Brain Evaluation

When Is Neuropsychological Evaluation Done Correctly?

Neuropsychological evaluation done correctly includes the following components:

Specific battery of Neuropsychological Testing: Halstead Reitan or Reitan Indiana and NEPSY for children.

Cognitive Evaluation: Using both books of the Woodcock Johnson Tests of Cognitive Abilities III

Achivement Evaluation: Using both books of the Woodcock Johnson Tests of Achivement III

Language Assessment: Overall assessment using the CELF-4 complemented by tests of receptive and expressive language, pragmatic language, word retrieval, confrontational naming, speeded language comprehension, listening comprehension, oral expression, reading skills and comprehension.

Visual spatial/Visual perceptual Assessment: Tests of visual perceptual skills, tests of visual spatial analysis, visuomotor functioning, line judgment and visual organization.

Attention Assessment to rule out genetic ADHD, including tests of divided attention, cancellation, verbal and non-verbal input, information processing and speeded processing.

Executive Reasoning, Problem Solving Skills: Assessment of cognitive deficits related to frontal processes; perseveration, sequential analysis, cognitive flexibility, integration, solution generation and problem solving skills.

Psychological Evaluation to address effects of trauma and premorbid or pre-injury issues: includes personality assessment (scored forensically if court situation) self-report and projective measures.

Dementia Assessment if serious injury or adult 50 years or older: Repeatable dementia assessment.

It is only with sufficient testing to rule out other disorders that the degree of injury (especially with bright individuals) can actually be documented. For this reason a full battery needs to be completed. Without doing a full evaluation, results cannot be guaranteed to truly be a measurement of brain functioning.  The purpose of finding out what is going on in the brain cannot be obtained with less than adequate evaluation and documentation.  Too often for the sake of time, money or both of these factors, partial evaluations are more commonly seen than the full evaluation that neuropsychological evaluation were meant to be.  A less than adequate evaluation does not provide sufficient information to accomplish the task of assessing the brain in the scientific manner that this testing was meant to do.   

When Children Are Not Learning Language by Two Years of Age: Think Brain

Too often professionals are reassuring the mother rather than sounding the alarm when their child is not talking by two years of age. By the age of 24 months children should be using far more words than jargon whereby jargon is almost gone.  They ask questions using intonation. They carry on conversations and are 65 percent intelligible or understandable.  They comprehend 300 words, point to five body parts on themselves or someone/something else, use approximately 50 words and verbalize their toilet needs.  They say their own name if asked and use two or three word phrases.  At this age language is used to develop social skills, to engage in play with same age peers. When language is not developed children become shy and hesitant about approaching other children to engage in play. Language is the single most important task a child learns that is the key to everything. Why are we not signaling a problem immediately? Why are professionals not sounding the alarm and instead reassuring the mother who is only going to be shell shocked later when there is less time to fix the problem?  Language delay is more often seen when children are not engaging with adults and/or not repeating what an adult has said.  If children do not repeat adult action and words, how do they learn?  The key is early diagnosis.

Are We Doing Our Children a Disservice?

We ask our children to work hard in school. We want them to be successful. We want to be proud of them. But are we taking the time to look at their needs? Do we just yell at them because homework is not done or do we take the time to find out why? We pay for sports and travel teams but do we invest the same amount of money in evaluation to find out if there is a reason they are struggling in school? Do we notice if they are snoring? If they are tired? If they are depressed? Children who are depressed can often appear angry.  We are rushing our children through school; first grade is really second grade, second grade is actually third grade. We are asking more of our children, however are we taking the time to prepare them for a rapidly changing world that has far more demands than we did as children?  If we are going to ask for more from our children then it becomes important to find out why they are struggling academically and not living up to our expectations.    

Are We Becoming Complacent?

It is easy to diagnose someone based upon observed symptoms.  The problem is reliance upon the skills of the professional interviewing the patient.  Are they having a good day? Are they alert? Are they thinking on multiple levels? If distracted they may miss some of the symptoms the patient is presenting. Symptoms are misleading. One symptom can be symptomatic of several different disorders. It takes effort to do testing.  The professional has to be trained in neuropsychological evaluation, an art form that takes knowledge of the brain and additional knowledge of this special form of testing.  If done correctly, neuropsychological testing is invaluable in preventing illness, diagnosing accurately and ensuring that treatment is just as accurate. How often do parents go from one professional to another looking for the reason for their child's difficulty in school, either learning or behavioral? How often do the professionals agree with one another? And how often does the profesional take the time to go the extra mile to figure out the problem by completing sufficient neuropsychological evaluation to provide the answer they need? Then you have the problem of parents coming to you after having spent thousands of dollars with either poor or no results and while interested in services, doubt that anyone can actually help them. It takes effort to get testing approved by managed care companies, filling out the necessary forms to convince someone to grant you testing dates that are limited in time and number. Any professional completing testing needs to be trained in evaluation, the art form of watching someone take the test, the method of response is equal in importance to the score obtained.  They need a wealth of experience to know what is normal and what signals a problem.  They need to understand the brain, how it works and why.  They need to know the impact of sleep. As the arm of the neurologist, neuropsychologists need to know brain anatomy, the pathways, how the brain works on a neuronal and cellular level. We are in the age of neuroscience where testing becomes paramount in separating disorders that require different types of intervention and treatment. So do professionals still care enough to take the road less traveled and to put forth the extra time and energy to look beneath the symptom for the problem? Do people still care enough to spend the time and money to help their child or themselves to have a better quality of life? Or are we content with status quo and no longer live in the hope of things being different?