The neurological examination at preschool age: A critical appraisal of current methods

The present paper reviews the methods available for neurological assessment at preschool age. General textbooks on pediatric neurology describe the neurological examination at preschool age in terms of the assessment of cranial nerves, muscle tone, muscle power, reflexes and the presence of abnormal movements. They stress the fact that assessment at preschool age is difficult due to the time needed to achieve the child's cooperation. Non-cooperation at the preschool neurological exam is associated with an increased risk for learning and behavioral problems at school age. At present three age-specific and standardized tests for neurological evaluation at preschool age are available. The method of Amiel-Tison and Gosselin has the drawback that it focuses on muscle tone and reflexes. It pays little attention to the quality of spontaneous motor behavior. Two other methods, the Neuromotor Behavioral Inventory (NBI) and the Hempel assessment are probably more promising in terms of assessment of minor neurological dysfunction than the Amiel-Tison and Gosselin method, as the former methods include a comprehensive evaluation of the quality of spontaneous motor behavior. The paper zooms in on the Hempel assessment, which is better documented than the NBI.