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2. Neuropsychological Evaluation

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What is involved in a neuropsychological evaluation?

The neuropsychological evaluation is a complex process that integrates information from a wide variety of sources in order to develop a clear picture of who the person is, how he or she is functioning and to determine what is interfering with the ability to function more effectively.

In contrast to educational or psycho-educational evaluations, where the focus is primarily on academic performance, the neuropsychological evaluation relies on multiple sources of data and is far more comprehensive.It includes the educational component, but also involves cognitive abilities, brain-behavior relationships, social skills and personality functioning.The comprehensive nature of such an evaluation enables more accurate diagnosis, determining areas of strength and weakness, and the need for academic, psychological and neurological interventions, including more accurate planning for individualized education plans.

The following sources of information are essential components of the neuropsychological evaluation:

The Clinical Interview is one of the most important components of the evaluation process.  It provides a context within which to understand the individual under examination and puts any other data within the context of the person’s historical background.  The evaluation focuses on developmental history, medical and mental health-related issues, academic and work functioning, and socialization.

Developmental history looks at the biological component involved in the maturation process.  It involves information about the person from gestation to the present, and includes complications associated with pregnancy if any, issues associated with the delivery process, attainment of developmental milestones for motor and speech functioning, problems with puberty, and those issues associated with getting older.

Medical history is important for some obvious and not so obvious reasons.  Obvious reasons include those issues that have a known and direct contact and how the person develops and ultimately functions.  Such factors as chromosomal abnormalities, head trauma and seizures or some of the more obvious factors can affect function.  Other medical issues have a more indirect impact on how the person functions.  For example, most of us have had at least one ear infection throughout the course of our childhoods.  However, when the infections are frequent and occur early on during the developmental process (i.e., during infancy), they can affect hearing, which in turn impacts language acquisition, which in turn can have the negative impact on the development of reading and writing skills.

Mental health history looks for the presence of psychological and behavioral factors that are having a negative impact on the person’s ability to function effectively.  For example, high levels of anxiety or depression can interfere significantly with academic and job performance.  In addition, serious mental illness is often associated with thinking and perceptual problems as well as socialization issues.  It is important to understand the extent of the symptoms that are present, their severity in terms of impact and the length of time that they have been present.  In addition, having an understanding of the type of treatments that have been attempted, whether psychological or psychiatric, and their degree of effectiveness at alleviating the problem is necessary.

Academic functioning involves examining how the person performed in school and the various subject areas.  Were there any areas of specific difficulty?  What were those difficulties the result of?  What services if any were provided and were they helpful in remediation of the problem?  With regard to work functioning, questions such as job stability and quality of performance are important, but also whether the type of work that the person is doing is in line with what they may be capable of.

Socialization refers to how well we are able to interact with others in our environment and our ability to understand the social demands that are expected of us in a given society.  So the type of questions that are asked include how well does this person function at home with siblings, at school with peers, and it worked with colleagues.  Does the person have friends or does he/she spend most of his/her time alone? In addition, for adolescents and adults it is important to understand their ability to develop more intimate relationships and the stability of those relationships in an age-appropriate way.

Record Review is another important source of information about the person undergoing evaluation.  It provides information that may not be easily obtained during the course of the neuropsychological evaluation or that sheds further light on the issue is under question.  For example, prior medical examinations including MRI and CT scans or EEG studies may reveal physiological abnormalities that could provide the basis for some of the neuropsychological test findings.  School records often contain information from prior educational and psychological evaluations as well as information from teachers that highlights areas of academic strength and weakness.  Information obtained from other mental health practitioners or familiar with the individual can shed light on areas of emotional and psychological difficulty.

Behavioral Observation as the term implies, involves observing how the person presents physically (e.g., how they are dressed and groomed), whether proper eye contact is made when speaking or being spoken to or whether there is a gaze aversion, the quality of speech (e.g., rate, vocal intonation & articulation), the quality of thinking (e.g., and to the person’s statements make sense in the context of what is being discussed?), and the range and appropriateness of emotional expression.  Also assessed at this point is the individuals effort (or lack thereof) and motivation during the evaluation session as well as the degree of supervision and monitoring that they require from the neuropsychologist in order to complete the tasks.

Test Administration is the primary source of information that will help the neuropsychologist understand how the person’s brain is functioning.  This will include determination of the areas of cognitive strength and weakness in a broad range of domains including: Abstract Reasoning, Academic Proficiency, Adaptive Functioning,    Attention & Concentration, Intellectual Functioning, Memory, Motor Skills & Coordination, Personality & Behavioral Functioning, Problem Solving Skills, Sensory/Perceptual Functioning, & Speech/Language Skills.

Who should seek services from a neuropsychologist?

The types of concerns for which neuropsychological services may be sought include:

  • Neurological conditions such as hydrocephalus, autism/Asperger’s Disorder, meningitis, brain tumors, genetic disorders, Cerebral Palsy, ADHD, Downs Syndrome, learning disorders and epilepsy.
  • Brain injury that occurs as a result of a motor vehicle accident, sports injury (concussion), stroke, or infection.
  • Exposure to toxins such as lead, mercury, inhalants, cancer treatment with radiation or chemotherapy, exposure to alcohol in utero, and substance abuse.
  • If an assessment has already been completed by a clinical or school psychologist or by an education specialist, but the interventions have not been effective.

What does a neuropsychological evaluation entail?

  • History- obtained by interview and review of records.
  • Patient observation- obtained through formal testing procedures and behavioral observation during the consultation.
  • Testing- administration of a variety of standardized instruments that measure different areas of brain functioning.
  • Interpretations and conclusions- based on test data and other information gathered during the consultation.
  • Recommendations- identify ways to improve functioning, which may include referrals to other healthcare specialists.

What kinds of tests are utilized?

  • Intellectual Functioning
  • Speech & Language Skills
  • Attention & Concentration
  • Memory
  • Sensory & Perceptual Functioning
  • Motor Skills & Coordination
  • Problem Solving Skills
  • Abstract Reasoning
  • Academic Proficiency
  • Adaptive Functioning
  • Personality & Behavioral Functioning