My child’s pediatrician (therapist, psychiatrist, early intervention team, school educational team) referred my child to have a neuropsychological evaluation. What exactly is a neuropsychological evaluation? And what can I learn about my child from this procedure:
A neuropsychological evaluation is a formal assessment of brain functioning including, but not limited to understanding your child’s cognitive capacity, language skills, attention, memory and executive functioning, fine and gross motor and writing skills, achievement potential and adaptive functioning and social, emotional and behavioral functioning. Your child may have been referred for this in-depth assessment after discussing concerns with your child’s doctor or therapist or a sub specialist about his or her learning problems, or regression in scholastic functioning as school demands have increased or after experiencing an acquired injury, such as a traumatic brain injury. You may have discussed concerns with your child’s physician about her attentional capacity, or ability to manage planning and organizational demands of school and homework, as demands, such as in response to the transition to middle school, have increased. You may have raised concern about your child’s development of literacy or language based learning, or have seen early signs of a language based learning disorder, such as dyslexia that needs to be addressed. You may have raised concern that your child appears to be “falling through the cracks,” or showing limited response to targeted educational intervention. Your child may have a diagnosed learning disability, but a poor response to intervention, such that you are still missing a level of detail about how exactly your child does learn best. Your child might be eligible for special education support, and yet you still need to better pinpoint his strengths and limits. You might be satisfied with the services your child receives at school, but need more information to guide recommendations for supporting your child at home. Your child might be graduating from early intervention and you are seeking a professional opinion on what type of early education services will best meet your child’s individual developmental needs. There are thus many reasons why a professional that knows your child or hears your concerns would recommend this type of testing. The 1-hour parent/guardian/caregiver interview that occurs before testing takes place is used to fully understand your unique reasons for the referral and questions that need to be answered through this assessment as essential to tailoring an assessment battery that is individualized to your child. While all testing is standardized, there is no “one size fits all” approach.
The evaluation is scheduled from 10am to 3pm. What can I expect my child to be doing for a full day? What will I be doing/where will I be waiting while my child is in testing?
Typically, the evaluation will start with an assessment of your child’s cognitive functioning, or general intelligence. This interactive, problem solving, question/answer, sometimes paper and pencil format is guided by a series of tests that are non invasive and engaging, and enjoyable to most children. Your child might be asked to complete block designs, or geometric patterns or solve problems using analogical or verbal reasoning. The IQ test is typically administered in about an hour. Following a general assessment of cognitive functioning, testing might progress to include tests of attention, and new learning and memory and/or tests of higher level reasoning or cognitive executive functions. Some tests that are administered will feel “academic” or similar to a task that he or she might perform at school, such as an essay composition or a math worksheet. For some tests, your child will be asked to write or draw something, while other tests are administered in a listening paradigm, and others in a question and answer format. Some tests, such as self-report inventories that might be given to an older child or adolescent, are computer administered. For very young children, such as children under the age of 5, testing will feel like preschool, while for children under the age of 3, the test situation will be set up like a play time, with parents typically present. When testing is scheduled over the course of a full day, the morning evaluation session tends to last 2-hours before a lunch break is given (typically noon to 1pm), with testing resuming in the afternoon, from about 1pm to 3pm. Short breaks are administered through the day as needed. And in some cases, a child might demonstrate more optimal performance when testing is administered over 2 to 3 brief, 1 to 1 ½ hour sessions.
Parents are invited to bring a book or laptop or work from home and to make themselves comfortable in our waiting room while their child is in testing. We have secure Wi-Fi if needed. There is also a coffee shop that serves homemade breakfast and lunch sandwiches and healthy fresh baked goods in the office complex that is open to 3pm daily. Parents of more independent children are invited to leave once their child is settled in testing and return to pick him up for the scheduled lunch break.
How should I verbally prepare my child for the evaluation?
