What is a neuropsychological evaluation?

A neuropsychological evaluation, also called neuropsychological testing, is an in-depth assessment of skills and abilities linked to brain function. The evaluation measures such areas as attention, problem solving, memory, language, I.Q., visual-spatial skills, academic skills, and social-emotional functioning. A neuropsychological evaluation is different from tests included in a neurological evaluation (e.g., EEG) or neuroimaging (e.g., CT or MRI scan). One thing to remember about any neuropsychological evaluation is that it will not change who your child is. They will be the same adorable (and sometimes challenging) child they were before the evaluation. The benefit of the evaluation, and the diagnoses and recommendations that come along with it, is that it allows other treating professionals, teachers, and parents or guardians to better understand why your child may be having difficulty in specific areas. The evaluation will provide recommendations for the types of interventions or treatments that may be effective and appropriate, given your child’s specific set of strengths and weaknesses. This can be a game changer!

What is the purpose of a neuropsychological evaluation?

The goal of a neuropsychological evaluation is to carefully and comprehensively assess and identify strengths and weaknesses across multiple areas. Some children referred for an evaluation may already have a known learning disorder or other diagnosis. Other children may be referred because of a concern or question. In either case, the results of a neuropsychological evaluation can help clarify diagnoses related to a range of learning and psychological concerns and develop specific recommendations to address a child’s needs at home and at school. The results and diagnostic conceptualization of a problem—or multiple problem areas—can also assist parents in better understanding their child’s strengths and weaknesses and address related concerns in the home setting. While a diagnosis isn’t absolutely necessary, a diagnosis is helpful in order to receive all of the services and accommodations that will help a child meet their ultimate potential in and outside of school. Diagnoses are used to communicate between and among providers and to make sure your child is getting all of the services they can so that they can meet their ultimate potential.If your child has received a neuropsychological evaluation in the past, an updated evaluation can also suggest changes to treatment or intervention and/or document changes and development in skills over time.

What happens during a neuropsychological evaluation?

There are several parts to a comprehensive evaluation. Specifics may vary based on the original reason for a referral or request for an evaluation.

Caregiver  Intake

Intake is a medical provider's term for getting to know you. The parent intake session will usually take place at the beginning of the evaluation, and is an opportunity for the parent or guardian to provide information regarding the child’s developmental, medical, educational, and psychological history. It also is a good opportunity to ask any questions you have about the process. This meeting usually takes one and a half to two hours.

Child Intake and Neuropsychological Testing

This is probably the first time I  will meet your child. They will talk to your child, make sure your child is at ease, and answer any questions your child (or you) might have.

 Depending on your child’s age, they may be asked to fill out some questionnaires about their everyday feelings and how they interact with other people. During testing days, your child will typically meet with me over two to three days for the length of a typical school day. However, the length of time for testing depends on the age and abilities of the child, as well as the reason for referral. Some re-evaluations or very brief evaluations only take one day to complete. When the testing sessions are longer, there are usually many breaks between tasks, as well as a generous lunch break—your child will not be working the entire time!

Classroom Observation and Consultation with Schools

A classroom observation is sometimes recommended to view the child’s behavior in the classroom setting. The neuropsychologist may look for functioning in the classroom in the following areas: behavioral response to teachers and peers, social interactions with peers, ability to work independently when expected, compliance with adult directives, ability to sustain attention with tasks, and any withdrawal or anxiety in the classroom.

Feedback Session

Results of the evaluation and associated recommendations will be reviewed during the feedback session with caregivers (90-120 minutes). Caregivers often wish to  share the results with a referral source,  school, or mental health or health provider.  Then we will schedule the feedback session with the child. This is a short 30 minute session where we review strengths, provide psycho-education about any diagnosis and it's neurobiological roots, read through a letter that I've written for them, and answer questions about the results. 

What can a neuropsychological evaluation test?

Components of a neuropsychological evaluation are determined based on the reason for referral, or need for the evaluation, as well as whether or not the child has received assessment in the recent past by another clinician. In general, a neuropsychological evaluation will typically include assessment of intellectual functioning (IQ), academic achievement, attention and executive functioning, and emotional and behavioral functioning. The evaluation may also include more in-depth assessment of visual-spatial and visual-perceptual skills, visual-motor and fine motor coordination, verbal and visual memory, aspects of language, and adaptive functioning.

