houston Warren Alpert School of Medicine of Brown University
Houston, TX Providence, RI
Marianne Barton, Ph.D. Jacobus Donders, Ph.D.
Department of Psychology Department of Psychology
University of Connecticut Mary Free Bed Rehabilitation Hospital
Storrs, CT Grand Rapids, MI
Miriam Beauchamp, Ph.D. Julian Dooley, Ph.D.
Department of Psychology Murdoch Childrens Research Institute
Royal Children’s Hospital Melbourne, Australia
Parkville, Victoria, Australia
Lianne English
Anne-Claude V. Bedard, Ph.D. Department of Psychology
Department of Psychiatry University of Guelph
Mount Sinai Medical Center Guelph, Ontario, Canada
New York, NY
Thomas Farmer, Psy.D.
Jane Holmes Bernstein, Ph.D. The Chicago School of Professional Psychology
Neuropsychology Program Chicago, IL
Children’s Hospital Boston
Department of Psychiatry Deborah Fein, Ph.D.
Harvard Medical School Department of Psychology
Boston, MA University of Connecticut
Storrs, CT
Olga G. Berwid, Ph.D.
Department of Psychiatry Lindsey Felix, Ph.D.
Mount Sinai Medical Center Alexian Brothers
New York, NY Neuroscience Institute
Chicago, IL
 Contact information for authors

Jodene Goldenring Fine, Ph.D. Betsy Kammerer, Ph.D.

Department of Psychiatry Deaf and Hard of Hearing Program
Michigan State University Children’s Hospital Boston
East Lansing, MI Waltham, MA
Felicia C. Goldstein, Ph.D. Michael W. Kirkwood, Ph.D.
Department of Neurology Department of Physical Medicine & Rehabilitation
Emory University School of Medicine and Wesley The Children’s Hospital
Woods Center on Aging Aurora, CO
Atlanta, GA
Bonnie Klein-Tasman, Ph.D.
Ilana Gonik, Ph.D Department of Psychology
Department of Psychiatry University of Wisconsin, Milwaukee
Loyola University Medical Center Milwaukee, WI
Maywood, IL
Kevin R. Krull, Ph.D.
Jeffrey M. Halperin, Ph.D Department of Epidemiology and Cancer
Department of Psychology Control
Queens College, CUNY St. Jude Children’s Research Hospital
Flushing, NY Memphis, TN
Lana L. Harder, Ph.D. Elizabeth Kunchandy, Ph.D.
Department of Psychiatry Rehabilitation Care Service
University of Texas Southwestern Medical School VA – Pudget Sound
Children’s Medical Centre Seattle, WA
Bruce Hermann, Ph.D. Maureen Lacy, Ph.D.
Department of Neurology Department of Psychiatry
University of Wisconsin Madison School of Medicine University of Chicago
Madison, WI Chicago, IL
Grayson N. Holmbeck, Ph.D. Susan H. Landry, Ph.D.
Department of Psychology The University of Texas Health Science Center
Loyola University of Chicago Department of Pediatrics
Chicago, IL Children’s Learning Institute
Houston, TX
Scott J. Hunter, Ph.D.
Departments of Psychiatry & Pediatrics Harvey S. Levin, Ph.D.
University of Chicago Cognitive Neuroscience Laboratory
Chicago, IL Departments of Physical Medicine and Rehabilitation,
Neurosurgery and Psychiatry
Peter Isquith, Ph.D.
Baylor College of Medicine
Department of Psychiatry
Houston, TX
Dartmouth Medical School
Hanover, NH David Marks, Ph.D.
Department of Psychiatry
Neelam Jain, Ph.D.
Mount Sinai Medical Center
Department of Epidemiology and Cancer Control
New York, NY
St. Jude Children’s Research Hospital
Memphis, TN Brenna C. McDonald, PsyD
Departments of Radiology and Neurology
Kelly Janke, M.A.
Indiana University School of Medicine
Department of Psychology
Indianapolis, IN
viii University of Wisconsin, Milwaukee
Milwaukee, WI
 Contact information for authors

Lisa M. Noll, Ph.D. Abigail B. Sivan, Ph.D.

