Neuropsychological assessment is a way to measure higher-level brain processes, such as memory, attention, and problem solving. Problems with a particular kind of information processing can be identified and addressed, with targeted therapy or educational support. Areas of strength are also identified, so that those processes can be utilized and developed. Neurolpsychological assessment is often recommended by a neurologist or psychiatrist to help clarify a diagnosis and plan a course of treatment. Educators may also recommend neuropsychological assessment to better understand and address a child’s learning or social emotional issues.
How it Works
Using carefully designed tests and activities, and exploring the person’s history and experience, we can shed light on what might be getting in their way in terms of learning, relationships, and day-to-day functioning. There are three areas of information processing explored: cognitive (thinking) processes, including memory, language, and reasoning; executive (control) processes, including attention and concentration, working memory (holding information in mind), and initiation and inhibition of responses; and emotional (motivation) processes, at the personality and neurochemical/hormonal levels, including anticipatory anxiety, novelty seeking and aversion, frustration tolerance, emotional regulation, and mood stability.
The neuropsychological assessment covers all areas, like a general physical exam. However a particular area may be explored in more depth. For children, we are also interested in issues of sensory and motor processing, such as sensory hypersensitivity and graphomotor (handwriting) coordination, and in the level of skills development in academic areas such as reading and mathematics. For older adults with memory problems, the neuropsychological assessment is shorter and more targeted.
The neuropsychological assessment is a comprehensive process that is billed once, as a package. It includes multiple visits for interview and testing, careful review of the history and medical or educational records, a final visit to explain the findings and recommendations, and a written summary report. Testing is done one-on-one, with pictures, puzzles, questions and so on, some of it presented on an iPad and some with paper and pencil. There is time built in for discussion and breaks. One or more testing sessions are scheduled, for two or three hours each. I do everything I can to make the process as comfortable and engaging as possible, so the person can do their best.
Child Neuropsychological Assessment
Children may have challenges with developing early skills, such as language and motor coordination, or with learning to read or making friends at school, or with anxiety, anger, impulsivity, or other problems with mood or behavior at home. Neuropsychological assessment can help identify the underlying problem and ways to support them, including occupational or language therapy, educational support, and parenting strategies.
IEE – Independent Educational Evaluation
Children who are not making appropriate progress in the regular educational program may be referred to their school district’s Committee on Special Education for a psycho-educational evaluation to see if they qualify for special education services, or an IEP. This includes a psychological evaluation – testing of their cognitive ability and questionnaires about social, emotional, and behavioral functioning, and an educational evaluation – testing of their skill level in reading, mathematics and written expression. Depending on the nature of the child’s difficulties, it may also include a speech and language evaluation or an occupational therapy evaluation to assess motor skills such as handwriting. Sometimes, if the parents or the district feel that the child’s issues are still not understood, or that the child is still not making appropriate progress, the district will recommend, or the parents can request, a neuropsychological assessment by an independent provider, someone who is not connected with, but has been approved by the district. This is referred to as an IEE, or Independent Educational Evaluation. This can be very helpful in understanding and supporting a child who’s issues are perhaps more subtle or complex.
Teens and Young Adults
Often in high school or college, young people hit a wall with academic or social emotional progress. The many challenges that come together at this stage of life, along with the desire for self-understanding, make this a very valuable time to do neuropsychological assessment. They often feel that they are supposed to know what they want to for as a career, or what they want to study in school, and yet they have no idea. They may feel confused and overwhelmed by the decisions they face, and unprepared for this next stage of life. At the same time, they are ready to participate in and benefit from the opportunity for self-examination that the neuropsychological assessment provides. It also can have a therapuetic effect, by providing an opportunity to express ideas and concerns in a safe setting, and to approach different kinds of tasks without fear of failure or criticism. He or she gets to see what kinds of tasks are easier or more enjoyable, and observe any difficulties with particular kinds of processing. Issues with mood or temperament, such as anxiety or depression, with social or executive functioning, such as autism or attention deficit disorder, will be illuminated, and recommendations for treatment or for educational or workplace accommodations can be made based on the findings.
Adult Neuropsychological Assessment
Neuropsychological assessment for adults can help clarify problems with work, relationships, mood, improve self-understanding and self-esteem. Sometimes we get further along in our life and realize that we may have a condition or processing problem that was never formally identified – do I have ADHD? Autism? A person may be stuck – in an unhealthy relationship, and unrewarding job, or have anxiety, depression or anger issues that need a better approach. The findings can clarify a neurologic or neuropsychiatric diagnosis or help guide psychotherapy, relationship counseling or career counseling.
Injury or Illness
Neuropsychological assessment can be valuable at any age to clarify the nature and extent of cognitive difficulties accompanying a neurologic, autoimmune, or chronic inflammatory or infectious illness, such as multiple sclerosis, long COVID, or persistent Lyme disease. People who suffer concussion or traumatic brain injury can benefit by getting concrete and specific information about any cognitive difficulties they are experiencing and how these are resolving.
Memory Loss Assessment
Sometimes we become concerned about our own or our family member’s memory or thinking. Neuropsychological assessment can help clarify the nature and extent of any age-related memory or cognitive decline, or changes in mood or personality, by providing an objective measure of higher-level brain function. We do this with game-like puzzles and pictures, so the process is not frightening and is often enjoyable. The results and recommendations are then discussed in a family meeting. We can also repeat the neuropsychological assessment in a year or two, if there continues to be a concern, to see if there has been any decline.