Tag

clinical neuropsychologist

Testing the Limits

By | NESCA Notes 2022

By: Ann Helmus, Ph.D.
NESCA Founder/Director; Clinical Neuropsychologist

In the world of assessment, “testing the limits” means essentially bending the rules of test administration in order to see if the change in administration allows the test-taker to demonstrate their knowledge more effectively. For example, some children and adolescents respond impulsively to multiple-choice tests, picking the first choice that appears to be correct without looking at all of the choices. Standardized test administration dictates that the evaluator accepts that impulsive response and, as such, impulsivity will compromise the client’s score.

In the example above, the student was unable to demonstrate their knowledge or skills effectively on tests because of the standardized administration procedures. While it is important to generate these scores, it is also important to gain an understanding of what the student actually knows, and this is where testing the limits comes in. For the impulsive student, the evaluator would test the limits by reminding the student to slow down and look at all the choices before responding. This is non-standard test administration, and so the score is not considered valid but the results give us a great deal of information about the student’s strengths and weaknesses. There is a big difference between the student who is able to achieve the correct score when cued to slow down and the student who still answers incorrectly, even with reminders to slow down. The former student can be said to have much higher potential than the latter student. However, their ability to demonstrate their potential is hampered by impulsivity, a problem that needs to be addressed.

In the course of most neuropsychological evaluations, we are trying to understand the student’s profile of strengths and weaknesses, which often requires testing the limits. This raises the question of the value of the standardized scores. The standardized scores likely reflect the level at which the child or adolescent is functioning in the “real world.” Impulsive test-takers are almost certainly impulsive students; just as they don’t demonstrate their true potential in testing, they are not doing so in school.

Many students are able to fully demonstrate their skills and knowledge with standardized testing and don’t require “testing the limits.” However, at NESCA, we also see many highly complex students whose ability to access their potential is limited by issues of attention, executive functioning, communication, or emotional/behavioral regulation. In these cases, we routinely “test the limits” and report both standardized administration and non-standardized (“testing the limits”) scores and explain what these scores mean for the individual, what the scores tell us about daily functioning as well as untapped potential.

 

About the Author
NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists, complete NESCA’s 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, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Looking for Answers? Ask the Right Questions.

By | NESCA Notes 2021

By: Ann Helmus, Ph.D.
NESCA Founder/Director; Clinical Neuropsychologist

Many parents have met with me concerned that, “We had a full evaluation and got a lot of scores and a diagnosis but we still don’t understand why our child has this problem and what we can do about it.” This outcome can be avoided if parents and the evaluator are both clear on why the child is being evaluated, have laid out specific questions to be answered and what kinds of recommendations are being sought. Determining the referral question(s) should be a key goal of the intake session.

During the intake meeting, the evaluator can help the parent to shape their concerns into a specific referral question that can be addressed effectively through the process of neuropsychological evaluation. The evaluator can manage parental expectations in this process so there is not disappointment with evaluation results that don’t answer the parents’ questions. For example, I’ve had parents request an evaluation because they want to know if their fifth grader will get into Harvard or their child with high-functioning ASD (autism spectrum disorder) will get married. These questions can’t be addressed through a neuropsychological evaluation, but they can be re-worked into answerable questions. A neuropsychological evaluation can tell us if a child’s cognitive and academic skills are in the range of students who attend the most competitive colleges. However, there are many other factors that influence the college acceptance process. In this case, the referral question might be revised into “assess the child’s potential for academic success in a rigorous academic setting.” Similarly, it is beyond the scope of a neuropsychologist to determine if anyone will get married, but through the evaluation process we can assess the child’s current social and emotional functioning and offer some predictions about their likely developmental trajectory in the social domain.

While the previous examples of referral questions are too broad or abstract, I am also often confronted with referral questions that are too narrow, such as, “Does this child have ADHD?”.  In this case, I would work with the parents to reframe the referral question to, “Why does this child appear to have difficulty paying attention in school?” This referral question recognizes the fact that there are many reasons that a child may have difficulty concentrating or appear distractible – ADHD being only one of the possibilities.

When I train neuropsychologists, I emphasize the importance of understanding “Why now?”. What is it that motivated the parent or school team to seek evaluation at this point in time as they work to frame the referral question with parents? Common reasons include: concern about how the child will manage an upcoming transition (e.g., to middle school), sudden appearance of a problem, obvious widening of the gap between a child and peers, inability to meet increased developmental demands, lack of response to interventions, change in emotional status, or deterioration in academic performance.

It is extremely helpful when parents and/or school teams prepare for the intake meeting by brainstorming what they are seeking from the evaluation, questions they hope will be answered, issues to be assessed, and specific guidance that is being requested. The evaluator can then work with the parents or school team to fashion these into a referral question that is specific and relevant to the child so that all parties are “on the same page” as they undertake the evaluation process.

 

About the Author
NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, complete NESCA’s 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, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.