Learning Support Center for Child Psychology Department of Psychiatry & Behavioral Science
Texas Children’s Hospital Feinberg School of Medicine
Houston, TX Northwestern University
Chicago, IL
Thomas Novack, Ph.D.
Department of Physical Medicine & Rehabilitation Elizabeth P. Sparrow, Ph.D.
University of Alabama, Birmingham Sparrow Neuropsychology, P.A.
Birmingham, AL Durham, NC
Sarah J. Paterson, Ph.D. Gregory M. Stasi, Ph.D.
Department of Pediatrics Rush Neurobehavioral Center
Children’s Hospital of Philadelphia Skokie, IL
Philadelphia, PA
Tyler J. Story, Ph.D.
Celiane Rey-Casserly, Ph.D. Division of Neurology
Department of Psychiatry Duke University Medical Center
Children’s Hospital and Harvard Medical School, Durham, NC
Boston
Boston, MA H. Lee Swanson, Ph.D.
Graduate School of Education
Tresa Roebuck-Spencer, Ph.D., ABPP-Cn University of California-Riverside
Department of Psychology Riverside, CA
National Rehabilitation Hospital
Washington DC Amy Szarkowski, Ph.D.
Deaf and Hard of Hearing Program
Anthony C. Ruocco, Ph.D. Children’s Hospital Boston
Department of Psychiatry Waltham, MA
University of Illinois at Chicago
Chicago, IL Lori G. Tall, PsyD
Rush Neurobehavioral Center
Andrew J. Saykin, PsyD Skokie, IL
Departments of Radiology, Neurology, and Psychiatry
Indiana University School of Medicine Heather B. Taylor, Ph.D.
Indianapolis, IN The University of Texas Health Science Center
Department of Pediatrics
Michael Seidenberg, Ph.D. Children’s Learning Institute
Department of Psychology Houston, TX
Rosalind Franklin University of Medicine and Science
North Chicago, IL Joey Trampush, M.A.
Department of Psychology
Margaret Semrud-Clikeman, Ph.D. CUNY Graduate Center
Departments of Psychology & Psychiatry New York, NY
Michigan State University
East Lansing, MI Christine Trask, Ph.D.
Department of Psychiatry and Human Behavior
Elsa Shapiro, Ph.D. Warren Alpert School of Medicine of Brown
Pediatric Clinical Neuroscience University
University of Minnesota Medical Center Providence, RI
Minneapolis, MN
Geoffrey Tremont, Ph.D.
Mark Sherer, Ph.D., ABPP-Cn Neuropsychology Program, Rhode Island Hospital
TIRR Memorial Hermann Providence, RI
Baylor College of Medicine ix
Houston, TX
 Contact information for authors

Marie Van Tubbergen, Ph.D. Keith Owen Yeates, Ph.D.

Department of Physical Medicine and The Research Institute at Nationwide Children’s
Rehabilitation Hospital
University of Michigan Columbus, OH
Ann Arbor, MI
Michael Zaccariello, Ph.D.
Clemente Vega Department of Psychiatry and Psychology
Yale University School of Medicine Mayo Clinic
Department of Neurosurgery
New Haven, CT Alexandra Zagoloff, M.S.
Department of Psychology
Seth Warschausky, Ph.D. Illinois Institute of Technology
Department of Physical Medicine and Chicago, IL
Rehabilitation
University of Michigan Kathy Zebracki, Ph.D.
Ann Arbor, MI Department of Behavioral Sciences,
Rush University Medical Center,
Desiree White, Ph.D. Pediatric Psychologist,
Department of Psychology Shriners Hospital for Children,
Washington University Chicago, IL
St. Louis, MO
Frank Zelko, Ph.D.
John Williamson, Ph.D. Neuropsychology Service, Children’s Memorial Hospital
Department of Neurology and Department of Psychiatry and Behavioral Science
Rehabilitation Feinberg School of Medicine, Northwestern University
University of Illinois at Chicago Chicago, IL
Chicago, IL
Richard Ziegler, Ph.D.
Julie M. Wolf, Ph.D. Pediatric Clinical Neuroscience
Yale Child Study Center University of Minnesota Medical Center
New Haven, CT Minneapolis, MN

