The CNA evaluates children with learning problems to adults and elderly people with cognitive and memory complaints
The year was 1992, 18 years before the creation of the D’Or Institute for Research and Education (IDOR), when a small clinic in Rio de Janeiro, Brazil, began performing neuropsychological tests aimed at children with learning difficulties. One of the competitive advantages of the clinic was the fact that it was the first service in the country where each patient was analyzed by a multidisciplinary team of physicians, psychologists, and speech therapists. This was the beginning of the Center for Applied Neuropsychology (CNA, in Brazilian Portuguese).
Working until the present day and an integral part of IDOR since the conception of the institution in 2010, the CNA is a pioneering nucleus with relevant international contributions in the field of learning disorders and other problems that affect cognitive functions, not only in children but in adults and the elderly.
When CNA emerged in the early 1990s, diagnoses of learning disabilities, Attention Deficit Hyperactivity Disorder (ADHD) and even autism were very uncommon and far from popular vocabulary in Brazil. Poor school performance was commonly attributed to disciplinary and psychological problems, and children and teenagers with difficulties at school were sent directly to psychotherapy, without proper investigation of possible primary learning problems, such as dyslexia, for example, which is a neurobiological disorder that affects reading and writing performance.
“Of course, the child will not be interested in studying or will have a great chance of living with low self-esteem due to frustration. Everyone understood the test and they didn’t, because they have dyslexia, and will get low grades even though they’ve studied. Before considering that this is a psychological problem and addressing the child to therapy, it is necessary to be sure that they don’t have what we call a learning disorder, such as dyslexia, dyscalculia, and even ADHD – which is not a learning disorder, but often causes school problems due to concentration difficulties”, comments Dr. Paulo Mattos, psychiatrist, researcher at IDOR and founder and clinical director of CNA.
Dr. Paulo Mattos had the idea of putting together a multidisciplinary team to diagnose cognitive difficulties after having contact with the neuropsychological examination during his master’s degree, when his studies evaluated the cognitive functions of people with HIV and AIDS at a time when there were no current antiretroviral therapies. Patients, at the time, brought many complaints about concentration and memory, and there were few resources to evaluate and measure these reports.
“Many complaints in my area are immaterial, that is, they are not objective, clear, or well-defined. Fever, weight loss, and hair loss, are material symptoms that you can measure and quantify, but evaluating an ‘I am very forgetful’ is more difficult. Are you forgetful concerning what? In comparison to others? In comparison to what you were before? You can also be a very anxious person, and you think you are getting forgetful. It is necessary to take these complaints and objectively quantify them, make them material”, explains the psychiatrist, emphasizing the clinical relevance of the tests and questionnaires applied to patients.
Later, during his doctorate, Mattos used neuropsychological assessments in another population, this time elderly people with memory complaints. The challenges were even greater, as it was necessary to distinguish whether forgetfulness was due to age or whether it was a pathological process, like dementia and other neurodegenerative diseases, such as Alzheimer’s. The contact with this new challenge made the CNA incorporate the examination and diagnosis of adults and elderly people with memory problems, thus creating the sector that goes by the name of Memory Clinic, following the same multidisciplinary evaluation pattern applied to other services, in addition to performing additional tests, such as neuroimaging.
Relevance of Early Diagnosis
Early diagnosis is a relevant factor in many cases of cognitive complaints, whether in young or elderly people. In preschool children (under 7 years old), it is possible to map how cognitive development is going. At that age, despite the difficulty in establishing a diagnosis, it is already possible to say whether attention, discrimination of colors and geometric shapes, initial calculation capacity, and motor development are evolving according to what is expected for their age, signaling to parents any area that needs to be more stimulated.
In the case of Autistic Spectrum Disorder (ASD), identifying the problem early enough can be of great benefit to the child. “In most little children, after 6 months there may be one or the other symptom, but isolated symptoms of autism occur in the general population. What professionals call autism is a combination of several symptoms at the same time. And this only becomes clearer around 2 to 3 years old. At the CNA, from the age of 4 it is already possible to carry out an evaluation and, if the hypothesis is confirmed, indicate an early treatment. Because the sooner you intervene, the better the adaptation and the result for the child”, explains the clinical director.