What is a neuropsych evaluation?
As Dr. Pickar explains it, a neuropsychology evaluation is a way to evaluate how someone learns and processes information. This testing might be used to help evaluate learning challenges, cognitive functioning, academic function, or psychological functioning.
A typical neuropsych evaluation involves 6-8 hours of testing, and may be done over one day or spread out over several days. The neuropsychologist works closely with the student throughout this time, engaging them in a wide range of short, fairly interesting activities. Once the testing is complete, the neuropsychologist will put together an evaluation.
What can be determined from neuropsych assessments?
These assessments provide information in two different areas. The first is how the student processes information in a range of domains. These skills, which are considered more “innate,” include:
- verbal skills
- spatial skills
- attentional skills
- memory skills
- reasoning skills
- organizational skills
The second area that is measured is academic skill development. This information gives a clearer picture of where a student is in terms of the skills developed in an educational environment, which include:
Each of these skills has multiple components, which are addressed through various portions of the neuropsych assessment.
The tests are standardized, although a student’s score is considered within a range: it may vary from day to day depending on factors such as sleep and stress. These standardized results allow for a student’s performance to be compared to the average scores of other students of the same age. There is also the opportunity to draw internal comparisons, such as comparing a student’s verbal skills to their reasoning skills. Differences between the “innate” skills and the “educational” skills are common. For example, a student might have excellent vocabulary skills but have significant difficulty learning to read; this may indicate a condition such as dyslexia.
What happens after the assessment?
The neuropsychologist will prepare a written report that details the student’s strengths and challenges. This will come with a set of recommendations.
Parents receive this report in a private conference, during which they and the neuropsychologist discuss the testing results and what kind of assistance the student might be eligible for that the parents might want to pursue. Dr. Pickar also recommends a separate private conference with the student, where the parents might join at the end of the conversation. It may also be appropriate for the neuropsychologist to share the results with a student’s school, particularly if the recommendations include any kind of special education programming or academic accommodations.
When does a student need neuropsych testing?
The short answer is that anytime a student is having trouble with some aspect of learning, a neuropsych assessment can be incredibly valuable. The student may bring up the concerns directly to their parents, or the parent may notice the student having certain difficulties. In many cases, one or more of a student’s teachers will notice the issue in the classroom and can bring it to the parents’ attention.
These assessments not only determine areas where a student is having learning challenges; they can assess personal strengths as well. This makes neuropsych testing an option for parents who want to know if their child is gifted. That’s a reasonable question to ask, because there are many opportunities for additional enrichment that might be appropriate for some students.
Are there any public testing alternatives available?
There is testing available within the public school system, known as a core evaluation. Even students who attend private school can request this testing be done through their zoned public school. The cognitive testing is typically administered by a psychologist, while the academic skill testing is administered by an individual with an educational background. This can be a good choice for families who don’t have the resources to do private neuropsych testing. However, parents should be aware that this testing is not as in-depth as the neuropsychological assessment that a private provider can offer.
This kind of assessment can be useful in determining whether a student needs special education or classroom accommodations. In cases where private testing has been done, the school district has the right to insist on its own assessment process before the student is placed into any special programs (although schools often deem this unnecessary). Some school districts do not feel it is within their purview to diagnose students; therefore, they may be reticent to say that a child has dyslexia, ADHD, or other conditions. The quality of assessments varies from school district to school district, so parents should talk to other parents in their area or consult with their local SEPC (Special Education Parent Committee) for additional information.
What about insurance coverage for these tests?
Coverage tends to vary from carrier to carrier, so parents should always check with their own insurance company to see whether neuropsychological assessments are covered. Often, if the testing is performed for an “educational” purpose, it is not covered. If, on the other hand, a student is being tested to potentially diagnose a condition such as ADHD, then the testing may be considered “medical,” thereby making it eligible for coverage. Parents may then be able to use the assessment results for other educational purposes.
How can neuropsych testing help students?
