Question 1

What is the purpose of a comprehensive diagnostic or neuropsychological evaluation?

Accepted Answer

Evaluations increase our understanding of cognitive, emotional, and behavioral functioning in relation to difficulties that an individual is experiencing, whether at home, school, or in the workplace. This information augments or goes beyond what can realistically be obtained via clinical observations, interview material, or medical findings. Through an interactive assessment combining standardized written tasks, hands-on activities, questionnaires, and computer "games", a greater awareness about present functioning and future risk factors is gained.
 
Once an individual's unique profile is understood, including aresa of relative strangths and weaknesses, specifically tailored recommendations for direct interventions and accommodations are provided. These recommendations are often essential for the development of optimal treatment, educational, or placement plans, or for qualifying for necessary services.
 
Diagnostic evaluations are also instrumental in re-evaluating current or past clinical impressions or identifying the presence of previously unrecognized disorders. These evaluation can also be utilized to track clinical and/or educational progress over time, serve as baseline when a new disorder or disease process has just been diagnosed, or determine the severity of a medical condition such as epilepsy or traumatic brain injury.

Question 2

Why are individuals referred for evaluations?

Accepted Answer

Evaluations can be particularly helpful when an emerging learning disability, attentional disorder, behavioral problem, memory problem, or language and communication issue is suspected or requires additional verification. These evaluations are also indicated when anxiety or social/emotional difficulties are interfering with an individual's functioning or when it is important to understand the psychological and/or cognitive ramifications of medical conditions (e.g. epilepsy, cancer, etc.) Individuals often self-refer or are referred for assessment by a parent, doctor, therapist teach or other professional because of one or more of the following reasons:
 
- Difficulty in learning, attention, behavior, socialization or emotional control
- Teachers or work supervisors report persistent difficulties
- Poor work performance despite adequate attendance and seemingly good attention and effort
- Problems with retention of information and needs frequent redirection
- Inadequate achievement in school or at work depsite sufficient effort
- History of neurological or developmental difficulties known to affect the brain and/or brain systems (e.g. epilepsy, toxic exposure, metabolic disorder, ADHD)
- Suspected developmental delay (e.g. language, motor, etc.) which may or may not be accompanied by other areas of impairment
- Traumatic brain injury or significant illness that impedes cognitive development
- Specific medical disease or congenital developmental problem that affects brain functioning
- Proper documentation of giftedness or other special educational need is required
- Documentation is desired regarding an individual's current level functioning (baseline) or an individual's progress or change after treatment or previous evaluations (re-evaluation or follow-up evaluation)

Question 3

At what age should an evaluation be considered?

Accepted Answer

It is best to conduct evaluations as soon as possible, especially for children. Nearly all professionals agree that early intervention plays a significant and vital role in the treatment of developmental needs and facilitation of long-term progress. Further, diagnostic evaluations and the resulting reports serve as important tools for documenting the development and pattern of cognitive strengths and weaknesses over time.
 
Evaluations are appropriate for individuals over 2 years of age, although children under 2 years of age may be seen as well, depending on the specific circumstances and referral questions. Our practice will evaluate ages 5 and up.

Question 4

What are the typical parts of the evaluation process?

