Neuropsychology is the study of behavior as it relates to the brain. Neuropsychological assessment (NA) is a complex investigative procedure geared toward gaining a detailed and comprehensive understanding of a person’s neurocognitive functioning. Neuropsychologists are licensed psychologists with specialized additional training and supervision in administering and interpreting neuropsychological tests. Pediatric neuropsychologists have further additional training in the use of these tests in relation to children and adolescents, whose brains are still developing (please see www.abpdn.org for more information about pediatric neuropsychology).
Neuropsychological assessment involves administering a series of tests that measure the performance of different brain areas or functions. These test results are examined in the context of a person’s behavior, history and symptoms. It is not uncommon for someone to spend eight hours or more with a clinician who is performing the assessment. By looking at patterns of test results (and how a person struggles, succeeds or fails) in the context of the other information gathered, it is possible to understand the deficits that contribute to or create that person’s problems. This process allows a very detailed understanding of an individual’s strengths and weaknesses and makes it possible to craft a treatment plan that is personalized and specific.
A thorough assessment will examine someone’s overall intellectual ability, visual-perceptual skills, ability to coordinate vision with movement, motor coordination and symmetry of motor movements, receptive and expressive language skills, learning and memory, planning, organizational skills, and the various elements of attention. Neuropsychological assessment often also includes an assessment of academic skills in order to clarify the underlying nature of any academic difficulties that might be present. A thorough assessment will also examine emotional and personality functioning, and will assist with understanding their relative contribution to a person’s overall difficulties.
Neuropsychological assessment has traditionally conceptualized brain function horizontally along lateralized (right/left) and anterior/posterior (frontal vs. temporal/parietal/occipital) gradients. This has provided useful information, but has limitations in application to individuals with either localized dysfunction in subcortical brain regions, or psychiatric/developmental disorders that often feature multiple areas of dysfunction within distributed brain systems.
Assessments that also include consideration of vertical brain systems including frontostrial and cerebro-cerebellar function can provide additional information about how well somebody adjusts to novel circumstances, alternates between automatic and controlled responding, and programs new sequences of behavior. These areas have particular relevance for attentional and learning disorders, where application of learned material is often relatively poor compared to expectations based on “ability.” Similarly, individuals diagnosed with anxiety disorders such as obsessive compulsive disorder, or with mood disorders, autism spectrum disorders or various psychotic disorders encounter difficulty learning and demonstrating procedures central to performing “activities of daily living.”
As very few specific measures accessing these brain functions are currently available, a skilled clinician often has to employ additional levels of pattern analysis and behavioral observation in addition to more traditional comparisons to normative data in order to assess these functions.