Ψ What is Neuropsychological and psychoeducational Testing?
Neuropsychological assessments provide a detailed picture of our cognitive strengths and weaknesses, allowing us to plan better for school, work or life in general. This process assists in better understanding an individual’s functioning in areas such as thinking, memory, attention, executive functions, processing speed, reasoning, perception, coordination, language, personality and mood.
Psycho-educational testing provides additional information about learning, probing for possible delays, disabilities or giftedness. The goal is to provide a thorough understanding of each individuals's unique learning profile, and to then identify strategies and treatment recommendations based on that profile. Our comprehensive assessments help family members and professionals (e.g., medical doctors, occupational therapists, speech therapists, neurologists) get the critical information they need to build on existing strengths, adapt teaching methods, and uncover the best ways to take on challenging situations. In some cases, the goal is about learning to cope and offer the right kinds of support.
Note that for children, certain diagnoses may permit them to attend school in their preferred language, obtain additional resources in the classroom and/or have access to a specialized academic environment. Those with marked impairments may also be eligible for a Disability Tax Credit (check with an accountant) as well as free assistive technology (e.g., learning software, laptops).
Evaluations conducted by an experienced clinical psychologist can also diagnose behavioural and psychiatric disorders such as ADHD, Anxiety, Depression, Bipolar Disorder, Autism Spectrum Disorder, Eating Disorders and Personality Disorders.
Ψ Behaviours that might warrant testing
Behaviours that might indicate the need for testing may include :
- Low grades/declining academic or work performance
- Memory problems
- Communication or comprehension difficulties
- Attention/concentration problems
- Disorganization/poor planning
- Poor impulse control or increasing impulsivity
- Communication difficulties
- Problems with reading, writing or math
- Social problems
- Persistent anxiety, sadness, depression, self-harm or low self-esteem
- Sudden, marked personality changes
- Disturbed thinking/confusion
A typical neuropsychological evaluation will involve the assessment of:
- General intellectual abilities, both verbal and nonverbal
- Higher-level thinking skills, such as abstract reasoning and problem-solving
- Executive functions (e.g., attention/concentration, working memory, planning, impulse control, self-monitoring)
- Learning and memory
If there is a need, more detailed testing can be done in additional domains, such as:
- Receptive and/or expressive language
- Social judgment, perception and interactional skills
- Visual-spatial skills
- Motor and sensory skills
- Mood, thinking style and personality
Ψ Your Visit: What to Expect
Step1: Initial Interview
The first meeting focuses on clarifying current concerns as well as taking a thorough developmental, social and academic history. In the case of adults, work and relationship histories are also explored. Parents and children come to the first interview together, while adults may want to bring a spouse, relative or close friend. In our experience, children, parents and adult clients usually value the opportunity to discuss their life experiences, thoughts and emotions. They tend to leave the session feeling understood, relieved and hopeful - often for the first time in a long time!
Step 2: Questionnaires
At the end of the first meeting, a carefully selected set of questionnaires is distributed for clients and their significant others to complete at home. Children who are old enough receive self-report measures, and questionnaires are always provided for their parents and teachers. Adults complete self-report measures on both current and past functioning, and ideally, additional questionnaires are given out to someone who knows them well. The purpose of these forms is to elicit insights and observations on "real life" behaviour and functioning; depending on the reason for assessment, the questionnaires chosen may ask about behaviour, learning, attention, social functioning, mood, anxiety, and so on. Note that most questionnaires are available in both French and English, depending on preference.
Step 3: (Optional) School Observation
For elementary school children, an observation in the classroom can be very informative. Neither parents nor psychologists get to see first-hand what happens in the classroom, and teachers are not always forthcoming about the child's behaviour or abilities. Our trained observers (all social workers, experienced educators or psychology doctoral candidates ) are unknown to the child and spend time in the classroom anonymously, ideally during periods that may be particularly challenging. These may be during both academic and social activities. There is usually some private discussion with the teacher(s), which is usually the source of helpful observations and insights.
Step 4: Neuropsychological/Psycho-educational Testing
The next step is the testing, completed in 50-minute sessions, preferably early in the day (no one performs their best after a full day of school or work!). Testing typically comprises a variety of tasks that most children and adults find quite enjoyable; these may include construction tasks, visual puzzles, pencil-paper activities, verbal questions and computerized listening tasks. If psycho-educational testing is required, reading, writing and/or math skills will also be assessed.
Note that while some psychologists test in chunks of several hours, we do not feel this approach offers fully valid or useful results. Even with breaks along the way, psychological testing is brain work; most people are tired after 50 minutes, let alone after three or four hours!
In our clinic, neuropsychological testing is conducted in the individuals's preferred language, while academic testing is done in the language of their schooling. Nevertheless, the process tends to be fluid, going back and forth between languages as necessary. Our assessment process usually includes an average of five 50-minute testing appointments, but the range can be anywhere from three to eight sessions depending on age, issues to be assessed and the pace at which the examinee progresses.
As a rule, children require more sessions than do adults. In fact, adults looking for ADHD testing can but do not typically have to undergo a complete neuropsychological assessment; according to research in this area, a clinical interview and questionnaire data from the adult as well as a significant other can be sufficient to make a diagnosis. The only exceptions are for adults attending or returning to school who may suspect cognitive or learning difficulties, and adults who are noticing a decline in cognitive functions and/or memory.