Students benefit from undergoing neuropsych assessments in a number of ways:
- Understand their own challenges: Many students feel immense relief knowing that they have concrete challenges or difficulties in certain areas. This helps them understand themselves better and also avoids drawing mistaken inferences about their intelligence or abilities.
- Prevent secondary emotional issues: Students with learning challenges may also struggle with anxiety, guilt, a lack of motivation, low self-confidence, or fear. By addressing the root causes of their challenges, a student may be able to prevent or mitigate these secondary issues. Psychotherapy or counseling may be useful to help students manage these concerns.
- Determine eligibility for assistance or accommodation: We’ve already touched on this, but an assessment of this kind is generally required to determine whether a student is eligible for help in the classroom, such as through special education programs, or whether they may need accommodations, such as additional time to take tests and exams (including standardized tests such as the SAT and ACT).
- Help parse the difference between “will” and “skill”: It is all too common for parents to mistakenly attribute a student’s academic difficulties to a lack of motivation or a refusal to try. Often these behaviors are actually a response to an underlying learning challenge. When parents better understand what their students are facing, they are able to bring more compassion and better strategies to the situation.
- Learn techniques for managing learning challenges: The first step to finding a solution for any problem starts with awareness of the problem. Once a student and their parents understand any learning challenges the student has, they can begin to seek out solutions and strategies for improving the student’s skills and minimizing the effect that any challenges have on a student’s academic performance and overall well-being.
What are the concerns around neuropsych testing?
There is some concern among parents that identifying a student’s learning challenges or providing a diagnosis will lead to a mentality of either entitlement or helplessness. In other words, students will expect the world owes them something because of their difficulties, or will feel incapable of achievement and will not live up to their potential.
In terms of entitlement, it is sometimes suggested that offering students accommodations in school sets an unrealistic precedent that won’t be matched in the “real world.” The fear is that students will grow up expecting the world to make exceptions for them and won’t learn to perform at the same level as their peers. Dr. Pickar thoughtfully points out that, in fact, many adults make accommodations for themselves in the “real world.” For example, a student who struggles with verbal skills is unlikely to become a journalist or a language arts teacher. A CEO who has difficulty with organizational skills may hire an administrative assistant to help them stay on top of things.
With respect to students feeling helpless when diagnosed with a learning challenge, Dr. Pickar reiterates that having a clearer picture of what’s going on helps a student get the best support possible. Many students are already feeling depressed or demoralized because school is difficult. They may appear disinterested or unmotivated, which can frustrate parents who perceive the issue to be a lack of effort. However, a comprehensive neuropsych assessment can tease out the underlying issues which may be causing a student to give up easily or act like they don’t care. Having this context allows parents to be more compassionate and allows students to get the help they need.
As students learn new strategies for addressing learning challenges, their habitual behaviors, attitudes, and thought patterns may need to be addressed as well. This is where psychotherapy and counseling can be particularly useful. A trusted professional can help a student accept their learning challenges while reducing or preventing a sense of helplessness or entitlement.
For students with learning challenges, being told to “try harder” is like telling someone who needs glasses, “Just look harder.” The effort is wasted until the proper support system is in place. Neuropsych testing can give students a better sense of why certain activities or subjects are difficult for them, and offer parents perspective on where their student is coming from. Armed with this information, families can move forward with a plan that makes the necessary accommodations to help students flourish and grow during their high school years.
Dr. Jeffrey Pickar is a neuropsychologist who has provided psychotherapeutic and psychodiagnostic services for children, adolescents, and adults for over 25 years. His work utilizes neuropsychological and psychological evaluations to assist children with learning, developmental, and psychiatric difficulties; he also consults with public and private schools about the needs of such children. Dr. Pickar is the former Coordinator of Outpatient Child and Adolescent Psychological Services at McLean Hospital as well as the former Co-Director of the Learning Evaluation Clinic at McLean Hospital, where he continues to supervise postdoctoral fellows.