The Pediatric Neuropsychological Assessment
Why this assessment?
A neuropsychological assessment provides a “road map” for intervention by systematically probing abilities and behaviors that correspond to specific aspects of intellectual, cognitive, and social-emotional functioning systems. Processing information, paying attention, and concentrating on school work, and remembering what they have studied are some reasons why students fail to function as efficiently as they could in school and in daily life. A neuropsychological assessment provides a detailed and accurate evaluation of a student's intellectual, cognitive, academic, social-emotional, behavioral, regulation, and adaptive functioning levels. This broad ranged view of a student is of great importance when a team (including the parents) is trying to understand why a child is struggling so much and to get them the help that they need.
Who refers for an assessment and why?
A neuropsychological assessment can be referred in by the student's parents, pediatrician, teacher, or any remediation oriented professional, i.e., neurologist, psychiatrist, speech-language pathologist, educational therapist, psychologist. An educational advocate or attorney may refer a student in order to obtain an independent educational evaluation to determine a student's real strengths and weaknesses and to identify appropriate educational accommodations and intervention.
Regardless of who refers, the neuropsychological assessment will identify a student's strengths and weaknesses across broad ranges of functioning, identify the appropriate diagnosis, and determine evidence-based interventions and accommodations. The assessment is critical as it outlines the parameters for intervention so that the specialist(s) can specifically target the problematic areas and use a student's strengths for overall intervention planning purposes.
Finally, a neuropsychological assessment may be required for high-stakes examinations such as the SAT/ACT/GMAT/LSAT/MCAT. The testing procedure is seen as necessary in order to determine current functioning, with specific diagnosis, and appropriate accommodations based on the diagnosis and disability.
In summary, a neuropsychological assessment is an integral and necessary component for directing and monitoring intervention efforts. It is crucial for providing direction for medical/educational team management as well as for overall parental educational purposes.
How does it differ from a neurological evaluation?
The neurological evaluation generally involves an 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. A detailed review of a student's medical history is obtained with additional testing ordered as necessary given the initial neurological consultation.
The most sensitive indicators of head injury, learning disabilities, etc., are often weaknesses in subtle and complex cognitive and behavioral functions. It is these functions among others that are assessed in the neuropsychological evaluation. The neuropsychological evaluation will assess a child's intellectual, language functions, attentional and concentrational skills, motor skills, sensory perceptual skills, auditory perception skills, verbal learning and memory skills, visual learning and memory skills, visual perceptual skills, executive functions, achievement, pragmatic skills, and social-emotional levels. Unlike the neurological evaluation, the neuropsychological assessment measures these areas in depth using standardized objective systematic tests. The performance of the child is then analyzed using both normative and individual comparison standards for measuring the relative strengths and weaknesses of neuropsychological systems.
How does it differ from psychological/psychoeducational testing?
The psychological assessment focuses on intellectual and social-emotional issues in light of a student's history. The school assessment administered by a school psychologist within a district is typically conducted in order to identify those children who would benefit from a special education program and/or specific accommodations within a classroom. This type of assessment does not diagnose disorders but helps the educational team within a school district understand why a child may be struggling and/or failing in school. The psychoeducational assessment will focus on achievement and selective social-emotional variables, with some districts also administering an intellectual measure. The school psychologist typically will not identify cognitive disorders, learning/behavioral disorders, or neurobehavioral disorders in the context of a comprehensive assessment.
What is the standard of training for the neuropsychologist?
The neuropsychologist will have a doctoral degree in psychology and a certificate of completion from an American Psychological Association (APA) accredited post-doctoral residency program in neuropsychology. A strong background in neuropathology (including familiarity with neuroanatomy and neurophysiological principles), cognitive psychology (including understanding of the complex, multifaceted, and interactive nature of cognitive functions), and in clinical psychology (including knowledge of psychiatric syndromes, test theory, and practice) is indicated as essential per standard guidelines (Division 40 Clinical Neuropsychology of the APA).
How long will the assessment take?
Each assessment is tailored to the student since the reasons for the assessment will vary. The neuropsychologist will also have hypotheses that will need to be answered when assessing the child. A specific “core” of tests will be administered, with other measures added to the assessment depending on the compromises indicated during the assessment process. Generally, the testing process itself takes two sessions with the second session scheduled after the first day of testing. Assessment times will vary depending on the student's age and challenges. The neuropsychologist will “work” with the child to ensure that the referral question(s) are answered thoroughly. A packet of rating scales is given to the parent(s) in order to gather data on their observations of their child within the home environment. Rating scales are given to one or more teachers to gather information on the student's behavior within the classroom settings. The teacher rating scales are also important in assessing a younger student's behavior in unstructured contexts, i.e., recess.
