What is Clinical Neuropsychology?
Clinical Neuropsychology is the study of brain-behavior relationships for the purpose of identifying and explaining abilities and disabilities that might affect a person’s behavior, learning, work performance, and/or daily functioning.
What Is a Neuropsychological Evaluation?
A neuropsychological evaluation is a comprehensive evaluation that studies how the brain “works” or functions. What makes an assessment “neuropsychological” is not the tests used, but the training of the doctor who performs the evaluation. These evaluations identify inefficiencies in brain functioning which contribute to attention, memory, language, motor, thinking, and learning difficulties. Neuropsychological evaluation involves assessing and understanding one’s overall functioning using noninvasive, comprehensive, clinical methods.
The evaluation helps to identify a person’s neurocognitive strengths and weaknesses and explain how these impact the individual in:
* Personal/Family relationships
* Social situations
Why have I been referred?
Neuropsychological evaluations are requested specifically to help your doctors, and other professionals understand how the different areas and systems of the brain are working. Testing is usually recommended when there are symptoms or complaints involving memory and thinking. This may be signaled by a change in concentration, organization, reasoning, memory, language, perception, coordination, or personality. The change may be due to any of a number of medical, neurological, psychological, or genetic causes, or a result of head injury. Testing will be helpful in understanding your current situation.
What is assessed?
* General intellect
* Higher level executive skills (e.g., sequencing, reasoning, problem solving)
* Attention and concentration
* Learning and memory
* Visual-spatial skills (e.g., perception)
* Motor and sensory skills
* Mood and personality
* Some abilities may be measured in more detail than others, depending on your needs and/or the referral question
How are test scores used to understand my specific situation?
Your test scores will be compared to scores from people who are like you in important ways. By using a database of scores from large groups of healthy people for comparison, the neuropsychologist can judge whether or not your scores are normal for your age and educational background. The pattern of your own test scores will also be reviewed to estimate whether or not there have been changes in certain abilities. How you go about solving the various problems and answering questions during the examination will also be noted. Using these methods, your strengths and weaknesses can be identified.
What will the results tell me?
Test results can be used to understand your situation in a number of ways:
* Testing can identify weaknesses in specific areas. It is very sensitive to mild memory and thinking problems that might not be obvious in other ways. When problems are very mild, testing may be the only way to detect them. For example, testing can help determine whether memory changes are normal age-related changes or if they reflect a neurological disorder. Testing might also be used to identify problems related to medical conditions that can affect memory and thinking, such as diabetes, metabolic or infectious diseases, or alcoholism.
* Test results can also be used to help differentiate among illnesses, which is important because appropriate treatment depends on accurate diagnosis. Different illnesses result in different patterns of strengths and weaknesses on testing. Therefore, the results can be helpful in determining which areas of the brain might be involved and what illness might be operating. For instance, testing can help to differentiate between Alzheimer’s disease, stroke, and depression. Your physician will use this information along with the results of other tests, to come to the most informed diagnosis possible.
* Sometimes testing is used to establish a “baseline,” or document a person’s skills before there is any problem. In this way, later changes can be measured very objectively.
* Test results can be used to plan treatments that utilize strengths to compensate for weaknesses. The results help to identify what target problems to work on and which strategies to use. For example, the results can help to plan and monitor rehabilitation or to follow the recovery of skills after a stroke or traumatic brain injury.
* Studies have shown how scores on specific tests relate to everyday functional skills, such as managing money, driving, or readiness to return to work. Your results will help your doctors understand what problems youmay have in everyday life. This will help planning for assistance or treatment.
How Does It Differ From a Neurological Evaluation?
The neurological evaluation generally involves examination of the basic motor and sensory functions (strength, reflexes, sensitivity to touch, and coordination) and of basic thinking skills including functional communication (speech and language), orientation to person, place, time and circumstances, simple memory functions, and an ability to follow basic commands.
The most sensitive indicators of head injury, learning disabilities, etc., are often deficits in subtle and complex cognitive and behavioral functions, and it is these functions that are assessed in a neuropsychological evaluation. Particularly sensitive to the evaluation is the measurement of cognitive domains and social-emotional functions. These involve the following areas: Intellectual ability, language functions, attentional and concentration skills, motor skills, sensory perceptual skills, auditory perception skills, verbal memory skills, visual perceptual skills, visual memory skills, executive functions, achievement abilities, as well as social-emotional levels. Unlike the neurological evaluation, the neuropsychological assessment taps these areas of cognitive functioning levels in depth using standardized objective systematic tests. The performance of the patient is then analyzed using both normative and individual comparison standards for measuring the relative strengths and weaknesses of cognitive and social-emotional systems
How Does It Differ From Psychological Testing?
