Neuropsychological evaluations are a deep dive into an individual’s profile. Humans are multifaceted. In order to understand what makes them tick, a good neuropsychological assessment must explore both brain and behavior. Neurology and psychiatry. Ability and achievement. Genetics and environment. That is to say, a neuropsychologist must think like a detective to discover the truth.
What is a neuropsychological evaluation?
A neuropsychological assessment is a series of tests administered to understand the intelligence, academic ability, executive function, and mental health of an individual. Neuropsychological testing seeks to identify neurodivergence, special needs, gifts, and anomalies that can better explain function, dysfunction, and a tailored treatment plan.
A neuropsychologist is usually referred by other providers who need clarification or a better diagnostic understanding to treat their patient. This can be a psychologist, a therapist, psychiatrist, a neurologist, a primary care physician, or a pediatrician. Sometimes, these referrals come from school or workplace, and sometimes they are self-referred after the individual has sought many other treatments, tests, and providers.
What does a neuropsychological evaluation entail?
It must be understood that no neuropsychologist should rely on one test or measure to reach a conclusion. This is why a proper battery of tests utilizes several measures to confirm or deny a diagnosis or to parse it out from another condition. Here are key features of a neuropsychological assessment:
- Intake interview: This is an extensive interview that spans the reason for referral, medical and personal history, detailed difficulties, social and academic standing, family background, genetic factors, events such as trauma and losses, as well as an understanding of what has come before. To this extent, a neuropsychologist often reviews previous test results, medical and educational records, even legal ones, to better understand how they can better serve the needs of their new patient.
- Cognitive testing: A cognitive test, better known as an IQ test, measures a person’s natural intelligence and reasoning abilities. It also takes into account factors like memory and visual scanning and processing, which fall under more executive abilities.
- Neurological and executive testing: These tests examine reaction rate and speed, memory, and attention, and can better diagnose ADHD and autism, in the context of the other areas of testing.
- Educational testing: The purpose of these tests is to assess whether a neurological disability such as dyslexia or dyscalculia exists. However, one test can indicate a writing disability (dysgraphia) while another might clarify whether the issue is with fine motor skills or organization.
- Psychological testing: These tests examine the role of mental health in an individual’s functioning. For instance, bipolar disorder symptoms have a tremendous overlap with what can appear to be ADHD. Similarly, social anxiety, ADHD, or a combination of these can easily resemble mild autism. In order to make an informed call, a neuropsychologist must have all this information at hand.
- Time commitment: A neuropsychological assessment can take weeks to months. The testing itself is the tip of the iceberg. A patient usually has to sit for 3-4 testing sessions which lasts several hours. Depending on the age and ability of the patient, these can be further broken up. The real fun is the scoring, the analysis of the data and the background, and the behavioral observation. Ideally this happens in a team setting like at Comprehend the Mind where clinicians can discuss and exchange ideas to decide on tests, diagnoses, and recommendations. In some cases, where there is urgency such as an upcoming test, court date, or even surgery, a neuropsychological evaluation can be performed in a day or two and requires lengthy hours. A report can be generated in 2-4 weeks.
- Environment: The testing environment must be free of distractions. Patients are advised to have a good night’s rest, a full breakfast or early lunch, and get comfortable. They can take breaks as needed, have a snack, or use the restroom. Usually, the neuropsychologist will advise the patient to take their medications, as usual, unless in any case, they should not. Always ask your neuropsychologist if you are unsure.
Why neuropsychological evaluations are conducted
Most neuropsychological evaluations are recommended because another health provider does not have clarity on the diagnosis. Without intensive testing, it is hard to isolate symptoms of one condition from another. Individuals may approach their primary care doctor or even a family member with issues of being forgetful, misplacing things, a recurring headache, or brain fog. They may also report unusual anxiety or depression along with neurological issues. We often hear in some referrals that symptoms begin with sudden concerns with attention and concentration or a worsening of these problems.
Parents may have noticed issues that seem to be either becoming more obvious, or the school and teachers are noticing. Parents may have also been advised that their child is acting out, is aggressive, inattentive, or impulsive. Grades may be failing, or problems in reading or math may become more prevalent. In some cases, mild or high functioning autism could also be in question.
Doctors can also refer their patients for a neuropsychological evaluation:
- A referral from a psychiatrist might be to rule out ADHD or bipolar disorder. Medication for one can exacerbate the other; hence, it is necessary to decide which one is primary.
- A referral from another psychologist or a therapist might be to decide whether a patient has the cognitive ability to participate in certain therapy. Perhaps the therapist wants to know the underlying psychological processes that can strengthen treatment.