What do I need to bring to the first testing session?
Bring your child's glasses/hearing aids if needed. Make sure that your child gets a good night's sleep before the assessment. Remember to have your child eat breakfast prior to the time of the assessment and wear comfortable clothes. Keep your child on their medication regimen (when applicable) unless their physician requests otherwise. Your child will be provided with breaks and snacks. Please bring your own snacks if your child has individual dietary needs. Your child will also be given one hour and fifteen minutes for lunch. Please remember to pick your child up at noon for lunch.
Bring educational report cards, any previous Student Study Team (SST) meeting documentation, 504 plans, Individual Education Programs (IEPs), previous psychoeducational report(s), neuropsychological assessment reports, psychiatric/neurological consultation reports, imaging results, and remediation reports. These materials are important for background information purposes and are necessary per standard neuropsychological testing guidelines.
What should I tell my child about the assessment?
Most children can be told that the neuropsychologist will find out how they learn. It is very important that you tell your child that they cannot pass or fail on the measures but that the most important thing is that they “do their best.” Students are not able to “study” for the examination. Older students can be told that the neuropsychologist is not a “teacher” and is only interested in helping them achieve at their optimal level. Please reassure the younger child that there are no “shots.” Tell your child that you are trying to understand how they learn and that all children learn differently. This process will help them understand how to make things better. Students find the process interesting as many of the measures are colorful and fun! You can also tell them that there will be snacks, breaks, and even a dog (if the child likes dogs) will be waiting for them. You are welcome to visit this office with your child before the date of the assessment so that they feel comfortable.
What happens before the assessment?
An intake with the parents is done by the office manager, Scott Mellor. He will obtain a "thumbnail sketch" of what is concerning you about your child. He will then explain the testing process to you. Any questions concerning insurance, etc., can be answered by Mr. Mellor. At that point, an appointment can be scheduled for the assessment. He will send you a packet by email, fax, or letter confirming the appointment. This confirmation package will have directions to the office, the consent form, the Health Insurance Portability and Accountability Act (HIPAA) form, and the office policies form for you to read, sign, and return to us.
The process of the neuropsychological assessment:
The neuropsychologist will interview the parents and any significant others that the parents would like concerning the presenting situation and for relevant background information purposes. Records can be mailed, faxed, or emailed to the office before the final analysis is completed. The parents will also be given their packets and the teacher packets at the time of the parent interview. The second session will be scheduled after the completion of the first session when the approximate needed remaining time will be known. After the assessment is complete, and all of the required documentation has arrived, Dr. Schiltz will review the records, score, interpret the data, dictate the report, and provide feedback to professionals given parental request. A feedback session will be scheduled with the parents within approximately 14 working days in order to discuss the test results. Parents are encouraged to call Dr. Schiltz if there are any questions after their feedback session and after they review the report. The neuropsychological report will be given to the parents and any professional that they request. No report will be sent out from the office without the consent from the parents. A feedback session with older children is encouraged as it will provide closure for the child. The child feedback session is brief and gives an opportunity for the neuropsychologist to discuss a child's strengths with them and to answer any questions about the testing process. The timing of the child feedback session is deferred to the parent(s).
What should I do if I have more questions?
Our office provides specialized, up-to-date services in the following areas:
- Accommodations for elementary, middle, high school, and college
- Accommodation requests such as the ACT, GMAT, GRE, LSAT, MCAT, SAT, SSAT
- Attentional disorders
- Autism spectrum disorder
- Carbon monoxide poisoning
- Cerebrovascular disease
- Chronic fatigue
- Cognitive behavioral therapy (CBT)
- Cognitive changes following rehabilitation or educational remediation
- Concussion education
- Decompression illness
- Disability assessment
- Emotional disorders associated with neurological diseases, developmental delays
- Executive disorders (e.g., initiation, working memory, planning, organization, time management, emotional dysregulation, monitoring, shifting, impulsivity)
- Expert review of reports (clinical and forensic)
- Fetal alcohol spectrum disorders
- Forensic evaluations
- Genetic disorders such as Fragile X
- Geriatric assessment
- Independent medical examination (IME)
- Language disorders
- Learning disability and weakness (reading, written expression, mathematics)
- Low birth weight
- Memory disorders, including dementia
- Neuropsychiatric disorders (anxiety, depression, mood instability, psychosis)
- Neurotoxin exposure
- Other neurological and neuropsychiatric conditions
- Post-chemotherapy disorders
- Posttraumatic stress disorder
- Pragmatic and social communication disorders
- Seizure disorder
- Substance use disorders
- Tourette’s syndrome
- Traumatic brain injury, including post-concussion syndrome