Accepted Answer

The team at The Neuro Co personally conducts each component of the evaluation process. Most evaluations include the following:  Initial Interview: At the first appointment, the psychologist meets with the patient and/or his/her family in order to gain an understanding of the reason for referral and to obtain a detailed developmental, medical, psychological, educational and, depending on age, occupational history. Evaluation: Testing sessions will be scheduled in typically one session, depending on the age of the patient and the presenting behaviors of concern. During testing, standardized measures are administered in a systematic manner in an appropriate environment. The same tests are not given to every patient, but rather our team devises an individualized battery. Tests generally include a series of interactive activities that assess language and perceptual processing abilities, attention and memory, other cognitive skills, emotional functioning, and behavior. Emerging skills can also be assessed in very young children. Parents and/or family members are usually not in the room during testing, although they be asked to be present with very young children or on a case-by-case basis. The time required for testing depends on the patient's age and problem. An evaluation may take six or more face-to-face hours and may spread across several sessions, depending on the needs of the patient. The evaluation of preschool children is usually shorter in duration. Informal feedback may be provided to family members at the end of each session, as appropriate and relevant to the process. During the course of the evaluation, the following areas may be assessed: - General intelligence- Academic achievement- Attention / concentration- Executive skills, such as organization, planning, inhibition, and flexibility- Learning and memory- Language and communication skills- Visual-spatial skills- Motor coordination- Social interaction skills- Social-emotional functioning- Behavior functioning- Personality and other psychological factors Some areas of functioning may be measured in more detail than others, depending on individual needs. Feedback Session: Approximately one to two weeks after the final testing session, a feedback session will be scheduled. This allows the psychologist time to obtain and score family and/or teacher report measures and to integrate and interpret all of the results gathered in the interview, record review, testing session(s), and behavior checklists. During the feedback session, each assessment that was completed and the subsequent results will be discussed. Based on the individual's performance, individualized recommendations will be offered that draw upon the individual's strengths and needs. Skills and other areas requiring intervention will be identified, and specific strategies and referrals will be offered, as necessary. Report: A comprehensive written report documenting the evaluation results, corresponding diagnostic findings, and subsequent recommendations will be provided upon completion of the evaluation, and approximately 2-4 weeks after in-person feedback of the results is conducted by the neuropsychologist. Families are also offered consultation services both before and after the evaluation process, as needed. Reports are disclosed to other persons, professionals, or agencies upon appropriate written authorization by the patient or patient's guardian.

Question 5

What are some of the benefits of an evaluation?

Accepted Answer

An evaluation is useful in:
 
- Providing or confirming accurate diagnoses and greater understanding of an individual's learning, cognitive, emotional and behavioral profile.
- Determining the effects of developmental, neurological, and/or medical problems on cognitive and emotional functioning
- Identifying specific clinical or developmental syndromes or symptoms of disorders as well as how patients may make progress in various treatment regimens.
- Obtaining a baseline assessment of functioning against which to measure treatment outcomes or positive or negative changes over time
- Assessing the effectiveness of current treatments and interventions
- Determining whether academic difficulties are due to cognitive problems, motivational difficulties, learning disability, or psychiatric problem
- Differential diagnosis, which means clarifying why an individual is experiencing a particular problem thath has a variety of potential explanations
- Determining whether a child qualifies for special education services or accommodations on standardized tests
- Outlining individualized recommendations to help patients develop remedial or compensatory strategies for their difficulties.

Question 6

What tests do you use in an evaluation?

Accepted Answer

Please see the table below for examples of the areas typically assessed as well as a sample of standardized tests* commonly used by The Neuro Co: Intellectual Functioning- Wechsler Preschool and Primary Scales of Intelligence- Wechsler Intelligence Scale for Children- Wechsler Adult Intelligence Scale- Wechsler Abbreviate Scale of Intelligence- Woodcock-Johnson Tests of Cognitive Abilities- Reynolds Intellectual Assessment Scales Academic Achievement- Woodcock-Johnson Tests of Achievement- Wechsler Individual Achievement Test- Gray Oral Reading Test- Gray Silent Reading Test- Wide Range Achievement Test- Kaufman Test of Educational Achievement- Academic Achievement Battery- Nelson Denny Reading Tests Attention/Executive Functioning-Conners' Continuous Performance Task-A Developmental Neuropsychological Assessment-Delis Kaplan Executive Function System-Wisconsin Card Sorting Test-Paced Auditory Serial Addition Test-Behavior Assessment Scales for Children-Conners' Behavior Rating Scales-Behavior Rating Inventory of Executive Function-Comprehensive Executive Functioning Inventory-Tower of London Test Language Processing-Peabody Picture Vocabulary Test-Expressive Vocabulary Test-A Developmental Neuropsychological Assessment-Boston Naming Test-Comprehensive Assessment of Spoken Language-Oral and Written Language Scales Learning and Memory-Wide Range Assessment of Memory and Learning-A Developmental Neuropsychological Assessment-Wechsler Memory Scale-California Verbal Learning Test-Hopkins Verbal Learning Tests-Child and Adolescent Memory Profile-Brief Visuospatial Memory Test Speed of Processing-Wechsler Measures-Woodcock-Johnson Test of Cognitive Abilities-Symbol Digit Modalities Test - Written and Oral Sensorimotor Functioning-Index Finger Tapping-Grooved Pegboard Task-Purdue Pegboard Task-Hand Grip Strength-A Developmental Neuropsychological Assessment-Beery-Buktenica Developmental Test of Visual-Motor Integration Visuospatial Processing-Rey-Osterrieth Complex Figure-Judgment of Line Orientation-Hooper Visual Organization Test-Wechsler measures-A Developmental Neuropsychological Assessment-Beery-Buktenica Developmental Test of Visual-Motor Integration Social Functioning-Autism Diagnostic Observation Schedule-A Developmental Neuropsychological Assessment-Autism Diagnostic Interview-Autism Spectrum Rating Scales-Social Responsiveness Scale-Social Communication Questionnaire-Childhood Autism Rating Scale-Adaptive Behavior Assessment System Emotions/Personality-Minnesota Multiphasic Personality Inventory-Personality Assessment Inventory-Beck Depression Inventory-Geriatric Depression Inventory-Beck Anxiety Inventory-Geriatric Anxiety Inventory-Behavior Assessment Scales for Children-Clinician Administered PTSD Scale for DSM-V-PTSD Checklist for DSM-V*Note that the battery of tests performed will vary based upon each individual case.

