|
On your site, it talks
about a “comprehensive
neuropsychological assessment” and a more focused
assessment, called an “attentional evaluation.” Which
is right for my child?
As noted on the pages describing each type of evaluation,
the attentional assessment is a much more narrowly
focused evaluation provided only to determine if
there is an attentional disorder (i.e. ADHD) present.
This type of evaluation is best suited for a child
that has not been diagnosed with ADHD and there are
concerns about inattentiveness and / or hyperactivity,
AND your child is not having serious academic problems
at this point, and there are no other serious concerns.
If, however, your child is struggling academically,
or there are other more serious concerns (i.e. your
child seems to have trouble remembering things, there
is a language delay, etc.), then the comprehensive
evaluation is more appropriate. It is also my belief
that if your child is under 8, then a comprehensive
assessment is more suitable because one would not
want to miss any problems your child might have,
particularly since children tend to do much better
when interventions are implemented at the youngest
age possible. Remember, with the attentional evaluation,
there is not going to be assessment of language,
visual-spatial reasoning, academic functioning,
etc.
TOP
What does the evaluation process entail?
Whether it is an attentional evaluation or a comprehensive
assessment, the process entails face-to-face testing
of your child, collecting developmental history and
background information from the parents, having parents
and teachers complete behavior rating scales, reviewing
prior records, observing your child at school (only
when necessary), providing a feedback session discussing
the findings and recommendations, and the submission
of a written report. For more details about each
type of evaluation, click on the “Neuropsychological
Testing” page and scroll down to the evaluation
of interest.
TOP
How long does the testing process take?
For the “attentional evaluation” the
actual testing of your child is typically completed
in one visit with a final report submitted in 2-3
weeks. For the comprehensive neuropsychological evaluation,
the testing is typically completed over three visits
with a report submitted in 4-6 weeks. Of course,
the amount of time to complete any evaluation can
vary from case to case and often depends upon multiple
factors, such as how long a child can sit for each
testing session, how quickly teachers respond to
requests to complete checklists, if there are extensive
prior records, the complexity of the case, etc.
TOP
Do I have to take my child out of school for the
testing?
I try to accommodate parents as best as possible.
I do test on Saturday mornings and late afternoon
to avoid having to pull your child out of school.
In most instances, it can be avoided, but it does
happen on occasion.
Why does it take 4-6 weeks to submit the report
for the comprehensive neuropsychological testing?
The reason the process takes this long is the evaluation
is very complex and involved. Not only does the testing
of your child take 7-8 hours (over three separate
visits), but the tests have to be scored and interpreted.
Also, there is typically phone contact to be made
with your child’s teacher (with consent of
course) and the teacher usually completes a number
of behavior checklists. I also review prior records
and the report writing is time consuming, requiring
detailed synthesis and integration of all the information.
The final report is typically 15-20 pages. Thus,
because of the time for face-to-face testing, as
well as completing many of the indirect steps described
above, the entire process cannot usually be completed
for at least 4-6 weeks from start to finish.
TOP
What is the cost of the evaluation and do you accept
insurance?
The cost of the attentional evaluation or comprehensive
neuropsychological assessment is a flat rate to cover
all aspects of the assessment process. Naturally,
since the attentional evaluation is limited in scope
compared to the comprehensive assessment, it costs
less. I do not accept private health insurance for
testing purposes for a number of reasons. Very often
parents will tell me that they called their carrier
and were told that neuropsychological testing was
a covered service. However, when parents are told
this it is most likely as a general statement in
that neuropsychological testing can be covered for
certain medical conditions (i.e. epilepsy, traumatic
brain injury, etc.). However, virtually all commercial
health insurance carriers will not cover neuropsychological
testing when it is “in whole or in part for
educational purposes.” For more specific information
regarding fees and insurance reimbursement, please
click on the “Fees” page of my site.
(Note: I do not list my actual rates at my site,
as I prefer to discuss this with parents directly).