Intellectual Functioning (IQ)

Intellectual functioning refers to an individual’s ability to reason and problem solve. It is often broken down into two parts: verbal and nonverbal reasoning abilities. Verbal reasoning is the ability to understand and use words (language) in solving verbal problems and/or thinking about concepts. Tests for verbal reasoning usually involve solving verbal puzzles and providing word definitions. Nonverbal reasoning is the ability to understand and analyze visual information. Tests can highlight an individual’s ability to solve visual puzzles, complete patterns, and use blocks to recreate target pictures.

There are also two underlying areas of cognitive skills that support verbal and nonverbal reasoning: working memory and processing speed. Working memory is the ability to hold many pieces of information in the mind while working with them. An example would be keeping a shopping list in mind or remembering complex directions without writing them down. Processing speed is the speed at which we process information and perform automatic tasks. When children process information more slowly than their peers, it may take them longer to understand new information and/or complete assignments.

Academic Achievement

Academic achievement includes assessment of math calculation and math problem solving, basic reading and reading comprehension, writing composition and spelling, and academic-readiness skills that support learning.

Attention and Executive Functioning

Attention refers to a person’s ability to selectively concentrate on a task while ignoring distracting stimuli. An individual’s ability to maintain attention serves as a baseline to all higher order processes, including visual-spatial skills, memory, and language. Executive functioning is the ability to plan, shift between sets of information, inhibit impulsivity, and self-monitor. When psychologists test executive-functioning skills, they are assessing a set of higher-level cognitive processes that act in a coordinated way to cue the use of other primary cognitive skills such as attention, language, and perception. Executive functions are responsible for a person’s ability to engage in purposeful, organized, strategic, self-regulated, goal-directed behavior, as well as creative and abstract thought. Because different executive functions work both independently and in tandem, one executive capacity may be well developed, whereas others may not.

Verbal and Visual Memory

Memory involves various processes, including the capacity for encoding (mentally processing information so it can be entered into memory), storage (holding that information for a period of time), and retrieval (accessing or recalling stored memories when needed) of the information. Visual memory refers to the capacity to store and process visual stimuli, whereas verbal memory refers to the capacity to store and process verbally presented information.

Visual-Spatial and Visual-Perceptual Processing

Visual-spatial processing refers to the visual cognitive skills involved in processing and interpreting meaning from visual information. This skill allows an individual to develop spatial concepts, as well as to judge the orientation of lines and angles, location, directionality, and relationships of objects in space.

Visual-Motor and Fine Motor Coordination

Visual-motor processing refers to the degree to which individuals can integrate their visual and motor abilities. Fine motor skills refer to the coordination of small muscle movements, including an individual’s ability to accurately manipulate small objects, such as a pencils, buttons, scissors, etc.

Language (Receptive, Expressive, Pragmatic)

Language refers to the human system of communication. Language falls into two categories: comprehension (receptive) and production (expressive). Furthermore, language can be examined at various levels: form (phonology, syntax, and morphology), its content or meaning (semantics), or its use (pragmatics). Phonology is the aspect of language concerned with the rules that govern the structure, distribution, and sequencing of speech sounds. Syntax describes the rule system that governs how words are combined into larger meaningful units of phrases, clauses, and sentences, while morphology describes the aspect of language that governs word structure and includes grammatical word inflections that carry tense. Semantics refers to the aspect of language that governs the meaning of words and word combinations, while pragmatics refers to the social use of language.

Adaptive Functioning (Behavior)

Adaptive functioning refers to the skills that are needed to meet the natural and social demands of one’s environment. Adaptive behavior includes day-to-day activities necessary to take care of oneself and get along with others. Expectations for adaptive skills depend on a child’s age and may include: communication skills, daily living skills, socialization, and the ability of the child to regulate their emotions and behaviors.

What should I bring to my child’s evaluation?

Please make sure your child has snacks, lunch, water, and anything they would like to share with the clinician. 

What happens after testing is completed?

Shortly following the feedback session, the family (and the child, if requested by the parent(s) or guardian(s)) will receive a detailed report outlining the results of the testing, as well as diagnostic impressions and associated recommendations.

I often continue to work collaboratively with parents and other members of a child’s treatment team following the evaluation. I typically  conduct follow-up consultations to answer any questions about the results or the report and may participate in school and/or IEP meetings, and  refer families to resources in the community.