Beyond the Scores: The Comprehensive Approach to Neuropsychological Evaluations

When parents think of a Neuropsychological Evaluation, they often envision their child completing a series of tests that generate scores. These test scores tell parents how their child is performing compared to a large group of other students their age across a wide range of cognitive and academic domains. While this is accurate, the evaluation process also integrates data from multiple sources beyond quantitative test scores to develop a comprehensive picture of your child. These other sources of data may be less obvious but are highly essential to developing an accurate “diagnostic formulation” of your child’s strengths and weaknesses, as well as interventions specifically tailored to support their individual neuropsychological profile.

Here’s an overview of the types of data typically involved:

1. Clinical Interview:

• Symptoms and Concerns: The individual’s description of their cognitive, behavioral, emotional, and academic symptoms, as well as those reported by family members or caregivers.
• Birth, Developmental, and Medical History: Information about the individual’s birth, medical, psychological, and developmental history, including any past or current health conditions, injuries, or psychiatric disorders.
• Family History: Information about any family history of neurological or psychological conditions that may help understand potential genetic or hereditary factors.
• Academic and Psychosocial History: Insight into the individual’s social relationships, educational background, and occupational history to understand the impact of cognitive or emotional issues on daily functioning.

2. Standardized Psychological/Neuropsychological Tests:

These are structured tasks designed to measure different aspects of cognitive and academic functioning. They provide objective data that help evaluate brain-behavior relations.

• Intelligence Tests (IQ Tests): Assess overall cognitive ability and intellectual functioning. A common test is the Wechsler Intelligence Scale for Children (WISC-V).
• Speech-Language Tests: Evaluate expressive, receptive, and pragmatic language skills, including verbal fluency, comprehension, and naming. Examples are the Boston Naming Test and the Clinical Evaluation of Language Fundamentals (CELF-V).
• Visual-Spatial Tests: Measure spatial processing, visual memory, and the ability to integrate visual and motor functions. Examples include the Rey-Osterrieth Complex Figure Test and the Block Design subtest from the WISC-V.
• Sensory-Motor Tests: Assess motor skills, coordination, and fine motor skills (e.g., the Grooved Pegboard Test).
• Memory and Learning Tests: Evaluate short-term, long-term, and working memory. Examples include the Wide Range Assessment of Memory and Learning (WRAML) and the California Verbal Learning Test (CVLT-C).
• Attention and Executive Function Tests: Measure selective-sustained attention and cognitive flexibility, such as the Continuous Performance Test (CPT); as well as assess higher-order cognitive functions, such as planning, decision-making, problem-solving, and impulse control. Examples include the Wisconsin Card Sorting Test (WCST) and the Tower of London task.
• Academic Tests: Assess reading, writing, and mathematical skills. An example is the Wechsler Individual Achievement Test (WIAT-IV).

3. Behavioral Observation:

• Behavioral Observations During Testing: The examiner notes the individual’s behavior, mood, and engagement during the testing process. This can provide insight into areas, such as attention, motivation, or emotional regulation.
• Classroom/Program Observations: This can involve observing a child’s functioning in a “real life” setting and provide insight about their ability to apply the skills noted in their test findings to more complex environments.

4. Behavioral Rating Scales and Self-Report Questionnaires:

These are used to assess subjective experiences related to mood, behavior, and cognitive functioning.

• Broad Band Rating Scales: Provide information about the individual’s functioning across multiple domains, which can be helpful to identifying areas of concern for additional investigation. An example is the Child Behavior Checklist (CBCL).
• Targeted/Narrow Band Rating Scales: Provide information about specific domains, such as depression and/or anxiety, which can be helpful for gaining a deeper understanding of an individual’s particular symptom profile. One example is the Beck Depression Inventory (BDI).

5. Collateral Information:

• Reports from Family Members, Teachers, Coaches, and Tutors: Provide insight from those who know the individual well, often providing information about changes in behavior, memory, or mood.
• School or Occupational Records: Include academic performance, work-related difficulties, or other performance metrics that may be reviewed to understand the functional impact of cognitive or emotional difficulties.

6. Neuroimaging and Medical Data (if applicable):

• Brain Imaging (e.g., MRI, CT scans, PET scans): Used to identify brain abnormalities, such as lesions, atrophy, or structural damage, which may contribute to cognitive impairments.
• EEG or Evoked Potentials: Sometimes used to assess electrical activity in the brain, particularly if seizures or other neurological concerns are present.
• Medical Reports: Data on neurological conditions, medications, or surgeries that may impact cognitive or emotional functioning.

By combining these different types of data, a neuropsychologist can create a comprehensive picture of an individual’s cognitive strengths and weaknesses, helping to identify any underlying neurological conditions or psychological factors that are contributing to their difficulties. While test scores are always important, interpreting your child’s performance on neuropsychological tests without the additional data outlined above can lead to misdiagnosis, ineffective treatment, and other unforeseen complications.

About the Author

Dr. Sean O’Brien has been providing comprehensive neuropsychological evaluations in the Greater Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as  Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To schedule an appointment with one of NESCA’s neuropsychologists, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.