What is a neuropsychological evaluation?
A neuropsychological evaluation assesses how your brain functions. While neuropsychological evaluations can be used in other areas, they’re often used in education to assess children for emotional, social, cognitive, and behavioral functioning. These evaluations typically consist of diagnostic tests and interviews with the child, their parents, and (sometimes) their teachers. The duration of testing varies based on the number of diagnostic tests. A neuropsychological evaluation typically includes an IQ test as one of the assessments, an achievement test, and a battery of other tests based on the needs of the individual. As a result, neuropsychological evaluations may be useful and/or necessary as part of an application to a gifted and talented program or school. If you suspect your child may be twice-exceptional, a neuropsychological evaluation will help assess your child’s exceptionalities and even provide recommendations for in-school accommodations to assist in the creation of an IEP or 504.
The evaluator will use a combination of screening questionnaires which ask parents to rate behaviors in terms of frequency and intensity, interviews with the parent, observations of the child’s behavior during conversation and play, standardized diagnostic tests, and often questionnaires or interviews with the child’s teacher.
The more time the clinician spends with your child, the better picture they’ll have with your child. Your honest evaluation of your child in paperwork and interviews is also integral to an accurate diagnosis.
Parents sometimes want to see how they can pair down the testing –to save on time and money, but it’s important for the evaluator to see all sides of your child. Some psychologists offer “flat-rate” testing which includes a comprehensive evaluation of “everything.” An evaluation for “just ADHD” may be more affordable, but it’s also more likely to result in misdiagnosis.
While a neuropsychological evaluation can evaluate a wide range of learning disabilities and neurological impairments, some of the most common things to assess for children who may be gifted or twice exceptional include IQ, Autism Spectrum Disorder, Sensory Processing Disorder, Auditory Processing Disorder, ADD, ADHD, and Dyslexia.
As part of a neuropsychological evaluation, your child will probably complete an IQ test. IQ scores are the most commonly accepted scores for entry into gifted and talented programs in public and private schools. Many parents seek out IQ testing to identify whether or not their child is gifted, and if you’re just looking to get your child into a specific program, this may be sufficient; however, a more comprehensive neuropsychological evaluation will give you a wider picture of how your child learns and thinks. For more information on IQ testing for identifying gifted children, click here.
Autism Spectrum Disorder
If a screening questionnaire indicates that a child may have ASD, your child may complete the ADOS-2 as part of their neuropsychological evaluation. The ADOS-2 is an activity based assessment that evaluates communication, social behaviors, and imagination. It takes approximately 40 – 60 minutes to administer and can be used with children as young as 1 year old through adulthood.
Sensory Processing Disorder
Sensory Integration and Praxis Tests consists of 17 tests and is often used to assess sensory processing disorder in children ages 4 to 9. These tests measure visual, tactile, and kinesthetic perception, and motor performance. Each test component takes approximately 10 minutes to administer. The sub-scores include: Space Visualization; Figure Ground Perception; Standing Walking Balance; Design Copying; Postural Praxis; Bilateral Motor; Coordination; Praxis on Verbal Command; Constructional Praxis; Post-Rotary Nystagmus; Motor Accuracy; Sequencing Praxis; Oral Praxis; Manual Form Perception; Kinesthesia; Finger Identification; Graphesthesia; Localization of Tactile; Stimuli
There’s no universal test for ADHD. To be diagnosed with ADHD, symptoms must occur in at least two or more settings. In children ages 4 to 17, at least six symptoms outlined in the DSM-V must be present. Generally, symptoms should be present for at least six months. Your child’s symptoms must impair their ability to function in some way. This can make diagnosing a gifted child with ADHD difficult; some children have a stronger ability to mask their symptoms, and impairment is subjective. A gifted child may still have great grades because distraction isn’t impairing their ability to do well in school, and their behaviors may be interpreted as “bad behavior” rather than “symptoms of ADHD.” For this reason, it’s important to have your child assessed for ADHD as part of a more comprehensive neuropsychological evaluation rather than as an isolated “ADHD screener.”
There are a number of different tests that can be used to identify whether or not a child has dyslexia; if you suspect your child has dyslexia, they may be given several of these. Some evaluators may pick and choose sub-tests from a wide array of longer tests based on their own preferences as there’s a decent amount of overlap among these tests. The CELF-5 is an evaluation of language fundamentals, and it’s good for kids with low verbal skills because there are subtests that don’t require much verbal feedback from the student (pointing). The CTOPP-2 can help assess whether a child has difficulty with phonological analysis versus synthesis, and it can also assess reading fluency. Other tests include: Expressive One-Word Picture Vocabulary Test IV, Gray Oral Reading Test V, Gray Silent Reading Test, Test of Auditory Processing Skills, Test of Early Written Language, Test of Pragmatic Language, Test of Written Spelling, and the Woodcock Reading Mastery Test.
