Flint — Maxine Onstott's son does not like getting his hearing tested, but the 6-year-old does like green Play-Doh.

So doctors at the Neurodevelopmental Center of Excellence in Flint came up with a plan to help Maximilliano, a cognitively impaired child, and his mother through a universal health screening and assessment that could lead to medical or behavioral interventions or entitle him to special education services.

"It was impossible to do a hearing test on him," Onstott said of the attempts to test her son's hearing at the Center in January. "He gets overwhelmed. He has some sensitivity. It could be the light and the noise. ... He may scream."

Staffers at the center, which is housed in an office building in northeast Flint, broke Max's assessment into three visits rather than one, and the next time Max came to the center, they had his favorite color of modeling compound ready to help the visit go more smoothly.

"They do accommodate, and they have a heart for what they are doing," Onstott said.

The center, which provides free screenings and neuropsychological testing, is the result of a $4 million settlement agreement reached in 2018 by attorneys representing Flint children in a civil lawsuit against the Michigan Department of Education over special education conditions in Flint Community Schools.

The center's work comes as thousands of Flint children may have been exposed to elevated levels of lead in the city water supply since 2014.

The settlement also partially funded the Flint Registry, an online project connecting children and adults in Flint to wellness services and programs.

Dr. Mona Hanna-Attisha, the Flint pediatrician and public health expert whose research helped expose Flint’s lead-contaminated water crisis, said another goal of the registry is to provide a quick pipeline of referrals to the center.

"The NCE is a dream come true for us," Hanna-Attisha said. "We always wanted to do more with children. We always wanted to do these intense assessments."

Operated by the Genesee Health System and staffed by pediatric neuropsychologists, psychologists and others, the center has processed nearly 1,003 referrals, conducted 67 screenings and performed 27 assessments. 

Katherine M. Burrell, associate director of the neurodevelopmental center, said the facility is providing specialized neuro-psychological assessments for eligible children who are ages 3 to 26, who live in Genesee County and were living in Flint from April 2014 to the present.

"The screening occurs and the threshold is very low: we are not looking to exclude. We are looking for any indication there is a problem, whether it's social or emotional or behavioral or cognitive or academic," Burrell said.

The screening begins with a face-to-face meeting with the child where he or she is given a brief cognitive screening test and a brief visual motor assessment test that measures eye and hand coordination, said Lauren Tompkins, vice president of clinical operations at NCE.

"This assesses their level of cognitive functioning at a screening level. It's not a full cognitive test," Tompkins said. "We ask for general information that at your age you should know."

Parents are interviewed as well and asked how they see their own child behaving, with questions geared toward behaviors one might see with lead exposure, such as impulsivity or problems with memory, organization or planning, Burrell said. Individualized Education Plans (IEP) are requested. 

Initial screenings can be done at home for families who need it. Clinicians are sent to gather information and do a portion of the screening, Burrell said. They also perform lead abatement in the home. A navigator also comes along to assist the family with needs such as making appointments or providing transportation to visits.

Once the screening is complete, an on-staff licensed psychologist makes the decision whether to move a child to a full neuro-psychological assessment, officials said.

A full assessment, performed by a master’s level psychologist, includes a full battery of detailed tests including measuring IQ, learning abilities, memory, language, attention, executive function, visual motor skills and autism spectrum disorders.

Testing can take up to two to four hours and may require one or more visits.

After testing, results are scored and presented to a neuropsychologist who provides any diagnosis, findings or requests for further work-ups as well as recommendations for the child, officials said.

"It will be rare that if somebody is referred for a neuropsychological assessment, that there won’t be some recommendations of some sort,” Burrell said. “That could be for school intervention, as well as the possibility of behavioral health intervention, connection with resources in the community."

Burrell said exposure to lead can manifest differently over time. That's why it is important for parents to have their child screened, even as a precaution.

"You might not see anything today, but you might see in a year some changes," Burrell said. "This should help give at least a baseline, and moving forward, you can have retesting done. It establishes a scientific, precise way to see all the different ways that an individual might have been impacted.”

Assessments done at the center are more in-depth than what a school may do if evaluating a child, Burrell said, and medical doctors elsewhere don’t normally get into psychological testing.

"When we get results, we can project how that child may need to have their learning approached differently," Burrell said. "It may explain things people are seeing. The struggles they face. And interventions can help with this."

Many people want to make a connection between what is found in the assessment and lead exposure, Burrell said.

"The goal of assessment is not to make that connection," Burrell said. "It's more or less to ID right here, right now that child's current functioning on different levels, and make recommendations and guidance on what to do with those."

Earlier this month, Max and his mother returned to the center where Max underwent an evaluation for autism, Onstott said.

"Next, I will have an appointment with a neuropsychiatrist to explain what services he is eligible for, whether he has a new diagnosis or it confirms the one we have," Onstott said. "I want it to have some backing while I am dealing with Flint schools and what the plan is for next school year."

Onstott says she doesn't blame the lead crisis for her son's disability but it has contributed to worsening his symptoms, such as behavioral aggression.

"I don’t feel the water is the reason for it, but it amplified some symptoms," she said.

Onstott's struggle to find an appropriate special education setting for Max has resulted in her son being assigned to four different classrooms in three different schools across the Flint school district.

She has high hopes for her son's experience at the center and what it could mean for his life and learning.

"This is helping me and my child," Onstott said. "I will be able to update his (education plan) and use his assessment and sit down and show them what the NCE found ... and make improvements."

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