TOP
Under the fees
page, it indicates that the insurance companies
will rarely cover testing for neuropsychological
assessment of children when "in whole or in
part for educational purposes." Will insurance
companies cover testing or psychotherapy for adults?
As with children, I am almost always willing to
accept insurance reimbursement for psychological
testing of adults if the testing is medically necessary
and the reimbursement rate is consistent with current
standards in the community (i.e. 2009 rates). In
most instances, when providing psychotherapy treatment
of emotional disorders or for treatment of psychological
distress in adults, the insurance companies will
not cover psychological testing because it is not
necessary. In those instances, the psychologist typically
conducts an initial interview and mental status examination,
and through this process the psychologist is able
to determine an appropriate diagnosis and treatment
plan. Testing would only be needed in those circumstances
when the psychologist is not able to determine the
diagnosis from the initial interview and the testing
administered will provide additional clinical information
to clarify the diagnosis. As noted, the need for
testing adults for emotional distress when providing
psychological treatment is extremely rare. However,
an example of when testing adults would be indicated
is when assessing an adult for an undiagnosed learning
disability. In such an instance, a formal IQ measure
and academic achievement test must be given because
this information would not be readily available from
the clinical interview. Again, I am willing to accept
insurance reimbursement as long as the testing is
covered under your policy and the reimbursement is
consistent with 2009 rates. Thus, it is advised that
you check with your carrier.
TOP
I see on the fees page, you mention an Independent
Educational Evaluation. What is this? Also, if the
school pays for the evaluation, will the evaluation
be biased?
An Independent Educational Evaluation is an evaluation
that is paid at district expense. It can typically
be requested when you do not agree with the evaluation
of the district employed evaluator or if your child
is in special education and you have serious concerns
about his or her academic progress. Typically, a
formal request must be made through the special education
department or pupil personnel services. My evaluations
are never biased. Any evaluation I complete is done
with the best interest of the child in mind. Who
is paying has no bearing on the conclusions and recommendations.
In fact, in some instances, I have completed evaluations
and have “agreed” with the district and
in some instances I have “agreed” with
the parents. In either case, parents do have a legal
right to have their child evaluated at district expense
and should do so when applicable.
TOP
What types of tests do you administer and will my
child be hooked up to machines or electrodes?
The tests are administered in a private, quiet office
setting and your child is asked to perform some hands
on tasks (i.e. putting block patterns together, copying
geometric figures, etc.) or your child is asked questions
and has to respond verbally. Since I do not perform
neurological testing, your child is not hooked up
to any machines or electrodes. The tests I utilize
are the latest and most advanced child neuropsychological
and educational tests, some of which include: NEPSY-II®,
Differential Ability Scales-II©, Dellis-Kaplan
Executive Functioning System™, Wechsler Intelligence
Scale for Children-4th Ed.®, Wechsler Individual
Achievement Test – 2nd Ed.®, Test of Everyday
Attention for Children™, Conner’s Continuous
Performance Test-2nd Ed.®, Expressive and Receptive
One Word Picture Vocabulary Test, and many others.
TOP
How is neuropsychological testing different from
a neurological examination?
In general, a neurological examination is completed
by a medical doctor (i.e. a neurologist) and the
purpose of such an evaluation is to rule out more
serious, underlying medical or neurological conditions,
which might be accounting for your child’s
academic or social problems (i.e. such a Epilepsy).
Typically, neurological examinations are aimed at
examining and measuring gross neurological functions,
such as reflexes, muscle strength, and sensory /
motor functioning. Also, neurologists can order,
when indicated, diagnostic tests such as EEG’s
or MRI’s. In contrast, neuropsychological testing
is performed by a qualified psychologist and tends
to measure detailed “higher cortical” functions,
such as attention, planning, reasoning, memory, language,
and academic functioning. Neither examination is
better; they just have a different emphasis. I believe
both are appropriate in many situations.
TOP
How will my child be diagnosed?
