My son had a moderate TBI 10 years ago at the age of 6. He fell 30 feet and injured the right prefrontal lobe area in his brain and lost vision in his right eye. He had a broken skull along with multiple facial fractures. He has had multiple neuropsychology evaluations completed over the time period. My questions are:
- Should a neuropsych evaluation be customized to the area of injury?
- Does a neuropsych evaluation actually test areas of weakness due to the TBI?
I have researched TBI and am concerned about the results from these evaluations. Do neuropsych evaluations test TBI efficiently? More specifically, they seem to test what the child already knows but don’t test how and if the child can learn new information. Can you shed some light on this for me?
Typically, a comprehensive neuropsychological evaluation will look at the function of many different areas of the brain. While the specific tests may vary based on the nature of the injury and the questions to be answered by the evaluation, most neuropsychologists have a relatively standard battery that they start with.
The testing should cover a broad spectrum of cognitive functions so that the neuropsychologist can determine not only which areas are stronger or weaker in comparison to the larger population, but also what the individual’s own capabilities are. Testing is only one aspect of a comprehensive neuropsychological evaluation. Additional information may be gained through a clinical interview, examination of medical records, imaging results, behavioral observation, and questionnaires completed by parents, teachers, or others who know the individual with the brain injury. All of these considered together with testing results allow the neuropsychologist to determine areas of strength and weakness, and to decide what is attributable to the TBI.
The crux of a neuropsychological assessment is not a measure of what the child, like your son, knows. Most of the tests that make up the neuropsychological battery — which is different from a psychological or academic assessment — are tasks that require the individual to take in new information, and manipulate it in some way. These measures look at how — and how well — the child is able to meaningfully manipulate this information. The individual may be required to remember the information, to rearrange it to make something new, to use it to draw an inference about something else, to copy it quickly, or any number of other tasks of varying complexity. The neuropsychologist observes and records both the results and the process of obtaining the results. Thus, the report — especially for a school-aged child — should talk about how the child best learns new information, and what types of supports and strategies will optimize his or her performance. It is sometimes necessary to specifically ask for this type of information when you are arranging for a neuropsychological assessment.
There are limitations to any office-based assessment. When testing is done in a quiet one-on-one setting, the child has the full attention of the evaluator. In a classroom, with lots of distractions, a child’s performance and behavior can look quite different. If you have specific concerns about your child’s ability to function in a classroom setting, ask if someone is available to observe your child in that setting. You can also provide written permission for the neuropsychologist and the classroom teacher to compare notes.
When looking for a neuropsychologist, find out if he or she has experience in rehabilitation and/or special education in order to find someone who is likely to be able to provide concrete and practical intervention recommendations.
Dr. Celeste Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults.