By Ann Helmus, Ph.D.
Founder & Director, NESCA
At NESCA, we often see students who have been through neuropsychological evaluations before—but whose needs remain unmet. Unfortunately, not all evaluations are created equal, and a poorly done assessment can have serious, lasting consequences for a child.
It’s important for parents to understand that test scores do not provide the answers; tests are tools that skilled evaluators use to evaluate hypotheses that arise from analyzing information provided by parents and teachers (e.g., the presenting concerns could be caused by ADHD, anxiety, or a poor teacher match). When an evaluator fails to carefully integrate the testing data with history and observations, the child’s underlying issues may not be accurately explained, and they are unlikely to receive the treatment or educational supports they truly need. Worse, they may be misdirected into interventions that are ineffective or even inappropriate. Time is lost. Money is wasted. And critically, the window for meaningful intervention begins to close.
Consider a recent case we saw at NESCA. A middle schooler had been diagnosed by an outside evaluator with Autism Spectrum Disorder (ASD) at a young age. More recently, she had another neuropsychological evaluation, again not at NESCA. The clinician didn’t question or reevaluate the ASD diagnosis and recommended placement in a specialized program for students with autism.
The problem? This student was not autistic.
She was more cognitively and socially advanced than her peers in the program and made little effective progress on her IEP goals.
Her parents knew that something was wrong and sought a reevaluation at NESCA. Our clinician doubted the diagnosis of ASD based on information provided by her parents and teachers. The results of NESCA’s comprehensive neuropsychological assessment clearly indicated that this student did not meet criteria for ASD. Rather, she was found to have a significant communication disorder, along with social anxiety, which is commonly seen in individuals with weak language skills.
Because these underlying challenges had not been identified, they had not been properly treated. By the time the student was reevaluated, she was already finishing middle school, and valuable years for remediation had been lost.
The differential diagnosis between autism, communication disorders, and anxiety can be complex. These conditions share many overlapping symptoms—difficulty with social interaction, trouble expressing oneself, rigid thinking patterns, emotional dysregulation—and it takes careful, thoughtful assessment to tease apart the diagnostic picture.
Too often, I read reports from outside of NESCA that show little analysis of the data: tests are administered, deficits are listed, and a diagnosis is selected without adequate integration of the child’s history, day-to-day functioning, and observed behavior. Neuropsychological testing is not a mechanical process or a checklist; it is a process of clinical reasoning based on experience, judgement, knowledge, and acumen.
When done properly, a neuropsychological evaluation can be life-changing. At NESCA, we take the power of this tool seriously and honor our commitment to parents to provide the high level of service that we would want for our own children. We train our clinicians to analyze test results in the full context of a child’s developmental history, real-world behavior, and educational trajectory. We make diagnoses carefully and intentionally, because we know that accurate identification is the first step toward effective support.
The NESCA Difference is in the level of training, support, and accountability that we provide for our clinicians. I am actively involved in training our neuropsychologists—reading and editing reports and providing guidance. We have two clinical directors who have been at NESCA for more than 15 years and are responsible for supporting clinicians in thinking through complex cases, reviewing reports, and honing recommendations. All NESCA clinicians participate in one to two case conferences each week for group discussion of complicated cases. All clinicians attend a weekly seminar or discussion group to learn about various evidence-based interventions and treatments, often from trusted professionals that we invite in to share their knowledge. Neuropsychologists who join the NESCA team are provided with at least six months of mentoring by a senior clinician on staff, regardless of how experienced they are when they are hired. As a result of these requirements, NESCA attracts intellectually curious professionals who want to continue to learn and develop skills as they progress in their careers. They are passionate about their work and take pride in the high quality of their evaluations, knowing that they are impacting the course 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.
