GUIDE TO PEDIATRIC NEUROPSYCHOLOGICAL ASSESSMENT

What Is Pediatric Neuropsychology?

Pediatric neuropsychology is a medically-related specialty concerned with the study of brain-behavior relationships in children and adolescents.

Who Practices Pediatric Neuropsychology?

A pediatric neuropsychologist is a Ph.D. fellowship–trained psychologist with expertise in how learning and behavior are associated with the development of brain structures and systems. 

A pediatric neuropsychologist uses standardized tests and observes behavior to define a child’s pattern of cognitive development and to compare performance with other children at the same developmental stage.

The pediatric neuropsychologist may work in many different settings and may have different roles in the care of the child:  

  • May act as a case manager who follows the child over time to adjust recommendation for the child’s changing needs.
  • Can provide treatment, such as cognitive rehabilitation, behavior management, family therapy or psychotherapy.
  • Usually works closely with the physician to manage the child’s problems.
  • Some pediatric neuropsychologists also work closely with the schools to help provide appropriate educational programs for the child.

When Are Children Referred for Neuropsychological Assessment?

Not every child experiencing school problems or behavior problems needs a neuropsychological assessment. Neuropsychological assessment can help if a child has:

  • A neurological condition such as ADD/ADHD, brain tumor, epilepsy, cerebral palsy, traumatic brain injury/concussions, sleep disorders, etc.
  • Pervasive developmental disorders such as autism, Asperger’s syndrome, etc.
  • Acquired disorders as a result of teratogenic substances such as alcohol, illegal drugs, radiation, etc.
  • Other medical conditions that may affect brain functioning, such as diabetes, chronic heart and respiratory problems, certain genetic disorders, or treatment of childhood cancer.
  • Learning problems that failed to be remediated by interventions implemented by the school.

Your physician may recommend a neuropsychological assessment to:

  • Assist in establishing a diagnosis.
  • Document your child’s current skills prior to a planned medical intervention such as surgery or change in medication regimen prior to chemotherapy or radiotherapy, etc. This initial testing is often referred as “baseline testing”. After the medical intervention, testing can be repeated to determine how treatment affected physical and brain functioning.
  • Document your child’s cognitive developmental pattern over time so that medical treatments, family expectations, and school programming can be adjusted to the child’s changing needs.

What Functions Are Assessed?

Usually a neuropsychological evaluation for a school-aged child assesses the following areas:

  • Intellectual abilities
  • Achievement skills such as reading comprehension, mathematics, and spelling
  • Sensory and motor functioning
  • Attention
  • Learning and memory
  • Language
  • Visual-spatial skills
  • Executive skills such as problem-solving, planning, organization, mental and behavioral control, and cognitive flexibility
  • Behavioral and emotional functioning
  • Social skills

Emerging skills can be assessed in very young children, also. However, the evaluation of infants and young children is usually shorter in duration because the child has not developed a wide variety of skills.

How Does a Neuropsychological Assessment Differ from an Evaluation Conducted by the School?

School assessments are usually performed to determine if a child qualifies for special services to optimize school-related functioning. School psychologists are not generally trained to diagnose learning or behavior disorders caused by altered brain functioning.

The clinical or school psychologist is primarily interested in the score that the child obtains and how the score relates to academic functioning. The pediatric neuropsychologist is interested in “how” and “why” the child obtains a specific test score as well as in the pattern of scores across different tests. Skills are broken down into component parts, attempting to define a pattern of strengths and weaknesses.

What Will the Results Tell Me About My Child?

By comparing your child’s test scores to scores of children of similar ages, the pediatric neuropsychologist can create a profile of your child’s strengths and weaknesses. The results help those involved in your child’s care in number of ways.

  • Testing can explain why your child is having problems in school. Testing also guides the pediatric neuropsychologist’s design 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 your child.
  • Testing can help detect the effects of developmental, neurological, and medical problems such as epilepsy, autism, attention-deficit/hyperactivity disorder (ADHD), dyslexia, or genetic disorder. Testing may be done to obtain a baseline against which to measure the outcome of treatment in the child’s development over time.
  • Different childhood disorders may 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. The pediatric neuropsychologist may work with the physician to combine results from medical tests, such as brain imaging or blood tests to diagnose your child’s problem.
  • Most importantly, testing provides a better understanding of a child’ behavior and learning in school, at home, and in the community. The evaluation can guide teachers and therapists as well as parents to better help a child achieve his or her potential.

