Exciting announcement! NESCA is accepting clients for home- and/or community-based Real-life Skills and Executive Function Coaching with Leah Bridge, MSOT, OTR. Leah is available for in-person occupational therapy (OT) and coaching services in the Newton, MA and Central MA areas. NESCA’s team of coaches offer Real-life Skills, Executive Function, Functional OT and Parent/Caregiver Coaching remotely for those outside of the Newton area. To learn more or book coaching services, complete our Intake Form.

The Importance of Behavioral Observations in Neuropsychological Evaluations

Neuropsychologist observing the behavior of a child being evaluated

Neuropsychologist observing the behavior of a child being evaluatedBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Neuropsychological evaluations integrate information collected from multiple sources: (1) history and presenting concerns obtained during clinical interviews with a parent/guardian and the patient, (2) information from a review of records (e.g., past testing reports, school plans, such as IEPs or 504 plans, medical documentation), and (3) neuropsychological and psychological test findings. While these sources of information are important components of an evaluation, behavioral observations are essential to truly understanding a child’s strengths and weaknesses.

Behavioral observations are the qualitative observations made by a clinician that help to understand the child’s unique set of strengths and weaknesses. This includes overall impressions of the child throughout the evaluation process, such as their cooperation level and general attentiveness, their mood/affect and interpersonal skills, any nuances noted in their expressive or receptive language skills, and their fine motor abilities. This provides a “big picture” context to help the interpretation of more specific test findings. For example, if a child appears depressed and, as a result, thinks and completes tasks slowly, this can provide context for test scores which indicate processing speed deficits. In addition, these “big picture” behavioral observations can highlight the daily life impact that results from a weakness. For example, a child may be observed having difficulty opening a food container during a snack break which relates to the fine motor weaknesses seen during direct testing. Lastly, observations during unstructured times (e.g., waiting room behavior, separation from parents, social chit chat in between tasks) can often contribute invaluable information that would otherwise not be elicited from structured standardized testing.

Behavioral observation during testing tasks is necessary to look for any factors that may help elucidate the specific strengths or challenges a child may be experiencing. For example, a child may receive a Low Average score on a “Block Design” task in which they are asked to use blocks to recreate a visual-spatial design within a time limit. However, this Low Average performance could occur for many reasons. First, it could be due to a child having a hard time perceiving the correct angles and shapes within the design, suggesting a visual-spatial deficit. Second, a child may answer all items correctly but had done so after the time limit, suggesting a processing speed weakness. Third, a child may make an error as they rush through each item, suggesting difficulties with attention to detail or impulsivity.

Behavioral observations allow the clinician to identify a child’s unique profile of strengths and weaknesses to a greater specificity, which, in turn, allows for more tailored treatment recommendations. For example, knowing a child has a fine motor weakness that results in difficulty opening food containers could suggest a more specific and targeted treatment goal for a school-based intervention plan or private occupational therapy than simply knowing the child scored below age expectations on a fine motor task. In addition, three children who performed similarly on a block design task would require very different treatment approaches (e.g., visual-spatial accommodations, extended time, attention/impulsivity accommodations). As such, good behavioral observations are the key to a comprehensive evaluation that can provide the most tailored treatment recommendations.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

 

To book a consultation with Dr. Burns or one of our many other expert neuropsychologists, complete NESCA’s 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, New York (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.

Skip to content