The field of neuropsychology has a long history, but modern understanding and practices of neuropsychology came about in the mid-1900s. As the name suggests, neuropsychology is a branch of the cognitive sciences that utilizes neuroscience and psychology to better understand the functionality of the brain and how it relates to behavior. The field of neuropsychology is concerned with understanding the relationships between the brain and behavior, especially in how those relationships can be applied to the assessment of cognitive and behavioral function, diagnosis of brain/mental disorders, and the design of effective treatments. Neuropsychology serves people of all ages. From developmental concerns in infants, to academic challenges in adolescents, to declining function in seniors, neuropsychology addresses the functional challenges of any age group. Some of the most common conditions neuropsychologists assess and treat are developmental disorders like autism, learning and attention disorders, concussion and traumatic brain injury, epilepsy, brain cancer, stroke, and dementia. In this blog, we will explore neuropsychological evaluations: what they are, what they are used for, and how they differ for children.
What is a Neuropsychological evaluation?
At its core, neuropsychological evaluations are used to measure how well a brain is functioning. It first involves gathering a mountain of patient history from medical records, an interview with the patient, and interviews with family or friends with the patient’s permission. A patient’s historical information is important in helping neuropsychologists understand their symptoms and their severity. After gathering historical information, a series of standardized tests are administered to a patient. These tests typically involve writing, drawing, solving puzzles, or answering questions verbally. Self-report questionnaires related to evaluating mood and psychological symptoms may also be administered. Scores on these tests are then compared to those of healthy individuals of a similar demographic background (age, gender, ethnicity, socioeconomic status, etc.) and expected level of functioning. Disparities between the scores are interpreted in terms of the particular skill tested, and thus, the neuropsychologist can determine where a person’s strengths and weaknesses appear in order to better understand any patterns in brain functionality. The areas of brain functioning studied during a neuropsychological evaluation are determined by a patient’s complaints and symptoms as well as the neuropsychologist’s observations made during interviews. Some of the mental functions assessed in a neuropsychological evaluation include:
- General intellect
- Reading and reading comprehension
- Language usages and understanding of speech
- Attention and concentration
- Information processing speed
- Learning and memory
- Executive functions, such as organizing, planning, time management, problem solving, and self-control
- Visuospatial skills
- Motor speed and dexterity
- Mood and personality
In adults, the assessment portion of a neuropsychological evaluation is typically completed in two to four hours, but can last up to eight hours depending on the complexity and severity of a patient’s condition. Fatigue, confusion, and motor slowing are just a few symptoms that could significantly extend the length of an evaluation, and occasionally, require that the evaluation take place over the course of multiple sessions. Some common symptoms that may signal the need for a neuropsychological evaluation are:
- Changes in short-term memory
- Repeatedly asking the same question after having received an answer
- Frequently losing items
- Getting lost easily
- Poor attention and concentration
- Losing track of a conversation that is still occurring
- Difficulty speaking or thinking of words to say
- Difficulty understanding what others say to you
- Decreased recognition of places, people, or things
- Visuospatial difficulties, such as writing in a straight line, drawing/coloring appropriately, or using a map
- Difficulty remembering even routine things, such as doctor’s appointments, paying bills, or taking the trash outside
- Poor judgment or decision making
- Decreased impulse control
- Unexplained changes in personality or mood
What are they used for?
Neuropsychological evaluations attempt to find patterns of strengths and weaknesses among a variety of cognitive and behavioral skills to pinpoint the root of disrupted brain function as well as its severity. Many conditions can result in changes in cognitive and behavioral function, such as Alzheimer’s disease, Parkinson’s disease, epilepsy, stroke, multiple sclerosis, brain and spinal cord infection, traumatic brain injury, and all psychiatric disorders. Because there is a wide variety of conditions that can disturb brain function, one of the key uses of neuropsychological evaluation is to assist in differential diagnosis. This is the process of exploring all possible disorders or conditions that could be causing a patient’s symptoms in order to more thoroughly determine their causality. For example, poor attention and difficulty concentrating are common symptoms of dementia, depression, and simply normal aging, so healthcare providers can use the results of a neuropsychological evaluation in tandem with brain scans, EEGs, blood tests, etc. to arrive at a more informed diagnosis.
