What to expect at the first visit?
The first visit will usually take the form of a clinical interview. It is generally 50-minutes long but can be up to 90 minutes, depending on circumstances. I will ask you and your child many questions about themselves, their developmental history, current concerns, and their likes and dislikes. The aim of this first visit is to get a better understanding of the issues from both your and your child’s perspective and how these difficulties have unfolded over time.
Usually, I would see both the child and the main caregiver at the first appointment. Depending on the issues involved and age of your child, I may see the parent first, then the young person on their own, or both together. There is no set formula and we make these decisions on the telephone together before the first appointment.
At the end of the first appointment, I provide a summary of the issues as I see it and we discuss the way forward. This may be referring to another specialist, a school-based assessment or treatment I conduct myself.
Treatment may include individual psychotherapy for the child, family therapy or a combination of individual and parent therapy.
The possible treatment options are discussed with you and your child to make sure that the treatment plan is in line with both your hopes and wishes.
What is neuropsychology?
Neuropsychology is the study of brain-behaviour relationships. This means we try to understand why a person is behaving the way they do.
The aim of neuropsychology is not only to establish THAT there is a problem, but WHY the problem is occuring. This is possible by understanding WHERE the problem is in the brain and this allows us to TARGET the affected mechanisms through TREATMENT.
In adults, it has been established that damage to certain brain areas result in changes in mood, behaviour and thinking. In some cases personality changes also occur.
In children, however, the issue is more complicated. The brain is still developing and does not work like an adult brain. Also children’s brains do not develop at the same rate and children learn and acquire skills in different ways, and at a different pace. A child neuropsychologist therefore not only understands the brain, but also has expert knowledge in child cognitive development.
What is a neuropsychological assessment?
Neuropsychological assessment uses specifically developed paper-and-pencil tests, not too different from what teachers may use in the classroom, or an educational psychologists may use to track school-based learning. The difference is that a neuropsychologist select tests to examine specific cognitive or brain functions. We do not examine simply whether a problem exist, but tries to understand WHY it occurs and how it can be TREATED.
A neuropsychological assessment examines the range of functions involved in thinking and learning. This can include IQ, reasoning, language, memory, information processing and attention. We also examine executive skills: the ability to organise, sequence, shift between tasks, flexible thinking, self-control, inhibition and initiation skills. We compare visual and verbal aspects of the same functions to examine discrepancies.
These skills map onto different brain functions and structures at different ages.
Through assessment, I can establish a cognitive profile of your child’s strengths and difficulties. This profile reads like a visual map of your child’s thinking and reasoning abilities compared to himself and others his age. You and s/ he can clearly see the things he is very good at, the things he struggles with and the skills that are in line with his age and developmental level. This allows us to think with your child how his behaviour, mood and coping is affected by the learning issues uncovered and a treatment plan, that is holistic and takes your child’s view into account can be considered.
What happens during a neuropsychological assessment?
Assessments can vary depending on the concerns that need investigation. Assessments can range from 2-4 hours. A specific assessment protocol is devised based on a child’s known difficulties or concerns and may need to be done over several sessions.
It consists of a number of pencil-and-paper tests, puzzles, drawings and brain tasks which are aimed at examining very specific brain regions and functions. Some tasks are easy and others more complicated. Some tasks tests only one ability whilst others test a group of abilities. Of course the aim is to see whether the difficulty is at a fundamental skill level (vision, hearing) or a composite level (integrating, reasoning). Specific brain skills such as attention and information processing is also tested at various levels of complexity, and within different modalities (visual and hearing).
These tests can be fun, there is no right or wrong answer, we are not interested in how “clever” a child is (although we may test IQ as well). More important is how someone tackles a problem, the strategies used to complete it and what cognitive and emotional resources they use to deal with challenges. This often tells us more about a child’s coping in the world, then the actual test results!
However, the results are important: neuropsychologists do not use IQ scores to group a child in a category, but look at the different components that comprise intelligence, compare it other cognitive abilities and brain modalities (verbal versus visual, expression versus comprehension, for example) to get a holistic picture of strengths and difficulties.
What is the purpose of neuropsychological assessment?
The aim of assessment is treatment!