x
Biography for Jacobus Donders Child Psychology training. Dr. Hunter obtained his
Jacobus Donders obtained his PhD from the University PhD in Clinical and Developmental Psychology from
of Windsor in 1988. He completed his internship at the University of Illinois at Chicago in 1996. He
Henry Ford Hospital in Detroit, MI, and his residency completed his internship at Northwestern University
at the University of Michigan in Ann Arbor, MI. School of Medicine’s Stone Institute of Psychiatry,
He is currently the Chief Psychologist at Mary Free and residencies in Pediatric Neuropsychology and
Bed Rehabilitation Hospital in Grand Rapids, MI. Developmental Disabilities in the Departments
Dr. Donders is board-certified by the American of Pediatrics and Neurology at the University of
Board of Professional Psychology in both Clinical Rochester. He serves as an ad-hoc editor for a number
Neuropsychology and Rehabilitation Psychology. He of peer-reviewed publications, and has authored or
has served on multiple editorial and professional exec- co-authored multiple peer-reviewed articles, presen-
utive boards, has authored or co-authored more than tations, and book chapters. He co-edited Pediatric
100 publications in peer-reviewed journals, and has Neuropsychological Intervention (CUP, 2007) with
co-edited two books about neuropsychological inter- Jacobus Donders. Both clinically and in his research,
vention. He is a Fellow of the National Academy Dr. Hunter specializes in identifying and character-
of Neuropsychology and of Divisions 40 (Clinical izing neurocognitive and behavioral dysfunction in
Neuropsychology) and 22 (Rehabilitation Psychology) children with complex medical and neurodevelop-
of the American Psychological Association. His main mental disorders.
research interests include construct and criterion valid-
ity of neuropsychological test instruments and predic- To Harry van der Vlugt, my original mentor, for
tion of outcome in congenital disorders and acquired sharing his lifespan wisdom and support.
brain injury. Jacobus Donders

Biography for Scott J. Hunter This book is dedicated to the memory of Arthur
Scott J. Hunter is an Associate Professor of Benton and Rathe Karrer, who each mentored my
Psychiatry, Behavioral Neuroscience, and Pediatrics professional development, and to Richard Renfro, for
in the Pritzker School of Medicine at the University his ongoing support and understanding during the
of Chicago, where he serves as the Director of development and completion of this project.
Pediatric Neuropsychology and Coordinator for Scott J. Hunter
Introduction
Jacobus Donders and Scott J. Hunter

Neuropsychology is the science and practice of evaluat- disorders. For many of the disorders, there is one chapter
ing and understanding brain–behavior relationships and focusing on pediatric aspects of the condition, one
providing recommendations for intervention that can be emphasizing adult and/or geriatric concerns, and a sum-
implemented in the daily lives of persons when brain mary commentary chapter that consolidates and synthe-
dysfunction compromises functioning at home or sizes the knowledge shared across the age-specific review
school, on the job, or in the community at large. The chapters, with a focus on identifying and guiding areas of
associated target behaviors and skills can range from further research and practice in the domain. For some
specific cognitive abilities to emotional and psychosocial conditions (e.g. cerebral palsy) there are currently simply
functioning. This specialty has advanced significantly not enough data about outcomes into adulthood to
over the past several years, but recent well-respected warrant a separate chapter, whereas for other diagnostic
published works about common neuropsychological groups (especially some of the neurodegenerative ones,
disorders have tended to focus primarily or exclusively which are often associated with death prior to adult-
on either children or adults, or have provided separate hood), the emphasis is placed on the time frame in
discussions of conditions that are traditionally seen more which they most commonly occur. However, for several
commonly at either end of the age spectrum (e.g. other disorders (e.g. traumatic brain injury), there is a
Morgan and Ricker [1], Snyder et al. [2]). Similarly, wealth of information about the correlates of new-onset
there is a dearth of comprehensive discussions in the cases of the condition at different ages, as well as longi-
available literature to date of various neuropsychological tudinal outcomes.
syndromes in their different manifestations across the Each of the chapters in this volume was written by
lifespan, and the longitudinal development and longer- one or more authors who specialize in clinical practice
term outcomes of such conditions. This has contributed as well as research with the disorder being discussed.
to a sometimes unwarranted bifurcation within the field, As a result, these experts give the reader an up-to-date
where developmental course has been left out of the account of the state of the art of the field at this time,
diagnostic and treatment equation. In response, the pri- and make suggestions for improvement in approaches
mary goal of this volume is to provide an integrated toward assessment, intervention, and empirical inves-
review of neuropsychological function and dysfunction tigation of the disorders as they present across the
from early childhood through adulthood and, where lifespan. We hope that this book will provide a vantage
possible, old age, to support the understanding and point from which to explore lifespan developmental
consideration of the role development plays in the pre- aspects of a wide range of commonly encountered
sentation and outcome of neuropsychological disorders neuropsychological disorders. We anticipate that it
across the lifespan. will be of interest not only to pediatric neuropsychol-
Each chapter in this volume is intended as an empiri- ogists but also to professionals in rehabilitation, neu-
cal review of the current state of knowledge concerning rology, and various allied health fields.
the manifestation and evaluation of common neuropsy-
chological disorders as well as their intervention, with References
additional consideration of what still needs to be done to 1. Morgan JE, Ricker JH. Textbook of Clinical
improve efficacy of practice and research. The first sec- Neuropsychology. New York: Taylor & Francis; 2008.
tion provides a review of the general principles behind 2. Snyder PJ, Nussbaum PD, Robins, DL. Clinical
lifespan developmental neuropsychology. The second Neuropsychology: A Pocket Handbook for Assessment, 2nd
section examines a number of commonly encoun- edn. Washington DC: American Psychological
tered neurodevelopmental, behavioral, and cognitive Association; 2006.
 Section I
Theory and models

