Neuropsychological Assessment

What is Neuropsychology?

Neuropsychology is a specialty profession that focuses on the study of brain-behavior relationships. A clinical neuropsychologist is a licensed psychologist who has specialized, with extensive additional training, in the field of neuropsychology with expertise in how different abilities, learning, and behaviors are related to brain functioning. Appropriate training for a neuropsychologist includes a doctorate in psychology and a two-year post-doctoral fellowship in neuropsychology. Division 40 Clinical Neuropsychology of the American Psychological Association guidelines require background in neuroanatomy, cognitive psychology, brain functioning, brain injury or disease processes, and neuropsychological testing.

Pediatric neuropsychology also requires specialized training in early development and how the young and maturing brain is involved in a child’s ability to learn, pay attention, monitor and control behavior, problem-solve, use language, organize and plan, perceive objects or pictures, regulate emotions, and use motor skills. Assessment of a child involves interpreting test results within the context of a child’s stage of development, history, and social environment. For this reason, it is important to obtain information from parents, teachers, and others who may have special knowledge of the child.

A typical neuropsychological assessment involves evaluation of the following areas:

  • General intellectual functioning
  • Attention and Concentration
  • Executive functioning skills (e.g., organization, planning, problem solving)
  • Learning and Memory
  • Language
  • Visual Spatial abilities
  • Motor coordination
  • Academic Achievement skills
  • Emotional and behavioral functioning
  • Social development

Assessment involves use of valid and reliable standardized tests designed to understand how different areas of the brain are working. These tests are primarily “paper and pencil” or hands-on type tests, in addition to a few that are administered on a computer. Because a person’s history and circumstances are important to understanding their functioning, it may be important to interview a patient’s family members or teachers and to observe the patient in other settings, such as school. Review of relevant medical, testing, or school records is also useful to gain additional information.

When to have a Neuropsychological Assessment

Referrals for neuropsychological assessment come from physicians, nurse practitioners, psychologists, schools, community organizations, DSHS, attorneys, and others. Reasons for referral may include:

  • Identification of learning disabilities (such as dyslexia), attention deficit/hyperactivity disorder, language disorders, or developmental delays
  • Identification of autism spectrum disorders
  • Identification of brain dysfunction after injury or illness, or alcohol/drug exposure in utero
  • Documentation of changes in brain functioning over time
  • Diagnostic clarification
  • Assessment of strengths and weaknesses
  • Clarification of behavioral or emotional difficulties when no biological cause is apparent
  • Correlation with medical procedures such as MRI, CT, or EEG scans
  • Detection of brain dysfunction when structural or electrical abnormalities cannot be detected on CT, MRI, or EEG scans

Following neuropsychological assessment, results are used to:

  • Formulate a plan for treatment or intervention
  • Assist in development of Individual Education Programs or 504 Plans at school
  • Document learning disabilities or other qualifying conditions for accommodations at the elementary, junior high, high school, college, or graduate school level
  • Make recommendations for healthcare providers
  • Refer for appropriate follow-up services (rehabilitation; language or occupational therapy; psychotherapy)
  • Provide recommendations for returning to work

Preparing for the Evaluation

Depending on the referral question to be answered and the patient’s stamina, testing usually takes between 4 and 8 hours. Testing sessions can be scheduled in smaller increments to accommodate a person’s age or level of fatigue. It is important to get a good night’s rest before the evaluation and to eat a good breakfast in the morning. Bring glasses or hearing aids if used.

For children, the same preparation is advised. Additionally, when talking to your child about the evaluation, avoid using the word “test.” Be brief and simple in your explanation and explain that the activities done with the doctor will be used to help make things easier for the child at home or at school by answering questions about why the child has “trouble with reading” or “a hard time paying attention” or “feels sad.” Encouragement should be framed in terms of “do your best” instead of “do well.” Breaks will be taken throughout the testing session to allow your child to relax, play, or eat a snack.

Most adults and children find the evaluation interesting, and some aspects even fun. The information gathered from the assessment will contribute to answering complex questions and to guiding future care.

How Does a Neuropsychology Assessment Differ From A School Assessment?

School evaluations are typically performed to document whether a child qualifies for special education services due to a learning disability or developmental delay in areas such as language or motor skills. Testing done by a school district is focused on achievement and other skills necessary to succeed in school. Thus, school evaluations are limited in scope and do not capture more subtle processing weaknesses that may interfere with a child’s progress, even if she or he does not qualify for special education services according to the school evaluation. School personnel do not diagnose problems caused by atypical brain development or underlying neurological weaknesses (e.g. autism spectrum disorders, problems with executive functioning, attention deficit/hyperactivity disorder).

Before and After the Assessment

A one-hour interview will be scheduled with you (and your child if this is a pediatric evaluation) to discuss the current concerns, developmental history, and background information. Please complete the Adult or the Pediatric History Form (see Forms link) prior to this interview and bring it with you. Also bring with you all relevant medical and/or school or prior testing records/reports for the doctor’s review. Additional forms to be completed by you, parents, or teachers will be provided at the time of the interview.

Following completion of the testing, and the return of all necessary information forms, a one-hour feedback session will be scheduled to discuss assessment results, any diagnoses, and recommendations. For pediatric assessments, you will be informed about whether or not to bring your child to this feedback session, depending on the child’s age. Feedback will also be provided to your referring provider and a copy of the comprehensive neuropsychological report will be provided to you and your referring provider.