What is neuropsychological testing? What does it entail? How can you use an evaluation to your child’s advantage? Clinical psychologist Dr. Lilliam Martinez, who has evaluated hundreds of children with learning differences, attention deficits, and executive function disorders, provides answers to frequently asked questions.
Why would my child be referred for neuropsychological testing?
The story usually begins when an adult – particularly a parent or a teacher – raises a flag about a child’s performance in school. Perhaps a child’s grades are very low or homework is a continual struggle. Perhaps the child is struggling in math but not in reading. Perhaps the child’s behavior is causing concern: she can’t sit still, he constantly forgets things, she can’t concentrate. Parents are very astute and teachers are equally likely to take notice.
Another common reason for a referral is that your child is applying to a new school, and that school requires an evaluation as part of every application for admission. For example, the Forman School, which serves students in grade 9 through Post Graduates who all have diagnosed learning differences, all applicants must submit a neuropsychological evaluation. The evaluation helps admission officers decide whether a child will be a good fit, socially and academically, and whether the school has the supports your student needs. Once a student has been admitted, an evaluation informs every faculty and staff member as to how your child learns.
What do I do if I think my child can benefit from neuropsychological testing?
As a parent, your first course of action is to meet with your child’s teacher. Arrange a meeting and tell the teacher what your specific concerns are. The teacher will likely suggest a number of strategies to try. If you try them and your child continues to struggle, then a neuropsychological evaluation may be the next step.
What is neuropsychological testing, exactly?
Neuropsychological testing is one of three common forms of evaluation, the others being psychological and psychoeducational evaluation. Without getting too technical, psychological testing is used to diagnose mental health issues such as depression and anxiety. Psychoeducational testing is driven by questions such as, “Is the student functioning within his or her grade and age level? How is the student processing information in the classroom? How can we help them in the academic context?”
Neuropsychological testing is more in depth and offers specific insights into how a child’s brain processes information. Evaluators look at memory, attention, learning, processing speeds, and abstract reasoning – all areas of cognition and behavior that are linked back to brain structures. Neuropsychological testing enables us to identify specific areas of deficit that have an impact on learning. It can also help clarify whether and how factors outside academia – such as family history, medical history, and environmental factors – may be affecting the student’s functioning. It really helps to give a comprehensive view of how the student is functioning in the classroom and outside of it as well.
What diagnoses come out of neuropsychological testing?
Through neuropsychological testing, a child may be diagnosed with what psychologists label “specific learning disabilities,” either with impairment in reading, or written expression, or mathematics. These diagnoses correspond to dyslexia, dysgraphia, and dyscalculia, though those are no longer official diagnoses in the Diagnostic and Statistical Manual (DSM). The clinician may also diagnose attention deficit disorders, problems with executive functioning, and autism spectrum disorder.
What does the process of neuropsychological testing entail?
The steps of the process generally go like this:
The clinician reads the referral, which is an explicit statement of questions that the testing is intended to answer: Why does my child seem so hyper? Why can’t she spell? A referral may simply request updating testing that was done three or more years ago, to revisit or clarify a diagnosis. The referral starts the ball rolling.
The clinician talks to parents or guardians to develop a case history, either in person or by phone. You will be asked for details about your child’s developmental, medical, social, and psychological history. The clinician will want to know if anyone in the family has struggled with learning challenges or mental illness. At this stage, the clinician seeks insights into the many factors that affect how a child functions. If your child is old enough to contribute, the evaluator may also seek his or her input.
Selection of Assessments
Behind the scenes, the evaluator decides which formal measures to use to assess the particular child’s cognitive abilities, academic achievement skills, levels of social and emotional functioning, language abilities, motor skills, and so on. During the testing process, the evaluator may add other measures in response to behaviors that show up during testing. For example, when I look at the data, I may see an indicator that the student is impulsive, so I will give another measure to determine if there are symptoms of ADHD.
Testing is performed in the evaluator’s office. It is always done in person, one-on-one, because the psychologist has to see the child to conduct a proper assessment.
Cognitive testing, which I hate to call “IQ testing,” gives us a baseline for understanding how a child processes information. It gives the evaluator insight into the child's ability to attend to information, to use abstract thought, to problem solve. It sheds light on verbal comprehension and social comprehension.
How the child takes the test – their testing behavior – is as important as their answers. We observe every single behavior. Factors such as how quickly he answers questions, or how focused she is on the task, figure into the analysis. It will also show whether your child exhibits impulsive or high risk behavior and give insights into his or her judgment. Again, the focus is, How do they look at information? How do they take in information? How do they retain information? And how are they able to retrieve information? Neuropsychological testing is not intended to measure intelligence. It uses cognitive testing to gain insights into how your child processes information.
Report and Recommendations
Doing an evaluation is like putting a puzzle together. The parents bring some pieces to the table, the child brings other pieces. The interviews, testing data, and clinical observations all go into a formal evaluation that will include background information, the reason for referral, summary of history, formal and informal measures, results and a diagnosis – if the child meets the criteria – as well as recommendations. The diagnosis will never really change, but the recommendations are meant to help the child learn new coping skills and strategies.
As a parent, can I interpret the report on my own? Or do I need an expert to walk me through the results?
You would definitely need an expert to walk you through the results. You should always have the professional who completed the testing sit with you and explain the report point by point. They can say what the data shows. The student should also know what’s going on and have the opportunity to ask questions. There are some subjective measures included in neuropsychological testing. The results represent the psychologist’s interpretation of the data. Only they can explain their analysis.
How can I use the diagnostic report to help my child succeed?
In the list of recommendations, you may see that your child needs to learn in a small classroom, or to use a scribe for note taking, or to be allotted extended time for testing or homework. If your child is diagnosed with ADHD, recommendations may include focusing on time management and organizational skills. The evaluator may recommend preferential seating to increase focus, use of a day planner or a phone set with reminders to help the child stay on task. The parent may learn to stay in the moment with that child, to maintain eye contact, and to help the child break assignments down into smaller tasks.
You can use the evaluation to advocate for the supports and accommodations that will serve your child best. You can also use the recommendations to help you decide whether to find a different school and how to evaluate alternative learning environments. The results will not tell you whether to place your child in public school, a mainstream school with support, or a school that serves only students with a diagnosed LDs. But they can help you draw that conclusion.
How long does it take to go from a referral to a report?
The length of the testing process depends on the evaluator, on the referral question, and on the student. Some clinicians perform testing in a single session; others break it up across a number of meetings. To complete a report can take anywhere from two weeks to six months. If you need a report in a hurry, say to meet an admission deadline, ask the evaluator what their schedule will permit.
How can I convince my child that neuropsychological testing is nothing to be afraid of?
No one likes testing, but neuropsychological testing can be a real gift. It can help your child get stronger. Students with learning differences are amazing. They just process differently. Their brains are not wired to learn well by rote, or by the clock. They have trouble fitting into the circle, so they have to work around it. When we can figure out how they think and process, and then add the right supports, they’re just brilliant. They have a different way of looking at the world. They have their own challenges and strengths. Testing, oddly enough, is a great way to identify and embrace what makes us special.
Lilliam Martinez, Psy.D., LPC
Lilliam Martinez is a School Psychologist in the Student Health Center at Forman School. Dr. Martinez holds a B.A. from Smith College, an M.S. in educational psychology from University of Connecticut, and her doctorate in clinical psychology from Union Institute & University. She is a member of the American Psychological Association, Connecticut Psychological Association, American Counseling Association, and The Association for Psychological Science.