1
Chapter

A lifespan review of developmental

neuroanatomy
John Williamson

On the development of functional

with respect to our current understandings of the brain
neural systems systems involved in the behavioral presentations Broca
The structure of the brain is in constant flux from the described (beyond the articulatory functions of the infe-
moment of its conception to the firing of its final nerve rior frontal gyrus); specifically the extent of behavioral
impulse in death. As the brain develops, functional changes identified by Broca is now more accurately
networks are created that underlie our cognitive and reflected by the apparent neuropathology.
emotional capacities. Our technologies for evaluating A contemporary of Broca’s, John Hughlings
these functional systems have changed over time as Jackson, offered a different perspective regarding local-
well, evolving from lesion-based case studies, neuro- ization. While Jackson had no problem with the notion
pathological analyses, in vivo neurophysiological tech- of probabilistic behavior profiles with specific brain
niques (e.g. electroencephalography), and in vivo lesions (e.g. a left inferior frontal lesion most likely will
structural evaluation (CT scan, magnetic resonance affect expressive speech), he did not agree with the
imaging (MRI), diffusion tensor imaging (DTI)), to prevailing idea at the time that these lesion/behavior
in vivo functional methodologies (functional magnetic observations represented a confined center of function
resonance imaging (fMRI), positron emission tomog- [4]. Jackson proposed a vertical organization of brain
raphy (PET)). And with these rapidly developing tech- functions, with each level (e.g. brain stem, motor and
nologies, we are able to more thoroughly test some of sensory cortex, and prefrontal cortex) containing a rep-
the earlier hypotheses that were developed about the resentation, or component of the function of interest.
nature and function of the brain. Though this idea was at the periphery of opinion at the
Although attempts to localize mental processes to time, when strict localizationist theory was gaining
the brain may be traced to antiquity, the phrenologists momentum, it has come to form the basis of modern
Gall and Spurtzheim may have initiated the first mod- thought regarding the mechanisms of brain and behavior
ern attempt, by hypothesizing that language is confined relationships.
to the frontal lobes [1]. While these early hypotheses Holes and gaps in the models of strict localization of
were largely ignored as phrenology fell in ill-repute, behaviors to specific, contained brain regions became
they were resurrected in the early 1860s by Paul more salient to the mainstream neuroscience community
Broca, who, inspired by a discussion of the phrenolo- over time (cf. the disrepute of phrenology and conflicting
gists’ work, sparked a renewed interest in localization of findings from lesion/behavior studies). In response, Karl
brain function with his seminal case studies on aphasia Lashley’s search for the memory engram typified another
[2]. Broca’s explorations were among the earliest exam- era in the exploration of brain–behavior relationships.
ples of lateralized language dominance. Using an experimental approach rather than the classic
Recently, high-resolution structural MRI was applied case study method, Lashley, famously unable to localize
to preserved specimens taken from two of Broca’s memory function in rats (through progressive brain abla-
patients, to examine the localization of damage on the tion), introduced the constructs of equipotentiality and
surface and interior of the brains. This modern technol- mass action [5]. Equipotentiality is the concept that all
ogy revealed extensive damage in the medial regions of brain tissue is equally capable of taking over the function
the brain and highlighted inconsistencies with previous of any other brain tissue (demonstrated in the visual
hypotheses in the area of the brain identified by Broca, cortex) and, relatedly, mass action references the idea
which is now identified as Broca’s area [3]. This is that the behavioral impact of a lesion is dependent on
interesting, both from a historical perspective and also its size, not its location. Also, although less popularized,
 Section I: Theory and models

