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Are We Working With a Full Deck of Cards? Why Neuropsychologists Want Results from Previous Evaluations

By August 1, 2022NESCA Notes 2022

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

Neuropsychological testing is a tremendous undertaking in time and effort for a family. It involves intake documents, questionnaires, financial paperwork, insurance information, teacher forms, and the list goes on. I promise this paperwork is meaningful and helpful, a way to get the most out of the time and investment in a neuropsychological evaluation. Over the next few weeks, several of NESCA’s neuropsychologists will tackle a few common questions that we face that will help you prepare for neuropsychological testing.

The first topic to tackle relates to the need for previous records. It can feel time consuming to track down documents from years ago, particularly if your child has grown and changed over time. There are many reasons why it is critical to provide these records so your provider has the full deck of cards as they build an individualized evaluation for your child. I’ll tackle the three most important reasons to me:

First, pediatric neuropsychologists want to understand the development of your child over time. For example, if we are evaluating learning problems, I want to know what it was like in kindergarten and early elementary school when your child learned to read. I want to know when the attention problems started or problems interacting with peers were first noticeable to those around them. As we build a developmental timeline, it can help to conceptualize where it all began to help us get at the magical “root cause” that parents often seek. Understanding development over time also helps us to build a better treatment plan. For example, if I can see that a child struggled to develop early reading skills and then years later is extremely anxious about attending school, it helps guide recommendations in both domains.

Secondly, records are critical so we do not risk “practice effects.” “Practice effects” refer to the improvement in scores that happens simply from being exposed to the task before. While guidelines are not as set in stone as some may think, it is generally advised not to repeat many neuropsychological measures within a year of testing. There may be reasons to speed up this timeline that are client-specific, but we cannot make that determination unless we see the documents. Research says practice effects diminish over a few months to a year. We want to eliminate any interfering factors that would make it harder to draw conclusions about the data in the current evaluation. With the time and investment you make in testing as a parent, I can only imagine how frustrating it would feel to hear that something we can manage interfered with the process. Access to records helps us to choose the right measures for the right moment.

Thirdly, providing previous records also allows us to track skill development over time. This is particularly important if we want to see if an intervention (e.g., reading instruction, therapy, attending social skill groups) is working to build the skills. Put simply, it tells us if a problem is getting better or getting worse. Even if you do not agree with the final conclusions drawn by the previous professional, the scores still provide critical data points in development. For more information on seeking a second opinion when you disagree with results, sit tight – that blog post is coming!

I often use the metaphor with kids and families that neuropsychological testing can help us to develop a type of “instructional manual” for how their brain works. With younger kids, I tell them that I am writing the LEGO instructional manual for which steps to take in what order and with what pieces. Without the prior records, I’m missing a bag of pieces. That is almost as frustrating as stepping on the actual LEGOs!

Please come back over the next several weeks to hear more from my colleagues about how to make the most of your child’s neuropsychological evaluation!


About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.


If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form


Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email or call 617-658-9800.