Suzanne Brooks, Psy.D.

What is the difference between an educational, psychological, and neuropsychological assessment?
An educational assessment most often conducted in a school setting by a certified educator (teacher), however it can also be done privately in an outpatient setting. It utilizes standardized instruments such as the Brigance to compare your child's academic performance to other children his or her age/grade.

A psychological evaluation can be conducted in a school or outpatient setting and can be done by a certified school psychologist or licensed clinical psychologist. If the person being evaluated is a child, the clinician should be specifically trained in assessing children. A typical psychological evaluation uses standardized measures to assess cognitive ability (historically referred to as an IQ or Intelligence Quotient), school achievement, and social/emotional functioning.

Some psychologists have additional specialized training in neuropsychology which studies the connection between brain and behavior. Clinicians with training in neuropsychological assessments additionally evaluate (in greater depth) the domains of attention, memory, intelligence, language, visual-perception, visual-spatial thinking, psychosensory and motor abilities, "frontal lobe" or executive functions, academic achievement, and personality or emotional functions.

What are the types of assessment done during an evaluation?
Tests of Cognitive Ability: Measures such as the Wechsler Scales (WISC,WAIS,WPPSI) are utilized to determine overall cognitive ability as well as specific strengths and weaknesses across verbal and nonverbal domains. Nonverbal intelligence includes spatial and abstract visual reasoning skills. It is these skills that help us to solve visual problems such as putting a piece of furniture together or doing a puzzle. Verbal ability involves oral and written expression, reading and comprehension skills, and literal understanding and use of words.

Achievement Tests: Achievement tests assess the skills the child has learned in school as opposed to their abilities. Typical measures of achievement include the WIAT (Wechsler Individual Achievement Test, Woodcock Johnson Tests of Achievement, and WRAT (Wide Range Achievement Test). A significant discrepancy between ability scores and achievement scores may provide evidence of a learning disability. Other techniques should also be utilized to determine whether the child has a learning disability.

Measures of Social-Emotional Functioning: Measures of social/emotional functioning can involve behavioral checklists (filled out by parents and teachers) and projective measures (Draw-A-Person, Rorschach, Tasks of Emotional Development). These measures will help to assess coping skills, social skills, and personality style.

Neuropsychological Tests: Individuals with training in neuropsychological testing operate under the knowledge that brains of individuals with learning disabilities function different from the brains of people without this condition. After taking a thorough developmental and educational history, a variety of behavioral measures ("tests") may be administered depending on the identifying concerns including the Halstead Reitan, Luria Nebraska, Rey-Osterrieth, Purdue Pegboard, and Wisconsin Card Sort. When weaknesses are identified in one or more of these areas, the clinician can begin to make a diagnosis of a specific learning weakness or disability and subsequently develop treatment recommendations. These recommendations can range from changes in the school setting to modifications in the way the child should take in information in the classroom (e.g. some children rely on visually presented material while others benefit much more from orally presented information).

What is a standardized test?
A standardized test is one that is norm-referenced. In simple terms, your child's performance is compared to other children his/her age or grade who were included in the standardization sample.

When Should I consider having my child evaluated?
Any time your child is having difficulties in school, you have legitimate concerns that should be taken seriously. However, a difficulty in school does not necessarily mean that your child has a learning disability. It is important that you consider all the reasons why your child may be having difficulties. There may be other environmental factors such as a teacher leaving, family illness, or inadequate teaching. Before deciding to have an outside evaluation done, you should first involve your child's school to determine the nature of the difficulty. If questions remain or if the parents and the school have not been able to come to an agreement about your child's difficulty, it may be helpful to consult a psychologist outside the school. Often times, children with learning difficulties display behavioral or social difficulties because they are having trouble learning. This leaves them feeling anxious, frustrated, and affects their self-esteem. Therefore, behavioral and emotional problems can often mask an underlying learning disability.

Will the clinician need any information from me before the evaluation?
Often, clinicians will ask that the parent fill out a developmental history, educational history, and a behavioral checklist. Parents will be asked to have teachers and other therapists answer questions about the child. This information helps to provide a complete picture of the child and will help guide the clinician during the assessment. On the day of the evaluation, the clinician will interview the parent(s) or caregiver(s) and child to gather more in depth information. This interview is particularly important in order to rule out any environmental, medical, emotional factors, or other conditions that may have impacted learning.

How long should an assessment take?
A comprehensive psychological or neuropsychological evaluation should take between four and eight hours to complete. Typically, the clinician will meet with the parent (s) (sometimes together with the child) before the testing begins. Some practices prefer to test children over the course of a couple of days while others prefer to perform the entire assessment in one day.

What does an assessment include?
This depends on the clinician conducting the assessment and is a question that you should ask during the initial phone consultation. In addition to the intake meeting many will also include a feedback session, and consultation with professionals who work with the child. The clinician may also be able to observe your child in the school and/or home setting and attend an IEP meeting at an extra charge.

Will my insurance be accepted?
This again depends on the clinician. Unfortunately, insurance companies are often hesitant to provide reimbursement for psychological assessments and their reimbursement rates are low. For this reason, many clinicians do not take insurance. If the clinician you select does not take insurance, you should request an itemized bill which you can submit to your insurance company for partial reimbursement.

How will I know what type of additional testing if any is needed?
After the evaluation is completed, the clinician may likely recommend additional testing such as a Central Auditory Processing (CAP) evaluation, or an Occupational Therapy or Speech Assessment.

Suzanne Brooks, Psy.D. has a private practice in Brookline, Massachusetts. Outside her private practice, Dr. Brooks is a Pediatric Psychologist at Children’s Hospital Boston in the Infant Follow Up Program. She also holds a faculty appointment at Harvard Medical School.