Pediatric Neuropsychological Evaluations: FAQs by Lindsay Whitman, Ph.D., Pediatric Neuropsychologist

By October 3, 2012Blog

What is pediatric neuropsychology? Pediatric neuropsychology is a specialty that focuses on cognition, learning, and behavior in children and adolescents. A pediatric neuropsychologist typically holds a Ph.D. in clinical psychology and is specially trained to understand the ways that thinking, learning, and behavior are associated with neurodevelopment, brain structures, and brain systems.

A pediatric neuropsychologist uses standardized tests to measure cognitive skills such as attention, executive functioning, memory, visuospatial processing, and language. A pediatric neuropsychologist utilizes the numerical results of these “objective” tests in conjunction with parent/teacher reported functional difficulties, a child’s behavioral presentation, and a detailed clinical history to draw conclusions, consider clinical diagnoses, and generate recommendations.

Pediatric neuropsychologists often work with a child’s doctors and/or therapists to help set goals, monitor progress, and manage expectations. They commonly consult with teachers and/or school officials to help provide necessary educational or academic accommodations. A pediatric neuropsychologist often helps families connect with the appropriate types of therapists (e.g., psychotherapists, speech/language therapists, occupational therapists) in an effort to develop a comprehensive treatment plan.

Pediatric neuropsychologists work in different clinical settings. Many work independently in private practice. Others work in a medical or academic-medical setting such as a hospital, medical school, or specialized health clinic. Often, neuropsychologists divide their time between clinical work with clients and research.

What is a standardized test? A standardized test is a test that is administered and scored in a consistent manner. They are designed in such a way that all questions, test materials, and testing conditions (e.g. in a quiet room, at a desk) are constant across administrations. One must possess specific professional credentials to purchase and utilize standardized neuropsychological tests.

How does a neuropsychological evaluation differ from an assessment performed in school? School based assessments (also known as psychoeducational assessments) are typically performed with one goal in mind: to determine whether a child qualifies for special education programs or therapies. School based assessments focus almost exclusively on intellectual and academic achievement skills. Although this type of evaluation suffices for some children, it is difficult for a professional to responsibly diagnose any difficulty other than a clear specific learning disability with the limited amount of clinical data gathered in this type of evaluation.

What types of children are referred for a neuropsychological evaluation? Children and adolescents are usually referred for a neuropsychological evaluation by a parent, doctor, teacher, school psychologist, or other professional because of one or more of the following reasons:

  • Difficulty with regard to learning and/or academic performance despite adequate attendance and seemingly good attention and effort
  • Difficulty paying attention, maintaining adaptive behavior, socializing, or maintaining emotional control
  • A history of neurological or developmental difficulty known to affect the brain and/or brain systems (e.g., epilepsy, perinatal toxic exposure, a metabolic disorder, possible Autism Spectrum Disorder or ADHD diagnosis)
  • Suspected developmental delay (language, motor, etc.) that are potentially accompanied by other areas of difficulty
  • A brain injury from head trauma or another type of physical stress
  • It is possible that a child may be “gifted” and proper documentation is required
  • It is necessary or desirable to document a child’s current functioning (a “baseline”) or assess progress or change (a re-evaluation or follow-up evaluation)
  • What specific cognitive skills does a neuropsychological evaluation measure?
    A neuropsychological evaluation aims to provide a clear picture of a child’s cognitive functioning with regard to intelligence, academic skills, memory, attention, visuoperception, language, executive functioning (e.g., organization, planning, behavioral inhibition), fine motor skills, emotional functioning, and (sometimes) personality. Depending on the referral question and goal(s) of the evaluation process, some areas of cognition may be measured in more detail than others.

    What will the results of a neuropsychological evaluation tell me about my child?
    Standardized test results enable a pediatric neuropsychologist to compare a child’s test scores to scores of children who are of similar age. With these numbers, a neuropsychologist creates a profile of cognitive strengths and weaknesses. This information is utilized to devise recommendations regarding how to best support this child in school, at home, and perhaps with peers. A neuropsychological evaluation should help one understand the factors that may be interfering with a child’s ability to reach his or her greatest potential.

    If I decide to go forth with a neuropsychological evaluation, what should I expect?
    A neuropsychological evaluation includes a parent/guardian interview regarding the child’s medical, psychological, and academic history, an interview with the child, behavioral observation of the child, and standardized testing. Testing typically involves paper and a pencil, hands on activities, verbal or nonverbal items, and a laptop computer.

    During testing, parents may be asked to fill out questionnaires about their child’s development and behavior. Teachers may be asked to complete similar forms. Although parents are not in the room during standardized testing, it may be appropriate that they remain present during testing with very young children. The time required to complete testing depends on the characteristics of the child or teen; adolescents may complete testing in one long day (with breaks), whereas younger children may require up to three or four shorter sessions. Dr. Whitman completes every aspect of testing herself (she does not involve psychometrists or clinical trainees).

    It is important to make sure a child has a good night’s sleep the night before an evaluation. If a child has special language needs, it is important to be sure that the neuropsychologist is well aware of these. If a child wears glasses, a hearing aid, or any other device, make sure to bring the device along. If a child is on medication, do not refrain from administering it on testing day. If a child has had previous school testing, an individual educational plan (IEP), or has related medical records, bring copies of these documents to the appointment for review.

    What should I tell my child before the evaluation?
    Although it is important that parents understand that pediatric neuropsychologists are trained to emotionally prepare children for the testing process once they arrive at the office, it is likely that a child will ask you questions about the process beforehand. What you should tell them about this evaluation depends on very much on the child. This said, it is usually best to keep explanations brief and simple. It is often helpful to relate explanations to a problem that your child is familiar with (such as “feeling frustrated with school”). Tell your child that adults are trying to understand his or her problem in order to try and make things better. If your child seems nervous about performing “well”, remind him or her that their only job is to try their best.

    If you have further questions regarding the nature or process of a neuropsychological evaluation, please contact Dr. Whitman for a free 30 minute consultation at lindsaywhitmanphd@gmail.com or 347-560-1399. Dr. Whitman also conducts neuropsychological evaluations with adults.