What Is a Neuropsychological Evaluation?
So you’ve been told your child needs a neuropsychological evaluation or neuropsychological testing? This suggestion may have come from your child’s teacher, pediatrician, therapist, or another treatment provider (speech therapist, occupational therapist, etc.). Learning more about neuropsychological evaluations can sometimes be overwhelming. There are a lot of new terms to learn and it can be confusing to find someone to do the evaluation. Keep reading to find out what’s involved in a neuropsychological evaluation and how you can go about finding the right person to work with.
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What is a neuropsychological evaluation?
Who completes a neuropsychological evaluation?
How do I find a neuropsychologist?
What is the purpose of a neuropsychological evaluation?
What happens during a neuropsychological evaluation?
What can a neuropsychological evaluation test?
What should I bring to my child’s evaluation?
What happens after testing is completed?
What is the fee for 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!
A neuropsychologist completes a neuropsychological evaluation. A neuropsychologist is a licensed clinical or school psychologist (with a Psy.D. or Ph.D. degree) who has also completed a two-year fellowship in neuropsychology. Child neuropsychologists provide comprehensive neuropsychological evaluations for preschool age children, school-age children, adolescents, and young adults, to help identify underlying neurocognitive factors that contribute to the strengths and weaknesses of their functioning across settings, usually home and school. Abilities and skills are considered within a developmental framework and compared to peers of the same age or grade, as well as to the individual’s own abilities.
Your pediatrician, a therapist, other parents, or the school may have recommendations. Sometimes the child’s school or the board of education can make a recommendation or provide an evaluation. You may want to google neuropsychologists in your area or contact your local teaching hospital to find someone near you (for example, ColumbiaDoctors | Children’s Health or www.psychologytoday.com). Your insurance company may also provide you with a list of neuropsychologists in your area who are in network. Since you will want to work with a neuropsychologist with whom you and your child feel comfortable, it’s reasonable to ask questions and/or check out their website before hiring them.
Typical questions might be:
- What’s involved in a neuropsychological evaluation? (Even if you know, it’s good to hear the explanation. Do they explain themselves clearly and fully?)
- How long does an evaluation take and how much does it cost?
- How do you work with parents, the child, and—if pertinent—the school?
- How long does it usually take to get a report after the evaluation is complete?
- Do you include educational recommendations in your report?
- Do you participate in IEP meetings at the school?
- Did the neuropsychologist and/or their office or website answer your questions, and did the explanations make sense?
- Did you feel listened to? Did they listen to your concerns?
- Do they seem like someone you could work with over the long term?
- If you know of someone whose child was evaluated by this professional, what was their feedback? Did the neuropsychologist complete their child’s evaluation and report in a timely manner?
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.
The list below outlines some areas of concern that may lead to making a referral for a neuropsychological evaluation:
- Learning disorders and learning differences
- Inattentiveness, hyperactivity, impulsivity
- Executive-functioning weaknesses, such as difficulty planning and organizing
- Processing-speed deficits
- Language disorders or delays
- Visual-spatial, visual-motor, fine motor deficits
- Intellectual disability
- Autism spectrum disorder
- Depressed mood
- Behavior difficulties in the home or at school
- Deficits in learning and functioning secondary to neurological and/or birth conditions (e.g., seizure disorders, epilepsy, traumatic brain injury, brain tumors, acquired or congenital hydrocephalus, premature birth)
- Giftedness combined with difficulties in learning or other areas
There are several parts to a comprehensive evaluation. Specifics may vary based on the original reason for a referral or request for an evaluation. Always double-check with an individual neuropsychologist to ask what will be involved in your child’s evaluation.
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 the neuropsychologist 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. Then, they will begin various tests with the neuropsychologist.
During testing days, your child will typically meet alone with the neuropsychologist 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. Different neuropsychologists space out testing in different ways—some professionals prefer to complete testing in the fewest number of days possible, so your child doesn’t miss many days of school. Others tend to work in three- to four-hour periods. 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.
Results of the evaluation and associated recommendations will be reviewed during the feedback session with the parent(s) and/or guardian(s). The results are often shared with a referral source (if not the parent) or school, with the parent’s consent. The child is sometimes included in part of the feedback session, if appropriate given the child’s age and level of functioning.
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 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.
If you child needs any visual or hearing aids, you should let the clinician know and bring them with you to the evaluation. It is also helpful to provide the clinician with any previous evaluations (even if completed at a young age), as well as school records, including assessments, report cards, and Individual Education Programs (IEPs). If your child takes medication, it is helpful to let the clinician know in advance, and to make sure your child takes their medication as prescribed on the day of testing.
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.
Neuropsychologists often continue to work collaboratively with parents and other members of a child’s treatment team following the evaluation. For example, the neuropsychologist may share the report with members of the child’s treatment and education team, and may conduct follow-up consultations to answer any questions about the results or the report. Additionally, some neuropsychologists may participate in school and/or IEP meetings, or they refer families to educational advocates and consultants, depending on the family’s wishes.
Fees are determined based on the type of neuropsychological evaluation needed and can vary widely depending on the type of clinical practice and the needs of the child.
Claire Golden, PhD, is a certified school psychologist and a New York State licensed clinical psychologist with a specialty in developmental neuropsychology. She is a neuropsychologist at PROMISE at Columbia and has a private neuropsychology practice through the ColumbiaDoctor's Neuropsychological Evaluation Service. She is also an Instructor in Medical Psychology (in Psychiatry) at Columbia University Medical Center.
Meghan Tomb, PhD, is a child and adolescent psychologist and neuropsychologist. She specializes in comprehensive neuropsychological evaluations of children, adolescents, and young adults with learning, language, attention/executive function, and developmental disabilities. Dr. Tomb is an Assistant Professor of Medical Psychology at Columbia University Medical Center, Associate Clinical Director of the PROMISE Program at Columbia, and a neuropsychologist at ColumbiaDoctor's Neuropsychological Evaluation Service.