What is clinical neuropsychology? Clinical neuropsychology is a specialty profession that focuses on brain functioning. A clinical neuropsychologist is a licensed psychologist with expertise in how behavior and skills are related to brain structures and systems. The clinical neuropsychologist conducts the evaluation and makes recommendations. She may also provide treatment, such as cognitive rehabilitation, behavior management, or specialized psychotherapy.

Why have I been referred? Neuropsychological evaluations are requested specifically to help your doctors, and other professionals understand how the different areas and systems of the brain are working. Testing is usually recommended when there are symptoms or complaints involving memory and thinking. This may be signaled by a change in concentration, organization, reasoning, memory, language, perception, coordination, or personality. The change may be due to any of a number of medical, neurological, psychological, or genetic causes. Testing will be helpful in understanding your current situation.

What is assessed?

• General intellect
• Higher level executive skills (e.g., sequencing, reasoning, problem solving)
• Attention and concentration
• Learning and memory
• Language
• Visual-spatial skills (e.g., perception)
• Motor and sensory skills
• Mood and personality

Some abilities may be measured in more detail than others, depending on your needs.

How are test scores used to understand my specific situation? Your test scores will be compared to scores from people who are like you in important ways. By using a database of scores from large groups of healthy people for comparison, the neuropsychologist can judge whether or not your scores are normal for your age and educational background. The pattern of your own test scores will also be reviewed to estimate whether or not there have been changes in certain abilities. How you go about solving the various problems and answering questions during the examination will also be noted. Using these methods, your strengths and weaknesses can be identified.

What will the results tell me? Test results can be used to understand your situation in a number of ways:

• Testing can identify weaknesses in specific areas. It is very sensitive to mild memory and thinking problems that might not be obvious in other ways. When problems are very mild, testing may be the only way to detect them. For example, testing can help determine whether memory changes are normal age-related changes or if they reflect a neurological disorder. Testing might also be used to identify problems related to medical conditions that can affect memory and thinking, such as diabetes, metabolic or infectious diseases, or alcoholism.
• Test results can also be used to help differentiate among illnesses, which is important because appropriate treatment depends on accurate diagnosis. Different illnesses result in different patterns of strengths and weaknesses on testing. Therefore, the results can be helpful in determining which areas of the brain might be involved and what illness might be operating. For instance, testing can help to differentiate between Alzheimer's disease, stroke, and depression. Your physician will use this information along with the results of other tests, to come to the most informed diagnosis possible.
• Sometimes testing is used to establish a "baseline," or document a person's skills before there is any problem. In this way, later changes can be measured very objectively.
• Test results can be used to plan treatments that utilize strengths to compensate for weaknesses. The results help to identify what target problems to work on and which strategies to use. For example, the results can help to plan and monitor rehabilitation or to follow the recovery of skills after a stroke or traumatic brain injury.
• Studies have shown how scores on specific tests relate to everyday functional skills, such as managing money, driving, or readiness to return to work. Your results will help your doctors understand what problems you may have in everyday life. This will help planning for assistance or treatment.

What should I expect? A neuropsychological evaluation usually consists of an interview and testing. During the interview, you will be asked about your symptoms, educational, work and medical histories, medications, and other important factors. Testing involves taking pencil-and-paper or computerized tests and answering questions. The time required depends on the problem being assessed. In general, several hours are needed to assess the many skills involved in processing information. Some tests will be easy while others will be more complex. The most important thing is to try your best. Bring glasses or hearing aids if you use them. Try to rest and relax before your evaluation. You will probably find testing interesting, and the detailed information that is gathered will contribute to your care.

In this section, parents can find information about what to expect during your child's appointment and evaluation, which includes information on what to bring and how to best prepare your child.

What is Pediatric Neuropsychology? Pediatric neuropsychology is a professional specialty concerned with learning and behavior in relationship to a child's brain. A pediatric neuropsychologist is a licensed psychologist with expertise in how learning and behavior are associated with the development of brain structures and systems. Formal testing of abilities such as memory and language skills assesses brain functioning. The pediatric neuropsychologist conducts the evaluation, interprets the test results, and makes recommendations. The neuropsychologist may work in many different settings and may have different roles in the care of your child. Sometimes, the pediatric neuropsychologist can act as a case manager who follows the child over time to adjust recommendations to the child's changing needs. He or she may also provide treatment, such as cognitive rehabilitation, behavior management, or psychotherapy. Often, the neuropsychologist will work closely with a physician to manage the child's problems or work closely with schools to help them provide appropriate educational programs for the child.