It is advised that you speak to your child about the evaluation in developmentally appropriate terms, using language that they understand and can relate to, and an explanation that makes sense to them. For instance, if your middle schooler had a rough 6th grade year, you might explain that you are taking her to visit with a learning specialist, whose job is to figure out how she thinks and learns and solves problems and processes information. You might explain that she will be asked to participate in a number of tasks and activities that will guide a better understanding of why she struggled at school last year, and how she learns best, so that we can guide a more thoughtful approach to her 7th grade curriculum. Alternately, you might explain to your 6-year-old that is struggling socially or emotionally and/or at school that he is going to see a learning specialist that will have educational games and learning tasks and questions to ask and games to play in the spirit of understanding how we can help with friends and make school more interesting and fun. It might make sense to a child that has had a number of school transitions to be meeting with a learning specialist to gain insight into his or her unique style of learning, so that teachers that don’t know him well can start the year off with an understanding of which aspects of curriculum he is predicted to thrive, and where he might need some support. At the end of the 1- hour caregiver interview, your child’s neuropsychologist will review the best way to talk to your child about what to expect, based on an understanding of your child’s developmental level, comprehension capacity, and emotional factors and temperament.
How should I physically prepare my child for the evaluation and what should I bring?
You should plan for your child to get a good night’s sleep and come well rested to the evaluation. Have your child eat a nutritious breakfast, and bring your child’s preferred healthy snacks if grazing can help your child make it to the noon lunch break. Bring your child’s glasses or hearing aids or other regularly used assistive devices. Have your child take his prescription medication as he typically does. You should bring initial paperwork, such as the completed Neurodevelopmental History Form and signed consents to the initial 1-hour parent/caregiver interview, or send them to the office in advance if you live out of state and your initial meeting is to take place via phone consultation. Subsequently gathered medical or educational records or completed teacher/caregiver rating inventories can be brought to the evaluation appointment.
I have insurance that I would like to use. What can I expect my insurance to cover for services?
Our providers have several panel affiliations, and are in or out of network with different national and state/local plans. We are paneled providers for both Utah Medicaid (Traditional) and Wyoming Medicaid. When you complete and return the New Patient Intake Form, which gives us expressed written consent to contact your insurance company, we can verify benefit eligibility and provide you a quote from your insurance company of what you can expect them to cover and what your estimated financial responsibility will be. We offer benefit checks as a courtesy to our clients, and because benefit quotes are not a guarantee of how claims will be processed and paid, we encourage you to also call your insurance company to be sure that we each receive the same information. As some plans also require a written pre-authorization process, we prefer to check benefits very early in the process, well before you and your child are scheduled to come in.
Once we review benefits and eligibility, we contact you to communicate what we have found out, and what we estimate your financial responsibility to be, whether this is an annual deductible that has to be met, a percentage of the fees that are billed, or a copayment per session. This estimate is expected to be paid at the time of the initial caregiver interview, via credit card or check payment. Please note that If you choose to make payment by credit card, there is 2.75% credit card processing fee that will be added to your fee (3.7% if we manually process your payment).
How and when will I find out the results of my child’s evaluation and who receives the written evaluation report?
The feedback session is a 1-hour session that is scheduled at the conclusion of testing and is a time that is set aside to review in detail the findings of the evaluation, recommendations that are made based on these findings, and suggestions and guidelines for moving forward with services that are recommended. This is the time to review test scores with the examiner, ask detailed questions, and understand what the findings tell us about your child and how he thinks and reasons and learns. We appreciate that you are eager to have these results as soon as possible, and strive to schedule the feedback within one to two weeks following testing. An exception might occur if we are awaiting the receipt of collateral data, such as teacher rating scales, after testing is completed and it is judged as important to receive and analyze this before the feedback session takes place. However we appreciate that you have likely waited a long time to have this assessment and are ready to receive the results as soon as possible. So again, our goal is to offer a timely feedback session/disposition.
The written report of findings may take up to an extra one to two weeks after the feedback session to be prepared for dissemination. This report is thorough and detailed and is often not finalized until after we have sat down with you to talk through the findings and conceptualization and finalize the recommendations. The responsible financial party, which is typically the legal guardian of the minor that received services, is the designated recipient of the written report. Reports are only disseminated to third parties with written consent.