What is a Neuropsych Anyway, and Why is it Necessary?

Under the FAQs pages on many websites you’ll find information about different types of testing.  The original neuropsychological evaluation included medical testing to find areas of brain dysfunction in those who may have suffered a head injury or disease such as Parkinson’s.  It was also intended to address attention and/or working memory issues, particularly in cases where medication might be prescribed.  In addition to an MRI or other medical tests, an individual would take tests that might include a general intelligence test to measure working memory, logic and verbal acuity.  By contrast, a psychoeducational evaluation would be administered by a professional with an educational background.  This would include intelligence testing (as described previously) along with educational tests, and ability versus educational levels were compared.

Over time, testing has become increasingly sophisticated.  We now have measures for executive functions beyond the original Stroop Color Word Test and the Wisconsin Card Sort that were the gold standard of their day.  The Rey Complex Figure Drawing provides more than a glimpse of memory or visual-perceptual weaknesses.  The Trail Making tests measure more than just speed.  As for educational testing, the breadth of interpretation has changed dramatically.  The ability versus academic level discrepancy model has long since been discarded, and a skilled professional catches the subtleties of skill weaknesses through observation and an array of different approaches to the same content areas, such as silent versus oral reading and timed versus untimed performance.

Now you may ask–so what does all this have to do with anything?  The short answer is that what was known as neuropsych testing and what was known as psych-ed testing has morphed into a discombobulated and confusing universe of five dollar words that mean little or nothing to the average person.  Some professionals will tell you one is superior to the other, while others will say that’s not true.  Some professionals perform some parts of each, while some perform none of these tests.  Neuropsychologists, Clinical Psychologists, School Psychologists, and Educational Psychologists among other professionals often perform overlapping tests.  And why does it matter who does the testing?  Or what type of testing is done?  The short answer is–it depends on what you want/need to know.

So why does one get tested (or refer their child for testing)?  Perhaps the individual is acting out or struggling with strong emotions.  Or they are struggling with attention.  Or with math.  Or with school in general.  Maybe they had a head injury that seems to have affected the speed with which they complete tasks.  Or their memory.  In any event, the goal of any evaluation should be to determine what the individual’s strengths and/or weaknesses are, and what can be done to help them achieve whatever is hoped for them to achieve (such as learning to read, learning to work independently, learning to manage their emotions, etc.).  And how do you decide what testing you need?  Instead of answering that question, I would like you to consider some questions you might ask a provider:

  • Our daughter has poor attention.  Do you test for that?
  • Our son is struggling in school.  Do you test for learning disabilities?
  • I am very depressed and anxious.  Are there tests for that?
  • Can you diagnose learning disabilities/attention deficit disorders/mental health disorders?
  • We had his eyes checked and he wears glasses, but he’s struggling with reading.  Do you test for dyslexia?
  • She doesn’t make eye contact and doesn’t have friends.  She doesn’t communicate much.  Does that mean she’s autistic?  Are there tests for that?
  • My son was always a strong student.  Now he just sits in his room all day and plays video games.  His grades have fallen and he doesn’t eat right or talk to anybody.  I’m concerned.  Should he be tested?

You may have more than one of these questions to ask–and that is okay, too.  Think about what you are looking for, even if you’re really not sure what it is, and see if you can frame it into a question.  An ethical professional will answer you and will ask you questions in an effort to figure out exactly what is needed for you or for your loved one.  Sometimes, a couple of different professionals will be needed as part of a team effort (such as a Clinical Psychologist to find underlying emotional dysregulation, and a physical exam to see if there are medical symptoms that may be amplifying those emotions).  Sometimes, one professional will be sufficient.  Sometimes, you may begin the work with one professional who will then suggest that perhaps something different is needed.

Another important consideration in selecting an evaluation is learning something about the experience and knowledge of the evaluator.  I have had families call and ask about other clinicians in the area.  I will not “rate” my competition–it would be highly unethical!  Besides, I know many good folks out there who do a fine job, so I am not going to insult them in order to get your business.  I can, if asked, provide copies of sample reports.  That can be helpful for parents who might realize they are seeking something different.  For other parents, that has been excessively helpful in pointing them in my direction.  There are also your referral sources to consider.  I, like many of my colleagues, refer routinely to other professionals when I think that a family’s needs are outside the parameter of the services I offer.  At the same time, there are many pediatricians and family health providers who regularly refer parents to me, as they already know what I do and what I can offer.

In summary, don’t feel like you have to do something, especially if it’s not warranted; however, don’t be afraid to move forward if it is.  Ask questions.  And if you don’t get satisfactory answers, ask someone else.

What is a Neuropsych Anyway, and Why is it Necessary?

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