Neuropsychology is a specialty within clinical psychology that studies brain-behavior relationships. Techniques such as MRI, CT scans, and EEG's provide us with information about the structure and physiology of the brain and nervous system. Neuropsychological assessment, however, can provide us with additional objective information about how the brain is functioning at a behavioral level. A variety of neuropsychological measures are designed to assess different types of neurocognitive functions in an effort to identify areas of strengths and weaknesses, provide diagnostic impressions, and ultimately identify appropriate intervention and treatment approaches.
A comprehensive pediatric neuropsychological evaluation typically targets the following areas of functioning:
Intellectual abilities (i.e., “IQ”)
Academic achievement (including reading, writing, and math)
Attention
Executive functions
Motor coordination
Language
Visuospatial skills
Learning and memory
Social, emotional, and behavioral functioning
While the evaluation is comprehensive, it is also individualized and targeted to address each individual’s needs and concerns.
A neuropsychological evaluation will provide a profile of cognitive and behavioral strengths and weaknesses. This, together with a comprehensive record review and developmental history, will help to explain why children may be struggling in school, at home, or in a social environment. Different developmental, neurological, or medical problems tend to have different profiles of cognitive strengths and weaknesses. This profile provides an understanding of which brain areas are involved and therefore differentiate between various childhood disorders. Understanding the child’s cognitive profile will aid in developing appropriate recommendations for interventions and accommodations. It will also help to tailor his/her academic instruction and relevant treatment approaches. A neuropsychological evaluation also provides a baseline of functioning from which the child’s abilities can be followed. Often children undergo follow-up evaluations to measure treatment outcome or to monitor development over time.
What is Dr. Marsh's approach to assessment?
As a former student of the late Dr. Edith Kaplan, a pioneer in the field of clinical neuropsychology, Dr. Marsh has had extensive training in the Boston Process Approach to neuropsychological test interpretation. This approach can offer great understanding and insight regarding diagnosis and treatment recommendations. Rather than focusing solely on test scores and diagnoses, the Boston Process Approach examines qualitative analyses and analyzes error patterns, which can provide a deep understanding of the underlying processes that are involved in observed behaviors.
Because individuals do not function in isolation, it is essential to view the individual as a component of a dynamic and evolving system. Dr. Marsh evaluates the individual in a comprehensive manner, incorporating family, school, or other social systems in the assessment and therapeutic process. As such, Dr. Marsh is often in collaboration with a number of the individual’s providers (i.e., medical, academic, social) and often conducts classroom observations as a part of the evaluation.
Who could benefit from a neuropsychological evaluation?
Children may be self-referred (by a parent) or referred for a neuropsychological evaluation by a doctor, teacher, school psychologist, or other professional for a variety of reasons. Children who are demonstrating difficulty learning in the classroom, who have a history of medical or neurological problems, developmental delay, or brain injury can be referred for such evaluations. For example, children are often evaluated for learning disabilities, language disorders, ADHD, autism spectrum disorders, epilepsy, traumatic brain injury, other neurological or genetic disorders that impact cognition and behavior, as well as social, emotional, or behavioral problems including depression, anxiety, and oppositional defiant disorder.
What should I expect on the day of the evaluation?
Please bring any prior testing, relevant medical records, and school records (e.g., report cards, mastery testing) with you on the day of the evaluation. The evaluation begins with a clinical interview with the parents and the child, during which time a comprehensive developmental history will be obtained. Following this, the child will work one-on-one with Dr. Marsh for the remainder of the day. The testing often takes several hours; typically testing takes 4-6 hours, depending on the type of evaluation. A lunch break and other breaks are taken throughout the day, as needed. In some instances, we may not complete all the testing in one day, so an additional day will be scheduled to complete the testing. It may be necessary to break the testing into several shorter testing sessions, conducted over the course of several days (typically for younger children).
Once the testing is complete, Dr. Marsh will analyze and interpret the data. The results of the evaluation will be written in a comprehensive report, which includes background history, test results, conclusions, and recommendations. A one hour feedback session is also included.
What should I tell my child about the evaluation?
Many children associate a visit to the doctor as a check-up that might involve shots, so it is important to reassure your child that there will not be any painful procedures. I often describe the evaluation as playing games that involve listening, talking, and remembering using toys like blocks and puzzles. For older children, it is appropriate to describe the testing like school. We will do many different activities to understand how your child thinks and learns, with the goal of learning ways he/she can learn better. We will take breaks throughout the day and we keep the testing process positive and enjoyable. You can help your child get ready for the assessment by making sure he/she gets a good night's sleep and a healthy breakfast prior to the testing.
Payment
Dr. Marsh does not accept insurance and is an out-of-network provider with insurance companies. Many health insurance companies will pay for some portion of consultations or neuropsychological evaluations. However, because Dr. Marsh does not bill insurance companies directly, payment is expected from clients at the time of service. Please inquire with Dr. Marsh regarding specific fees.
If you are interested in scheduling a call to discuss whether these services would be beneficial to you, please contact us to make an appointment.