By Ann Helmus, Ph.D.
Founder & Director, NESCA
In a recent blog, I discussed how not all neuropsychological evaluations yield equally useful outcomes for helping a struggling child and touched on the consequences of misdiagnosis. This week, I’d like to explore another common challenge: evaluations that merely label a symptom without uncovering the underlying cause.
Consider a patient who visits a doctor with concerns of persistent fatigue and weight gain. After routine labwork returns normal results, the doctor offers the diagnoses “mild obesity” and “idiopathic fatigue”—labels that describe the symptoms but do not provide a meaningful explanation. The patient is advised to get more sleep or possibly prescribed a new medication. After waiting months for the appointment and paying out of pocket, the individual is left feeling frustrated and still without clarity or direction about how to address the root cause of the problem.
Parents sometimes experience this result from their child’s neuropsychological evaluations, particularly when conclusions focus primarily on standardized test results without integrating the broader picture of a child’s daily functioning, course of development, and learning profile.
For example, I recently reviewed a report for a fifth grader whose parent was deeply concerned about the emotional distress their child experienced with writing. Despite the teacher reporting that the child’s writing was “fine,” and the child handling other homework with ease, the parent observed significant distress during writing tasks. The evaluation found a discrepancy between IQ and written expression scores, diagnosing a Disorder of Written Expression (ICD-10 F81.81), and recommending a writing tutor as intervention.
While this diagnosis is valid based on test scores, it simply labels the problem rather than explaining why the writing challenge existed or what type of support might be most effective for this individual. Difficulties with written expression can stem from a variety of root causes—fine motor challenges, language deficits, executive functioning difficulties, or learning differences like dyslexia, among others. Effective interventions vary widely depending on the underlying issue. For example:
- Children with communication disorders may benefit most from working with a speech-language pathologist on written expression embedded in the context of language development
- Children with dyslexia often require structured literacy approaches
- Children with executive functioning challenges may need explicit, scaffolded instruction in planning and organizing written output
In the case I reviewed, the child’s intellectual abilities were in the Very Superior range, with especially strong abstract reasoning and pattern recognition. Standard tests showed that his organizational skills were age-appropriate, yet he struggled to express his ideas in writing. Why? Because the complexity and richness of his ideas exceeded his ability to structure them effectively. In this case, his frustration stemmed from a bottleneck in translating thoughts into written form—a challenge not uncommon in gifted learners.
The solution wasn’t simply more writing practice; it was a targeted program matched to his unique cognitive profile, along with strategies for reducing emotional stress around writing.
After additional observation and analysis, we were able to offer the family not only a clear explanation but also a tailored plan, including specific interventions and home supports. Most importantly, we helped the child understand why writing felt so difficult and reassured him that effective help was available.
When done thoughtfully, a neuropsychological evaluation can be truly transformative. At NESCA, we are deeply committed to providing comprehensive evaluations that go beyond scores to understand the whole child. We aim to provide the kind of service we would want for our own children—thorough, compassionate, and actionable.
NESCA clinicians receive ongoing training and mentorship to ensure a consistently high standard of care. Each clinician participates in multiple weekly case conferences to discuss complex profiles and refine their clinical thinking. We also offer weekly seminars to stay informed about evolving interventions and treatments. New team members—regardless of prior experience—receive six months of mentorship to support their transition into our collaborative model. This structure fosters a culture of continual learning and clinical rigor. We take pride in our work because we know that careful, individualized evaluations can change the trajectory of a child’s life.
About the Author
NESCA Founder and Director Ann Helmus, Ph.D., is a licensed clinical neuropsychologist who has been
practicing neuropsychology for 35 years and has been director of NESCA’s Neuropsychology practice for nearly three decades, continuously training and mentoring neuropsychologists to meet the highest professional standards.
To book a neuropsychological evaluation at NESCA, 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.