How Can a Child Be Referred for a Neuropsychological Assessment?

The following are the steps that both the physician and parent must follow to refer a child for neuropsychological assessment:

  • The physician should complete the Referral Questionnaire, especially the indication for the referral and specific areas of concern. Referral questions that are medically relevant are approved by insurance companies more readily, so it is important that a primary medical condition suspected to be related to current symptomatology be mentioned on the referral form.
  • The provision of available medical records is crucial so that the neuropsychologist has a better understanding of all the factors that may affect brain development and functioning. Medical information should include child’s medical history, including information about birth, early development, recurring or chronic medical problems, and prescribed medications the child is on.
  • The parent should provide the neuropsychologist with copies of previous assessments of the child. If the child is receiving special education services, the neuropsychologist will need a copy of the child’s current Individual Education Plan (IEP) and testing performed by the school as a basis for this plan.

Will the Neuropsychological Assessment Be Covered by Insurance?

  • Some insurance plans will require a letter from the referring physician, indicating the medical necessity of the assessment. Medical necessity means that the physician needs the information to help provide care for your child. For example, a neuropsychological assessment is typically considered to be medically beneficial if it assists in formulating a differential diagnosis, determining appropriate medication or titrating medication, or documenting side effects of medication, and if it assists in deciding between behavioral and psychopharmacological interventions.
  • Assessment to establish or confirm a diagnosis as the basis for medical treatment is usually covered.
  • Most insurance plans will deny coverage for assessment used to establish an educational diagnosis (e.g. learning disability). Medical insurance carriers view this as the responsibility of the patient’s school. However, when learning problems emerge in the context of a neurodevelopmental disorder, traumatic brain injury, a chronic medical condition, the assessment of psychoeducational functioning in the context of a complete neuropsychological evaluation may be reimbursed.
  • The other option is to pay “out of pocket” and then try to be reimbursed by your insurance company. This process will allow your child to receive services faster since insurance clearance for neuropsychological services may take up to several months.

What Information Will the Pediatric Neuropsychologist Need for My Child’s Appointment?

  • You will need to provide copies of any previous medical records, psychological or neuropsychological assessments that your child has had, and your child’s current Individual Educational Plan (IEP) or 504 plan.
  • You may be asked to bring with you the completed parent and teacher’s report questionnaires that were previously mailed to you by our center.
  • Since the pediatric neuropsychologist will ask you questions about your child’s medical history, early development, social history and school history, you will need to bring to the appointment any information that will help you answer these questions.

What Should I Expect?

  • A neuropsychological interview usually includes an interview with the parents about the child’s history and observation of and interview with your child.
  • Testing involves paper and pencil, hands-on activities, and sometimes the use of a computer.
  • Parents are usually not in the room during testing, although they may be present with very young children.
  • The time required depends on your child’s age and reason for assessment. Children are usually seen in two sessions; however, assessment may require even more sessions before all information needed is collected. Testing sessions last 3-4 hours at a time.
  • It is imperative that your child have a good night’s sleep before the testing.
  • It is important that your child has eaten before testing. It is recommended that you bring snacks to ensure that the child will not be hungry during the assessment.
  • If your child wears glasses or a hearing aid or any other device, be sure to bring it with you.
  • If your child has special language needs, please alert the neuropsychologist to these.
  • If your child is on stimulant or any other type of medication, check with the neuropsychologist beforehand about coordinating dosage time with testing.   
  • Neuropsychological evaluation reports are permanent medical records, so the neuropsychologist will need to have as much information as possible before a final report is completed. Usually reports can take anywhere from 2 to 8 weeks to be completed, depending on the available information. However, preliminary results could be released within two weeks after the completion of the neuropsychological evaluation.

What Should I Tell My Child to Prepare Him/Her for Neuropsychological Assessment?

Children sometimes think that visits with a doctor will involve shots. It is important to reassure your child that no shots or painful procedures will be involved in the visit with the neuropsychologist.

Explain to your child in simple words the reason for the assessment. Relate your explanation to a problem that your child knows about such as “trouble with spelling, “problems with remembering, etc. Tell your child that you are trying to understand his/her problem to make things better.

You may also tell your child that nobody gets all the questions or tasks right and the important thing is to try his or her best.

If you have more questions please do not hesitate to contact our practice and we will answer your questions to the best of our ability.

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