The Utility of a Comprehensive

Neuropsychological Evaluation

Jillian Bennett, Ph.D., BCBA-D, LABA

Kevin A. Domingos, Ph.D. – Clinical Director

Michael A. Fearing, Ph.D.

Boston Neuropsychological Services, LLC.

687 Highland Avenue, Second Floor

Needham, Massachusetts 02494

Learning Objectives

1. Identify when to refer for an evaluation

2. Identify the utility of a neuropsychological

evaluation

3. Identify types of evaluations based on age and

pathology

4. Resources and recommendations based on

evaluation

• Mild TBI (even if imaging does not show brain abnormalities)

• Difficulty with learning, attention, behavior, socialization, language,

and/or emotional control

• Regression in skills, slow progress, or complete lack of progress

• Current interventions ineffective & need more specific

recommendations

• Not sure if the educational setting is appropriate

• No diagnosis or inappropriate diagnosis

• Several diagnoses and diagnostic clarification is needed

When to Refer for an Evaluation

• Inpatient

• Outpatient

• F/U Re-Evaluation

Evaluation Settings

• Establish baseline

• Track decrements and/or improvements over time

• Slow progress, complete lack of progress, or regression

• Transition points in child’s education or development

• Interventions have been unsuccessful

• Change in functioning at any point

When to Refer for a Re-Evaluation

The Utility of a

Neuropsychological Evaluation

Neuropsychological Approach

Research Project with an N=1

Ho Generation and Assessment

An Excuse to Collect Data

• Baseline functioning:

• Developmental milestones

• Social functioning

• Behavior

• Academic functioning

• IQ

• Work History

• Post-TBI functioning:

• Social, Behavioral & Academic Functioning

History Section

• Inattention

• Orientation

• Non-compliance

• Trouble understanding directions

• Expression/Comprehension

• Anxiety

• Fatigue

• Problem solving process

Behavioral Observation Section

Assess Many Domains

• Intellectual functioning

• Language

• Visual-Spatial/Motor Skills

• Learning and Memory

• Academic Achievement

• Attention and Executive Functioning

• Social, Emotional, and Behavioral Functioning

• Adaptive Functioning

Functional Domains

Executive Functioning

Learning and Memory

Language & Spatial

Attention Basic sensorimotor/perception

Level of Consciousness – Alert - Orientation

• Tracking

• Visual Field Testing (Cuts, Blind Spots, neglect-multiple

domains)

• Visual Acuity (eye chart) – R/L/both

• Hearing

• Tactile

• Balance - Proprioception

Sensory Processing

• Upper/Lower - Grip Strength - Quad strength and transfers

• Apraxia (Wave, throw, hammer, blow out match)

• Hand-eye coordination

• Manual Dexterity/Motor Speed

• Finger tapping or grooved pegboard

Motor Skills

• IQ is a construct

• Why is it important?

• Premorbid

• Declines?

• Limitations

Cognitive Test Results

• Interview

• Digit Span Forward (Simple Auditory Attention)

• Digit Span Backward (Working Memory component)

• Trail Making Part A (Visual Attention and Scanning)

• Response to instructions and directions

• Behavioral observations (looking out window, scanning room,

distracted by noises, etc.)

Attention Test Results

• Repetition

• Comprehension of simple instructions

• Comprehension of simple questions

• Reading (WTAR)

• Assess premorbid verbal intelligence

• Confrontation Naming (Boston Naming Test)

Language Skills Test Results

PLEASE COPY THIS DESIGN

Visual Spatial Processing Test

Results

PLEASE DRAW THE DESIGN YOU JUST COPIED

Visual Spatial Memory Test

Results

Visual Spatial Processing Testing

Example

Visual Spatial Memory Testing

Example

• Attention and concentration

• Immediate recall

• Learning and improvement with repetition

• Recall after distraction/interference

• Recall after delay

• Recognition

• Forced Choice

Auditory/Verbal Memory Test

Results

• Visual Perception

• Graphomotor abilities

• Planning

• Sequencing

• Working Memory

• Abstraction

• Language (Following directions)

Executive Functioning Test Results:

Clock Drawing

1. Draw a large clock.

2. Put in all of the numbers.

3. Set the time to 15 after 7.

Clock Drawing Exercise

Executive Functioning Testing:

Clock Drawing Example

Executive Functioning Testing:

Clock Drawing Example

• Initiation

• Word Generation

• Perseveration

• Phonemic vs. semantic

Executive Functioning Test Results:

Word List Generation

• Trail Making Test Part A

• Visual attention and scanning

• Graphomotor speed

• Trail Making Test Part B

• Mental flexibility

• Muli-tasking

• Complex cognitive abilities

Executive Functioning Test Results:

Trail Making

Executive Functioning Testing:

Trail Making Example

• Depression

• Effects effort on other tests

• Creates cognitive impairments in memory, executive function, etc.

• Anxiety

• Self induced pressure can lead to failure

• Impacts processing speed

• Impacts executive functioning

Emotional Functioning Test Results

Test Results Data

• Not just about the numbers

• Example: Poor Math Test Results

• Spatial Organization Errors: Misaligning columns

• Visual Detail Errors: Misreading the sign or misplacing small details

(e.g., decimal points)

• Procedure Errors: Failing to complete all steps in a problem or

completing them in the wrong order

• Memory Errors: Failure to remember a particular math fact

• Graphomotor Errors: Caused by poor handwriting

Test Results:

The “Why” is Important

• Ties everything together

• Symptoms vs. diagnosis

• Etiology guides treatment (e.g., TBI vs Developmental)

Diagnostic Impression Section

Rank ordered

Summarizes test results

Guides recommendations

Strengths & Limiting Factors

Section

• Specific

• Individualized

• Match parent & teacher/other provider concerns

• Guided by history, behavioral observations, and test results

• Provides resources

Recommendation Section

• Cognitive Rehabilitation – (e.g., Community Rehab Care)

• Occupational Therapy

• Physical Therapy

• Speech and Language Therapy

• Counseling

• Driving Evaluation

Recommendation Section

• Psychiatry and Psychopharmacological

Therapies

• Sleep Clinic

• Pain Clinic

• Brain Injury Organizations and Support Groups

Recommendation Section

Review Learning Objectives

1. Identify when to refer for an evaluation

2. Identify the utility of a neuropsychological

evaluation

3. Identify types of evaluations based on age and

pathology

4. Resources and recommendations based on

evaluation

Boston Neuropsychological Services, LLC

687 Highland Avenue, Second Floor

Needham, Massachusetts 02494

www.bostonneuropsych.com

Phone: (781) 559-8444

Fax: (781) 559-8117

jbennett@bostonneuropsych.com

kdomingos@bostonneuropsych.com

mfearing@bostonneuropsych.com