What recommendations might follow a neuropsychological evaluation for attentional or learning problems?

Earlier this week I blogged about a practical alternative which I regularly offer to individuals and families who have questions about ADHD and related disorders, but aren't sure they're ready to spring for a full neuropsychological evaluation. The next post here at this blog was a consideration of how to determine when such evaluation is in fact right for you or your family member.

So what happens after a neuropsychological evaluation? After all the testing and scoring and writing up the results...what next?

The Feedback Session

As much as I enjoy (I really do!) administering the various tests which make up the neuropsychological battery, and as interesting as it is to score these tests and look at the pattern of strengths and weaknesses, the real heart of the neuropsychological evaluation is the Feedback Session.

Usually scheduled a week or two after the evaluation is complete (you'll need a chance to breathe!), the feedback session offers the client and his spouse or parents a chance to review the test scores with the neuropsychologist and "make sense of the scores" together.

In the Feedback Session, I'll explain how a neuropsychologist thinks about these tests and scores and how I pull this data together to answer referral questions. In the Feedback Session we'll connect the dots - I'll relate your chief concerns to my own mental status exam observations and to the test scores. We'll identify patterns of strengths and weaknesses among test scores and relate those patterns to know patterns of brain-behavior relationships in the scientific literature. (There are identifiable patterns among neuropsychological test data which suggest, for example, ADHD or dementia or brain injury or depression-related concentration problems.)

Feedback Session data typically fall into three categories:

It confirms what the client already knew or suspected about him/herself;
It challenges the client to see him/herself in a new way, but seems reasonable or acceptable or "true";
It just doesn't seem to fit - the client says "nope, I don't think that fits the picture for me, doesn't seem consistent with my experience of myself."

When my clients reject feedback data, I assume that maybe they're right or maybe they're not ready to hear that feedback about themselves just yet. Either way, we don't focus on feedback data that falls into category #3. We focus on that second category - feedback which the client can accept, but which "pushes" him/her a bit, and offers a new way of seeing himself or moving towards treatment or rehabilitation or supports.We typically consider two or three next steps. As a result of this feedback, what are you going to do next? What are you going to do differently? What will help? We set specific behavioral goals and agree to meet again for the Followup Feedback Session.

The Followup Feedback Session

A unique feature (as far as I know) of my own evaluations is the Followup Feedback Session scheduled for 6-8 weeks after the first feedback meeting. This second feedback session allows the client, his family, and I to "check in" and see what they might have missed from the first feedback hour, and what they need to review.

The Followup Feedback Session builds in a bit of accountability. Did the client do what he said he/she was going to do as a result of the first feedback visit? If so - how is it working out? And if not - why not, what obstacles have prevented that follow-through? At the Followup Feedback Session the client and her spouse or parents have had a chance to review my report and offer any comments or feedback to me, or to clarify any remaining questions.

What recommendations might follow a neuropsychological evaluation for attentional or learning problems?

Speaking with a mom who was considering neuropsychological evaluation for her son, I indicated that I try to write jargon-free reports which are user-friendly for parents, doctors, teachers, and therapists. I also let her know that I don't presume to tell pediatricians how to do medicine, or to suggest to occupational therapists how to plan OT interventions. And I don't tell educators how to do curriculum planning or how to teach. At this point, mom asked, "Hmmm, what do you recommend then, David, after your evaluation?" It was a good question, and the answer depends on the type and severity of neurocognitive deficit identified in the evaluation. But some interventions which might follow my evaluation include:

preferential seating for the distracted student
frequent checks for understanding (by the teacher) for a student with auditory processing problems
use of multi-sensory teaching styles for students with auditory processing problems or easy distractibility
reduced homework assignments (as permitted by classroom objectives) for a student with speed of information processing challenges
"buddy system" with either younger students (to give the child the experience of teaching) or older students (to give a child the experience of learning from a slightly more mature student who has mastered navigating lockers and hallways and other "executive" challenges outside the classroom)
considering special education services (for students with adhd, learning disability, or general developmental delay)
considering Section 504 services (for the same students noted above)
considering state agency support (for students with documented head injury or students with developmental delay)
involvement of occupational therapy (for students with sensory overload, or students who need more sensory input throughout the day)
involvement of speech/language services (for students with developmental articulation problems or with "language pragmatics" problems associated with autistic spectrum disorder)
allowing alternate ways of turning in homework (google docs, memory sticks, faxing at start of day, etc).
use of FM system (lapel microphone) for students with central or peripheral hearing/auditory impairment
regular teacher-family communication re: homework details (for students who "lie" or "forget" about homework assignements as a way of avoiding hard work)

None of these recommendations is appropriate for every student with a particular diagnosis, and some of them might even be a bad idea for a particular student. That's why any recommendation should flow logically from the findings of neuropsychological evaluation. For each recommendation, I ought to be able to answer a question like "why do you think this strategy would work for this student?"

Contact me - or come to an ADHD/Processing Disorders workshop near you - to learn more!

2 Comments to What recommendations might follow a neuropsychological evaluation for attentional or learning problems?:

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Gary Ares on Thursday, April 12, 2012 8:45 PM

Very thorough, and thoughtful. The person receiving this level of detailed feedback is so incredibly fortunate. First of all to have found a resource who is not only competent, but actually cares about the outcome. Certainly, there have been many other amazingly intelligent professionals in the past, but it wasn't that long ago when recommendations were not the proven results of studies and testing. There's more, but the main point is that the recommendations provided today are grounded, actionable, and when carried out properly will bring results. The more I learn every day, as a layman, about this profession, the more amazed and jealous (sort of) I am, because he's a man who enjoys his calling to help people, doing exactly that. So great!

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	David on Thursday, April 12, 2012 9:01 PM Hey Gary thanks for reading. And for your comments!

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