he suggested that, at any given time, the pattern of neural Luria presented a theory of functional systems
activity is more important than location when under- development based on these three functional units. He
standing higher cognitive functions [6]. Although plasti- suggested that the three functional units develop hier-
city in the human brain does not conform to notions of archically in the form of increasingly complex cortical
equipotentiality, recent research on stem-cell treatments zones. These zones correspond to primary, secondary,
in neurodegenerative diseases has reinvigorated the con- and tertiary motor and sensory areas, which develop in
struct in an albeit new form. Guillame and Zhang [7] order of complexity, with the tertiary planning unit
review the use of embryonic stem cells as a neural cell (anatomically demarcated by prefrontal areas) appear-
replacement technique and strides in functional integra- ing last [12]. Luria’s developmental theory mirrors
tion, axonal growth, and neurotransmitter release (e.g. the Jackson’s proposal that neuro-anatomical development
development of dopamine-producing cells in mouse proceeds upward from the spinal cord to neocortex and
brains after stem cell implantation). from the posterior to anterior [4].
Historically, political and social influences on the Functional systems, of course, are organized
philosophy of science trended Western societies away within a far more complicated web than Luria’s orig-
from the study of brain structures in the understand- inal three-tiered theory. Still, modern brain research-
ing of behavior after World War I [8]. In contrast, ers have “run” with the idea of the functional system.
researchers in the former Soviet Union continued that Recent research has explored questions of the nature
approach. For example, while in opposition to the idea of top-down control (vertical integration), with some
of equipotentiality, Filimonov (cited in Luria, 1966 [9, investigators arguing for specific areas within the
10]), a Soviet neurologist, presented the concepts of stream as primary originators (e.g. lateral prefrontal
functional pluripotentialism and graded localization cortex [13]), while others argue for different cortical
of functions. Specifically, he postulated that no cere- systems as top-down controllers (e.g. fronto-parietal
bral formation is responsible for one unique task, and and cingulo-opercular control networks [14]).
that the same tissue is involved in multiple tasks, given Functional neuroanatomy is the basis of our
the right conditions. These concepts signaled a move understanding of the human condition, as is an under-
from strict localization approaches to understanding standing of how that anatomy interacts with the body
brain–behavior relationships to a dynamic functional and its environment; a complex dance. What we do
systems approach (i.e. back to a Jacksonian view), most know is that almost any behavior, even a slight devia-
notably attributed to Alexandr Romanovich Luria. His tion in heartbeat interval, may be influenced by
approach to neuropsychological investigation stood myriad factors within the nervous system. A deviation
in contrast to Western psychometric methods, by of heartbeat interval can be influenced by fluctuations
instead focusing on the effect of specific brain lesions in physical activity, thinking, and emotional status [15,
on localized/adjacent functional systems (syndrome 16]. Our exploration of brain–behavior relationships
analysis) [10]. is further complicated by language, and more specifi-
Luria stated that simple to more complex behavioral cally the definition of constructs that are chosen to
operations are not localized to a particular brain region, define these relationships. Take, for example, our
but instead managed by an “elaborate apparatus con- understanding of a change in heartbeat interval and
sisting of various brain structures” [11]. Though other its relationship to emotion. Constructs such as fear,
definitions of functional systems, or even neural net- anger, sadness, and happiness describe rather large
works, have since been posited, this early view elo- subsets of behavior. In order to capture these emotions
quently described the construct. Luria proposed that at a brain level, Arne Ohman has suggested that emo-
all functional systems must involve three core blocks tion is a “flexibly organized ensemble of responses,
including (1) the arousal block, (2) the sensory input which uses whatever environmental support is avail-
block, and (3) the output/planning unit. Structurally, able to fulfill its biological function” [17].
the arousal unit referenced reticular formation and This is a noticeably loose definition. It has to be with
related structures that impact cortical arousal; the sen- constructs such as emotional memory [18], expressive
sory input unit referenced post central-fissure struc- aprosodia and receptive aprosodia [19], emotional intel-
tures and the integration of cross-modal sensory data; ligence [20], approach and withdrawal [21], and terms
and the output/planning unit referenced primarily the such as melancholy, wistfulness, euphoria, mirth, and
4 frontal lobes and involved planning and execution of doldrums floating around in the collective consciousness
behavior [12]. of researchers and the lay public. To understand that
 A lifespan review of developmental neuroanatomy

