Does my kid really need a neuropsych?
When I was in lab meetings in graduate school, the most damning criticism to receive was that it sounded like you were going on a “fishing expedition” with data. Essentially, that meant that when you had a whole bunch of data, you considered it without predictions or specific questions. Instead, you developed hypotheses based on patterns you saw after it was gathered. This is a complicated problem. On the one hand, if unexpected patterns emerge in data, a good researcher certainly wants to consider those patterns rather than hastily jettisoning them. On the other hand, no dataset is pure, without variance or noise, and as such, some findings really are random. How to interpret evaluation data really depends on the client, the costs of “missing” or erroneously identifying something, and what you are trying to accomplish in the process. I receive many calls from families who ask for a “neuropsych” without seeming to understand what it entails, what questions it can answer reliably, and what benefits it yields. While it’s clear that many children can benefit from an in depth assessment, it’s possible that your child could benefit from more focused and streamlined evaluation.
Neuropsychological evaluations can be extremely informative, particularly if your child has, or is suspected to have, some organic or underlying developmental issue that is interfering with their functioning at home or at school. Perhaps your child has a really hard time learning, despite being highly verbal or visually skilled. Maybe you or someone else has noticed a regression in their skills, meaning, something they used to be able to do with ease, they no longer can. These are situations in which a broad based evaluation may illuminate specific patterns of cognitive abilities that are remediable or at least responsive to intervention. Further, if your child requires accommodations for standardized testing, there may be specific assessments that are required in order for the accommodations to be granted.
The most common request I receive from parents is to do a neuropsychological evaluation for ADHD. Often, this is unnecessary. Symptoms of ADHD may or may not emerge in the context of an extended evaluation. Kids who struggle to attend in a group setting may be just fine working one-on-one with an examiner. Thomas Brown, Ph.D. leading scholar in the area of ADHD and author of the excellent book Attention Deficit Disorder: The unfocused mind in children and adults argues that a good clinical interview used in conjunction with rating scales is the most efficient and cost-effective way to reliably identify ADHD. You should not fear something being missed by using this approach. A skilled psychologist will determine whether additional testing is necessary in order to identify any potential co-occurring disorders (e.g. learning, anxiety, etc.) and make appropriate recommendations.
Some psychologists complete neuropsychological evaluations when only a psychological evaluation is needed. If you or your child is in treatment and your provider is having a tough time understanding what is going on clinically, a psychological evaluation can be extremely valuable. Psychological evaluations often include projective assessments (e.g. drawings, the Rorschach), which can be controversial due to less-robust empirical support. Still, those assessments, when used conservatively, can provide powerful insights that help providers get to specific diagnostic conclusions. In my experience, another benefit of psychological testing is that it’s more likely than neuropsychological evaluations to be reimbursable by insurance companies.
When deciding whether to go ahead with a neuropsychological evaluation for your child, be thoughtful about what you hope to gain from the process. It’s expensive, and depending on your question, may not be reimbursable by insurance companies. The time involved for the client is heavy, you or your child may be tested for up to 8-10 hours. Some kids who are being shuttled to therapists, psychiatrists, tutors etc. often feel pathologized already and an additional evaluation may be an unnecessary burden.
If you do decide to go ahead with the evaluation, consider the following questions:
1) What is your turn around time for writing reports? How long will the evaluation take from the first intake interview to the feedback session and finalization of the report?
2) How do you evaluate functioning outside of the testing room? (Do you do blind observations at school, talk to collateral providers, educators, etc.?)
3) Do you have a standard test battery? Is there flexibility with the tests you use? (be skeptical of a provider who does all the testing in one day as it does not allow them time to score and redirect their evaluation)
4) If your child has complex emotional symptoms, ask-Do you use projective assessments? What is your training and experience in administering and interpreting them? How can they help you understand what is going on with my child?
5) If you need testing accommodations ask-Do you have experience helping people get accommodations on the SAT/ACT/MCAT? Are you familiar with the specific evaluation requirements for the testing companies?
6) What kind of recommendations do you typically offer? Can you help facilitate referrals to qualified providers?
7) Do you take my insurance? Do you provide a detailed receipt that I can submit to my insurance company? What are the costs that will not be covered by insurance?
For some families, an evaluation offers a road map to success. For young children, this can help direct educational and medical interventions that improve functioning quickly. For older children and adults, information gained from a thorough evaluation may give a family a sense of ease, having answered questions that have lingered for years. Being knowledgeable about the assessment process will be enormously helpful in getting your questions answered in the most efficient way possible.
