August 13, 2015
The Expert: Lisa Nowinski, Ph.D.
Question from a parent:
I’ve heard a lot about neuropsychological evaluations, but I’m not sure what they are or whether my child with ASD should have one done.
"Neuropsychological Evaluation" is a term that is used to describe a battery of tests that measure a child’s cognitive skills and overall brain functioning. They include formal evaluation of skills such as intelligence, visual perception, language, memory, learning, attention, and executive functioning.
A neuropsychological evaluation should be completed by a psychologist who has special training in neuropsychology – and, if appropriate, training in autism and developmental disabilities as well.
Almost every child with a neurodevelopmental disorder will at some time require a neuropsychological evaluation. Because Autism Spectrum Disorder impacts your child’s developmental trajectory, it is important to monitor his or her progress closely.
For children who have had a developmental regression, or who have another complicating medical factor such as a seizure disorder, ongoing neuropsychological evaluations are often an essential part of care.
Children as young as 4 or 5 years old can complete neuropsychological testing. Some young children will complete neurodevelopmental evaluations with a neuropsychologist who specializes in early development.
Q.) What's the difference between the type of testing a psychologist does and the type of testing a neuropsychologist does?
A.) Many psychologists complete some psychological evaluation as part of their work. Psychological evaluations refer to the assessment of a child’s social, emotional, and behavioral functioning. Unlike neuropsychological evaluations, psychological evaluations may not have an explicit focus on cognition or how a child’s brain is working.
A psychologist may see your child for a diagnostic evaluation or for therapy and be able to obtain all of the information needed without neuropsychological testing; however, in more complicated cases, a neuropsychologist may be able to help you determine what aspects of your child’s brain functioning are contributing to his or her specific challenges.
Once we know what contributes to your child’s challenges, we can help you to plan the appropriate intervention and support your child’s success.
Q.) What will a neuropsychological evaluation look like? What will my child be asked to do?
A.) Neuropsychological evaluations can take place over single or multiple visits. Most neuropsychologists will want to speak with you and meet with your child before they begin formal testing. This first visit is an opportunity for you to share your specific questions or concerns (for example, Why is it so hard for my child to follow instructions? How can I help my child with school or homework?).
Many children with ASD do best once they are familiar with a new environment. This first visit allows your child to meet the neuropsychologist and familiarize himself or herself with the office. It is important to share previous evaluations and pertinent medical and school records with your neuropsychologist.
On the day of the formal testing, be sure that your child has had a full night’s rest and eats a healthy breakfast. Arriving a few minutes early will allow your child to settle in, without feeling rushed. From your child’s perspective, testing will seem like a series of games or activities. Depending on their age and skill level, this will include puzzles, races, and questions.
Testing can last up to several hours. Together with your neuropsychologist, you may decide to break the evaluation into several smaller sessions, if needed. Throughout the day, your child will be allowed breaks and it is always a good idea to bring preferred activities to support your child’s optimal performance if necessary.
After the evaluation, your neuropsychologist will prepare a written report that includes the results of the evaluation, as well as information about what the results mean and what to do next. Specific treatment and educational recommendations are often included. It may be helpful to share this report with your child’s teachers, IEP team, and doctors.
Q.) My child is nonverbal. Can she be tested?
A.) Yes, absolutely! Nonverbal children have many other skills that are important to understand. School evaluations for nonverbal children are often limited to parent-report and observations, which do not fully capture a child’s underlying cognitive skills. In this case, it is especially important for you to find a neuropsychologist who has extensive experience working with nonverbal children and young adults.
Q.) Are these kinds of evaluations covered by insurance? Where do I find an evaluator?
A.) Neuropsychological evaluations are often covered by insurance companies (NOTE: with prior authorization!); however, your insurance may limit how often you can see a neuropsychologist (NOTE: and the scope of the testing!). Some plans do not cover testing for a primary diagnosis of ASD.
Be sure to contact your insurance company directly (in advance!) to verify your plan benefits.
In addition, many neuropsychologists complete additional educational and academic assessments that are not covered by insurance. There may be an additional cost for this.
Although there are many neuropsychologists practicing in the greater Boston area, the best way to find an appropriate evaluator is to ask your child’s treatment team for a specific recommendation. It is important that you see a neuropsychologist who is attuned to the specific cognitive, social, and behavioral presentation of ASD, even if your child does not yet have an official diagnosis.
Lisa Nowinski, Ph.D. is a clinical neuropsychologist and licensed clinical psychologist at the Lurie Center for Autism at Massachusetts General Hospital for Children. Dr. Nowinski holds joint appointments at Massachusetts General Hospital and McLean Hospital’s Center for Neurodevelopmental Services. She is also an instructor at Harvard Medical School.
Dr. Nowinski joined the Lurie Center for Autism after completing her training and postdoctoral fellowship in pediatric neuropsychology at Massachusetts General Hospital and her graduate training at the University of California Santa Barbara.