minute shift in heartbeat interval, we need to understand myelin–white matter creation) and have a role in neuro-
the emotional state of our subject. To evaluate the func- genesis during development (e.g. radial glia as neuron
tional systems involved in that heartbeat shift, we need to progenitors [22]).
understand the interconnecting pathways involved in
vagal (cranial nerve X) control of the heart (direct para- Neurons
sympathetic nervous system influence is necessary in a Within the adult neocortex, there are billions of neu-
beat-to-beat change in heart rate). What structures con- rons and 10 to 50 times more glia. The total number of
nect to the vagus? What structures connect to those synapses is estimated to be approximately 0.15 quad-
structures? Are there afferent feedback loops? How do rillion. Myelinated white matter is estimated to span
these control systems develop? The so-called “decade of between 150 000 and 180 000 kilometers in the young
the brain” has extended and we have an ever-developing adult [23, 24].
complexity in our understanding of the brain’s role in Neurons are composed of a cell body, axon, and
defining what it means to be human. It is an exciting time dendritic fields. The cell body contains less than
to be a neuropsychologist. a tenth of the cell’s entire volume, with the remain-
The development of functional neuroanatomy der contained within the axon and dendrites [25].
across the lifespan is a complicated topic. This chapter, Synapses are interaction points between neurons.
necessarily, is not a comprehensive review of the subject, An individual neuron communicates via action
but is instead a detailed introduction. As such, the potential. Action potentials are all-or-none electrical
purpose of the following sections is to discuss current events which are excited (promoted) or inhibited
research and our current knowledge regarding the neu- (prevented) based on the nature of synaptic stimu-
roanatomical structures that are of particular interest lation (e.g. the nature of chemical and electrical
with regard to understanding cognitive and emotional stimulation via neurotransmitters and graded poten-
development. The chapter is therefore organized as tials). A single neuron may be in direct contact (via
follows: (1) Brain structure. In this section, we cover synapse) with thousands of other neurons. The firing
cellular structures and brain areas in their prototypical rate of a neuron is influenced by the summation of
forms, discussing general associated functions. (2) Brain inhibitory and excitatory events along the axon and
development across the lifespan. This section covers the dendritic–synaptic interactions among the numer-
mechanism of brain development and notable changes ous connections. Speed of transmission is a function
over time in anatomy and function. of white matter width and myelination.
White matter may be myelinated or unmyelinated.
Brain structure Myelination increases transmission speed. Myelin
The nervous system is composed of central (CNS), sheathes (covering axons) are generated by specialized
peripheral (PNS), and enteric branches. The brain glial cells in the brain called oligodendroglia, and in the
and spinal cord form the CNS. Nerves that connect periphery by cells called Schwann cells.
the spinal cord and brain to peripheral structures such Neurons may be classified as unipolar, pseudounipo-
as the heart compose the PNS. The enteric nervous lar, or bipolar depending on the cell body form and
system controls the gastrointestinal system primarily number and arrangement of processes. Functional char-
via communication with the parasympathetic and acteristics are also used in classification (e.g. afferent
sympathetic nervous systems. neurons that conduct signals from the periphery to the
CNS are also called sensory neurons, and efferent neu-
rons that conduct signals from the CNS to the periphery
Brain cells are also called motor neurons). Further, neurotransmit-
The brain has two classes of cells, neurons and glia. There ter receptor types are also used to describe neurons.
are many different types of cells within each class, For example, neurons containing serotonin or gluta-
although they all share characteristics that distinguish mate are referenced as serotonergic or glutaminergic
these nervous system cells from other cells in the body. neurons [26].
Generally stated, neurons are specialized electro-chemical
signal transmitters and receivers. Glia serve a supporting Neurotransmitters
role in the brain (e.g. nutritional and scavenger functions, Neurotransmitters are chemical agents that bind to
growth factors, blood–brain barrier components, and specialized receptors on neurons. Neurotransmitters
5
 Section I: Theory and models