Step 5: (Optional) Quotient ADHD System Test
The Quotient ADHD System is an innovative device that objectively measures three core symptom domains of ADHD: hyperactivity, inattention and impulsivity. Based on research from the McLean Hospital, a Harvard Medical School Affiliate, this standardized computerized test also uses advanced motion tracking technology to track micro-movements via headband. After the test is completed (it takes about 20 minutes for children and 30 minutes for adults), patterns of motion, response accuracy and fluctuations in attention state are analyzed and scored using proprietary algorithms. These data predict the likely presence of ADHD and the magnitude of deficits compared to expectable results from typically developing gender- and age-based peers. Note that the Quotient Test can also be used to evaluate changes in functioning over time as well as response to medication dose levels.
Step 6: Feedback
Once the assessment process is done, the psychologist will present the results to the family or individual. The nature and outcome of each test and questionnaire is thoroughly explained, usually with a visual illustration, after which diagnostic impressions and recommendations are offered. Detailed information is provided on any potential interventions, school/work accommodations and tax benefits, if applicable. Barring unforeseen circumstances and as per OPQ guidelines, a written report summarizing all findings and recommendations will be provided within 30 days of this feedback session. We are happy to write the report in English or French. Should immediate treatment or accommodations be required, the psychologist will happily communicate a brief summary of the findings upon the client's request to the appropriate physician/pediatrician, school administrator, government agency, insurance company or examination board (e.g., LSAT, MCAT, bar exam, CFA, CPA).
Our team is dedicated to the needs of our clients. Even after the assessment is done, we are always available for consultation or to answer questions by phone or by email. Most concerns can be dealt with quickly, at no extra charge.
Ψ Important Tips
Licensed psychologists are regulated health service providers, uniquely qualified to use certain kinds of psychological tests to assess intellectual, neuropsychological, emotional, social and behavioural problems, and to communicate assessment results and diagnoses. In addition, psychologists are uniquely trained as scientist-practitioners. This means that we stay on top of the current research literature and constantly evaluate and update the treatments we provide so they are consistent with the latest scientific findings.
While a neuropsychologist is interested in the brain's cognitive functions, such as attention, language, memory and learning, a clinical psychologist focuses mainly on behaviours and emotions. Dr. Vicki Veroff, Ph.D., the clinic’s founder, uniquely belongs to both categories, allowing her to offer clients a comprehensive range of services. It should be noted that in Quebec, neuropsychological testing can only be administered by an accredited neuropsychologist. Before embarking on the evaluation process, make sure to check the credentials of your psychologist!
Be sure to ask about the payment process for testing. In some cases, psychologists charge a flat rate that may cover more sessions than are actually necessary. Alternatively, a flat rate may include only a limited number of sessions, which often results in an incomplete assessment. At the West Island Neuropsychology and Counseling Centre, all testing is charged at an hourly rate and the tests administered (thus the number of sessions) are carefully chosen for each individual; in this way, you only pay for what you need – no more, and no less. If you have private insurance, make sure to check how much coverage you get per family member, per calendar year, as well as what the maximum coverage is per session.
Finally, discuss scheduling issues with your psychologist. It may be convenient to do testing after school or work, but the brain becomes tired and the results may be less valid when testing is done at the end of the day. Similarly, many psychologists will do testing in two- or three-hour blocks, but even when breaks are offered, the process is draining for both children and adults. Scores obtained after two to three hours of heavy brain work may not accurately reflect an individual’s true cognitive or academic functioning. It may be more convenient to get the testing done quickly, but what is the point if the results are less than meaningful?
Ψ Preparing for your visit
During your first appointment with a psychologist, you will want to explain the reasons for consulting. Think about what you want the psychologist to understand and offer examples whenever possible. In the case of children, try to remember teachers' feedback given in parent-teacher interviews, meetings or on report cards. Adults may include this information, as well as work and relationship histories. It is often helpful to look into family history – whether any learning or psychiatric issues were ever diagnosed (or suspected) in parents, grandparents, aunts, uncles, cousins, etc.
Ψ Who should attend?
Ideally, when it comes to testing children, both parents would be present for the initial interview. However, it is most important for both parents to be present at the feedback session, to make sure they fully understand the results and recommendations. There is a lot of information to absorb, so having two people present means twice the ability to remember details. On testing days, any adult can accompany the child, since only the child attends the session.
For adults, it can be helpful to have a spouse, family member or close friend come to the initial appointment; this person may offer valuable insights into both current and prior functioning, and may have helpful examples to share. It can also be helpful to bring someone to the feedback session, both to offer support and to ensure a thorough understanding of results and recommendations. Note that on testing days, adults can come alone.
Ψ What to tell children about the testing process
Many children think that visiting a "doctor" means they'll get a check-up or needle. Let them know that psychologists are talking doctors, not body doctors, so no shots are given. Let them know why they are coming in for testing; most children are aware of their difficulties, even if it is never openly discussed. You can tell your child that everyone has areas that are easier and harder for them, and the psychologist's job is to find what's hard and try to help make it easier. Parents who are uncomfortable with this approach sometimes prefer to explain that as children progress through school, it can be helpful to see how their brains work and decide which schools or programs are best for them. Let children know that the testing involves many different activities such as puzzles, drawing, listening, remembering and answering questions. In our experience, most children enjoy the testing and many are sad when it's over!