Diagnosis is a complex process. In general, psychological
tests do not “diagnose” patients. The
clinician provides a diagnosis. In these types of
cases, the neuropsychological tests cannot in isolation
diagnose any disorder. As with all testing, information
has to be gleaned from multiple sources, such as
developmental history, testing data, behavioral checklists
completed by caregivers, reviewing prior records,
behavioral observations, and interview / self-report
information obtained from the child. Of course, with
younger children (i.e. ages 4-6), self-report is
not emphasized. For more information about this,
I have developed a visual depiction of this process
at my site called, the “Assessment Triangle.” Click
on the “Articles” page or the “Neuropsychological
Testing” page to obtain more information.
TOP
Do you use Continuous Performance
Testing (CPT’s)
in evaluating for ADHD? What is a CPT? I heard that
such testing is not always accurate.
I do use CPT’s in my practice. CPT’s
can be completed on a computer or through an audio
CD player – I utilize both sensory modalities
(i.e. visual and auditory). This line of testing
requires the child to sustain attention for an extended
period of time (i.e. from 7-14 minutes) on a mundane,
fairly simple task. The purpose of such testing is
that children diagnosed with ADHD often have significant
difficulty with mundane tasks that require sustaining
attention over an extended period of time. Such testing
often can differentiate ADHD children from non-ADHD
controls (for instance, on the Test of Everyday Attention,
measures of sustained attention have been shown to
differentiate those with ADHD and those without the
diagnosis – for more information, see the Test
of Everyday Attention article or click
here).
In any event, as with all testing, medical or psychological,
these tests are not perfect. There will always be
false positives and false negatives. The idea of
course is to incorporate the CPT testing data with
all other sources of information to come up with
an accurate diagnosis. For more information about
the diagnosis of ADHD or CPT’s, click on the “Articles ” page
at my site, and then click the article “Controversy
of ADHD”, which addresses CPT’s in more
detail.
TOP
Why is a written report not provided at the feedback
session?
I usually do not provide the written report at the
feedback session for one main reason. That is, almost
always as I am going through the findings, parents
will provide additional relevant feedback and information
about their child that I did not know or requires
elaboration, which I then incorporate into the final
report.
Once the evaluation is complete, what happens next?
After completing the evaluation, I submit a written
report directly to the school (only if it is an independent
educational evaluation being paid through the district)
or I provide a written report to the parents. The
final report will contain detailed recommendations
for your child. Because your child may already be
classified, some of the recommendations may already
be in place. In either case, recommendations typically
take two forms, compensatory and remedial. In general,
compensatory recommendations are those that do not
try to fix the underlying problem (usually because
the problem is so entrenched), but rather provide
some type of accommodation or compensation. For instance,
a 14 year child with a math disorder that does not
have down basic math “facts” due to dyscalculia
might require the use of a calculator as an accommodation
or compensatory strategy. In contrast, remediation
techniques are those that try to actually “fix” the
underlying problem. Often, the recommendations will
be a blend of both. In general, the younger the child,
the more likely recommendations will favor remediation
whereas with older children some of the weaknesses
are so entrenched that a compensatory strategy is
the only option.
TOP
If I obtain an evaluation from outside the
district, such as through an independent educational
evaluation or pay for an evaluation out of pocket,
does the district have to utilize the findings?
According to NYS Part 200 Regulations: “If
the parent obtains an independent educational
evaluation at public expense or shares with the
school district an evaluation obtained at private
expense, the results of the evaluation: (a) must
be considered by the school district, if it meets
the school district’s criteria, in any
decisions made with respect to the provision
of a free appropriate public education for the
student…” Thus,
since my evaluations are comprehensive in nature
and utilize standardized tests in accordance
with current standards of psychological practice,
the evaluation completed by me should be incorporated
into the decision making process to meet your
child’s educational needs.
TOP
*Disclaimer: The information provided at
this “FAQ page” is for general information
purposes only and is not to be considered formal
legal or medical advice. If a parent
wishes to obtain formal legal advice, then the
parent should consult with an educational attorney.
If a parent wishes to obtain formal medical advice
about their child, then the parent should consult
with their child’s medical doctor (i.e. pediatrician,
pediatric neurologist, etc.).
|
*
