What are psychological and neuropsychological evaluations?

Psychological evaluations are designed to assess for the presence of mental health disorders and personality disorders. These disorders can include (but are not limited to) the following disorders: major depressive disorder, bipolar disorder, schizophrenia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, somatic symptom disorder, conversion disorder, substance use disorders, borderline personality disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, intermittent explosive disorder, or any other mental health disorder that is referenced in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition. (This is the diagnostic guide that psychologists use to assess for mental disorders).

These evaluations can assist in treatment planning, legal proceedings, and medical treatment.  In order to participate in treatment, it is essential to determine the correct presenting problem or diagnosis.  If the treating provider does not have a correct understanding of diagnosis, then the treatment plan may not be as targeted and effective as it could be if the diagnosis had been clarified.  This can lead to longer time in treatment, frustrations with treatment providers, and dissatisfaction with the treatment process. Understanding the complete “diagnostic picture” for an individual can lead to enhanced clarity when the treatment provider designs the treatment plan and collaborates with the individual to resolve the presenting symptoms.

There are also times when your lawyer may advise you to complete a psychological evaluation. This may happen as a result of custody proceedings, a criminal trial, filing for disability insurance, or a court order that requires you to take a psychological evaluation.  We can provide evaluations for many of these situations (although insurance does not typically pay for evaluations that are required by the legal system). In addition, your medical provider may ask that you complete a psychological evaluation.  This evaluation is usually requested so your medical provider can understand the psychological factors that contribute to your medical presentation.  Medical providers often want diagnostic clarity before they proceed with certain components of medical treatment.

Psychological testsPsychological and neuropsychological evaluations often consist of a clinical interview, an intelligence test, questionnaires to assess personality traits, and questionnaires to assess for various mental health diagnoses.  The clinical interview is important to gather background information about the person being tested. Unless we have a thorough understanding of the person’s past and present history, we might mis-interpret the scores we gather from testing.  An intelligence test is also administered, although you may wander at first glance what cognitive performance has to do with establishing a mental health diagnosis.  Generally speaking, cognitive ability is not directly related to mental health diagnoses.  However, it is often helpful to understand how mental health symptoms have impacted cognitive ability.  For example, depression and anxiety can have a negative impact upon processing speed and working memory.  Understanding these factors can help us better tailor a treatment plan to meet your specific needs.  Further, personality testing and diagnostic measures are given to understand the mental health symptoms and personality traits that impact your functioning. 

Psychological testing is designed to gather information regarding potential mental health disorders, so please be aware that these tests tend to focus on symptoms indicative of mental health disorders.  Thus, when you read the summary of our reports you will notice we focus on these elements as opposed to a description of all of the positive elements of your personality.  We want to emphasize that your personality is multifaceted, complex, and more richly comprised than our tests will be able to describe.  There are some personality tests that do measure these positive aspects of personality (i.e. a test like the Myers-Briggs); however, the focus of our evaluation is to diagnose or rule out various mental health disorders.  Lastly, psychological evaluations may last anywhere from four to five hours.  Due to the length of this evaluation, and the sensitive information that you may disclose to the examiner, we recommend that you take breaks throughout the evaluation and inform the examiner if you need to pause or take time to manage your stress level. 

A neuropsychological evaluation is an assessment of how the brain functions in various domains. The combination of the words Neuro and Psychology indicate that both neurocognitive (brain functioning) and psychological/mental health factors are assessed within this evaluation. A common question we are asked is if instrumentation is used to place on the head or body to measure internal processes. In contrast to imaging tests conducted at a neurologist or doctor’s office that require instrumentation to be placed on the head or body, our testing process does not require this sort of instrumentation. 

Neuropsychological testing is primarily comprised of an interview and a series of performance-based tests and questionnaires.  The majority of tests are paper and pencil tests, with some tests requiring verbal responses to confirm your answer.  Thus, when people ask what they should bring to our evaluation, the most important thing to bring is your brain!  Otherwise, we will provide everything else that is needed to initiate testing.

Mental Health EvaluationsTesting can be divided into three portions: the interview, psychological testing (as noted above) and neurocognitive testing.  The interview will consist of the examiner asking you questions about your symptoms and relevant background information.  The psychological portion of testing can determine the presence of personality disorders and/or mental health disorders.  Testing for personality and mental health disorders is an important part of the neuropsychological evaluation, although some people are initially confused why we assess for mental health concerns.  The reason to test for mental health symptoms is that various mental health presentations can contribute to impaired cognitive functioning and can even sometimes mimic certain neurological or medical conditions.  Thus, it is important for us to determine if these disorders are present, and to determine the impact they might have upon your cognitive functioning.  Next, neurocognitive testing measures the functioning of your brain in areas such as attention, memory, visual-spatial reasoning, learning, executive functioning, language, processing speed, and fine motor functioning.  This constitutes the majority of the evaluation, and it can be somewhat fatiguing for many individuals.

The emphasis for a neurocognitive evaluation is to determine the brain’s ability to function in these various areas.  This is in contrast to testing/imaging you may receive at a neurologist’s office where your doctor might take a picture of your brain to determine the presence of something abnormal.  In contrast, our evaluation focuses on how the brain is able to function when given various tasks to perform. 

A neuropsychological evaluation may be necessary if you are trying to determine your level of functioning following a brain injury such as a traumatic brain injury, stroke, concussion, or vascular injury.  You may want to understand how your cognitive functioning has changed after these events have occurred, or you may want to have an understanding of your neuropsychological functioning for other reasons (i.e. to determine the presence of an intellectual disability, to measure adaptive functioning and capability to make financial or medical decisions, or to measure cognitive functioning in order to determine eligibility for certain services). 

Furthermore, neuropsychological evaluations can be helpful to determine a course of medical or mental health treatment, inform the care your neurologist/medical doctor has initiated, or to determine if a decline in cognitive functioning has occurred as a result of dementia or another neurocognitive disorder that often begins later in life. Lastly, neuropsychological testing is quite extensive and generally takes six to eight hours to complete (sometimes longer depending on the person taking the test). 

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