Neuropsychotherapy Q&A

What is Neuropsychology?

Neuropsychology is that branch of Psychology that tries to understand how brain systems interact at various levels of complexity to produce behaviors. We usually experience our minds as integrated wholes. But, our brains are comprised of many, many different kinds of processors that are linked together in complex hierarchies or systems that interact with one another on a variety of levels. These interactions create systems of their own, and the end results are our complex perceptions and behaviors.

What is a Neuropsychological evaluation?

A neuropsychological evaluation is an attempt to integrate information about your everyday behaviors with information about your brain. Typically, it consists of two parts. One is questionnaires and an extensive interview that provide history and information about your day-to-day life, things that you do well and areas where you run into trouble. The second part consists of a series of tests, most of them fairly brief, that measure how a variety of systems in the brain, such as those that control aspects of language, attention, memory, visual-spatial skills and emotion are functioning. Performance on these tests is compared to data usually gathered on a large number of other people who, as much as possible, share your demographic characteristics (i.e. age, education, etc.). It is a little bit like an electrician testing a complex series of circuits one by one. By comparing this information to your day-to-day experience, we can infer how your brain and mind are interacting. This allows us to get a picture of your strengths and weaknesses. When there are complaints or problems (which is usually the reason people come in), it is possible to identify the contributions, positive and negative, that certain brain systems may be playing in them.

How long does this take?

The interview usually lasts about an hour.  You will be asked to fill out some history forms in advance, which are useful in making sure that all the important issues get covered.  Testing lasts anywhere from 2 to 6 hours, depending on the question.  We take breaks as necessary, and usually there is the option of dividing the testing time into two sessions in order to avoid fatigue.  This isn't always necessary.  Unless there is a very clear referral question, I typically prefer to schedule the interview separately in case testing is unnecessary.  After the testing is finished, a report is written and when it gets done (hopefully within three weeks) you will be asked to come in and the findings will be explained to you.

How is this knowledge useful?

The purpose of a Neuropsychological evaluation varies depending on the referral question. In all cases, the purpose is on one level the the same: an accurate description and diagnosis that will identify those strategies, techniques, therapies or accommodations that are most likely to be helpful, while reducing the use of treatments and interventions that are not.

In cases of learning disabilities, a neuropsychological evaluation can identify the nature of specific problems, for example, whether difficulty with aspects of phonetic processing or difficulty in translating letters into sounds or difficulty with processing whole words are the central issues in a reading disability. This permits targeted interventions, such as the right type of reading remediation, and appropriate accommodations that encourage growth while reducing unnecessary frustration.

In the case of concussion, it gives us important information about when the injury to the brain has resolved, and if it hasn't what the effect have been and how to proceed.  In other cases, for instance in changes in memory due to aging the information is useful because it makes it possible to distinguish between normal changes, the effects of anxiety on thinking and between patterns that distinguish specific types of brain injury or dementia. This allows some predictions to be made about what is likely to lie ahead.

Neuropsychological assessment is the gold standard for correctly identifying early dementias.  Based on this information recommendations can be made as to appropriate expectations and planning, as well as about which therapies are most likely to be useful.

My child did well in grade school, but now in high school is struggling and has been referred for a learning disabilities/ADHD evaluation. If these are lifelong issues, why wouldn’t they have been a problem sooner?

Different stages of academic life and beyond make different demands, and some vulnerabilities are not tested earlier on. For instance, in grade school, requirements tend to be very structured and memorization tends to be strongly rewarded. As you move along, different skills, such as organization and initiation are emphasized and difficulties that were masked earlier may come to the fore. The same issues can occur for adults in the world of work. The good news is that there are few problems that once recognized cannot to some extent be better addressed.