Maybe the teacher has contacted you. Maybe the pediatrician has raised some questions. Now they have agreed that your child should be referred for testing. What are they looking for?
The question is sometimes as vague as: “Why isn’t this child performing up to his/her potential?” Or there may be a specific focus, such as processing speed, reading ability, attention or concentration. In some cases, testing is required to justify allotting the child additional time on tests.
Assuming a medical professional has already ruled out any possible problems with vision and/or hearing, a neuropsychological or psychoeducational evaluation can determine the best way to proceed with treatment or academic accommodations.
Differences in testing
Depending on the evaluator, the differences between neuropsychological and psychoeducational testing can be either virtually nonexistent or quite dramatic; but a neuropsychological evaluation typically covers more ground.
Evaluators work within two basic models: they employ either a “fixed battery” or a “flexible battery” of tests. Clinicians using a flexible battery try to tailor their tests to the exact demands of the referral question. Clinicians who use a fixed battery employ essentially the same set of tests for all cases; the rationale being that because there are often coexisting conditions, overlaps may not be picked up if an evaluator does not look at all areas of functioning.
If an evaluation is needed to satisfy the requirements of the College Board, specific tests are included. This is true for any of the standardized tests, including the SAT, LSAT, MCAT, and GRE.
What is a neuropsychological evaluation?
A neuropsychological evaluation is an interactive process where the evaluator and student sit together for several hours working on various tasks. Although the idea of being “tested” for several hours sounds grim, the process is usually described by students as “not nearly as bad as I thought.”
A thorough neuropsychological evaluation will cover the following domains:
Cognitive functioning. This is basically an intelligence test, similar to the Educational Records Bureau (ERB) evaluation given to 4-year-olds. It helps determine the overall level of a child’s functioning and provides insight into whether the child is better at verbal or nonverbal tasks. Another aspect of cognitive testing involves processing speed.
Achievement tests. These are academic tests aimed at determining the child’s specific pattern of strengths and weaknesses in the academic domain. Tests are administered in a timed/untimed fashion to establish whether additional testing time is necessary.
Executive functioning. This area encompasses factors such as planning, organization and cognitive flexibility. Executive functioning assesses the skills necessary to complete complex goal-directed tasks (such as planning ahead and completing homework).
Memory. These test short-term, visual and verbal memory, which impact the ability, for example, to copy notes accurately from the board and/or take good notes in class.
Language. These tests examine how well a child processes spoken and heard language.
Visual-spatial skills. These look at traits like the visual-motor coordination demands of handwriting.
Social and emotional functioning. Many children who are struggling in school begin to have a drop in self-esteem. What seems to be a problem with focus may actually be an issue with anxiety. It is important to take note of the child’s current sense of self.
What disorders can be uncovered?
Clinicians present the results of these tests as an accurate description of the child’s strengths and weaknesses. Among the problems a neuropsychological evaluation can pick up are learning disorders, the most common being dyslexia. Despite some common myths, dyslexia is not a problem of simply reversing letters — it involves specific signs and symptoms that can be evaluated.
A common reason for referral is to determine whether a child has Attention Deficit Hyperactivity Disorder (ADHD). While there is not one specific test for ADHD, other problems can be ruled out through careful testing. There are also a variety of tests that can measure functioning in areas associated with ADHD (such as inattentiveness and/or impulsivity).
A thorough evaluation assesses possible behavior disorders or mood disorders. One of the common misdiagnoses of ADHD occurs when a child who appears to be preoccupied is labeled “inattentive”, when in fact the cause of the problem is anxiety-based.
How are the results used for treatment?
In the last example, if a child who looks inattentive is actually anxious, then the treatment might consist of some sort of psychotherapy. If the anxiety is particularly acute, medication might be advised. (The evaluator would not suggest medication, but would recommend a referral to a medical doctor such as the child’s pediatrician or a child psychiatrist. The same would be true if the problem is depression or another mood disorder).
If a learning disability is found, recommendations would be made about specific types of tutoring as well as academic accommodations. There would also be suggestions about what could be done at home. If ADHD is diagnosed, academic accommodations and strategies for parents as well as students would be recommended. In addition, a referral to a medical doctor would be made to look at the possibility of prescribing medication.
Frequently, a combination of issues is determined; there may be a learning disorder that has resulted in a loss of self-esteem and the child is now depressed. ADHD often goes hand-in-hand with a learning disorder.
Strengths and weaknesses
The most important goal of a neuropsychological evaluation is to provide parents with an overview of their child’s strengths and weaknesses. The report itself should be written for parents to decipher it, and should contain enough technical information to be useful for schools, tutors and any mental or medical health professionals who may be involved. The report should contain objective data, generally in terms of percentile ranking, that highlights the student’s strengths and weaknesses. The recommendations section should provide specific strategies and accommodations that will minimize the effect of the student’s weaknesses, and maximize her strengths.
KATHLEEN BERGESON, Ph.D., is a clinical neuropsychologist in private practice in both New York and Pennsylvania. She can be reached at 877-368-8351 or firstname.lastname@example.org.