Pediatric neuropsychologists are often asked by parents when a child would ever need this kind of evaluation. Other common questions center on not knowing why a physician has made the referral or not knowing why the evaluation is needed in addition to the traditional child study team assessments.
The simplest definition of neuropsychological assessment describes the process as the study of brain and behavior relationships. More specifically, it addresses the core processes of brain functioning such as attention, processing speed, language and visual functioning, memory, and intelligence. The procedures, frequently derived from cognitive research, apply standardized measures and tools in which an individual’s performance is statistically compared to those of other individuals of similar age and sometimes gender and education. By understanding where a child performs relative to those normative groups, areas of weakness, deficiency, and even strengths can be identified.
Even when provided with the definition, it may still be unclear as to why such a procedure is needed or being requested. For one, there are many obvious circumstances often related to medical issues which prompt the need for evaluation. These can include brain injury and concussion, as well as illnesses which can affect the brain such as cancers and infections. However, for the healthy child, neuropsychological assessment may be requested by either a physician or even the school district in order to clarify behavioral and functional concerns. For example, pediatricians, neurologists, and psychiatrists often request neuropsychological assessment to clarify the source of certain behavioral presentations such as inattention, impulsivity, forgetfulness, and disorganization. The neuropsychological assessment in conjunction with behavioral and psychological screening can help pinpoint the underpinnings of such behaviors and help derive treatment plans including techniques such as behavioral management, therapy, and pharmacological interventions. The assessment may also shed light on specific areas of weakness requiring further investigation such as speech/language, audiological, and/or occupational therapy evaluations.
In the case of the child already evaluated by the school’s child study team, neuropsychological assessment can be helpful in providing additional useful information. Most child study team evaluations include educational assessment, psychological evaluation (with assessment of intelligence), and psychosocial assessment. The goal of the evaluation is to determine whether a child meets the specific criteria for one of the special education categories and to then put in place the proper educational interventions. On the other hand, the child study team evaluation cannot provide specific diagnoses. Nevertheless, the child study team evaluation is often times quite sufficient for most children requiring services in the school setting.
However, there are instances in which even those assessments have not fully captured the breadth of concerns and the child’s behaviors and difficulties continue to be poorly understood. In those situations, the comprehensive neuropsychological assessment can be particularly useful in understanding the underlying components of processing which may be impacting on the child’s learning. For example, educational assessments performed with accepted batteries such as the Woodcock-Johnson IV Tests of Achievement and the Wechsler Individual Achievement Test III provide very detailed profiles describing a child’s reading, writing, and mathematical skills as well as a picture of a child’s ability to apply these skills. However, the areas assessed by these comprehensive batteries necessarily draw on multiple brain regions and functions in order to manifest the skills being assessed. For example, the dyslexic child may exhibit deficiencies in specific areas of cognitive functioning such as phonological processing or the ability to appreciate phonemes in words and speech, verbal fluency, ability to access to language labels, and even aspects of visual processing.
Through the neuropsychological assessment process in concert with child study team assessments, areas of impairment contributing to the manifested learning disability can be identified. This elaboration of findings can be extraordinarily useful in designing and recommending more specific interventions and accommodations for a child who continues to struggle in school even though special education services may already be in place.
There are many other instances in which neuropsychological assessment can be particularly helpful and, should the recommendation or question of further assessment arise, parents should never hesitate to reach out to the pediatric neuropsychologist in order to gain a better understanding of how the process may be helpful to their child.