Neuropsychological Evaluation

Comprehensive evaluations are generally requested in order to better understand why a child may be having difficulty meeting age-appropriate demands in school or at home or to monitor a child’s progress and course of development. The provide a detailed description of a child’s learning style based on careful integration developmental history with findings from test data, as well as observations by parents, teachers and clinicians. These evaluations address the underlying reasons that a child may be struggling academically, socially or emotionally, and offer parents and teachers a set of tools for supporting the child’s development.

How to Select a Neuropsychologist to Evaluate Your Child

Parents often ask us how to go about identifying the “right” neuropsychologist to evaluate their child. The evaluation process is unfamiliar to most and difficult for many, and it’s a big, expensive decision, with potential long-term consequences.

Here are some thoughts as to how you can find a clinician whose skills will meet your needs, in a practice that inspires your trust and makes you feel at home.

Choose a practice, not just a practitioner.

Obviously, the most important thing is that the clinician you choose to evaluate your child be professionally qualified and experienced. But you should also give serious consideration to your overall confidence in his or her practice, and how comfortable you feel within it, because ideally, you will be establishing a long-term relationship that will support you and your family throughout the life of your child. Do the size of the center and its culture encourage the development of that kind of relationship, or does it feel institutional or impersonal? Is there adequate privacy?

You may be unfamiliar with the evaluation process itself and have numerous questions about it, or about insurance, educational and other issues. Are they all answered graciously and to your satisfaction by a knowledgeable staff? Are your calls and emails returned promptly? Does the practice do its best to accommodate your scheduling and other requirements? Are you dealt with considerately, by administrative staff sensitive to the prospect that this may be difficult and demanding for you?

Is the practice clean, comfortable and easily accessible to local amenities, including shops and restaurants? Is there off-street parking? Does it offer public-access computers or Wi-Fi connectivity? How about access to a copier? You may be coming a considerable distance for your evaluation, but irrespective of your address, you will be investing a good deal of time in it. Your experience will be much more positive if you can readily make yourself at home and/or work productively while your child is being tested.

Visit the practice website. Its tone as well as its content may be revealing.

Evaluate the evaluators.

Google them. Read their website biographies. Are their credentials, experience and interests appropriate given the nature of your concerns? For some conditions, correct diagnoses and treatment demand special expertise. Do they have all of the appropriate testing instruments, and have they been professionally trained in their use?

Do you feel that you can establish a rapport with them, confident that they will care for your child as an individual?

Ask about their caseloads: how many clients do they see per month? Historically, insurers like Blue Cross Blue Shield have judged a thorough neuropsychological evaluation to be a 16-hour unit, including a clinical intake interview, two appointments for testing and behavioral observation, collateral contacts as necessary (e.g., phone calls to doctors, therapists or teachers), a parental feedback session and subsequent preparation of a lengthy report with analysis of test results and detailed recommendations.

High-quality neuropsychological evaluations demand a good deal of time and thought; be certain that your clinician manages his or her caseload effectively, ensuring that adequate time is devoted to your child’s report.

In that vein, ask how long after your final appointment you will receive your report. It is completely reasonable to expect a commitment from your clinician that it will be delivered no more than 6-8 weeks after your final feedback session.

Ask also if the neuropsychologist with whom you have made your appointment, and whose name will appear on that report, will be present throughout the testing, or if instead, the tests will be administered solely or primarily by a post-doctoral trainee or technician. If the latter, ask about how extensively he or she will be supervised by senior staff.

You are investing in, and are entitled to, the skill, experience, clinical judgment and professional reputation of the neuropsychologist to whom you have been referred. Will he or she be able command the attention and respect of physicians, special educators, attorneys and other professionals who may become involved with your child?

Find out if the clinician evaluating your child is actually employed by the practice, or compensated as a contractor on a fee-for-service basis. Why? Because independent practitioners may not always be held to the same high standards of care as staff members of a practice which must stand behind the quality of their work. When you see someone on staff, you are assured that subsequent appointments will be with that same person in comfortably familiar surroundings, which by reducing anxiety may improve the efficiency of the evaluation and the accuracy of its results.

