Neuropsychological Assessment, Consultation and Guidance Service for Children, Adolescents, and Families
Neuropsychological Evaluations | Therapy | Parent Guidance | Consultation
Photos are dramatized for illustration purposes and do not depict actual clients.
Neuropsychological evaluation is testing that evaluates specific brain functions, such as attention, memory, planning and organization, language processing and visual processing.
I can assess for the following:
Autism Spectrum Disorder (ASD) is a disorder of social communication and social interaction. Children with ASD have difficulty making eye contact and using gestures appropriately, struggle with the back-and-forth aspect of everyday conversation, and have difficulty developing, maintaining, and understanding relationships. They also manifest restricted, repetitive patterns of behavior, interests, or activities. For example, a child with ASD might be obsessed with makes of vehicles, or switch the light on and off repeatedly. Children with ASD might be intellectually gifted, or might have a profound intellectual impairment. Children with ASD might or might not have an accompanying language impairment.
The latest report from the CDC states that one in 68 children has been identified with an Autism Spectrum Disorder (ASD). The report also shows that most children with ASD are diagnosed after age 4, even though ASD can be diagnosed as early as age 2. We know that early diagnosis and treatment is essential for children on the Autism Spectrum, because the brain is still actively developing and is capable of rewiring during the first 3-5 years of life.
Because of the recent reported statistics about the increase in prevalence of ASD, parents and teachers sometimes wonder if a child has Autism Spectrum Disorder, when in fact, other issues are at play. For example, children can be inflexible and insist on things being just the right way because of anxiety, rather than ASD. Children also might have a language disorder that makes it difficult for them to communicate and establish friendships. Treatments and interventions for these disorders are very different. To correctly diagnose Autism Spectrum Disorder, a comprehensive neuropsychological evaluation is crucial.
I am trained in the use of the ADOS-2, which is considered the gold standard in diagnosing an Autism Spectrum Disorder. I never use this tool in isolation, however. When considering a diagnosis of ASD, I might observe the child's interaction with peers and teachers in the classroom or at a playgroup, taking into account the child's developmental history, intellectual functioning, speech and language difficulties, and social-emotional functioning. ✖
ADHD (Attention Deficit and Hyperactivity Disorder) is a disorder of attention and impulse control. Children with ADHD may have predominantly symptoms of inattention, predominantly symptoms of impulsivity and hyperactivity, or both.
Children who have predominantly inattentive symptoms often have trouble with sustained attention, working memory, planning and organization, and other executive functions. These children often fail to finish their schoolwork or other projects, lose or forget their belongings, “space out” or daydream during class. Because these children can be calm and compliant, their attentional difficulties are sometimes missed. Worse yet, they may be labeled as “lazy.” A proper diagnosis is essential to get these children the help they need to be successful.
Children who have predominantly symptoms of hyperactivity and impulsivity have difficulty stopping themselves from doing what they know they are not supposed to do. They might blurt out an answer without waiting for their turn, get up from their seat when they know they are supposed to be sitting down, or interrupt others in conversation. They often appear fidgety and squirmy. Parents describe them as “on the go” or as if “driven by a motor.” Children with predominantly impulsive-hyperactive presentation of ADHD can get into trouble because of their behavior. It is important to remember that children who appear hyperactive may be experiencing other difficulties, such as anxiety or PTSD. A proper diagnosis and treatment will help these children to be more successful at home, at school, and with their peers. ✖
Children with executive functioning difficulties often have trouble finishing their schoolwork and keeping their desk space organized; they might appear forgetful and lose their belongings; or might become overwhelmed by a task that has more than one step in it. The term executive functions refers to a group of skills performed by the frontal lobe of the brain that helps a person plan and organize an action, pay attention to and remember details, and manage time and space. Executive functions have been described as the brain's “chief administrative assistant,” or the brain's “air traffic control” system. Children with ADHD always have trouble with some aspects of executive functions. However, it is possible to have executive functioning difficulties without the diagnosis of ADHD. ✖
Gifted children demonstrate outstanding levels of ability or competence in one or more areas (e.g. mathematics, verbal or written language, art, music, etc.) Research shows that gifted children have unique intellectual, academic, and social-emotional needs. Identifying intellectual or academic giftedness in a child is often the first step towards addressing their unique needs.
