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Neuropsychological Evaluation

QUESTION
Neuropsychologists use their education and experience in psychology, neurology, and human anatomy to evaluate and treat behaviors due to impaired brain functioning. A neuropsychological evaluation can help to localize areas of the brain responsible for an individual’s strengths and weaknesses. In this way, neuropsychologists can measure changes in behavior with quantifiable results. The assumption of a neurological basis for behavior change is the major difference between traditional psychological and neuropsychological evaluations. The education and training required to become a neuropsychologist is regulated by each state. Similar to becoming a clinical psychologist, the minimum requirements are a doctoral degree, practica, and a postdoctoral internship. In addition, neuropsychologists must show education, training, and a postdoctoral internship in neuropsychology. This means if you want to practice in this area, you must first become licensed as a psychologist. It is important to check with your state psychology licensing board, since the requirements can vary from one state to another. If you are not yet ready for licensure, check back periodically since requirements can change.

TOGGLE DRAWERHIDE FULL INTRODUCTION

The Evaluation

Neurocognitive functioning is not the extent of a complete evaluation. Personality and emotional functioning are two more areas that can affect overall neuropsychological behavior. Having as much relevant information as possible gives a better foundation to understand a person. Neurological evaluations can give more in-depth information of cognitive functioning than traditional testing. While both types of evaluations may involve similar tests, the results can be used for different purposes. For example, both evaluations can include tests of intellectual functioning. Traditionally, these tests are used to measure general cognitive functioning and IQ. While that information might be important for the neuropsychologist, the results may suggest further testing is needed to rule out an organic cause due to central nervous system involvement.

Quantifiable results that can be generalized are important when obtaining baseline behavior and measuring changes over time. That is one reason why standardized tests are so important. They also allow for comparison of test results with the standardization sample and the normed data they provide. Looking for patterns in test performance from a given domain will increase the accuracy of the overall evaluation. After all tests are administered, the neuropsychologist must still interpret the results of each one and give meaning to the entire evaluation. Standardized tests do not provide all the information needed to evaluate the neuropsychological basis of cognitive functioning.

Qualitative data is needed to complete the picture. This can include information about mood, anxiety, and daily activity. Careful observation of test behavior can allow for the observation of stress level, motivation, mood, staying on task, and the ability to follow directions. As an example, a 70-year-old woman was being evaluated for possible cognitive impairment. Her husband was in the waiting room. Soon after the first test began, she started to cry; she would not explain the crying and would not stop. Testing was discontinued, and the initial assumption was that she had an untreated mood disorder. The woman’s husband was asked to come in and was told what happened. He explained that she has had difficulty talking and following directions, but was able to hide it until recently. She did not want this decline in functioning to be seen by anyone, especially not a psychologist. The woman’s behavior and her husband’s explanation gave a great deal of information which also changed the test battery.

Applications

The role of neuropsychology has grown as we discover the relationship between human behavior and neurological, chemical, and physiological functioning. Neuropsychologists supply much-needed information in order to diagnose and treat a wide range of cognitive problems. They are called on to not only diagnose, but to determine how medical conditions effect development as well as cognition. Determination of disability, ability to work, drive, or go to school are just a few areas that benefit from neuropsychological evaluations.

Neuropsychologists are working with school psychologists to develop assessments and treatments for students with developmental disabilities, learning disabilities, attention deficit hyperactivity disorder, and other conditions that can affect learning. Students are beginning to receive the treatment they need as we continue to learn more about how learning and neurology are related. School-based evaluations and treatment have seen the beginnings of school neuropsychology. While this is not mandated at this time, many school districts are seeing the benefits of neuropsychology.
-(—Part 1—) Neuropsychological Evaluation
Assume you are a clinical psychologist who is working with an individual needing a neuropsychological evaluation, but you do not have training in this area. You decide to make a referral to a neurological clinic run by Dr. Sigmund Myers, Dr. Stanford Binet, and Dr. M. M. P. I. Wechsler ll, all neuropsychologists. Dr. Myers and Dr. Wechsler are on vacation, so an appointment is made with Dr. Binet. Based on the required reading for this unit, discuss the following:
Describe what you will tell Dr. Binet about why you made the referral (what are the problems of this individual). These can be any conditions appropriate for a neuropsychologist.
Identify a minimum of two neuropsychological tests Dr. Binet is likely to administer and explain why the tests were chosen.
Discuss any potential ethical and legal issues of doing the neuropsychological testing yourself.
Discuss how you might use the results of Dr. Binet’s neuropsychological testing by synthesizing your responses to the above and your post in the Unit 8 discussion, Published or Locally-Produced Tests?

ANSWER.

Neuropsychological Evaluation
During the practicum experience as a clinical psychologist, a child who had a problem in following the direction was brought to the clinic. In addition, the patient had a problem of paying attention to what he was told. After further diagnosis, it was realized that the child needed to be attended by a pediatric neuropsychologist. Therefore, the patient had to be referred to a pediatric neuropsychologist. I contacted Dr. Myers, who confirmed to us that he was on vacation. He contacted Dr. Binet, who is a pediatric specialist in this field. Dr. Binet informed that had i to book an appointment since he always has a tight schedule. I explained to him that I am a clinical psychologist and according to the condition of my patient; he needed to be done a neuropsychological evaluation (Cleary & Scott, 2011). I also provided him with copies of the psychological assessment that I have done to the child.

Dr. Binet confirmed the date of appointment and the patient was to comply. Some of the tests that Dr. Binet may conduct include; memory skills, tactual and visual processing as well as auditory. Other tests may include expressive and receptive language evaluation, attention and organizational skills. Memory skills will determine whether the patient is able to keep the memory and retrieve the memorized information (Cleary & Scott, 2011). Visual, tactual and auditory tests will enable the doctor to know whether the child is seeing, hearing or sensitive to touch. Evaluating the attention and organizational skills will determine whether the child is paying attention and his ability to interact with others. Expressive and receptive skills will help the doctor evaluate the ability of the patient in sharing feelings, thoughts and information (Whitsken, D’Amato & Hartlage, 2008).

The results obtained helped diagnose the problem. In addition, the results helped interpret whether there was a delayed milestone in the intellectual development. Then there was a need to develop an intervention plan that helped in supporting the development of the weak and delayed skills (Whitsken, D’Amato & Hartlage, 2008). The strengths of the child will be used in compensating the weak skills.

References
Cleary, M. J., & Scott, A. J. (2011). Developments in clinical neuropsychology: Implications for school psychological services. Journal of School Health, 81(1), 1–7.
Whitsken, D. E., D’Amato, R. C., & Hartlage, L. C. (2008). Neuropsychology and other assessment approaches. In R. C. D’Amato & L. C. Hartlage (Eds.), Essentials of neuropsychological assessment: Treatment planning for rehabilitation (pp. 4–25). New York, NY: Springer Publishing Company.

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