Centra Articles

By: Gail Silverstein, PhD

Neuropsychological testing can provide diagnosis and a detailed description of learning disabilities, ADHD, post-concussion syndrome, and autism spectrum disorders as well as useful recommendations as to how to remediate or compensate for these problems. Testing provides a picture of how the person thinks and solves problems. Conclusions are based on a combination of background information, input from family members and/or teachers, my observations during the evaluation, and the test results. Testing yields a great deal of information which I will present and explain clearly in a test report. The information will be interpreted, summarized, and integrated so that the meanings and implications of it are clear. Sometimes people learn new information from the results of testing. Sometimes they learn new and more useful ways to think about what they have always known or to make sense of things which have always confused them. Most importantly, the results of the testing lead logically to recommendations for a productive course of action.

One important function of neuropsychological testing is to provide documentation of the need for accommodations, such as extra time, on tests such as the SAT, ACT, GRE, LSAT, MCAT, etc. Testing can also be used to help develop Individualized Educational Plans (IEP’s) and to document the need for accommodations in college or the workplace.

When I do neuropsychological testing, I select the tests depending on the purpose and goals of the evaluation. I generally include all or part of an IQ test in order to get a baseline for realistic expectations. However, I always take into account the fact that IQ tests can be influenced by many things besides how smart a person is, including attention problems, language weaknesses, anxiety, depression, effort, and fatigue. I think of an IQ test as being basically a series of problems that you put in front of a person. The scores compare this person’s ability to solve these problems to the ability of other people the same age to solve the problems. The pattern of scores on different parts of the test helps me to get a picture of the person’s cognitive strengths and weaknesses. Careful observations of how the person goes about solving these problems and what types of errors they make in the process yields a wealth of valuable information. For example, one person may get an item wrong because he or she worked slowly and did not finish before the time limit expired. Another person may get the same item wrong because he or she responded quickly and impulsively and made a careless error. A third person may get the same item wrong because he or she was simply incapable of responding correctly. If these patterns persist over the entire testing, these three people may have the same scores but very different issues and need very different services or treatments.

I also generally include a variety of tests which measure executive functioning. Executive functioning is what allows us to apply our abilities in order to get things done. This includes sustaining attention and directing it to the proper place, self-control, organizing, planning, prioritizing, mental flexibility, and multi-tasking. People with ADHD generally have some executive functioning weaknesses, so these tests can help in the diagnosis of ADHD.

Testing will also likely include a variety of tests measuring learning and memory. Some of these tests will measure auditory memory and some will measure verbal memory. The tests vary as to the amount of information to be learned, the way in which it is learned, and obstacles to learning. Performance on these tests gives me a good idea as to how the person learns best, how they should be taught or communicated with, how they should study, and whether they need any educational modifications or accommodations.

I sometimes include part or all of an achievement test. Achievement tests measure the person’s basic skills in reading (including reading comprehension), math, spelling, writing, oral expression and listening comprehension. The results of these tests can help in the diagnosis of learning disabilities. In interpreting the results, I look at the scores, the pattern of scores, and analyze the errors and the process the person used to get their answers. In evaluating a learning disability, I look not only at where the scores are lower than expected, but also at how problems in underlying skills contribute to the learning disability. For example, math skills can be impaired by difficulty remembering basic math facts, by executive functioning problems, by difficulty understanding the language in word problems, by visual-spatial weaknesses, etc. It is important to know which of these underlying skills are problematic so that appropriate interventions can be recommended.

I evaluate language skills through a combination of parts of the various tests described above. I look at the person’s ability to understand language and in what circumstances it may break down. I also look both quantitatively and qualitatively at the person’s knowledge of words, their ability to find the words they want when they need them, and their ability to string words together to express themselves in both brief and in longer communications.

I ask the person being tested and family members and/or teachers to fill out a variety of questionnaires providing background information and the informant’s view of the problem. Some of these are subjective and others can be scored so as to provide more objective information. I also review as many old report cards as are available (as a way of getting input from teachers) and any previous evaluations which have been done.

After the testing is complete, I put my findings into a report which includes all of the results on the various tests and my interpretation of what these results mean. Any appropriate diagnoses are included. There is no point to doing testing unless it leads to useful recommendations as to what to do about any problems which are uncovered. My reports include a number of individualized recommendations as well. I present my findings and recommendations in a feedback session. Depending on the circumstances, sometimes spouses, parents or other family members attend this session. If there is a treating professional, they may attend the session as well.