Neuropsychology is a specialty of psychology that focuses on the relationship between brain function, learning, emotions, and behavior.
A neuropsychologist is a licensed psychologist with expertise in how learning and behavior are related to brain structures and systems. The neuropsychologist conducts the formal assessment of abilities such as language and memory skills assessing brain functioning, interprets the test results, clarifies a diagnosis, and provides recommendations. A neuropsychologist may have different roles in your care. Sometimes, the neuropsychologist is a case manager who follows a patient over time to adjust recommendations to the patient’s changing needs. A neuropsychologist may provide treatment such as cognitive rehabilitation, behavior management, or psychotherapy. Often, the neuropsychologist will work closely with a doctor to manage the patient’s thinking of emotional problems. Neuropsychologists may work closely with a school to help them provide appropriate educational programs for a child.
A neuropsychologist has additional expertise about the brain and how it functions. A neuropsychologist has completed a one-year internship focusing on neuropsychology plus two years of clinical experience and specialized training in the study and practice of clinical neuropsychology at the post-doctoral level. These two years of fellowship include supervision by a clinical neuropsychologist as well as research and seminars in the area of neuropsychology. Although a neuropsychologist and psychologist both have a doctoral degree in psychology, a neuropsychologist has more specialized training about the brain and related disorders during their doctoral level coursework, research, internship and fellowship.
A neuropsychological evaluation is a way of determining a person’s overall thinking, learning, attention and output abilities. It provides information on how a person’s brain works. A neuropsychological evaluation involves gathering information from a patient's background, behavioral observations, and neuropsychological tests to understand a person's unique development to clarify diagnosis and plan/provide treatment. It involves a clinical interview, detailed analysis of a person’s behavior in different settings and the administration of neuropsychological tasks. We evaluate the following:
General cognitive ability
Communicative and language skills
Executive (reasoning, organization, planning, inhibition) skills
Learning and memory abilities
Sensory and motor skills
Social cognition and interpersonal skills
Academic achievement, such as reading and math
One's ability to live independently and to manage financial affairs
Some abilities may be measured in more detail than others, depending on the patient’s needs. Specific tasks are chosen based on (1) the referral question or reason for the evaluation, (2) the person's age, and (3) any previous evaluations. Observing a patient to understand his or her motivation, cooperation, and behavior is a very important part of the evaluation.
The feedback session is an integral and very important component of the overall assessment. It is usually scheduled within two weeks of the last evaluation session.
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.
Yes. Emerging skills can be assessed in very young children by Dr. Cristi and her team as they have particular expertise in this age range. However, the evaluation of infants and preschool children is usually shorter in duration, because the child has not yet developed many higher order cognitive skills.
Children are referred by a doctor, teacher, school psychologist, or other professional because of one or more problems, such as:
- Difficulty in learning, attention, behavior, socialization, or emotional control;
- A disease or inborn developmental problem that affects the brain in some way; or
- A brain injury from an accident, birth trauma, or other physical stress.
A neuropsychological evaluation assists in better understanding your child’s functioning in areas such as memory, attention, perception, coordination, language, and personality. This information will help you and your child’s teacher, therapists, and physician provide treatments and interventions for your child that will meet his or her unique needs.
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 or 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. Testing will be helpful in understanding your specific situation.
The neuropsychological evaluation typically involves a clinical interview, one evaluation session, and a feedback session. In some cases, an additional evaluation session may be needed if a child is very young, a child needs time to become familiar with what is required, or if a child or adult patient has limited stamina secondary to medical condition. The feedback session is an integral and very important component of the overall assessment. Every effort is made to schedule it at a time convenient for patients/parents/guardians, usually within two weeks of the last evaluation session.
Session I - Interview (30 minutes-1 hour)
The initial diagnostic interview session is conducted by Dr. Cristi with the patient alone or with his/her parent(s) as well as family members/legal guardian. This is to review the reason for the assessment and to obtain details of the developmental, medical, and educational history. There will be opportunity to discuss sensitive information without a child being present if requested. Patients and their family members may be asked to complete questionnaires. For children, questionnaires will also be provided for teachers to fill out in order to gather information about how the child thinks, feels, and behaves at school.
Session II - Testing (1-5 hours)
The child or adult works with Dr. Cristi and/or one of the Center's clinicians on various tasks. If the child is age appropriate, the parent(s) usually waits for the child in the reception area. The time required to complete testing depends on the patient’s age, development, behavior and the reason/concerns for evaluation. Typically, it takes between 3-5 hours for school aged children and adults. It can take 1-3 hours for those with significant cognitive challenges, preschoolers, and the elderly. Screenings typically take 90 minutes. We take a 1 hour lunch break between 12-1pm for comprehensive assessments.
