What Is a Neuropsychologist?

A neuropsychologist is a licensed psychologist with extensive training in neuroscience, neuroanatomy, and brain-behavior relationships that is in addition to their other training.  What makes an assessment “neuropsychological” is not the tests used, but the doctor who performs the evaluation.  (See also “What is a Psychologist?” under “Common Questions.”)  Look immediately for the “Ph.D.” or “Psy.D.” after the name when someone is claiming to be a psychologist or neuropsychologist. Then look for a license number issued by the CA Board of Psychology (PSY followed by a 4 or 5 digit number). 

A doctorate in psychology and a Board of Psychology license are the minimum requirements for calling oneself a psychologist and neuropsychologist.  Those of us with the actual credentials are extremely wary (and also a bit tired) of those who call themselves psychologists or neuropsychologists without a doctorate (in the medical field it would be the equivalent of a nurse practitioner claiming to be a pediatrician or neurologist).  Even though the term “psychologist” is protected by CA state law, it will not be until the American Psychological Association, in concert with the legal system, finally cracks down on the abuse around the title “psychologist” that the confusion will hopefully end.  Until that time, it is often unfortunately up to the consumer to discern the difference.  To that end, I have provided this information in the interest of public education and awareness.

CONSUMER ALERT! Master’s level school psychologists are now touting a vanity board designation in “school neuropsychology.” Be aware that this is a rogue board that is not recognized by Division 40 (Clinical Neuropsychology) of the American Psychological Association. 

What Is a Neuropsychological Evaluation?

Neuropsychological evaluation is a specialized psychological assessment that includes systematic, comprehensive assessment of cognitive functions, including:

  • Intelligence & problem solving
  • Attention & executive function
  • Language & auditory processing
  • Memory, & learning
  • Visual-perceptual & sensorimotor abilities
  • Academic achievement
  • Emotional, & behavioral functioning

Neuropsychological evaluation has been classically used to assess the cognitive consequences of brain injury and neurological problems.  It is, however, also an excellent tool for ascertaining the underpinnings of learning difficulties and other childhood disorders because it identifies specific intellectual strengths and weaknesses. For example, knowing that your child struggles with reading does not tell you what neuropsychological processing problems (or other, coexisting disorders) may be at the root of the difficulty. Therefore, remediation becomes a “shot in the dark.” Subsequently, neuropsychological assessment is perhaps the most useful means available for guiding educational remediation and other recommendations.

How Long Does A Neuropsychological Evaluation Take and What Does It Entail?

Neuropsychological evaluation is the most thorough (and therefore the most time-consuming) means of evaluating cognitive functioning. A comprehensive neuropsychological work-up includes testing time, scoring of protocols and evaluation of results, report writing, and final consultation.

Here is the typical course of events for my neuropsychological evaluations with children and adolescents:

  • Initial visit with parents, review of previous assessment results (if any), clinical interview
  • Testing. This can take 6 or more hours, depending on the age of the child, the amount and quality of previous assessment results, etc. It usually requires 2-3 appointments.  The first testing session is more general in order to obtain broad-based results so that I may begin to form hypotheses about areas of strength and weakness.  Subsequent testing sessions include more fine-tuned assessment, based on the results of previous sessions.
  • I score the protocols, evaluate the results, and write the report.
  • Feedback session is held with parents (child may also be present for all or part of this session). Results are explained, recommendations are made, written report is given, questions are answered.

There are really no shortcuts to a good neuropsychological evaluation. Those with minimal or no training in neuropsychology often jump to conclusions about a specific area of functioning (e.g. attention) without proper investigation of all cognitive domains.  This leads to errors because what may appear to be a “malfunction” of one system is really a consequence of a problem in another system.  For example, a child with a superficial attention problem may have an underlying difficulty with language. Or a child with a superficial problem with memory may have an underlying difficulty with attention.  Sometimes there is an interaction between more than one area of difficulty. Therefore, systematic evaluation of more than one area of cogntive functioning is often necessary in order to “put all of the pieces of the puzzle together.” Besides deficit areas, a neuropsychological evaluation also indicates areas of strength that may be useful in remediating learning difficulties.

Neuropsychological evaluation provides comparison between areas of functioning, as well as comparison of the individual cognitive domains with general intellectual functioning.  Additionally, it provides rich and detailed information about strengths and weaknesses within a particular area of functioning. This information can be extremely helpful for educational planning.

Do you perform ADHD assessments?

Yes and no.  Although I assess and diagnose ADHD, it is the context of a comprehensive evaluation. For example, if you were to go to your pediatrician and tell her/him that you think your child has say, diabetes, your physician would be remiss if s/he did not run the proper tests to rule out other possibilities. In other words, the diagnosis cannot precede assessment for any suspected disorder. 

Shouldn’t the diagnosis of ADHD require more than behavioral checklists?

YES! It is heartening to hear that parents want *real* assessments for possible ADHD. It is also great to know that many pediatricians are not prescribing ADHD medication based on behavioral checklists alone. ADHD has been overdiagnosed and misdiagnosed due to the use of checklists without actual performance results and/or comprehensive clinical interview by a doctor. Behavioral checklists are only valuable insomuchas they provide an easy way to obtain a lot of information in a short period of time, but should not be used as the main instrument for diagnosis. They are typically given to parents and/or teachers, and therefore actually measure what the behavior in question looks like to the caregiver. Conversely, neuropsychological tests measure actual cognitive function.  Neuropsychological assessment may also  uncover problems in other areas that masquerade as attention problems but are not primarily attention problems.  Additionally, since ADHD often co-occurs with other disorders (such as learning disabilities and ODD), neuropsychological evaluation addresses these problems as well.

 

Special Education Questions

What Disabilities Are Assessed?

 

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