Question 7

What is a standardized test?

Accepted Answer

A standardized test is a measure that is administered and scored in a consistent manner and then compared with the appropriate age and/or group norms. They are designed in such a way that all questions, materials, and conditions are consistent across administrations. One must possess specific professional credentials to purchase, utilize, and to interpret standardized tests.

Question 8

What should I tell my child about the evaluation?

Accepted Answer

Our team is trained to assist children with adjusting the evaluation process once they arrive at the office. It is often helpful to prepare a child in advance. Most often, it is best to keep explanations brief and simple. For example, an older child might be told that they are going to be trying memory games, puzzles, learning tasks and "brain teasers". Younger children and toddlers can be told they are going to play puzzles and "thinking games". If a child asks, "Why do I have to do this?", they may be informed that these activities help to identify what they do best; and also what is hard for them. A further explanation may be given about trying to find ways to help them with difficult skills, such as paying attention, solving math problems, or organizing homework. Some children find it helpful if explanations are related to a problem that the child is familiar with (e.g. "feeling frustrated with school"). If the child seems anxious about performing "well", reminding him or her that their only job is "trying" is often beneficial.

Question 9

Is there anything else I should know before I come into the office for a testing appointment?

Accepted Answer

Comprehensive evaluations often take an entire day. It is important to make sure there has been adequate sleep the night before an evaluation and that the person does not arrive to the session without eating. If special language needs are evident, it is important to be sure that the psychologist is well aware of these. Similarly, if the individual wears glasses, a hearing aid, or any other device, please make sure they bring them. If any medications are prescribed, do not refrain from administering them on the day of testing. If a child has had previous school testing, an individual educational plan (IEP), or has related medical records, please bring copies of these documents to the appointment for the case record. See our intake packet for additional information.

Question 10

What is a neuropsychologist?

Accepted Answer

A neuropsychologist is a licensed psychologist that specializes in studying brain-behavior relationships. Neuropsychologists receive extensive training in evaluating learning, cognition, and behavior in relation to neurological structures and systems. By objectively testing various skills, such as attention, memory, and/or language skills, neuropsychologists are able to assess an individual's complexities of global brain functioning in areas that cannot be measured by scans or laboratory tests (e.g. information processing, abstract reasoning, or memory functions). In order to be considered a neuropsychologist, major professional organizations such as APA, NAN, and INS, have outlined specific training guidelines. Specialization in clinical neuropsychology begins at the doctoral (Ph.D. or Psy.D.) level. In addition to gaining essential core academic knowledge, skill competencies must be further developed by completing an APA approved internship with extended speciality preparation in clinical neuropsychology. Additionally, a neuropsychologist must complete a supplementary two-year post-doctoral training experience.

Question 11

How is a neuropsychological evaluation different from testing performed at school?