Session III - Feedback (45-60 minutes)
The findings of the evaluation and recommendations will be discussed with you in detail. Interpretation of results and feedbacks are done by Dr. Cristi. An adult patient may choose to come alone or bring a family member. For children under 18, both parents are expected to attend this session. Children 16 and up are typically required to attend. Depending on the age of the child, others may wish to attend also. This will be followed by a written report that presents the patient’s history, behavioral observations, test findings, diagnostic formulation, management plan, and recommendations.
Understanding a patient's neuropsychological strengths and weaknesses can:
- help explain the integrity of brain functions
- clarify a diagnosis and identify brain areas that are involved
- determine cognitive, emotional, or behavioral consequences from brain impairment
- help determine if a given treatment and/or brain surgery (e.g., epilepsy, deep brain stimulation) is appropriate for a particular person and whether treatment has any positive or negative effects on cognitive functions and behavior
- establish a baseline against which to measure the outcome of treatment (new medications, surgery) or an injury (athletes who are at risk for sustaining a concussion)
- inform real-world interventions that are needed, including rehabilitation potential depending on daily functioning
The neuropsychologist will work with your physicians to combine results from medical tests, such as brain imaging, to help clarify diagnosis and help plan interventions. Test findings will help you and/or your child’s school, rehabilitation specialists, and doctors provide treatments and interventions for you and/or your child that will meet your unique needs.
Neuropsychological testing may be repeated at regular intervals to help monitor developmental, cognitive, emotional, and academic progress after treatments and/or injuries. Identification of any changes leads to interventions to help manage challenges. The goal is to develop strategies so that the individual can meet or exceed expectations at home, school, work, or in the community.
Testing results will be communicated with you and/or to your doctors (with your consent) by the neuropsychologist. You will receive a neuropsychological report that you can share with school personnel and others involved in care.
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 also guides the neuropsychologist’s design of interventions to draw upon your child’s strengths. The results identify what skills to work on, as well as which strategies to use to help your child.
- 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. For example, 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. Your neuropsychologist may work with your physician to combine results from medical tests, such as brain imaging or blood tests, to diagnose your child’s problem.
- Most importantly, testing provides a better understanding of the 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.
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 in 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 among Alzheimer’s disease, stroke, and depression. Your physician will use this information along with the results of other tests, such as brain imaging and blood 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 objectively.
- Test results can be used to plan treatments that use 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 you may have in everyday life. This will help guide planning for assistance or treatment.
What you tell your child about this evaluation depends on how much he or she can understand. Be simple and brief and relate your explanation to a problem that your child knows about such as “trouble with spelling,” “problems following directions,” or “feeling upset.” Reassure a worried child that testing involves no “shots.” Tell your child that you are trying to understand his or her problem to make things better. You may also tell the child that “nobody gets every question right,” and that the important thing is to “try your best.” Your child will probably find the neuropsychological evaluation interesting, and the detailed information that is gathered will contribute to your child’s care.
It is important that the child or adult gets adequate sleep the night before and eats breakfast before the evaluation since it can take most of the day. Also, patients should take all medications as scheduled on the testing day. Please provide us with a copy of relevant medical records such as neurodiagnostic tests (brain scans such as CT or MRI; EEG). Please provide a copy of any previous neuropsychological evaluations or academic testing, if available. A copy of an Individualized Educational Plan (IEP) would be helpful. Glasses and hearing aids are important for optimal test performance. If the patient has special language needs, please alert the neuropsychologist to these. Remember to bring your insurance card and driver’s license.Feel free to bring a snack and/or lunch if you do not plan to go to a local restaurant during the break.
- The questionnaires will help us to assess the needs of your child and family so that we can best determine how we can help.
- The information we are asking for is vital to the planning and treatment of your child. We ask for your patience and cooperation in filling out the requested information to the best of your ability.
- The first set of questionnaires will focus on your child and his/her behaviors, while the remaining questionnaires may be related to you and some possible challenges that you may experience as a function of parenting a child with developmental, medical, or behavioral difficulties and these stressors may also impact your child’s behavior.
- It may help to fill out the questionnaires over a period of days rather than in just one sitting. Other parents have also found it helpful to fill out these questionnaires at a time when they are least likely to be interrupted by the kids, such as after the kids’ bedtime. It typically takes about 1 hour to answer these questionnaires which is why we give you this “homework.” We can also set up our iPads in the office so you can do it during your child’s testing.