What is Neuropsychology?
- Neuropsychology is the study of brain-behavior relationships.
- It is not a type of test or category of tests/techniques or a set of test scores. There is no “neuropsychological” test, per se.
- The process of neuropsychological evaluation is a way of thinking about cognitive abilities, academic achievement, and behavior – often expressed as test scores – and their interplay with an individual’s “internal” (emotions, personality, psychological makeup) and external environments (school/work, family, social, stressors)
- Tests are multifactorial – different individuals may obtain the same score for very different reasons. This applies equally in cases of success as well as failure and stresses the importance of an evaluation being of sufficient scope to tease out the multitude of factors that may impact a person’s results – and likely their daily functioning.
The complexity of the above cannot be emphasized enough, which is why it is important to work with a well-trained and seasoned expert psychologist.
Each person’s brain is as unique as their fingerprint.
Accurate assessment of a child or adult’s functioning should be comprehensive. A neuropsychological evaluation needs to be both Broad Scope and Appropriate in Depth and ideally should cover the following areas:
- General Intelligence
- Executive Functions
– Initiating, sustaining, inhibiting
– Mental flexibility, set-shifting
– Concept formation, problem solving
- Receptive & Expressive Language
- Visual-Spatial & Visual-Motor Integration
- Motor Functioning
- Sensory/Perceptual Functioning
- Learning & Memory
- Psychological/Emotional Functioning
- Social Functioning
Neuropsychoeducational Evaluations would also include tests of Academic Achievement, such as:
- Assessment of the “Five Pillars for Reading Success:
- Phonemic Awareness – manipulation of spoken syllables in words
- Phonics – letter-sound correspondence
- Fluency – reading speed and accuracy
- Vocabulary – lexicon of known words
- Comprehension Skills – deriving meaning from print
- Numerical Operations
- Quantitative Reasoning
I have taught neuropsychological assessment for nearly two decades. Over that time, I have seen a concerning trend of evaluations being lacking both in their breadth and depth – a practice guided more by insurance pressure than by clinical factors. This increases the chances for underdiagnosis or misdiagnosis. This can result in the lack of proper clinical treatment, or vocational/rehabilitation services, or educational supports and interventions.
Assessing children and adults is quite different.
Child and Adolescent Evaluation:
When you assess a child or adolescent, the assessment is a snapshot of a child at a point along their developmental course. Identified problems will not only change as the child matures but will also impact how the child develops, affecting the development of other abilities – such as social and executive functioning.
- There are many reasons why parents, teachers, pediatricians/psychiatrists/neurologists refer for evaluation:
– Assist in confirming or clarifying a neurodevelopmental diagnosis, such as ADHD, Autism Spectrum Disorders, a Specific Learning Disability such as Dyslexia, or to determine if the child is continuing to suffer cognitive problems from a concussion (Return to Play issues) or a Brain Injury.
– Provide more accurate understanding of the child’s behavior and school performance to assist in the development of alternative methods for addressing maladaptive and disruptive behaviors.
– Determine what educational services and accommodations are appropriate based on the child’s assessed areas of not only cognitive weaknesses but also their cognitive strengths to better ensure academic success.
Adult and Geriatric Evaluation
- For adults, depending on the referring question(s), the evaluation frequently is used to help provide objective information regarding a person’s cognitive function to determine if any change has occurred (e.g., head injury, stroke, or dementia). If a change in cognition has occurred, the results can help determine the extent/severity of the change.
- With serial testing over time, the rate of change can be objectively quantified, such as in recovery from a traumatic brain injury or stroke or the extent of decline in a progressive neurological disorder such as Alzheimer’s Disease.
- An assessment also should speak to the person’s emotional functioning and the complex interplay of the cognitive with the psychological, emotional, and behavioral.
- A thorough neuropsychological evaluation will frequently be used in treatment planning and to address a number of serious life concerns that require a careful, thoughtfully-guided approach that is informed by the most current medical/psychological research and knowledge of complex issues, such as competency and disability law (e.g., ADA):
– Return to work and work disability
– Level of independent functioning, such as ability to handle finances and driving
It is important to keep in mind that, given the complexity of the situation, a comprehensive evaluation will increase the likelihood of accurately identifying the core problems to be addressed.
- I teach that the evaluation phase is the most important part of any intervention.
- It leads to better targeting of areas of difficulty, as well as the identification of strengths that may be utilized to maximize an individual’s coping skills.