- A referral from a neurologist might want to explore whether there is traumatic brain injury, leading to memory loss, or simply a weakness stemming from birth or genetics. Could the learning disability or dyslexia be more that just an academic issue? Could there be a more biological answer or treatment?
The neuropsychologist may focus on the following as part of their assessment battery:
- Diagnosing neurocognitive disorders like dementia, traumatic brain injury, learning disabilities, and ADHD.
- Diagnosing giftedness, intellectual deficiency, dyslexia or autism.
- Diagnosing or clarifying psychiatric conditions from bipolar to schizophrenia or how more commonly diagnosed anxiety or depression can play a role.
- Tailoring interventions to specific needs, making referrals, and monitoring treatment progress.
What to bring to a neuropsychological evaluation
These are the essential or more common things to remember to bring in prior to or during your neuropsychological assessment:
- Medical records: a patient is generally asked to bring in previous medical reports such as prior testing from a psychologist or a neurologist, as well as educational records such as an IEP. They may also bring in discharge summaries or MRI results. Since patients may not remember their whole background, the records that exist may be critical at not only establishing a narrative but also clarifying what’s already passed so the neuropsychologist is able to tailor a battery to their needs.
- Medications: you may bring a list of both prescription medications and dosages, current and past.
- List of providers, current and past, especially pertaining to your concern.
- Glasses or contacts
- Hearing aids
- Water and snacks
Questions to ask your doctor or neuropsychologist
When seeking a consultation for a neuropsychological evaluation or prepping for one, it’s vital to ask questions to better understand the doctor's process. Note that neuropsychologists have different training, specialties, and practice settings, so these questions can help ensure the evaluation meets your specific needs.
- Will I get a diagnosis?
- Will you make referrals to a psychiatrist or therapist?
- How long does the evaluation take?
- What do the results mean?
- How are results communicated?
- Are there recommendations that I can follow after my assessment?
At Comprehend the Mind, we focus our final sessions on not just informing the results but also making clear diagnoses. The recommendations that follow are both for the patient and relevant providers to establish a care plan. We also recommend that patients return within an 18-month period for a follow up.
Understanding the results of neuropsychological testing
Your neuropsychologist should explain all the data, results, and clinical conclusions including diagnosis in informal, easy to understand language. You can bring in a family member or a spouse if you feel that you may be overwhelmed by the answers you get. You can ask to record the session to listen tolater. Feel free to take notes and stop the neuropsychologist to explain something again. You do not have to pretend the understand the data, the tables, or the charts. Ask for clarification and ask to translate in laymen’s terms whatever seems complex. A neuropsychologist should provide examples and the areas of your life that may be impacted by the findings. The main idea of neuropsychological testing is addressing your difficulties in a proactive manner but also preventing a simmering issue from becoming worse.
Common myths about neuropsych evaluations
Most people have never had a neuropsychological assessment and know little about the process. Hence, this very scientific sounding process may be intimidating and create stress and confusion. Below are some common myths or concerns that patients may have:
- Myth 1: Neuropsychological evaluations are only for people with severe brain injuries. While brain injuries are a common referral, they don’t have to be severe. Someone does not need a brain injury to investigate why they may have lifelong or acute struggles and seek answers.
- Myth 2: Neuropsychological evaluations are painful or invasive or need equipment like brain probes. People often think that neuropsychological evaluations require probes and wires to conduct such testing. This is not true. The majority of neuropsychological evaluations are conducted in a one-on-one interactive setting with verbal and nonverbal commands and computerized testing such as on an iPad or laptop.
- Myth 3: Neuropsychological evaluations are only for children. 20 years ago when Dr. Hafeez started out as a neuropsychologist, her population was much more pediatric than adult. Today Comprehend the Mind estimates that it's about half pediatric, half adult. The children have grown up and still need support, and more and more adults are curious about neurodivergence and seeking understanding.
- Myth 4: Neuropsych tests are pass/fail. Neuropsychological tests show you strengths, weaknesses, and clinical significance, meaning areas of psychopathology, abnormality, emerging issues, and focus for treatment.
- Myth 5: Neuropsychological testing can be used against you by a school, employer or court. No one can access your results but you. All patients are protected by the HIPAA laws and their assessments are confidential. There are also laws that protect persons with disabilities and ensure that all individuals are provided support and reasonable accommodations at school and workplace.
Receive neuropsychological testing at Comprehend the Mind
Neuropsychological evaluations can offer valuable insights into your brain's function. Interested in learning more about how a neuropsychological evaluation can benefit you or a loved one? Get started with Comprehend the Mind today. Our expert neuropsychologists are here to help you make sense of your mental health and more.
