What is the difference between a neuropsychological (NE) and a psychoeducational assessment?
The main differences are breadth, depth and utility. A comprehensive NE takes into account history, family dynamics, all aspects of cognitive functioning, emotion regulation and behavior expressions when interpreting cognitive profiles and finding possible underlying causes for observed challenges. NEs must be administered by psychologists who have extensive education and experience in understanding brain-behavior relationships and integration of test findings. No single test is definitive or determinative of a specific deficit/weakness. Psychoeducational testing is typically more narrow, and is targeted usually only for assessing a specific learning disability or processing challenge that could qualify a child for special education services and/or testing accommodations. Here the clinician looks for a specific discrepancy between ability and achievement, for example, and only the measured scores are given significant weight. This testing has limited utility, however, because if the measured discrepancy is not significant - i.e., does not meet certain specified thresholds- eligibility for services is often denied. NEs consider many more factors than simple test scores and accordingly provide a broader picture of an individual’s learning style and the interplay of cognition, emotion and behavior.
What are some reasons to choose a neuropsychological evaluation over another kind of assessment? At what point should one consider a NE?
This is an important but tricky question as each child is unique and problems vary widely. Since neuropsychological assessments are the most comprehensive, they paint a picture of the child as a 'whole.' Since neuropsychologists have extensive education, training and specialization in understanding of how behavior, emotions and cognition inform each other, they are highly qualified to provide interpretations, recommendations, strategies and effective interventions. Furthermore, only licensed psychologists (in addition psychiatrists) can render formal diagnoses, which often is key when trying to ensure services for individuals. On the other hand, NEs are more expensive and thus the cost-benefit analysis vis-a-vis other testing should always be discussed with the parent to ensure full understanding and consent. Furthermore, full evaluations are not always necessary at certain points in an individual's life.
For example, if a child has a specific issue - e.g., learning to read in 1st grade - (and in the absence of any other countervailing 'issue') , he/she may only needs a focused assessment to determine the presence of dyslexia/reading disorder. Re-testing to show continued need for testing accommodations (typically every three years) would be another example requiring only a brief assessment. Furthermore, certain psychological assessments that focus on shedding light on one's social emotional status may be sufficient when cognition does not appear to play a major factor.
Nonetheless a comprehensive NE is probably called for under more complicated scenarios, such as when a child has been assessed several times by various professionals and the presenting problem has never been fully understood, or when the puzzle pieces have never been put together for adults to provide the right and lasting interventions, or when symptom presentation changes over development and functional status declines. Furthermore, third-party evaluations are usually always comprehensive assessments. Lastly, emotional disruptions, such as symptoms of depression and anxiety are often present when children experience learning challenges. At that time it often is difficult to discern causation and a comprehensive evaluation is most likely the best choice in differentiating between emotional and cognitive issues.
How do I choose the right provider?
I believe most practitioners with a specialization in neuropsychology and several years of experience assessing and working with children can do a fine job and provide a satisfactory work product to help you and your child. I also believe in intuition and chemistry, so I always recommend parents to talk to several providers, to ask many questions and see how it feels to 'be' with that person. Assessments are personal and involve sharing close family information. Therefore one has to feel comfortable with the evaluator, especially since their judgement can have a significant impact on how your child’s emotional and educational needs are understood and supported.
What types of recommendations can one expect from a NE?
A thorough assessment provides the parent/referring party with a treatment plan that includes referrals to other professionals (e.g., psychologists, psychiatrists, educational, speech/language, occupational therapists, tutors, institutions) to target specific interventions as well as a list of recommendations for remediating or accommodating specific areas of cognitive/academic weaknesses. Where necessary, it also contains steps to be taken to obtain services either through the public realm (e.g., IEP, 504 plan) or in a private setting (SST meeting, collaboration with learning specialists). Based on the unique constellation of a child's neurocognitive profile (including strengths and weaknesses) a list of recommendations is given as a guideline on how to teach a child, what to avoid when presenting novel information, how to avoid overload, what learning environment is needed, etc. Suggestions for parenting and setting up a home environment/daily schedule that accommodates the individual's needs and optimizes their chances of success may also be given.
Do neuropsychologists attend meetings (e.g., IEPs, SST, collaborative meetings?
Yes, regularly, and in fact the presence of an evaluator in meetings concerning the welfare of a child is often particularly important to ensure that everybody involved is working as a team and has the best interest of the child in mind when making decisions about interventions and services. Especially in the public arena, educational lawyers/advocates who are experts in navigating the educational law/code can benefit and guide parents greatly in their efforts to receive the most effective services for their child.
Will test findings qualify my child for testing accommodations?
When an assessment clearly determines a condition/disorder that meets eligibility criteria for special education services, then yes, testing accommodations are usually not difficult to obtain. However, often those stringent criteria are not met despite the fact that processing, learning, and/or behavioral issues affect a child's academic performance. In those cases one must strongly advocate for the child, and the NE can be a strong document in helping parents (or educational lawyer) advocate for their child (or client).
What is your fee schedule? Do you take Insurance reimbursement for services rendered?
For comprehensive evaluations I charge a flat fee, which is communicated at the outset of the assessment. The flat fee covers the entire assessment - no matter now many meetings I may require with you and/or your child (but excluding school observations and IEP/SST meetings). I am also available to provide follow up meetings with parents - after some time has passed - to check in how interventions have made a difference or how the treatment plan might be modified.
For short consultations/brief assessments, I charge an hourly rate. In any engagement, however, you will never be charged a cumulative total amount that exceeds the flat fee rate.
I prefer to divide payments into two installments with an upfront nonrefundable deposit requested if appointments are scheduled at least two or more months in advance. As is the case with most neuropsychologists, I am not paneled with an insurance carrier, so I highly encourage parents to inquire in advance with their insurance about reimbursement rates and possible forms necessary to be completed before and/or after the evaluation. Once the assessment is completed I provide an invoice for submission to your insurance for reimbursement and am available to provide any additional supporting documentation if so inquired.
Do practitioners contract with school districts for an independent educational evaluation (IEE)?
Yes, parents can request an IEE when they disagree with the outcome of an assessment completed by the school psychologist as part of an IEP. IEEs are not always granted but the more advocacy you invest in, the more likely you are to get approved for services. Please note that it is not unusual for a school district to argue (mostly for cost reasons associated with a comprehensive NE) that a neuropsychologist should not be used for a psychoeducational evaluation. This is incorrect, however, as, per the education code, any qualified specialist can be retained to complete an IEE.