In addition to contributing to a more informed diagnosis, neuropsychological evaluations also help guide treatment plans. Because these evaluations can identify areas of cognitive function shortfall, results can be used to determine what form of treatment – or compilation of treatments – would be most effective in addressing those specific cognitive and behavioral shortfalls. For example, results of a neuropsychological evaluation could reveal a patient is experiencing clinically-significant memory challenges due to depression and dementia. A neuropsychologist may suggest a treatment plan consisting of psychotherapy, pharmacological measures, and occupational therapy would be most beneficial for their patient.
Another important use for neuropsychological evaluations is that their results provide a baseline for which subsequent evaluations can be compared. This component is especially important in neurological diseases that are known to worsen over time, such as dementia, Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis. Doctors can use changes in cognitive and behavioral function over time to assess the effectiveness of a treatment plan and measure the rate of declining function due to a patient’s conditions. Additionally, using neurological evaluations as a baseline is incredibly important in weighing the benefit and cost of certain interventions, such as deep brain stimulation (DBS), which is an invasive procedure that involves surgically implanting devices that use electrical stimulation to treat disorders like Parkinson’s disease and severe depression. Comparing the results of a neuropsychological evaluation done before DBS treatment to those after the treatment could reveal positive or negative effects of the treatment on a patient’s cognitive and behavioral function, and thus, determine if the invasive treatment is worth it.
Children vs. Adults
As with all other areas of medical assessment and treatment, differences exist between neuropsychological evaluations for children and those for adults. To start, neuropsychological evaluation of children is often far more dependent on input from the patients’ immediate environment than from the patient themselves. Children are not the instigators of their evaluation so neuropsychologists must initially rely on the concerns and goals of patients’ parents or caregivers to guide their assessment. Therefore, patient permission does not need to be granted before interviewing outside sources like parents and teachers, which is a stark contrast from an adult neuropsychological evaluation.
Another common difference between neuropsychological evaluation in children as opposed to that of adults is the length of evaluation for children is often longer. Whereas adults can provide a significant amount of information by self-report and personal anecdotes, children are often unaware of any developmental, educational, or social challenges they display, and therefore, may not provide or articulate problems in the most informative manner. Therefore, the initial interview phase of neuropsychological evaluation is imperative for a child’s assessment and may require a neuropsychologist to speak to more people, over a greater amount of time, before administering tests. Then, in terms of test administration, what takes two to four hours for an adult to complete may take a child multiple sessions to complete when accounting for frequent breaks and other accommodations. Additionally, some neuropsychologists insist observing and testing a child at school or in another more familiar environment is essential to understanding the complete picture of a child’s functioning, which again, often takes more time than a scheduled assessment at their office.
Finally, a key difference that has been indirectly suggested by those above relates to the neuropsychologist’s role during and after assessment. Whereas the role of a neuropsychologist treating an adult does not extend far past evaluation and generating a treatment plan, neuropsychologists that specialize in children are often much more involved with their patients’ day-to-day environments during assessment and remain involved after the neuropsychological evaluation itself. Child neuropsychologists may need to make routine classroom observations, be familiar with their local school districts and individual schools’ programming, and even collaborate with educational advocates and attorneys. Ultimately, neuropsychological assessment and treatment of children often requires the neuropsychologist to work in closer collaboration with a host of key individuals in their patients’ lives, such as parents, caregivers, teachers, and school counselors, than they would in the assessment and treatment of adults.
The results of a child’s neuropsychological evaluation are much more than a diagnosis. They greatly affect the services and accomodations a child receives early on in their development, which ultimately translate into much longer lasting implications for their future cognitive and behavioral function. Therefore, because the developmental, educational, and social needs of children are so different from those of adults, healthcare providers highly recommend that neuropsychological evaluations of children are performed by a neuropsychologist that has significant experience specializing in the treatment of children.