A – 72 Pediatric Neuropsychology Off the Grid: A Case Study of an Amish Child

Objective The Amish are a secluded Christian community that eschews modern technology in favor of a simple life. Although assessment biases have been documented generally, pediatric-specific neuropsychological considerations, including academic aptitude, attention, executive functioning, and intelligence quotient (IQ), remain understudied. For example, many measures provide norms up to age 6:11, while Amish children in one Midwestern community begin formal schooling at 7.5–8 years. Other barriers include the use of technology in many assessments and language differences, as Pennsylvania Dutch is spoken at home and English is learned as a second language. This case study explores cultural considerations in the neuropsychological evaluation of a 7-year-old Amish girl. Method Retrospective review of medical records, parent interview, and neuropsychological testing was conducted. History was notable for developmental delay and hypotonia. Pre-academic instruction occurred at home. Given language and cultural factors, a battery was selected that minimized verbal demands and excluded technology. Results Evaluation revealed exceptionally low IQ, fine motor, visuographic, language, and verbal memory skills. Academic measures showed a lack of foundational skills; pre-academic tests were administered qualitatively. Adaptive functioning was below age expectations. Executive functioning tests requiring basic concepts (e.g., colors, shapes) were discontinued. Inattention was qualitatively assessed using technology-free gross motor tasks. Strengths included a positive disposition and strong family/community support. Conclusion The patient met criteria for intellectual developmental disorder (provisional), developmental coordination disorder, and attention-deficit/hyperactivity disorder (ADHD), combined type. Clinicians must consider cultural norms, language differences, and restricted technology use when assessing Amish children to avoid diagnostic errors and ensure culturally sensitive recommendations.