What Is Clinical Neuropsychology and Pediatric Neuropsychology?
Clinical neuropsychology is a specialty profession that focuses on brain functioning. In clinical neuropsychology, brain function is evaluated by objectively testing motor, sensory, memory and thinking skills. A very detailed assessment of abilities is done and the pattern of strengths and weaknesses is used to assist with diagnosis and treatment planning. Pediatric neuropsychology also addresses how learning and behavior are associated with the development of brain structures and systems.
Why Are Children and Adults Referred for Neuropsychological Assessment?
Children are typically referred because of difficulty in learning, attention, behavior, socialization or emotional control. They also may be referred for neuropsychological assessment because of a disease or developmental problem that affects the brain in some way. Both adults and children may be referred when there is a brain injury from an accident, illness, or other trauma, or there is some unexplained change in the persons concentration, organization, reasoning, memory, language, perception, coordination, or personality.
What Is Assessed?
A typical neuropsychological evaluation will involve assessment of the following:
Executive skills such as organization, planning, reasoning and problem-solving
Attention and concentration
Learning and memory
Receptive and Expressive Language
Visual-spatial skills (e.g., perception)
Motor and sensory skills
Behavioral and emotional functioning
Achievement skills such as reading and math
Some abilities may be measured in more detail than others, depending on the individual’s needs. Emerging skills can be assessed in very young children. However, the evaluation of infants and preschool children is usually shorter in duration, because the child has not yet developed many skills.
What Will the Results Tell Me?
Test results can be used to understand the patient’s 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 reflecting 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 on 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," for documenting a persons skills before there is any problem. In this way, later changes can be measured very objectively.
Test results can be used to plan treatments that use strengths to compensate for weaknesses. The results help to identify what cognitive problems to work on and which strategies to use. For example, the results can help to plan and monitor a cognitive rehabilitation therapies following 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 and treatment.
Testing can explain why your child is having school problems. For example, the child may have difficulty reading because of an attention problem, a language disorder, and auditory processing problem, or a reading disability. Testing also guides the pediatric neuropsychologist to design interventions that 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. The profiles of abilities can help identify 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 processing language, social shyness, autism, or cognitive delay.
Most importantly, testing provides a better understanding of the child’s behavior in learning and 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.
What Should I Expect?
A neuropsychological evaluation usually includes an interview and testing. A detailed intake history form and symptom checklist is filled out by adult patients or parents of children prior to the initial visit. During the interview, information that is important for the neuropsychologist to consider will be reviewed. The testing involves taking paper-and-pencil or computerized tests and answering questions. The time required to complete the testing depends on the problems being assessed. In general, several hours are needed to assess the many skills involved in processing information. Some tests will be easy while others will be more complex. It is important that the person being tested gets a good night’s sleep before the testing. Also, it is important that glasses or hearing aids be used during the evaluation. Any medications that are being taken at the time of testing should be reported to the examiner.
More sensitive than CT, MRI or EEG in detecting brain impairment/dysfunction.
Provides objective information regarding functional limitations.
This information can be used to develop helpful treatment interventions.