The Quick Neurological Screening Test (QNST)
The QNST is a 20 minute individual test which taps neurological integration as it relates to learning. Its items are adapted from a pediatric neurological examination. It is designed so that it is easy for volunteers, nurses and educators to administer and the items are selected to be non-threatening to the subject.
The QNST is a screening tool. It will not provide enough detailed information to justify a neurological diagnosis. Rather the data collected would only be used as a referral to a trained neuropsychologist.
The QNST allows the examiner to sample, in an orderly way, how the child monitors and integrates sensory information from visual, tactile. auditory and propioceptive or kinesthetic sources. Using the QNST, the examiner samples the child’s control of muscles, both large and small, as they are used to maintain position and for voluntary motion. The examiner also assesses the child’s ability to organize that motion in time and space for purposeful output.
Using this information, the examiner is then able to take a rapid look at the child’s fine-motor control, gross-motor control, balance, rhythm, strength, motor planning and sequencing, sensory awareness, spatial orientation, visual perception, auditory perception, distractibility, impulsiveness, left-right differences, and visual-motor skills.
The QNST attempts to identify three populations
1. Children who demonstrate no failures in age-related tasks and no abnormal neurological signs.
2. Children who have distinct, even if minor, neurological signs as clear-cut differences from one side to the other in sensation or motor control, or disorders of control of movement, such as tremor, ataxia, or nystagmus
3. Children with frank organic neurological signs who, even so, are not able to perform at the level predicted for their age – often called neurologically immature but often labeled as learning disabled.
The way a child picks up and holds a pencil contains a wealth of information. Unusual pencil grasp in asymptomatic children is rarely noted.
Figure Recognition and Production
This subtest assesses attention, visual discrimination, visual perception, motor planning, fine-motor control, eye-hand skills, and motor maturity. The geometric forms selected are chosen because normal children can complete these figures by age 6 although mastery of the diamond may be delayed to age 7. Girls achieve success earlier than boys. Performance on this task in part relates to cerebellar-vestibular function. It also predicts computation skills and reading success or failure.
Rapidly Reversing Repetitive Hand Movements
Rate, rhythm, symmetry and accuracy are all components of this subtest. The task is particularly sensitive to boys with learning disabilities.
Palm Form Recognition
In older children, this task corresponds with IQ and reading success.
Finger to Nose
Smoothly executed excursions are accomplished by unimpaired children by the age of six.
Thumb and Finger Circles
95% of subjects between 6 and 7 1/2 can perform this successfully. Girls develop ability earlier than boys.
Double Simultaneous Stimulation of Hand and Cheek
(Extinction Test)
Displacement (when a subject indicates that the stimulus occurred at a spot other than the one touched by the examiner) and extinction (failure to indicate a spot touched) are common in young children. Up to 50% of the adults tested failed to indicate the hand stimulus on the face-to-contralateral-hand subtest.
Hand, Foot, Eye Preference
Cerebral dominance, resulting in hand, foot, and eye preference is a natural proclivity. However. very bright, highly coordinated children often demonstrate little difference in accuracy or skill between preference tests of right or left hand, foot or eye. However, lack of dominance may result in delayed development of a clear sense of direction. Where hemispheral injury or local lesions are present, one may see a large variety of choices or preferences, resulting in mixed dominance. ambidexterity, or shift of dominance to the side opposite the one which has been destined genetically.
Eye Tracking
Jerkiness, asymmetry of movement, rapid alternating uncontrolled movement is abnormal at any age.
Sound Patterns: Rhythm, Rate, and Sequencing
Discrimination
Observation of badly-scarred eardrums and ear infections are related to failure on this subtest even without failure on pure tone eudiometry. Thus failure is not a hearing impairment but some type of auditory inattention or apraxia. Presence of hearing problems is a major source of school performance problems.
Tongue Protrusion – Arm and Leg Extension
Considered abnormal are random quick irregular movements most often appearing in fingers during arm-finger extension. Boys with this problem have more reading and spelling difficulties. Unusual posture of wrist flexion (wrist dip) and finger hyperextension is related to cortical dysfunction. The test is particularly effective in demonstrating subtle differences between right and left side gross- and fine-motor control.
Tandem Walk
Heel-toe walking is performed satisfactorily in 100% of normal school aged children. Backward tandem walking is skill not acquired until 7. Failure is an indicator of cerebellar-vestibular dysfunction.
Stand and Skip
90% of normal subjects are able to stand on one foot for 10 seconds without external support and without unusual posturing by age 6 on 2 out of 3 tries. In 6 year olds, 77% of the girls succeeded on the right foot for 30 seconds, and 59% of the boys; while 65% of the girls and 60% of the boys succeeded on the left foot.
Behavioral Irregularities
Toe or finger tapping, excessive talking or making noises, fidgeting, impulsiveness, withdrawal, defensiveness are worth of noting. Hyperactive patterns of behavior predict may problems in the classroom. Hypokinetic behaviors (withdrawal or defensiveness) are also valuable to note.
Medical Interpretations
Success on QNST activities indicate the child does not have neuromotor problems.
Of concern are tremor, persistent differences between the two sides, abnormal posture, inability to carry out smooth coordinated rhythmic activity or uncontrolled involuntary motor activity.
“Suspect” behavior, fitting neither of the two above descriptions, usually does not indicate structural brain defects but may be indicative of seizure disorders. Testers look for lapses of continuity (petit absence), forgetting the task at hand (amnesia), variability in attention span, bizarre responses or organic tics
QNST Assignment
Tabulate the scores on your score sheet. Review these scores and make qualitative notes on your score sheet of your child’s performance.
It is often reported that females should be rapid neuro-development than males. With the class scores tabulated, determine if there is any sub-test in which there are large differences between males and females. Describe any tasks in which large differences are observed.
Using your individual data, write a brief report for the child's parent indicating is position relative to the developmental norm. Comment if you think several of the sub-tests are inter-related in some way and what that says about the child's developmental status.