Pediatric Neuropsychology

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.

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.

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)

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.

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.

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 will be asked to fill out questionnaires about their child’s development, functioning, and behavior. Teachers will be asked to complete similar forms. 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 four shorter testing sessions.

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.

Although pediatric neuropsychologists are trained to prepare children for the testing process once they arrive at the office, it is likely that a child will ask their parents questions about the process beforehand. I recommend that you be honest about what the experience will be like and keep things brief. Tell your child that he/she will be meeting a new adult who is excited to get to know him/her. Tell him/her that he/she will be doing things like working with blocks, drawing shapes, listening to instructions, and answering questions. Let them know that they will be able to take play and snack breaks. Most importantly, emphasize that he/she will feel successful and that their only job is to try their best.