The term twice-exceptional refers to children who are gifted and have a learning or emotional challenge, such as a learning disability, ADHD, Autism Spectrum Disorder, or mental illness. Twice-exceptional children are frequently mis-diagnosed (either their intelligence masks their disability, or their disability masks high intelligence), and therefore, under- served. A neuropsychological evaluation is crucial for obtaining an accurate diagnosis and for providing a roadmap for how to build on the child's strengths while addressing areas of challenge. ✖
Children with learning disabilities have difficulty acquiring ageappropriate academic skills in areas such as reading, writing, or mathematics. These children might have average or aboveaverage intelligence, or might be gifted. Because of the presence of a learning disability, however, they might get frustrated in the classroom. This can lead to behavioral problems, low self esteem, or a refusal to go to school. A neuropsychological evaluation can help identify the presence of a learning disability and recommend appropriate interventions. ✖
The term dyslexia refers to a specific learning disability in the area of reading. Children with dyslexia struggle with reading accuracy and fluency, word decoding, and spelling, which may result in problems with reading comprehension and slow down vocabulary growth. A comprehensive neuropsychological evaluation can identify which areas of phonological processing are affected and help create an intervention plan that is geared towards a particular student's strengths and challenges. ✖
The term dyscalculia refers to a specific learning disability in the area of mathematics. Children with dyscalculia may have trouble memorizing simple arithmetic facts, struggle to understand the concepts of quantity or place value, and may use fingers to count well beyond the early elementary-school years. A comprehensive evaluation can identify specific neuropsychological processes that may be responsible for the child's difficulties in mathematics and help create an intervention plan geared towards the child's particular strengths and challenges. Learn more.... ✖
Children with an anxiety disorder worry about many things: missing their school bus, a tornado hitting their house, or failing a test for which they have studied for hours. These children feel like they cannot control their worries, and that might make them restless or irritable. They often seem tense or “on edge,” become tired easily, and have trouble concentrating in school. They might have difficulty falling or staying asleep, and might experience nightmares. They may also complain of headaches or stomachaches.
When children are restless or have trouble concentrating, without a proper evaluation, they might be misdiagnosed with ADHD. They might even be prescribed a stimulant medication which, at best, will be ineffective, and at worst, will exacerbate the symptoms of anxiety. Because an anxiety disorder requires a very different treatment approach than ADHD, a correct diagnosis is crucial.
Children with anxiety can also appear inflexible and may become preoccupied with getting things “just right.” Due to this lack of flexibility, these children are sometimes mistakenly diagnosed with autism. Again, interventions for these disorders are very different, and a correct diagnosis is essential. ✖
It is not always easy to recognize depression in children. Unlike adults, whose symptoms present as a depressed mood or a loss of interest in normally pleasurable activities, children who are depressed might appear mostly irritable or angry. They might have a poor appetite or overeat, have difficulty concentrating in class, or might refuse to get out of bed in the morning. They might become extremely sensitive to rejection by peers and withdraw from many social activities. In some children, depression can manifest itself as frequent and severe temper tantrums. Because symptoms of depression can interfere with a child's ability to do well in school, to interact with peers, or to participate in activities, a correct diagnosis is essential to get the child the help that she needs. ✖
Children who experience speech and language difficulties might have trouble understanding spoken language, expressing themselves verbally, or communicating with others. A language disorder can affect all areas of a child's functioning, from being able to express their feelings, to answering a teacher's question in class to making friends. Children with a language disorder can feel very frustrated by their inability to express themselves and may act out because of this frustration. Because of their difficulty communicating and making friends, children with a language disorder can sometimes be misdiagnosed with having an autism spectrum disorder. ✖
Children who have directly experienced or witnessed a traumatic event might present with a variety of psychological issues that affect different areas of functioning, such as their behavior at school and at home, quality of their school work, relationships with peers, etc. Children might re-enact the traumatic experience in their play and avoid activities or places that would remind them of the trauma. Some children who have experienced or witnessed trauma might meet formal diagnostic criteria for PTSD. Even if they don't, effects of trauma might still be impacting their development and everyday functioning.
Because children who have experienced or witnessed a traumatic event might have angry outbursts (often with little or no provocation), become aggressive towards peers, teachers, or family members, they are often misdiagnosed as having Oppositional Defiant Disorder. Because these children also tend to have problems with attention and concentration, are hyper-aroused and restless, they are often misdiagnosed with ADHD. It is important to remember that traumatic experiences can affect every aspect of a child's life. To correctly diagnose the nature of a child's difficulties, a comprehensive neuropsychological evaluation is essential. ✖
Neuropsychological evaluations help you understand your child's unique strengths and challenges in learning, behavior, and relationships with others. This information can help you:
- determine which educational setting is most appropriate for your child
- advocate for your child in school
- identify a diagnosis, if appropriate
- determine which treatment approach would work best for your child (if necessary)
- enable you to be a more effective parent
Here are examples of questions parents have that resulted in a neuropsychological evaluation:
- My child is three years old, and not talking yet. I am worried that he might be autistic.
- I know my daughter is really smart, but reading is really hard for her. Does she have dyslexia?
- I think my son gets bored at school. I wonder if he is gifted.
- My son keeps acting out in preschool. Is there something wrong with him, or are the teachers not doing their job?
- I can't get my daughter to go to school in the morning. I am worried that she is depressed.
To answer these questions, I conduct appropriate neuropsychological evaluations to determine the diagnosis (if any) and to provide specific recommendations to parents, teachers, therapists, and other professionals working with the child regarding most effective interventions and treatment.