The list below outlines some areas of concern that may lead to making a referral for a neuropsychological evaluation:

•    Learning disorders and learning differences
•    Inattentiveness, hyperactivity, impulsivity
•    Executive-functioning weaknesses, such as difficulty planning and organizing
•    Processing-speed deficits
•    Language disorders or delays
•    Visual-spatial, visual-motor, fine motor deficits
•    Intellectual disability
•    Autism spectrum disorder
•    Anxiety
•    Depressed mood
•    Behavior difficulties in the home or at school
•    Deficits in learning and functioning secondary to neurological and/or birth conditions (e.g., seizure disorders, epilepsy, traumatic brain injury, brain tumors, acquired or congenital hydrocephalus, premature birth)
•    Giftedness combined with difficulties in learning or other areas

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Components of a neuropsychological evaluation are determined based on the reason for referral, or need for the evaluation, as well as whether or not the child has received assessment in the recent past by another clinician. In general, a neuropsychological evaluation will typically include assessment of intellectual functioning (IQ), academic achievement, attention and executive functioning, and emotional and behavioral functioning. The evaluation may also include more in-depth assessment of visual-spatial and visual-perceptual skills, visual-motor and fine motor coordination, verbal and visual memory, aspects of language, and adaptive functioning.

Intellectual Functioning (IQ)

Intellectual functioning refers to an individual’s ability to reason and problem solve. It is often broken down into two parts: verbal and nonverbal reasoning abilities. Verbal reasoning is the ability to understand and use words (language) in solving verbal problems and/or thinking about concepts. Tests for verbal reasoning usually involve solving verbal puzzles and providing word definitions. Nonverbal reasoning is the ability to understand and analyze visual information. Tests can highlight an individual’s ability to solve visual puzzles, complete patterns, and use blocks to recreate target pictures.
There are also two underlying areas of cognitive skills that support verbal and nonverbal reasoning: working memory and processing speed. Working memory is the ability to hold many pieces of information in the mind while working with them. An example would be keeping a shopping list in mind or remembering complex directions without writing them down. Processing speed is the speed at which we process information and perform automatic tasks. When children process information more slowly than their peers, it may take them longer to understand new information and/or complete assignments.

Academic Achievement

Academic achievement includes assessment of math calculation and math problem solving, basic reading and reading comprehension, writing composition and spelling, and academic-readiness skills that support learning.

Attention and Executive Functioning
Attention refers to a person’s ability to selectively concentrate on a task while ignoring distracting stimuli. An individual’s ability to maintain attention serves as a baseline to all higher order processes, including visual-spatial skills, memory, and language. Executive functioning is the ability to plan, shift between sets of information, inhibit impulsivity, and self-monitor. When psychologists test executive-functioning skills, they are assessing a set of higher-level cognitive processes that act in a coordinated way to cue the use of other primary cognitive skills such as attention, language, and perception. Executive functions are responsible for a person’s ability to engage in purposeful, organized, strategic, self-regulated, goal-directed behavior, as well as creative and abstract thought. Because different executive functions work both independently and in tandem, one executive capacity may be well developed, whereas others may not.

Verbal and Visual Memory

Memory involves various processes, including the capacity for encoding (mentally processing information so it can be entered into memory), storage (holding that information for a period of time), and retrieval (accessing or recalling stored memories when needed) of the information. Visual memory refers to the capacity to store and process visual stimuli, whereas verbal memory refers to the capacity to store and process verbally presented information.

Visual-Spatial and Visual-Perceptual Processing
Visual-spatial processing refers to the visual cognitive skills involved in processing and interpreting meaning from visual information. This skill allows an individual to develop spatial concepts, as well as to judge the orientation of lines and angles, location, directionality, and relationships of objects in space.

Visual-Motor and Fine Motor Coordination
Visual-motor processing refers to the degree to which individuals can integrate their visual and motor abilities. Fine motor skills refer to the coordination of small muscle movements, including an individual’s ability to accurately manipulate small objects, such as a pencils, buttons, scissors, etc.
 

Language (Receptive, Expressive, Pragmatic)
Language refers to the human system of communication. Language falls into two categories: comprehension (receptive) and production (expressive). Furthermore, language can be examined at various levels: form (phonology, syntax, and morphology), its content or meaning (semantics), or its use (pragmatics). Phonology is the aspect of language concerned with the rules that govern the structure, distribution, and sequencing of speech sounds. Syntax describes the rule system that governs how words are combined into larger meaningful units of phrases, clauses, and sentences, while morphology describes the aspect of language that governs word structure and includes grammatical word inflections that carry tense. Semantics refers to the aspect of language that governs the meaning of words and word combinations, while pragmatics refers to the social use of language.
 

Adaptive Functioning (Behavior)
Adaptive functioning refers to the skills that are needed to meet the natural and social demands of one’s environment. Adaptive behavior includes day-to-day activities necessary to take care of oneself and get along with others. Expectations for adaptive skills depend on a child’s age and may include: communication skills, daily living skills, socialization, and the ability of the child to regulate their emotions and behaviors.
 

Emotional Functioning / Emerging Personality Traits / Love Language

Emotional functioning looks at underlying emotional processes such as anxiety, depression, anger, somatization, grief, sadness, and other emotions children experience. Understanding your child’s unique emerging personality traits, unmet needs, and love language help us tailor a specific intervention plan to help regulate their big feelings and undesirable behaviors. 

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While each referral question is specific to the child, our general process of evaluation with us is as follows:

Parent/Guardian Intake
Intake is a medical provider's term for getting to know you. The parent intake session will usually take place at the beginning of the evaluation and is an opportunity for the parent or guardian to provide information regarding the child’s developmental, medical, educational, and psychological history. It also is a good opportunity to ask any questions you have about the process. This meeting usually takes an hour.

Child Intake and Neuropsychological Testing
This is probably the first time the psychologist will meet your child. They will talk to your child, make sure your child is at ease, and answer any questions your child (or you) might have.

Depending on your child’s age, they may be asked to fill out some questionnaires about their everyday feelings and how they interact with other people. Then, they will begin various tests with the psychologist.

During testing days, your child will typically meet alone with the psychologist over one to two days for the length of a typical school day. However, the length of time for testing depends on the age and abilities of the child, as well as the reason for referral. Some re-evaluations or very brief evaluations only take one day to complete. Others tend to work in three- to four-hour periods. When the testing sessions are longer, there are usually many breaks between tasks, as well as a generous lunch break—your child will not be working the entire time!

Classroom Observation and Consultation with Schools
A classroom observation is sometimes recommended to view the child’s behavior in the classroom setting. The psychologist may look for functioning in the classroom in the following areas: behavioral response to teachers and peers, social interactions with peers, ability to work independently when expected, compliance with adult directives, ability to sustain attention with tasks, and any withdrawal or anxiety in the classroom.

Feedback Session
Results of the evaluation and associated recommendations will be reviewed during the feedback session with the parent(s) and/or guardian(s). The results are often shared with a referral source in addition to the parent(s) or guardian(s) such as the school if the parent consents. The child is sometimes included in part of the feedback session, if appropriate given the child’s age and level of functioning. The parent receives a comprehensive report with the information covered at the feedback session, diagnosis and treatment plan. 

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ARD Meeting / School Meeting

Our psychologist will join you for an ARD meeting to share the testing results and ensure that your child receives all the appropriate accommodations and recommendations they are entitled to under state and federal law. If your child does not have or does not need a 504/IEP, our psychologist will meet with school teachers and staff to help them understand your child better.