Auditory Processing Disorder
Auditory Processing Disorder is often diagnosed using a multi-disciplinary approach, and a neuropsychological evaluation is often only a part of the diagnostic process. Teachers, speech-language pathologists, and audiologists may participate in the evaluation of APD in children. While an audiologist will actually provide the diagnosis of APD in the end, a neuropsychological evaluation is often necessary in isolating the symptoms during the diagnostic process. An APD evaluation with an audiologist will consist of dichotic tests, Low-redundancy Monaural Speech tests, temporal processing tests, and binaural interaction tests.
Visual Processing Disorder
Like Auditory Processing Disorder, Visual Processing Disorder isn’t often diagnosed by a psychologist; however, the assessments given during a neuropsychological evaluation are often necessary in isolating symptoms during the diagnostic process, and/or it can help isolate the child’s abilities apart from their processing disorder (i.e. what effect their processing disorder may have on their learning). A vision specialist will assess visual closure, visual discrimination, visual figure-ground, visual sequencing, visual-spatial, and visual processing speed.
Results and Interpretation
Interpreting the results of the evaluation can be difficult, and often the clinician must make a judgment call. There aren’t always clear answers, and children with multiple exceptionalities can be even harder to evaluate. Evaluating young children is different than evaluating adolescents or young adults. For this reason, finding a psychologist that understands gifted and twice exceptional children that has experience working with children similar in age to your child is important.
You should receive a report with your child’s scores and performance on each standardized test that was administered and a written report with the evaluator’s interpretation and conclusions. In addition, neuropsychological evaluations for children typically provide recommendations for in-school accommodations and therapy services if relevant.
How to prepare your child for a neuropsychological evaluation
Always tell your child in advance. Springing an evaluation on your child with little or no warning will cause your child stress, and your child’s participation is vital. If you have a very young child, tell them that they’re going to meet with someone who’ll ask them questions and play with them. Do your best to answer the questions, and it’s okay if you don’t know all the answers! They’ll also do some activities that might make them feel like they’re in school. They may be asked to write or read. Depending upon your child, you might explain to them that everyone’s brain works differently, and this person is just trying to see how their brain works.
Make sure your child gets a good night of sleep and a solid breakfast. Neuropsychological evaluations can be tiring, and starting off well-rested and fed goes a long way. Avoid high-carb breakfasts; make sure your child has some protein. You may also want to send a snack for your child; ask the evaluator ahead of time if this is appropriate.
Your child does not need to study or prepare for their evaluation in any other way; this is not a test that they can pass or fail.
How much do neuropsychological evaluations cost?
Unfortunately. Neuropsychological evaluations can be quite expensive because they need to be administered by licensed psychologists, and each psychologist needs to pay to license each test. Typically, you’ll pay a flat fee for an initial consult with the psychologist. Some psychologists charge a flat rate for neuropsychological evaluations regardless of the number of hours or tests they administer. In Central NJ, this is usually about $3500 to $4000. This cost varies by location. Some bill based on the number of hours or sessions each individual requires; this can start at about $2,500, but gifted and twice-exceptional children often take longer to evaluate, so expect to spend more than the minimum.
Many psychologists do not accept insurance though you can submit your receipts to insurance for reimbursement. You can call your insurance carrier to find out what percentage (if any) they’ll reimburse if you’re unable to find a provider in-network. Typically, you’ll want to get a referral from the pediatrician to submit as well; insurance isn’t likely to cover just an IQ test for the purposes of identifying a gifted child, but they may cover a comprehensive neuropsychological evaluation for suspected twice exceptionalities.
Some providers in the NJ Area include:
- Mindful Assessments and Psychological Services
- Center for Neuropsychology Services
- Children’s Specialized Hospital
If your child is showing signs of a learning disability, you can also request an evaluation through the school; however, many parents find that private evaluations garner more thorough results. For cost and time reasons, schools are more likely to administer isolated screeners for suspected disabilities rather than a comprehensive neuropsychological evaluation, and schools are not required to administer IQ tests to identify gifted children. Instead, most schools utilize group-administered intelligence tests like the CogAT to screen children for gifted programs.