Possible Reasons for a Child to Receive Neuropsychological Assessment

Attention Problems (e.g., ADHD/ADD):
It has been estimated that at least 7-10% (and possibly as many as 17%) of children in the United States demonstrate significant symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD or ADD). Common symptoms of ADHD include failure to listen to instructions; lack of attention to details; being bored easily; fidgeting/squirming in seat; excessive talking; restlessness, interrupting/intruding on others; and being impulsive. Children with ADHD may show signs of inattention, hyperactivity/impulsivity, or both. A common myth is that children with ADHD are unable to focus their attention on most tasks. However, children with ADHD are typically able to focus on enjoyable activities (e.g., playing games) without difficulty, but struggle to focus on non-preferred tasks.

Neuropsychological testing can help determine whether a child is experiencing significant problems with inattention and/or hyperactivity/impulsivity related to an attentional disorder (ADHD/ADD) or other causes. Cognitive testing includes computerized, paper-and-pencil, and other tests that explore domains such as focused/sustained attention, processing speed, and impulse control. We carefully rule out other problems that may resemble ADHD before making a diagnosis. We then develop specific treatment recommendations for improving the child’s attention/concentration; reducing hyperactivity and impulsivity; and improving functioning in various domains (e.g., academic performance, social functioning, task completion, etc.). Following the evaluation, brief re-evaluations can be conducted to determine whether there has been improvement in areas of difficulty as a result of  specific interventions.

Autism-Spectrum Disorders (ASD):
As described in the “Autism Evaluation” section of this website, approximately 1 in 110 children exhibit diagnostic criterion for an Autism-Spectrum Disorder (ASD), including milder symptoms that do not meet full criterion for Autistic Disorder (e.g., PDD-NOS and Asperger Syndrome). We carefully explore the underlying problems contributing to these symptoms to determine whether an autism-spectrum diagnosis is appropriate. Cognitive testing includes assessment of facial processing (e.g., identifying emotions on faces, memory of faces), “theory of mind” abilities (i.e., the ability to understanding others’ perceptions and beliefs), basic and complex language, and various other domains. We thoroughly assess the child’s strengths and weaknesses to develop recommendations and interventions for improving the child’s functioning. School personnel often benefit from neuropsychological test results to develop accommodations and special services to help children with ASD and other diagnoses. The information can also be used in determining whether a child could be eligible for services through the Division of Developmental Disabilities (DDD; www.azdes. gov/developmental_disabilities).

Academic/Learning Difficulties:
Neuropsychological testing is very helpful for clarifying the underlying reason(s) a child is experiencing academic difficulties. For instance, children with reading difficulties may have underlying problems related to phonological awareness (awareness and access to the phonological structure of oral language), rapid naming (retrieval of phonological information from long-term or permanent memory, and the ability to execute a sequence of operations quickly and repeatedly), and/or reading comprehension. We evaluate the child’s strengths and weaknesses, and this information is helpful for developing appropriate interventions for improving the child’s reading skills.

Similarly, children who struggle in math may experience deficits in visual-spatial skills (e.g., writing out problems and carrying numbers), although these deficits may not hinder math performance until later grades since earlier grades place less emphasis on complex math calculations. Other children struggle with math because of limited math knowledge, and subsequently benefit from drilling in math facts and concepts. Children may also experience difficulties performing math story problems because of reading comprehension difficulties. Neuropsychological testing can be used to determine the specific strengths and weaknesses related to broad math skills, as well as other impairments (e.g., visual perceptual/spatial skills, working memory, and planning skills) that may contribute to poor math performance. Test results are used to develop specific recommendations for interventions and accommodations in school to improve the child’s math skills and academic performance.

Finally, children with problems related to spelling and/or written expression may experience problems with phonological processing and/or hand graphomotor skills (which may result in sloppy handwriting or slowed written production). These children may benefit from participating in occupational therapy to improve their hand motor skills. We also determine possible accommodations that may be beneficial for these children in school, which may include dictating test responses, receiving note-taking services, etc. We carefully evaluate various problems that may underlie spelling/written expression disorders, including basic spelling, written sentence/paragraph writing, hand graphomotor skills, and visual perceptual/spatial skills.

Neurological Injury/Illness:
Neuropsychological testing can also be useful for children experiencing symptoms associated with a neurological injury/illness. Children with a history of neurological injury (e.g., concussion, stroke, brain tumor, etc.) often have problems performing tasks that require rapid information processing, attention/concentration (e.g., sustaining attention for longer periods of time, distractibility, etc.), and learning/memory.

Nonverbal Learning Disability:
Children with nonverbal learning disabilities (NVLD or NLD) may have problems related to visual-spatial skills, visual-motor coordination, social functioning, and organizational skills. These children are often at risk for academic problems related to reading comprehension, written math calculations, and written expression (particularly in higher grades). Neuropsychological testing is very useful for diagnosing this disorder, as well as developing recommendations for improving the child’s functioning in academic, social, and other domains.

Emotional Distress and Psychiatric Disorders:
Children experiencing increased anxiety, depression, emotional dysregulation, and other emotional symptoms often demonstrate reduced cognitive functioning (e.g., inattention, difficulties retrieving learned information, slowed responding, etc).

Baseline Data:
Neuropsychological evaluations provide a baseline of a child’s functioning in various cognitive and academic domains, and this information is valuable if the child were to ever experience a concussion or other type of neurological injury/illness. In those instances, repeat testing can help determine whether there has been a significant change in functioning. Unless baseline data is available before an injury/illness, it is difficult to determine whether there has been a change in functioning above and beyond what could be attributed to longstanding strengths and weaknesses before the injury. Dr. Baker provides parents/guardians with the raw test scores so this information is available to other providers in case the child is re-evaluated in the future.