From the Public Interest Advisory Committee,
Division 40, American Psychological Association.
Visit www.div40.org for more information.

Clinical Neuropsychology

• What it is
• What is assessed
• How test scores are used
• What results show
• What to expect

Pediatric Neuropsychology

• What it is
• Why children are referred
• What results show

      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. In clinical neuropsychology, brain function is evaluated by objectively testing memory and thinking skills. A very detailed assessment of abilities is done, and the pattern of strengths and weaknesses is used in important health care areas, such as diagnosis and treatment planning the clinical neuropsychologist conducts the evaluation and makes recommendations. He or she may also provide treatment, such as cognitive rehabilitation, behavior management, or psychotherapy.

      A typical clinical neuropsychological evaluation will involve assessment of the following:

• 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.

      Your test score will be compared to scores from people who are like you in important ways. By using database 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 has been a change 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.

      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 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 because appropriate treatment depends on accurate diagnosis. The results can also be helpful in determining which areas of the brain might be involved. Your physician will use this information along with the results of other tests, such as brain imaging and blood test, 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 measure very objectively.
• Test results can be used to plan treatments that use strengths to compensate for weaknesses. The results help to identify what target problems to work on and which strategies to use.
• 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 you doctors understand what problems you may have in everyday life.

      A neuropsychological evaluation usually consists of an interview and testing. During the interview, information that is important for the neuropsychologist to consider will be reviewed. You will be asked about your symptoms, medical history, medications, and other important factors. Testing involves taking paper-and-pencil 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 other will be more complex. The most important thing is 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.

      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. The neuropsychologist may work in many different settings and may have different roles in the care of your child. Sometimes, the pediatric neuropsychologist is 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. Some pediatric neuropsychologists work closely with schools to help them provide appropriate educational programs.

      Children are referred by a doctor, teacher, or school psychologist because of:

• 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.

      By comparing you 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 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 a genetic disorder. Testing may be done to obtain a bseline against which to measure the outcome of treatment or the child’s development over time.
• Different childhood disorder result in specific patters 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 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, such as brain imaging or blood tests, to diagnose your child’s problem.