Neuropsychological Testing for Children and Adults

Neuropsychological Testing

Neuropsychological testing includes examination of abilities on tests of general intelligence or cognitive abilities, academic achievement, and personality functioning. Specific strengths and weaknesses are mapped out, so that each individual has a profile which may allow for further analysis. What is useful and interesting to the neuropsychologist is not the total score on any test, but the profile created by looking at subtest scores and the scatter within each test (intratest scatter) and the scatter among the subtests (intertest scatter).

By analyzing the profile created by neuropsychological test results, neuropsychologists are able to see individual strengths and weaknesses in various domains, including memory, language, attention, concentration (sustained attention), visuospatial functioning, executive functioning, personality functioning, and academic functioning. Tests of cognitive ability differ from those of achievement in that the latter looks closely at how one may function in the school setting, and the former attempts to examine general abilities. For example, there are tests of comprehension in tests of intelligence and tests of comprehension in tests of academic ability. The tests which focus on academic ability provide stimuli in the format often presented in schools, and gives a picture of how the individual functions on a particular domain in the school setting.

Neuropsychological tests may be utilized to address diagnostic issues or issues of functionality. Test results may be utilized to help to understand what it is like to be the person, how the individual functions, and what may be done in order to improve functioning or to maximize his or her potential. For children, the concern may be improving functionality in the home and at school. For the older person, concerns about changes in functioning, such as memory or cognitive functions, may be addressed. Recommendations will be included in any good report, and those recommendations should include training strategies or compensatory strategies as well as treatment recommendations, if any. In many cases, the main question is a diagnostic question. In those cases, specific tailoring of the evaluation may include additional tests or subtests in order to rule out diagnoses.

The actual time required to complete a neuropsychological evaluation varies from person to person. A typical neuropsychological battery will take hours of face-to-face testing by a clinician, followed by report writing. Although the tests themselves include instructions that indicate the administration time for one of the tests used will be one and a half hours, that test may take six hours for one person and two hours for another, if done properly. Experienced clinicians often will 'test the limits' and will provide breaks as needed. This adds time to the testing. A typical neuropsychological test battery will include several tests of varying lengths. The true time it will take to complete an assessment and a more-than-adequate report will surpass the actual time approved by insurance companies. After testing is completed, the neuropsychologist will present the results to the patient so that the results are fully reviewed and understood in lay terms. Typically, the patient is responsible for passing on copies and information to the general practitioner, pediatrician, neurologist, school, lawyer, or other involved parties.

Neuropsychological evaluations may focus on varied diagnostic issues, such as Autism or Pervasive Developmental Disorders, Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, Major Depressive Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder (Overanxious Disorder of Childhood), Substance-Related Disorders, and Mental Disorders Due to a General Medical Condition. Often, individuals seek testing to assess baseline cognitive functioning; check for possible memory impairment, or to check for cognitive changes due to medical illness, surgery, or substance abuse. Parents seek testing for their children in order to assess strengths and weaknesses, to maximize children's potential, or to examine how a child's cognitive, academic, or social functioning is affecting their performance in school or at home.

Dr. Shapiro performs neuropsychological testing for patients of all ages, including young children. The first session or two includes an interview, in which a history is obtained. After the neuropsychological testing is performed, Dr. Shapiro creates an individualized report, which includes recommendations for the home (and school, if applicable). Dr. Shapiro usually completes the writing of her reports within 48 hours of completion of testing. After the report is completed, it is presented to the patient (for children, the report is presented to the family) and fully reviewed.