A Guide to Psychological/Neuropsychological Testing
Evaluations, or testing, can be a helpful component in obtaining information about an individual's learning style, behavior, or mental health concerns. An evaluation may be recommended by a mental health provider, a medical provider, or school staff working with the individual who is looking for a greater understanding of the individual's presenting concerns. Licensed psychologists (i.e. Ph.D, Psy.D, Ed.D) or interns under the supervision of licensed psychologists are the only professionals trained to administer and interpret psychological and/or neuropsychological evaluations.
The procedures are administered as part of a comprehensive evaluation, or battery, and should address the referral question(s). Standard psychological/diagnostic evaluations include clinical interviews, record reviews, face-to-face testing sessions, self/parent/teacher/informant reports, a write-up of test results, and consultations with the therapist and other providers. The evaluations should provide individualized recommendations to foster improvements in the area(s) of concern. These recommendations may also help individuals and families make informed decisions about treatment, allow therapists working with the individual to adjust the therapeutic approach or treatment plan, and assist educators in making adjustments in order to maximize the individual's learning potential in an academic setting.
Evaluations/Assessments typically consist of three appointments, which are listed in subsequent order:
1. Initial Intake: The first appointment is an information gathering session, where the clinician may ask questions that are relevant to the primary concern(s).
- It can be helpful to come to intake appointment with a timeline for the onset of the primary concern(s), symptom descriptions, functional impacts (e.g., disruptions in occupational/academic performance, sleep quality, appetite, etc.) and any other relevant information.
- Towards the end of the initial intake, it is important to ask about expectations for the evaluation appointment (e.g., estimated date of evaluation, estimated length of evaluation, if there are any medication restrictions required for the evaluation and clarify the primary concern).
2. Evaluation/Test Administration: The second appointment where the evaluation and/or battery is administered.
- Try your best to sleep well before the evaluation appointment and bring a snack, if allowed.
- It is important to note that there are no right or wrong answers for evaluations.
3. Feedback Session: The final appointment where the clinician discusses test results, treatment recommendations, and answers any questions or concerns that the client/family has.
- Prior to the feedback session a draft report is typically sent to the client/family. It is important to review the report prior to the feedback session and write down any questions or concerns that the client/family wants addressed during the feedback session.
Though the basic format of an evaluation is similar across types, there are a few different categories of evaluations to be aware of in speaking with providers:
- Psychological Assessments/Psychological Evaluations
- Neuropsychological Assessments/Neuropsychological Evaluations
- Academic and Educational Testing
- Forensic Assessments/Risk Assessments
1. Psychological/Diagnostic Evaluations:
A psychological evaluation may consist of a variety of procedures ranging from standardized tests of cognitive functioning to projective tests of social-emotional functioning. Psychological assessments are typically requested around questions of differential diagnosis (i.e. helping a clinician better distinguish or understand an individual’s psychiatric diagnosis), testing for more broad learning disabilities or IQ, or as a component of a forensic or risk assessment. Standard testing includes:
- Cognitive Testing: To determine a person’s strengths and weaknesses and assessment of attention, verbal comprehension, visual-spatial ability, computation, abstract thought, impulsivity, problem solving, social comprehension, and judgment.
- Emotional: To assess for depression, anxiety, obsessive/compulsive disorders, sleep disorders, etc., as well as personality functioning, developmental and emotional age, and family dynamics.
- Behavioral: To evaluate substance abuse, trauma and abuse, risk of self-harm, aggression, and treatment compliance/readiness; screen for behaviors that are high risk, illegal, or violate the rights of others or major social values; rule out thought disorders and screen for brain-based impairment.
- Executive Functioning: To evaluate self-regulation, problem solving, planning, organization, inhibition, self-awareness, communication, and working memory.
2. Neuropsychological assessments, or neuropsychological evaluations:
Neuropsychological evaluations are used when there is evidence to suggest neurological problems like: ADHD, autism spectrum, intellectual disabilities, learning disorders, brain injury, neurodegenerative diseases, and other neurologic conditions. Neuropsychology is the unique integration of genetic, developmental, and environmental history combined with extensive testing data to better understand brain functioning.
Building upon the standard evaluation, neuropsychological evaluations assess:
- Attention and Concentration
- Executive Functioning
- Verbal and Visual Memory
- Auditory and Visual Processing
- Visual-Spatial Functioning
- Language and Reading skills
- Phonology and Audiology
- Sensory Integration
- Gross and Fine Motor Abilities
3. Academic and Educational Testing:
Academic testing (also sometimes called Educational or Achievement Testing) is used to diagnose learning disabilities. It can also help better understand the academic level at which someone is performing. This is typically done within a child’s school system when you formally request a CORE evaluation if the child is struggling academically. A School Psychologist, which can either be doctoral or Master’s level) can complete this testing through the school. This type of testing is not covered by insurance if you choose to see an outside provider.
4. Forensic or Risk Assessments:
Forensic assessments are generally ordered by a court or hospital while Risk Assessments are generally around topics such as violent behavior (e.g violent behavior, fire setting, etc.). These may involve some of the same measures as other forms of assessment, in addition to more specific forensic measures, and a clinical interview more focused on subject of that referral. Mental health professionals (i.e. Master’s level clinicians) can be trained to complete risk assessments.
Many health insurance plans cover a percentage of the fee for psychological testing; however, academic or educational testing is not covered by insurance and will be an out-of-pocket expense if you are not going within your child’s school system. Prior authorization for testing may be needed and it is always important to understand your insurance coverage and whether or not you have a deductible that applies. If you have questions about insurance coverage, contact your health insurance company to better understand your mental health benefits.
Please see the following resources for more information:
From the American Psychological Association: Understanding Psychological Testing and Assessment
From Psych Central: What is Psychological Assessment?