By treatment I do not always mean to fix, as this may not be possible. Treatment also entails understanding – understanding leads to empowerment and with that a child or parent knows how to think about a difficulty and how to tackle it more effectively.
Often things go wrong when we do not know what we are dealing with, we do not have a model to understand a problem. This breeds fear and fear breeds anger, frustration and a range of unhelpful behaviours.
The most important outcome of an assessment is when a family and/or young person is able to grasp how their brain works, exactly where the kinks are (as much as we can untangle this) and together think through how best to tackle these issues.
Many child-based assessments focus only on difficulties – this is because specialists want to identify what is wrong quickly and cheaply. This approach is too one-sided as you do not understand what a child’s strengths are and how they actually manage to cope in the world, despite the challenges!
A cognitive profile of strengths and difficulties are extremely important in remediation and I believe it can transform a child’s view of themselves and how they interact with the world.
How do i know if my child needs a neuropsychological assessment?
These assessments are time consuming and expensive and at first a psychological explanation for difficulties need to be considered. Then, if there are clear indications of perhaps an unidentified learning or developmental concerns, these assessments are also diagnostic and can be used to obtain a diagnosis if this is something you feel is needed. Other children may have previously identified developmental issues, or known head-injury or illness which may be associated with learning problems and it is not sure how they will cope at school, or they are struggling to cope already. Neuropsychology assessments are very important in such cases as it can educate the child, parents and teachers about the child’s specific needs; it can demystify a diagnosis and empower a young person by showing what he actually can do and what is getting in the way of them achieving in the classroom. It is also the basis for a remediation plan which is targeted to your child’s specific difficulties and not a blanket approach which may be demoralising for your child and missing the point completely in terms of brain functioning.
How often does a child need such an assessment?
This is a difficult question as a child’s brain can develop significantly over time. From my experience, in a child with known concerns, assessment may only be needed in the foundation years, age 7-9 (when skills are being acquired) to ensure that fundamental skills are learnt at an age-appropriate rate and again during transition to secondary school (age 12-14) when skills are consolidated and integration of knowledge becomes important. It is during this period where many learning and behavioural issues emerge as some children who were able to use their well-established memory to learn fundamentals may struggle to integrate complex information as this skill cannot rely on memory alone.
How does a neuropsychological assessment differ from an educational or school-based assessment?
There may be some or little overlap between an educational and neuropsychology assessment. Whilst similar tests may be used, the way it is interpreted is vastly different. Only a neuropsychologist can make inferences about brain-behaviour relationships as it requires specific training in neuroscience, cognitive and brain development.
This means that a neuropsychologist can diagnose a problem, i.e. confirm that there is a difficulty, but can also infer WHY this may be. i.e. what brain mechanisms are involved, and what can be done about it!
Why is it important to know what brain mechanisms are involved?
It is often difficult to change a specific behaviour or function, which is made up of multiple brain interactions if we do not know which mechanism is affected and impacting on learning. Thus a child struggling to learn new information may do so for multiple reasons, difficulties processing information, poor attention, poor working memory, auditory processing or even visual difficulties – strategies on increasing classroom attention may not work if the problem is information overload for example. Often being able to help a child understand how their brain process information and where the difficulties are, is a treatment in itself as the “problem” is somehow not “in them” but the consequence of brain mechanics. This is instrumental in all remediation or treatment – getting the child on board and involved in their own learning journey.
What is paediatric neuropsychology and how does it differ from child neuropsychology?
There is little difference between child and paediatric neuropsychology. Both studies brain and cognitive development, but child neuropsychology focus on neurodevelopmental conditions, whilst paediatric neuropsychology occurs within the context of a child who has a physical health condition.
Neuropsychological intervention in a paediatric context aims to understand how a child’s health condition is impacting on brain and emotional development, with the aim to support the child and family to maintain a healthy, age-appropriate trajectory as far as is possible. Often treatment-related trauma impacts on both emotional and cognitive functioning and untangling the impact of underlying trauma is an important aspect of paediatric neuropsychology.
In child neuropsychology it is important to know what brain mechanisms underpin different neurodevelopmental syndromes, their trajectories over time and the associated learning and emotional problems that may occur. The focus is on maintaining or supporting healthy development as far as possible through remediation and supportive mechanisms which may be required periodically throughout the child’s life.