specifically relevant to neuropsychology include, Rhombencephalon

but are not limited to, serotonin (e.g. depression/
anxiety), acetylcholine (e.g. memory), dopamine The rhombencephalon, or hindbrain, is composed of
(e.g. motor), norepinephrine (e.g. depression), gluta- the medulla oblongata, the pons, and the cerebellum.
mate (e.g. memory), and gamma-aminobutyric acid Functionally, the hindbrain contains several structures
(e.g. anxiety). The effect of a particular neurotrans- involved in neural networks regulating autonomic
mitter on a functional system is largely determined nervous system (ANS) function and arousal. Cranial
by receptor types. Each neurotransmitter can bind to nerves regulating the ANS (vagus), and movements of
multiple receptor types. The distribution of receptor the mouth, throat, neck, and shoulders (glossophar-
types is not even throughout the brain and may yngeal, hypoglossal, trigeminal, spinal accessory) are
influence emotional state/traits, disease outcomes found in the hindbrain. Additional structures include
in mental health, and response to psychopharmaco- the reticular formation (basic autonomic functions,
logically active medications. For example, protein respiration), nucleus of the solitary tract (in actuality,
expression of serotonin receptors in the prefrontal this refers to several structures) and the nucleus ambi-
cortex differentiates successful suicidal patients and guus. The nucleus ambiguus and the nucleus of the
controls [27]. Asymmetry in serotonin receptors is solitary tract are the primary interface junctions for
found in depressed patients with greater right prefron- the vagus nerve, which enervates the viscera. In think-
tal receptor density than left compared with controls ing about the development of brain structures and
[28]. Moreover, higher baseline binding potential in functional systems relevant to emotional and cognitive
chronic depression pharmacological treatment is behaviors, it may be helpful to consider phylogeny and
associated with worse outcomes [29]. For a more lessons from comparative neuroscience.
comprehensive review of neuronal structure and Transitioning from reptiles to mammals, we see
function, see Levitan and Kaczmarek [30]. the emergence of myelinated vagus. Returning to our
earlier example of emotion and changes in heartbeat
intervals, Porges [32, 33] discusses the impact of this
Cranial nerves system and its development on social engagement
There are 12 cranial nerves. A solid understanding behaviors in humans with his polyvagal perspective,
of the effects of cranial nerve lesions, or the effects contrasting and elucidating the interactions of brain-
of upstream lesions on cranial nerve activity, is an stem structures, peripheral afferents, cortical and
important tool for neuropsychologists in evaluating subcortical top-down control, and myelinated and
patient presentation. Cranial nerves have both sen- unmyelinated vagal efferents. Regulation of the auto-
sory and motor functions. For example, cranial nerve nomic nervous system is a complex component of
level control of the muscles of the eye is distributed social behaviors and emotional response. Cortical, sub-
across three nerves (the oculomotor, trochlear, and cortical, and other brain structures such as the amyg-
abducens nerves), whereas sensory information from dala, hypothalamus, orbitofrontal cortex, and temporal
the eye is transmitted via the optic nerve. The optic cortex all interact via direct and indirect pathways
nerve projects from the retina, to the thalamus, with these hindbrain structures to influence parasym-
through the temporal and parietal cortices, and to pathetic and sympathetic nervous system response.
the calcerine cortex in the occipital lobe. Processing Further, the nucleus of the solitary tract receives affer-
is not performed at the level of the cranial nerves, ent input from the periphery (e.g. baroreceptors, which
which only serve to connect/transmit information monitor and relay changes in blood pressure), which
from processing centers. Testing cranial nerve func- is in turn distributed to subcortical and cortical struc-
tion can, however, give clues as to the nature of a tures for processing.
lesion. For example, the optic radiations of the optic These hindbrain structures should be considered as
nerve travel close to the surface of the cortex of the output and input nuclei for a range of supportive behav-
temporal lobe. A unilateral lesion of the temporal ioral features in the human (e.g. facilitating appropriate
lobe can cause a contralateral visual field cut. arousal levels for performing cognitive, exertional, and
Examining associated behavioral changes can suggest social functions). Also contained within the rhomben-
a location for a functional lesion. For a more detailed cephalon are the pons and cerebellum. Functionally,
review of cranial nerve functions and assessment see these structures contribute to fine motor control via
6 Monkhouse [31]. postural and kinesthetic feedback to volitional areas
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