A Parents Guide

by Lynn B. Blackburn, PhD, ABPP
Dr. Blackburn is an Assistant Professor of Neurology at Washington University School of Medicine and Director of Pediatric Neuropsychology at St. Louis Children’s Hospital.

What is a Pediatric Neuropsychologist?

Neuropsychology is a specialty within Psychology focused on brain-behavior relationships. A Pediatric Neuropsychologist uses skill tests and behavior observation to define a child’s pattern of cognitive strengths and weaknesses. The neuropsychological assessment is guided by the pediatric neuropsychologist’s knowledge of brain development, brain organization, and the effects of various forms of brain injury on development.

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

The pediatric neuropsychologist and the clinical or school psychologist may use some of the same tests. They differ in what they do with the test results. The clinical or school psychologist is primarily interested in the score that the child obtains. The neuropsychologist is interested in how the child obtains a specific test score as well as in the pattern of test scores. Skills are broken down into component parts, attempting to define the source of problems and to define relative strengths that can be used to compensate for weak skills.

The pediatric neuropsychologist may look at a broader range of skills, using measures typically not used by the clinical or school psychologist. The pediatric neuropsychologist may assess memory, visual processing, auditory processing, organization skills, and fine motor control. The pattern of results is interpreted in the context of brain organization, medical history, and developmental stage. An intervention plan is developed to support development of weak skills and/or to use strengths to compensate for weak skills.

Why might my child need a neuropsychological assessment?

Children with epilepsy are at increased risk for learning and behavior problems. This does not mean that your child will have a problem. It does mean that the chances that your child will have some difficulty are higher than the chance for children without epilepsy.

Learning and behavior problems can results from the same brain process that produced the seizures. Seizure activity and side effects from medications can also contribute to learning problems. Children with generalized tonic clonic seizures are at risk for problems in all areas of learning. Children with focal epilepsy are at increased risk for problems with memory and/or learning disabilities, i.e. learning problems in only one or two subject areas.

The skills that are necessary to succeed in school change over the school years. While memory is important throughout school, teaching gradually moves from the learning of facts to the learning of concepts and to the flexible use of the information learned. This places new demands on the memory system. Teaching initially is multi-sensory, with information presented both verbally and visually. However, by the upper elementary grades, teaching becomes increasingly dependent on language skills. In the lower grades, the teacher provides structure for the children. By Junior High, the student is responsible for organizing work and keeping track of it. As a result of these changes, a child who did well in the First Grade may develop problems in later grades.

When should I consider a neuropsychological assessment?

Neuropsychological assessment can help when:

  • Your child is having difficulty learning one or more specific subject
  • Your child’s academic performance suddenly changes, i.e., your child starts having difficulty with subjects that they used to do well.
  • Your child does well on daily assignments, but fails tests
  • Your child has had learning problems diagnosed by school staff, but is not responding to the interventions used to address the problems.
  • Your child is having behavior problems in spite of your having tried “everything.”

Your physician may recommend a neuropsychological assessment to:

  • Assist in establishment of a diagnosis
  • Establish a performance baseline for use in measuring the functional effects of a planned medical intervention such as a change in medications or surgical intervention.

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
  • Suggested interventions to remediate weaknesses or to help your child compensate for weakness
  • Recommendations for educational programming.
  • Suggestions for what you can do to help maximize your child’s development.
  • Assistance in setting appropriate expectations for your child
  • Assistance in improving your child’s behavior or referral to an appropriate resource to help you help your child improve his/her behavior.

Will assessment be covered by my health insurance?

  • Neuropsychological assessment is typically covered under the medical coverage of your insurance plan. The services from other psychologists are included in your mental health coverage.
  • Neuropsychological assessment is usually covered if the reason for testing is related to a medical condition, to establish a diagnosis for the basis of medical treatment, or to evaluate the functional impact of a medical treatment (baseline testing). Given that your child has epilepsy, testing related to this diagnosis is typically covered.
  • Some insurance plans will require a letter from your child’s physician indicating the medical necessity of the assessment, i.e. how it will affect your diagnostic assessment or medical management of the patient.
  • 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.

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

  • You will need to have your medical insurance information available when you call to schedule the appointment.
  • You will need to provide copies of any previous psychological or neuropsychological assessments that your child has had, and copies of your child’s current Individual Educational Plan.
  • You may be asked to complete parent report questionnaires and to have your child’s teachers complete questionnaires.
  • If your child is being seen because of a medical problem, the pediatric neuropsychologist may have you sign a release for your child’s medical records.

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

Children 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 preschool children, you can describe neuropsychological assessment as involving playing listening, talking and remembering games. Let the child know that the neuropsychologist will have toys like blocks and puzzles that they 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 stuffed animal as opposed to an action figure with many small parts).

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. Let your child know that you will be close by while he/she works alone with the neuropsychologist. For school aged children, parents are not typically allowed to be present during testing. Reassure your child that she/he can have breaks to use the bathroom and to eat lunch.

For adolescents, it is important to provide a reason for the testing. Talk with your adolescent about the relationship of testing to medical care if testing is being done to establish a baseline or to assess the possible side effects of his/her medication. If testing is being conducted to address academic problems, present testing as something that will help find “answers” for the problems your adolescent has been facing. Most neuropsychologists will discuss test findings with adolescent patients. Check when you schedule the appointment to determine if the neuropsychologist working with your adolescent routinely does this.