The word "comprehensive" defines the scope of an evaluation process. It means that it takes into account everything that is necessary to make an informed decision and come to a reasonable conclusion to the origin of challenges, experienced by the child. It is a rather exhaustive assessment and focuses on finding the origins/causes of described problems/difficulties in a child's functioning in a top-down fashion, meaning that we take history, observations and testing in all areas of cognitive functioning into account when making our conclusions. It is a holistic approach to assessment instead of looking at isolated pieces of a puzzle one at a time (this is not always needed, please see FAQ section). In addition, neuropsychologists have extensive experience and training in identifying brain-behavior relationships and are best qualified to interpret and analyze testing patterns. It is not about scores per se (single test scores rarely if ever directly translate into everyday functioning of the individual) but about patterns and understanding what causes these patterns across a test profile. One can obtain (almost) identical test scores on the same administered measures; yet the reason for the underlying 'pathology' or processing style might be completely different for each individual.

 

Types:  

• private evaluations referred either by parents who have their own concerns or who are advised by other professionals to obtain more clarification about their child's functioning

• legal evaluations referred or requested by attorneys and/or advocates

• Independent Educational Evaluations (IEE), typically referred by a specific school district for a third-party opinion

 

Procedure of a typical evaluation:

• an initial phone consultation to evaluate whether an evaluation is necessary and desired at this point in the child's life

• when the answer is affirmative, an initial parent/caregiver interview is conducted

• parent/teacher questionnaires are administered

• educational/medical record review 

• a consultation with involved professionals in the individual's life is done to obtain as much collateral information as possible

• at least 2, often 3 testing sessions are performed with the individual

• in person observation (during testing and in classroom if necessary)

• scoring of test data and interpretation of all the information obtained during the evaluation process

• a feedback session with parents and/or individual, depending on age and level of insight

• a report delineating results, conclusions, diagnosis (if criteria met), and recommendations is produced 

• additional follow up is provided as needed for clarification, advocacy and consultation with teachers/professionals involved in the individual's life and education

 

Areas of functioning assessed using a variety of tests and tools:

Any type of neuropsych assessment is dynamic in that it is driven by the referral questions, and must take into account intermediate results to drive further testing in focused areas. Certain areas of mental functioning, like intelligence, are almost always part of testing but the depth of testing in other areas may vary depending on what is reported as an area of concern/weakness. However, as testing progresses, I might chose to dig deeper in certain areas that were not noted as problematic originally, because I develop working hypotheses on the origin of described challenges. Assessment is exciting because we cant assume we know the answer before we are given adequate signals to be guided to the answers, and even that remains an approximation of what we claim to know.

 

Areas of functioning typically assessed by testing include:

 

• general intelligence (IQ)

• language skills (e.g., receptive-expressive; phonological processing/awareness; pragmatics)

• social pragmatics (e.g., ability to process nonverbal aspects of communication, empathy, taking another person's perspective)

• visual-spatial reasoning and conceptualization skills

• visual-motor integration and fine-motor skills

• academic achievement

• various types of attention (e.g., focused, sustained, divided, shifting attention)

• various aspects of verbal and nonverbal memory (incidental, short/long term, recognition, declarative vs. procedural, discrete vs. complex information recall)

• executive function skills (i.e., higher order cognitive skills, planning, organization, self-monitoring, initiation, inhibition etc.)

• adaptive functions (ability to function independently in everyday life)

• social-emotional functioning (often, emotional problems are tightly intertwined with cognitive issues, and testing is a way to tease apart what are the primary and secondary issues)

 

Conditions typically assessed:

 

1. Neurodevelopmental disorders/conditions

• Learning differences/learning disabilities in all areas of academics

• Information processing challenges affecting learning 

• Attention deficit/hyperactivity (ADHD) and other dysregulatory disorders

• affective disturbances, such as depression and anxiety, and any other psychiatric condition

• Genetic disorders (e.g., Down syndrome)

• Autism Spectrum Disorders

• Intellectual developmental disorders

• Language/social-pragmatic disorders

 

2. Acquired brain injuries/illness

• Traumatic brain injury

• Brain tumors, leukemia

• Side effects of treatment (e.g., chemotherapy and radiation) on the developing brain

• Epilepsy/seizure disorders

• Cerebral vascular accidents

• Cerebral palsy

• Other medical conditions affecting cognition/learning