How Does a Neuropsychological Evaluation Differ From a School Psychological Assessment? School assessments are usually performed to determine whether a child qualifies for special education programs or therapies to enhance school performance. They focus on achievement and skills needed for academic success. Generally, they do not diagnose learning or behavior disorders caused by altered brain function or development.

Why Are Children Referred for Neuropsychological Assessment? Children are referred by a doctor, teacher, school psychologist, or other professional because of one or more problems, such as:

· Difficulty in learning, attention, behavior, socialization, or emotional control;

· A disease or inborn developmental problem that affects the brain in some way; or

· A brain injury from an accident, birth trauma, or other physical stress.

A neuropsychological evaluation assists in better understanding your child's functioning in areas such as memory, attention, perception, coordination, language, and personality. This information will help you and your child's teacher, therapists, and physician provide treatments and interventions for your child that will meet his or her unique needs.

• What is Assessed?

A typical neuropsychological evaluation of a school-age child may assess these areas:

· General intellect

· Achievement skills, such as reading and math

· Executive skills, such as organization, planning, inhibition, and flexibility

· Attention

· Learning and memory

· Language

· Visual-spatial skills

· Motor coordination

· Behavioral and emotional functioning

· Social skills

Some abilities may be measured in more detail than others, depending on the child's needs. A detailed developmental history and data from the child's teacher may also be obtained. Observing your child to understand his or her motivation, cooperation, and behavior is a very important part of the evaluation.

Emerging skills can be assessed in very young children. However, the evaluation of infants and preschool children is usually shorter in duration.

• What Will the Results Tell Me About My Child? By comparing your child's test scores to scores of children of similar ages, the neuropsychologist can create a profile of your child's strengths and weaknesses. The results help those involved in your child's care in a number of ways.

· Testing can explain why your child is having school problems. For example, a child may have difficulty reading because of an attention problem, a language disorder, an auditory processing problem, or a reading disability. Testing also guides the pediatric neuropsychologist's design of interventions to draw upon your child's strengths. The results identify what skills to work on, as well as which strategies to use to help you child.

· Testing can help detect the effects of developmental, neurological, and medical problems, such as epilepsy, autism, attention deficit hyperactivity disorder (ADHD), dyslexia, or a genetic disorder. Testing may be done to obtain a baseline against which to measure the outcome of treatment or the child's development over time.

· Different childhood disorders result in specific patterns of strengths and weaknesses. These profiles of abilities can help identify a child's disorder and the brain areas that are involved. For example, testing can help differentiate between an attention deficit and depression or determine whether a language delay is due to a problem in producing speech, understanding or expressing language, social shyness, autism, or cognitive delay. Your neuropsychologist may work with your physician to combine results from medical tests, brain imaging or blood tests, to diagnose your child's problem.

· Most importantly, testing provides a better understanding of the child's behavior and learning in school, at home, and in the community. The evaluation can guide teachers, therapists, and you to better help your child achieve his or her potential.

What Should I Expect? A neuropsychological evaluation usually includes an interview with parents about the child's history, observation of an interview with the child, and testing. Testing involves paper and pencil and hands-on activities, answering questions, and sometimes using a computer. Parents may be asked to fill out questionnaires about their child's development and behavior.

Many neuropsychologists employ trained examiners, or technicians to assist with the administration and scoring of tests, so your child may see more than one person during the evaluation.

Parents are usually not in the room during testing, although they may be present with very young children. The time required depends on the child's age and problem.

Make sure your child has a good night's sleep before the testing. If your child wears glasses or a hearing aid or any other device, make sure to bring it. If your child has special language needs, please alert the neuropsychologist to these.

If your child is on stimulant medication, such a Ritalin, or other medication, check with the neuropsychologist beforehand about coordinating dosage time with testing.

If your child has had previous school testing, an individual education plan, or has related medical records, please bring or send this information and records to the neuropsychologist for review.

What you tell your child about this evaluation depends on how much he or she can understand. Be simple and brief and relate your explanation to a problem that your child knows about such as "trouble with spelling," "problems following directions," or "feeling upset." Reassure a worried child that testing involves no "shots." Tell your child that you are trying to understand his or her problem to make things better. You may also tell the child that "nobody gets every question right," and that the important thing is to "try your best." Your child will probably find the neuropsychological evaluation interesting, and the detailed information that is gathered will contribute to your child's care.