The psychological assessment focuses on social-emotional issues whereas the neuropsychological assessment tests both cognitive and social-emotional areas. Neuropsychological assessments are routinely ordered on adults who have thinking problems, attentional and memory disturbances, and other suspected or documented learning problems. Therefore, it is very important to determine whether there is a deficit or compromise of cognitive and social-emotional levels in order to assist with appropriate treatment planning.
How Long Will The Assessment Take?
Each assessment is tailored to the individual since the reasons for assessment will vary. A specific “core” of tests will be administered with additional tests being performed depending on the referral question and/or compromises seen during the assessment. The tests will identify the areas of strengths and weaknesses and will allow for more specific treatment planning. Generally, adults will complete the assessment in 3 to 5 hours.
What Should I expect?
A neuropsychological evaluation usually consists of an interview and testing. During the interview, you will be asked about your symptoms, educational, work and medical histories, medications, and other important factors. Testing involves taking pencil-and-paper or computerized tests and answering questions. The time required depends on the problem being assessed. In general, several hours are needed to assess the many skills involved in processing information. Some tests will be easy while others will be more complex. The most important thing is to try your best. You will probably find testing interesting, and the detailed information that is gathered will contribute to your care.
What Do I Need To Bring To My First Appointment?
Please bring your completed intake forms, also bring any copies of previous assessments, educational records, and neurological/psychiatric records for background information purposes. These materials will not change the neuropsychological test data, but will provide a background context for the referral question(s). Please bring your glasses or a hearing aid if applicable. Remember to eat breakfast prior to the time of the assessment and wear comfortable clothes. An hour for lunch is taken and breaks are provided as needed.
What Happens Before And After The Assessment Is Done?
A clinical interview is scheduled with you before the assessment begins to discuss the presenting situation and relevant background information. At that time, all medical/educational records are collected for review, including the information packet you and/or a significant other were asked to complete.
After the assessment is completed, records are reviewed, test data is scored and interpreted, and a written report is compiled. A feedback session will be scheduled to discuss the test results, usually within 10-15 working days of assessment.
At what age can a neuropsychological evaluation be performed?
Age-appropriate tests are used for so that an individuals ages 4 years and older can be evaluated.
What Will the Results Tell Me About My Child?
By comparing your child’s test scores to scores of children of similar ages, the neuropsychologist can create a profile of your child’s strengths and weaknesses.
The results help those involved in your child’s care in a number of ways.
* Testing can explain why your child is having school problems. For example, a child may have difficulty reading because of an attention problem, a language disorder, an auditory processing problem, or a reading disability.
* Testing can help detect the effects of developmental, neurological, and medical problems, such as epilepsy,autism, attention deficit hyperactivity disorder (ADHD), dyslexia, or a genetic disorder.
* Testing may be done to obtain a baseline against which to measure the outcome of treatment, or the child’s development over time.
* Different childhood disorders result in specific patterns of strengths and weaknesses. These profiles of abilities can help identify a child’s disorder and the brain areas that are involved.
* Testing can help differentiate between an attention deficit and depression, or determine whether a language delay is due to a problem in producing speech, understanding or expressing language, social shyness, autism, or cognitive delay.
* The neuropsychologist may collaborate with your child’s physician to combine results from medical tests, such as brain imaging or blood tests, to help diagnose your child.
* Most importantly, testing provides a better understanding of your child’s behavior and learning in school, at home, and in the community. The evaluation can guide teachers, therapists, and you to better help your child achieve his or her potential.
How is a Neuropsychological Evaluation Different from a School Evaluation
School assessments are usually performed to determine whether a child qualifies for special education programs or therapies to enhance school performance. They focus on achievement and skills needed for academic success. Generally, they do not diagnose learning or behavior disorders caused by altered brain function or development. For more information, see the American Psychological Association’s (APA) Division 40 (Clinical Neuropsychology) at www.div40.org.
What Should I Expect?
A neuropsychological evaluation usually includes an interview with parents about the child’s history, observation of an interview with the child, and testing. Testing involves paper and pencil and hands-on activities, answering questions, and sometimes using a computer. Parents may be asked to fill out questionnaires about their child’s development and behavior.
Parents are usually not in the room during testing, although they may be present with very young children. The time required depends on the child’s age and the referral question.
Make sure your child has a good night’s sleep before the testing. If your child wears glasses or a hearing aid or any other device, make sure to bring it. If your child has special language needs, please alert the neuropsychologist to these. If your child is on any medication, check with the neuropsychologist beforehand about coordinating dosage time with testing.
If your child has had previous school testing, an individual education plan, or has related medical records, please bring or send this information and records to the neuropsychologist for review.