Neuropsychological Evaluations: An Integral Part of Your Child’s Success Lisa G. Hahn, Ph.D., ABPP Board Certified Clinical Neuropsychologist Neuropsychology Associates of New Jersey Morristown, New Jersey

What is Neuropsychology? Clinical specialty in the neuroscience field Refers to the study of brain-behavior relationships Influenced by the following disciplines: Neurology Psychology Anatomy

What is a Clinical Neuropsychologist? Training Involves Doctoral training in psychology Commonly clinical psychology or neuropsychology programs Specialized coursework associated with brain-behavior relationships Two-year Postdoctoral Fellowship Additional training with specialized populations Medical Psychiatric

What is a Clinical Neuropsychologist? Proficiency Expertise in how behavior and skills are related to brain structures and systems Clarify relationship between disease state and behavioral consequence How does brain dysfunction relate to every day life and one’s ability to interact with others, learn, function in their world in a meaningful manner

What is a Clinical Neuropsychologist? Role Diagnose Psychological, Cognitive, Learning, and Emotional Conditions Provide information to assist differential diagnosis of medical and psychological/psychiatric conditions Identify cognitive problems associated with neurological or psychological conditions Monitor progression or response to treatment Develop treatment and intervention strategies

What is a Neuropsychological Evaluation? Objective testing of skills that correlate with brain function using: Standardized psychometric instruments used to evaluate multiple aspects of normal cognition Objective assessment of emotional/psychological functioning Integration of objective test data subjective input from parents qualitative information from the Neuropsychologist such a clinical observations

What does the appointment entail? It is typically a full day evaluation The evaluation includes: Clinical interview of the parents and child Review of medical, school, and previous testing records, if available Neuropsychological testing of the child Completion of questionnaires that assess behavioral, emotional and psychological functioning Preliminary feedback of diagnostic findings and recommendations Feedback is provided after the report is received and reviewed

Who Refers to a Neuropsychologist? Parents General practitioners or pediatricians Medical specialists (e.g., neurologists, oncologists) Psychologists, therapists or social workers School Counselors Child Study Teams Attorneys or advocates

What are common referral questions posed to a Neuropsychologist? General ability or rate of growth Learning and memory Academic achievement Language acquisition Social development Fine motor development Emotional development Chronic or acute medical problems Family issues Attention and behavior

What is the Purpose of the Referral and Evaluation? Clarification To better understand the child’s neurobehavioral profile in the presence of an academic, social or emotional issue or medical condition. Prevention and Monitoring To gain a baseline and follow-up evaluation for future Intervention To aid in developing a plan to assist individuals with known or suspected cognitive or emotional problems

What are the domains assessed? New Learning & Memory Speech Language Sensorimotor Visual-spatial and perceptual skills Intelligence Attention Academic achievement Executive function Mood Personality

What diagnoses are elucidated from a Neuropsychological Evaluation? A neuropsychological evaluation can help differentiate or confirm diagnoses such as Attention Deficit Hyperactivity Disorder Executive Dysfunction Learning Disorders Learning/Memory Disorders Fine-Motor Disorders Depression Anxiety Bipolar Disorder Thought Disorders

What is a Psycho-Educational Evaluation? This typically includes tests of Intellectual Functioning Academic Achievement Parent self-report questionnaires It does not include comprehensive assessment of additional neurocognitive domains It does not include comprehensive assessment that can result in any diagnosis with the exception of Learning Disorder Developmental Disability (i.e., Mental Retardation) Intellectual Functioning – WISC or WAIS Academic Achievement – usually a Woodcock or WIAT

Why Not Have My District Complete a Psycho-Educational Evaluation? By law District does not need to provide this evaluation until your child is doing very poorly in school (i.e., there is a significant problem with their achievement) or their behavioral problems are clearly interfering with their learning For many children by this stage they have developed low self-esteem, feel inefficacious, are failing academically, and may even be negatively labeled by their teachers or peers The evaluation is very limited in scope, unlike a neuropsychological evaluation

The Common Question: Why So Much Testing? The brain is a complex organ that encompasses many neural networks and functional abilities It is important to conduct a broad based assessment When we leave no stone unturned then we can be more positive the diagnosis is accurate Often parents are familiar with a psycho-educational evaluation (usually 2 maybe 3 hours) and expect the neuropsychological evaluation to be a similar process. However, the brain is a complex organ that encompasses many neural networks and functional abilities. It is important to conduct a broad based assessment. Our evaluation is comprehensive and we leave no stone unturned. As a result we can be positive the diagnosis is accurate. How does one know a child has ADHD if the evaluator (school psychologist, pediatrician, psychiatrist) only spends a brief period of time with the child and does not gather actual objective data about executive function? Typically a parent will fill out a self-report questionnaire or the school psychologist only administers the WISC/WAIS. But executive function is a very broad area of functioning. Our testing is always comprehensive to rule out and rule in any potential diagnoses.

The Final Result: An Integrative Report Results of standardized testing are integrated into a broader understanding of the individual’s neurobehavioral pattern Summary of previous evaluations/treatments Behavioral observations Test results Integrative summary of findings placed in the context of medical, developmental and psychosocial history Diagnostic formulation Recommendations for intervention and remediation The report is typically anywhere from 6 to 20 pages in length depending on the complexity of the individual’s background, number of previous evaluations, and number of diagnoses.

Possible Recommendations Medical Consultation with another specialist Therapeutic Support Cognitive restructuring ADHD coach Psychological counseling or therapy Educational Special education services Classroom accommodations Advocacy Out of district placement Transition planning for after high school

Beyond the Final Product of the Report My goal is always to advocate for the child’s best interests When a parent is working with an advocate or attorney, I too become part of their team I am available to participate in Child Study Team meetings to help explain the neuropsychological evaluation findings I work as a liaison to assist the parents/family in finding appropriate community services or school placement I provide follow-up testing to assess efficacy of interventions (i.e., medication, academic programs, etc.)

Neuropsychology Associates of New Jersey How to contact me: Neuropsychology Associates of New Jersey Board Certified Clinical Neuropsychologists 250 Madison Avenue Suite 200 Morristown, New Jersey 07960 973-267-5646 npanj.hahn@yahoo.com www.npanj.com