What is a Pediatric Neuropsychologist?

Neuropsychology is a specialty within the field of Psychology that focuses on brain-behavior relationships. A Pediatric Neuropsychologist uses standardized tests and observes behavior to define a child’s pattern of brain functioning and overall development. The child’s performance is compared to what is expected at the child’s age-level or compared to a specific group of children.  The child’s individual pattern of strengths and weaknesses is defined based on these comparisons. The pediatric neuropsychologist uses his/her knowledge of brain development, organization and functioning and their effects on development to guide the assessment, interpret the results and guide the recommendations.

How does neuropsychological assessment differ from the testing provided by a clinical psychologist or school psychologist?

Although the pediatric neuropsychologist and the clinical or school psychologist may use some of the same tests, the pediatric neuropsychologist differs from these psychologists in not only the additional tests they use, but also what they do with the test results.  The neuropsychologist is interested in how the child obtains a specific test score as well as the specific pattern of skills. Skills are broken down into component parts, attempting to define a pattern of strengths and weaknesses. For example, a child may have difficulty following a direction because he/she did not pay attention to the direction, did not understand the direction, or did not remember the direction. The pediatric neuropsychologist works to understand where the child is having trouble and why.

The pediatric neuropsychologist may look at a broader range of skills, evaluating skills not usually tested by the clinical or school psychologist. A neuropsychological assessment may include tests of the child’s intelligence, academic skills, attention and concentration, learning and memory, processing speed, visual spatial perception, language skills, visual motor and fine motor skills, sensory perception, executive functioning (such as planning, organization, initiating and inhibiting behaviors) and emotional functioning.  The pediatric neuropsychologist interprets the pattern of results in the context of the child’s developmental stage, their current setting and the child’s medical history.  An intervention plan is developed to support the development of skills and/or how to use the child’s strengths. The pediatric neuropsychologist can use assessment results to help parents plan for their child’s future.

What’s involved in the typical pediatric neuropsychological assessment?

Because of the complex and thorough nature of the neuropsychological assessment, the process can take several meetings.  The first is with the child’s parent(s) or legal guardians to review the developmental history and provide a focus for the evaluation.  We encourage both parents to attend this first meeting if at all possible.  Testing is conducted over two, half-day sessions, typically from 9:00 – 12:00 in the morning.  We feel that in keeping sessions to this length, we are able to avoid the fatigue and stress that can accompany all-day evaluations.  After the testing is completed, the tests are scored and reviewed.  The documentation and history are reviewed.  Observations may be conducted.  Telephone contacts may be made with professions that are either previously or currently working with the child.  Once all of this is completed, a feedback session is held to review the findings of the evaluation and the impressions of the pediatric neuropsychologist.  After this meeting, a full report is written, detailing the reason for the testing, the child’s history, the test used, their results, the diagnostic impression (if appropriate) and finally, the recommendations for interventions.

When should I consider a neuropsychological assessment?

Not every child experiencing school problems or behavior problems needs a neuropsychological assessment. Neuropsychological assessment can help if your child has:

• A neurological condition such as hydrocephalus, cerebral palsy, epilepsy (seizures), neurofibromatosis, tuberous sclerosis, or a brain tumor.
• A neurodevelopmental diagnosis that require a comprehensive evaluation
• A brain injury as a result of an accident, concussion, stroke, or infection of the brain.
• Other medical problems that place him/her at an increased risk of brain injury such as diabetes, chronic heart or respiratory problems, certain genetic disorders, or treatment for childhood cancer
• Been exposed to toxins such as lead, street drugs, inhalants or was exposed to these substances or to alcohol prior to birth.
• Had an assessment, but interventions resulting from that assessment failed to help your child.

Your physician may recommend a neuropsychological assessment to:

• Assist in establishment of a diagnosis
• Document your child’s current skills prior to a planned medical intervention such as a change in medications, a surgical treatment or treatment for cancer. After the medical intervention, testing can repeated to determine if the treatment has had an effect on his/her continued development of skills. Your physician may refer to this process as “baseline testing.”
• Document your child’s cognitive developmental pattern over time so that medical treatments, family expectations, and school programming can be adjusted to your child’s changing needs.

