What is pediatric neuropsychology?

Pediatric neuropsychology is a professional specialty focused on learning and behavior in relationship to a child’s brain. A pediatric neuropsychologist is a licensed psychologist with expertise and specific training in how learning and behavior are associated with the neurodevelopment of brain structures and systems. Formal testing of abilities such as memory, executive functions, and language skills are used to assess brain functioning. Often, the neuropsychologist works closely with a physician to manage the child’s problems. Pediatric neuropsychologists also work closely with schools to help them provide appropriate educational accommodations for the child.

How does a neuropsychological evaluation differ from the school psychological assessment?

School assessments are usually performed to determine whether a child qualifies for special education programs or therapies to enhance school performance. They focus on achievement and skills needed for academic success, but often ignore many critical aspects of functioning (e.g., inattention, hyperactivity). Generally, they do not diagnose learning or behavior disorders caused by altered brain function or development.

Why are children referred for neuropsychological assessment?

Children can be referred by a doctor, teacher, school psychologist, or other professional because of one or more problems such as:

• Difficulty in learning, attention, behavior, socialization, or emotional control.
• A disease or inborn developmental problem that affects the brain in some way.
• A brain injury from accident, head trauma, or other physical stress.

A neuropsychological evaluation assists in better understanding your child’s functioning in areas such as memory, attention, perception, coordination, language, organization and planning, inhibition, as well as personality. This information will help you and your child’s teacher, therapist, and physician provide treatments and interventions for your child that will meet his or her unique needs.

What is assessed?

A typical neuropsychological evaluation of the school age child may assess these areas:

• General intellect
• Academic achievement, such as reading, math, and writing.
• Executive skills, such as organization, planning, inhibition, and flexibility.
• Attention.
• Learning and memory.
• Language.
• Visual–spatial skills.
• Motor coordination.
• Behavioral and emotional functioning.
• Social skills and development.

Depending on the child’s needs, some areas may be measured in more detail than others. In addition, a detailed developmental history and data from the child’s teacher are also obtained. Observing your child to understand his or her motivation, cooperation, and behavior is also a very important part of the evaluation.

Newly acquired and emerging skills can be assessed in very young children. However, the evaluation of infants and preschool children is usually shorter in duration because the child has not yet developed many skills.

What will the results tell me about my child?

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

1. Testing can help elucidate why your child is having problems in school. For example, a child may have difficulty reading because of an attention problem, a language disorder, and auditory processing problems, 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 most effectively.
2. 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 baseline against which to measure the outcome of treatment or the child’s development over time.
3. Different childhood disorders result in specific patterns of cognitive 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 delays. 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. 
4. Most importantly, testing provides a better understanding of the child’s behavior and learning in school, at home, and in the community. The evaluation can guide teachers, therapists, and you to better help your child achieve his or her potential.

What should I expect?

A neuropsychological evaluation usually includes an interview with parents about the child’s history, behavioral observation of and interview with the child, and testing. Testing involves paper and pencil and hands on activities, answering questions, and sometimes using a computer. Parents may be asked to fill out questionnaires about their child’s development and behavior. Many neuropsychologists employ trained examiners, or technicians, to assist with the administration and scoring of tests, so your child may see more than one person during the evaluation. Parents are usually not in the room during testing, although they may be present with very young children. The time required for testing depends on your child’s age and problem. It is important to make sure your child has a good night’s sleep before the testing. If your child wears glasses or hearing aid or any other device, make sure to bring it. If your child has special language needs, please alert the neuropsychologist to these. If your child is on stimulant medication, such as Ritalin, or other medication, check with the neuropsychologist beforehand about coordinating dosage time with testing. If your child has had previous school testing, an individual educational plan, or has related medical records, please bring or send this information and records to the neuropsychologist for review.

What should I tell my child?

What you tell your child about this evaluation depends on how much he or she can understand. Be simple and brief and relate your explanation to a problem that your child knows about such as “trouble with spelling,” “problems following directions,” or “feeling upset.” Please do not use the term “tests” when preparing your child for their visit, as this can trigger unnecessary anxiety and worry. Tell your child that you are trying to understand his or her problem to make things better. You may also wish tell the child that “nobody gets every question right,” and that the important thing is to “try your best.” Your child will probably find the neuropsychological evaluation interesting, fun, and the detailed information that is gathered will contribute to your child’s care. 

Adapted from Pediatric Neuropsychology: A Guide for Parents, a brochure published by the public interest advisory committee division 40 (clinical neuropsychology), American Psychological Association.