Neuropsychology is a way of understanding the brain by looking at its behavior. The focus is on the basic building blocks of thinking and problem solving (such as attention, language, and memory), rather than on feelings, personality, etc. Neuropsychological testing can help with diagnosis of and recommendations for a wide variety of problems or concerns. Neuropsychological testing involves giving a person a series of tasks to do and then statistically comparing their performance on those tasks to their performance on other tasks, and to the performance of other people on the same tasks. Conclusions of a neuropsychological evaluation are based on not only the test results but also on a combination of background information, input from spouses, other family members and/or teachers, and my observations of behavior during the evaluation. The evaluation yields a great deal of information which will be presented in a feedback session and clearly explained in a test report.
I select the tests depending on the purpose and goals of the evaluation. I generally include all or part of an IQ test in order to get a baseline for realistic expectations. However, I always take into account the fact that IQ tests can be influenced by many things besides how smart a person is, including attention problems, language weaknesses, anxiety, depression, effort, and fatigue. I think of an IQ test as being basically a series of problems that you put in front of a person. The scores compare this person’s ability to solve these problems to the ability of other people the same age to solve the problems. The pattern of scores on different parts of the test helps me to get a picture of the person’s cognitive strengths and weaknesses. Careful observations of how the person goes about solving these problems and what types of errors they make in the process yields a wealth of valuable information. For example, one person may get an item wrong because he or she knew what to do but worked slowly and did not finish before the time limit expired. Another person may get the same item wrong because he or she responded quickly and impulsively and made a careless error. A third person may get the same item wrong because he or she was simply incapable of responding correctly. If these patterns persist over the entire testing, it can be concluded that these three people may have the same scores but very different issues and would benefit from very different services or interventions..
I also generally include a variety of tests which measure executive functioning. Executive functioning is what allows us to apply our abilities in order to get things done. This includes sustaining attention and directing it to the proper place, self-control, organizing, planning, prioritizing, mental flexibility, and multi-tasking. People with ADHD generally have some executive functioning weaknesses, so these tests can help in the diagnosis of ADHD.
Testing will also likely include a variety of tests measuring learning and memory. Some of these tests will measure auditory memory and some will measure verbal memory. The tests vary as to the amount of information to be learned, the way in which it is learned, and obstacles to learning. Performance on these tests gives me a good idea as to how the person learns best, how they should be taught or communicated with, how they should study, and whether they need any educational modifications or accommodations.
I sometimes include part or all of an achievement test. Achievement tests measure the person’s basic skills in reading (including reading comprehension), math, spelling, writing, oral expression and listening comprehension. The results of these tests can help in the diagnosis of learning disabilities. In interpreting the results, I look at the scores, the pattern of scores, and analyze the errors and the process the person used to get their answers. In evaluating a learning disability, I look not only at where the scores are lower than expected, but also at how problems in underlying skills contribute to the difficulty. For example, math skills can be impaired by difficulty remembering basic math facts, by executive functioning problems, by difficulty understanding the language in word problems, by visual-spatial weaknesses, etc. It is important to know which of these underlying skills are problematic so that appropriate interventions can be recommended. The reading and oral comprehension tests provide information not only about academic strengths and weaknesses but also about how the person understands the world in general.
I evaluate language skills through a combination of parts of the various tests described above and by some additional language tests. I look at the person’s ability to understand language and in what circumstances it may break down. I also look both quantitatively and qualitatively at the person’s knowledge of words, their ability to find the words they want when they need them, and their ability to string words together to express themselves in both brief and in longer oral and written communications.
I ask the person being tested and family members and/or teachers to fill out a variety of questionnaires providing background information and the informant’s view of the problem. Some of these are subjective and others can be scored so as to provide more objective information. When testing children, adolescents, or young adults, I also review as many old report cards as are available (as a way of getting input from teachers) and any previous evaluations which have been done.
After the testing is complete and I have a chance to analyze and integrate the results, I meet with the client for a feedback session. Depending on the circumstances (and the client’s wishes), sometimes spouses, parents or other family members attend this session. If there is a treating professional, they may attend the session as well. The purpose of the feedback session is to help the client and others understand what I think and why I think it and to answer any questions that people have. There is no point to doing testing unless it leads to useful recommendations as to what to do about any problems which are uncovered. We will also discuss these recommendations in the feedback session. Shortly after the feedback session, I will provide the client with a detailed report. This report will contain the results of all of the tests, an integration and summary of the findings, and my interpretations of what it all means. Any appropriate diagnoses and detailed individualized recommendations are included in the report as well.