How will neuropsychological assessment help my child and me?

The neuropsychological assessment and report will provide you with:

• A description of your child’s strengths and weaknesses
• Help in understanding your child
• Suggestions for what you can do to help your child.
• Recommendations for educational programming.
• Help in knowing what is fair to expect from your child at this point in time
• Help in knowing what your child’s needs may be in the future, so that you can plan appropriately.
• Suggestions for improving your child’s behavior.
• In addition, the pediatric neuropsychologist may refer you to another professional such as a clinical psychologist, neurologist or occupational, physical or speech therapist for ongoing help with your child’s behavior and development.

What is the usual cost of an assessment and will it be covered by my health insurance?

We require payment at the time of services and are not in any insurance plan networks. If your coverage does not require seeing an “in-network” doctor (such as auto insurance or some health insurance plans), we might be able to accept insurance payment.  The cost of an evaluation varies depending on the length of time need to complete it.  However, most comprehensive evaluations cost between $3,000 and $4,000. We accept cash, checks and credit cards.  We offer a sliding scale (i.e., a reduced fee) for families who may have difficulty paying. You need to document your need.

Some tips on improving your ability to be reimbursed by your insurance company:

• If neuropsychological services were prescribed by your physician (neurologist, family doctor, etc.), check with your insurance company to see if they have a neuropsychologist in their network.  If not, you may be able to be reimbursed at the in-network rate.
• Neuropsychological assessment is typically covered under the medical coverage of your insurance plan when your child is referred by a physician.  It is usually covered if testing is being conducted to establish a diagnosis as the basis for medical treatment, to evaluate the functional impact of a medical treatment (baseline testing) or to assist in selecting a treatment.
  Neuropsychological assessment is usually covered if your child is having learning or behavior problems and has a history of brain injury or has a current medical problem that may be affecting brain development.
• Many insurance plans will require a letter from your child’s physician indicating the medical necessity of the assessment. Medical necessity means that the physician needs the information to help him/her provide care for your child.
• Most insurance plans will deny coverage for assessment used to establish an educational diagnosis (e.g. learning disability). Medical insurance carriers view this as the responsibility of the patient’s school. However, coverage will often be provided if the question prompting testing is the relationship of the academic problem to some other medical problem or medical treatment.
• In order to process the claim, most insurance companies require a copy of the report.

What information will the pediatric neuropsychologist need for my child’s appointment?

You will need to provide copies of any previous medical, developmental, psychological or neuropsychological assessments that your child has had, and copies of your child’s current Individual Educational Plan (IEP), Evaluation Report (ER) and/or 504 plan.

The pediatric neuropsychologist may have you sign releases for your child’s records.

The neuropsychologist will ask you to complete a developmental questionnaire about your child’s medical history, early development, social history and school history; you will need to bring it to the appointment along with any other information that will help you answer these questions.

What should I tell my child to prepare him/her for neuropsychological assessment?

Children sometimes think that visits to a doctor will involve shots. It is important to reassure your child that no shots or painful procedures will be involved in the visit to the neuropsychologist. For school aged children, it is appropriate to describe testing as like school. You can tell your child that he/she will be doing many different activities. Some activities involve listening and talking, while other activities involving looking at things, building things and drawing. Parents are not typically allowed to be present during testing. If need be, you can let your child know that you will be close by while he/she works with the neuropsychologist.  Reassure your child that she/he can have breaks to use the bathroom and to eat lunch.

For preschool children, you can describe neuropsychological assessment as playing games involving listening, talking and remembering. Let the child know that the neuropsychologist will have toys like blocks and puzzles that he/she will get to use. Your preschool child may wish to bring a security object along to the appointment. Try to choose an object that will not be too distracting for the child (e.g. a security blanket or small stuffed animal as opposed to an action figure or toy with many small parts).  You can help your child get ready for assessment by making sure that he/she gets a good night’s sleep prior to testing. Make sure that you child has eaten so that he/she will not be hungry during testing. Make the assessment day a special day for your child by leaving brothers and/or sisters at home