Accepted Answer

When schools conduct school-based assessments (also known as psychoeducational assessments), they are typically performed to help determine eligibility for special education and related services. These evaluations focus primarily on intellectual and academic achievement skills needed for academic success, whereas comprehensive psychological and neuropsychological evaluations provide detailed information regarding a child's strengths and weaknesses across a variety of cognitive domains. By objectively testing various skills, neuropsychologists are able to assess an individual's overall cognitive, developmental, and psychological functioning, leading to a diagnostic formulation and to recommendations linked with what that individual's unique profile of results. School assessments do not diagnose learning or behavior disorders caused by altered brain function or developmental delays. Although a psychoeducational evaluation suffices for some children, it may miss the more nuanced learning problems of other children.

Question 12

What is an ADHD assessment?

Accepted Answer

The Neuro Co will tailor evaluations to meet the individual needs of each patient, but in general our ADHD battery includes an assessment of intellectual and academic functioning as well as an investigation of other neurocognitive functions. Each assessment also includes parent and teacher forms to report on the patient's emotional, behavioral, and social functioning outside of the testing session. Once the evaluation is complete and the data have been analyzed, we prepare an integrated written report outlining the relevant background and developmental information, assessment results and interpretations, and recommendations. We develop specific recommendations for intervention, accommodations, and modifications for each child that are not only linked to the child's unique profile, but also supported by research. Parents and other stakeholders have the opportunity to provide feedback on the intervention and strategies recommended and to make contributions to the overall report because our team seeks your expertise in this collaborative process. Because up to 70 percent of individuals diagnosed with ADHD have a co-occurring condition or disorder, it is usually recommended to complete a full battery of testing in order to consider common co-existing disorder, such as learning disabilities and anxiety disorders, as well as executive functioning concerns. Additionally, by undergoing a comprehensive evaluation, you will ensure that your child's attention deficits are not due to other often overlooked disorders, such as OCD, Auditory Processing Disorder, or Seizure Disorder.

Question 13

How do I find out if my child has a learning disability?

Accepted Answer

In order to determine whether or not your child suffers from a learning disability, formalized testing and/or data collection will be necessary. First, a parent may want to contact their child's principal to discuss their observations and concerns. A meeting should then be arranged with the child's teacher and other service providers in order to see if others also suspect a learning problem. If everyone agrees the child is struggling academically, the school may initiate individualized data collection in response to various levels of academic supports and interventions they agree to put into place for the child. A psychoeducational evaluation might also be started. Parents can also elect to seek out private psychoeducational or neuropsychological evaluations. Psychoeducational evaluations focus primarily on intellectual and academic achievement skills necessary for academic success, whereas neuropsychological evaluations focus on educational issues as well as altered brain function or developmental problems causing learning or behavioral difficulties. A significant part of both assessments is investigating the child's IQ, information processing, and academic achievement. In a neuropsychological evaluation, the clinician might also specifically examine cognitive functions, such as attention capacity, motor skills, or language functioning. In addition to formal testing, both evaluations will include clinical interview as well as parent, teacher, and self-reports of functioning outside of the testing session to clarify whether the learning difficulties are resulting from another attentional and/or emotional issue. Once the results of testing are analyzed, the clinician will perform a detailed feedback session with the parents/caregivers in order to review the specific areas of strength and weakness identified in testing. The diagnostic impressions are reviewed, and we educate the parents about any available special programs offered by the school, such as a 504 plan or the Exceptional Student Education (ESE) program. Individualized treatment recommendations and corresponding referrals are given based on the findings. A detailed report of this information is also offered. The Neuro Co is highly skilled in preparing reports that are useful to school districts. We encourage parents to share our evaluation report with the child's school for consideration for accommodations, modifications, and services to address any found learning disabilities or educational needs. Since we hope to help children function at their optimal level in all facets of their lives, The Neuro Co will support you in any way while you navigate the school process. We are available in person or by phone to educate school personnel about our test findings and recommended interventions, accommodations, and/or supports.

Question 14

How much do your services cost, and do you accept insurance?

Accepted Answer

We are not contracted with any insurance companies. Depending on the plan and deducible, reimbursement from your company for consultations and neuropsychological evaluations may be available. Patients or their families are encouraged to submit superbill receipts to their carriers after paying for services directly to The Neuro Co. Full payment is required at the time of service. Please call us for information regarding pricing of our various consultative and evaluation services.

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