Will your doctor go the extra mile for your child, by making him- or herself available for classroom observations, participation in TEAM meetings, IEP reviews and consultation with other professionals, or by providing whatever other supports may be appropriate under the circumstances?

Recommendations are fruitless if there’s no one to ensure that they have been, or will be, effectively implemented. Be sure to ask. Some programs do not provide these critical ancillary services.

Ask around, and don’t be shy!

Don’t hesitate to ask your pediatrician or primary care physician, your educational advocate, attorney or other professionals involved in your child’s care for their recommendations. Most will have worked with several neuropsychologists or have had a chance to read their reports. Consult the various SEPAC websites and review their lists of member-recommended evaluators. If you have access to their ListServs, read the messages posted by users and ask questions of your own. Use the web resources available to you.

Finally, you may have a friend, neighbor or relative whose child has already been evaluated. Discuss their experience and its outcome with them. Positive word-of-mouth is the lifeblood of any good practice.

Five Good Reasons to Choose NESCA

  • Our clinicians are highly-trained, pediatric neuropsychologists, most trained by Dr. Helmus and all of them employed exclusively by this practice. Collectively, they bring many, many years of experience to bear in thoroughly evaluating even the most complex and challenging conditions. By nurturing collegiality and the open exchange of information between longtime colleagues with different specialties and interests, we assure that the best and most current practices are embraced by all.
  • We have developed a set of protocols, standards and shared values that insure the quality, consistency and reliability of the work we do, which we fully stand behind. Culture counts! We have also cultivated a network of professional connections that affords high-level access to the people in all fields who can really make a difference in the life of your child
  • We sponsor weekly staff training seminars and periodic, full-day workshops featuring guest experts addressing topics of interest. These advanced training sessions are in addition to the continuing education courses that psychologists are required by the State of Massachusetts to attend as a condition of licensure, which we subsidize.
  • Our clinical and administrative staff members are uncommonly well coordinated, acting in concert to provide the smoothest, least stressful, most efficient and productive experience for you and your child. We encourage you to seek out information about us, about the quality of our work and the satisfaction of our clients.
  • We listen, respectfully. We know a lot about neuropsychology; you are the best expert on your own child and family.

Evaluating a Neuropsychological Evaluation Report

At NESCA, our clinicians take particular pride in the quality and clarity of their written reports. These are essential tools for parents and teachers to use in supporting the development and educational progress of children with special needs. Here are some things you’re entitled to expect in a good one:

  • It should be comprehensible and meaningful to non-psychologists in “painting a picture” of a child’s strengths and needs without excessive jargon;
  • Current findings should be put in historical context and related directly to previous findings;
  • The report should contain all test data as well as cogent interpretation of that data;
  • A diagnosis should be stated clearly and substantiated by information from the evaluation regarding the child’s history, test findings and clinical observations;
  • A statement of the developmental risks associated with a child’s profile is important;
  • Its recommendations should be specific and backed up by information from the testing — e.g., “Given Bobby’s poor reading skills as seen on standardized testing and reported by his teacher, I recommend that he receive remedial reading instruction as follows:
    1. Systematic, phonetically-based curriculum with clear scope and sequence (e.g. Wilson, Orton-Gillingham, Lindamood-Bell);
    2. Instruction to occur at least 45 minutes daily individually or with 1-2 other students who have similar levels of need;
    3. Reading instructor to be properly trained and certified;
    4. Instruction to take place outside of the classroom;
  • The evaluator should review the child’s IEP carefully and indicate whether the delivery of services appears to be appropriate; in some cases, a classroom observation is necessary;
  • Strengths-based recommendations are particularly helpful (e.g., a photograph of a “clean room” for a visual learner; sequential step-by-step instructions for a verbal learner);
  • Recommendations should be prioritized based on discussion with parents at feedback;
  • The evaluator should assist with the implementation of his/her recommendations by speaking with other professionals, making appropriate referrals and, as necessary, being available for classroom observations, participation in Team Meetings and expert testimony at BSEA hearings.
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