This paper was prepared by the Encephalitis Society with advice from David A
Johnson, Consultant Neuropsychologist, Royal Hospital for Sick Children, Edinburgh
What is it?
NeuropsychologicaI Assessment is an appraisal of the brain's psychological, that
is cognitive and behavioural, functions.
Who does it?
Neuropsychologists are psychologists who have special training and experience in
the field of neuropsychology. Neuropsychology is a distinct field of knowledge
and skill which bridges the neurosciences and psychology.
Neuropsychologists are trained in understanding how a person's behaviour, intellect,
memory and emotions are related to the status of their brain.
Expertise in Neuropsychology takes many years of special training and experience
with a range of patient groups. It complements clinical psychology, educational
psychology and neurology but offers additional and specific information to understanding
and managing an individual who has sustained some brain insult.
Why have a Neuropsychological Assessment?
It can offer the person; their family; their colleagues; their school and their
treating doctors and therapists additional information to help place any difficulties
they are having in the proper context. Knowledge of a person's strengths and
weaknesses, how brain damage or injury may have affected specific aspects of their
thinking ( and left others intact ), what areas need to be compensated for or be
given rehabilitation, and what the likely impact of those problems might be in life
is a valuable tool for managing and coping with disability.
Sometimes, neuropsychological assessments are used to help plan return to work or
school, apply for special resources or to assist in medical management of problems
( e.g. adverse side effects from antiepileptic drugs, etc.)
Neuropsychological assessments can help to chart the process of change. Improvement
over time is important to document as resources and plans may need revision.
So too is any apparent worsening over time which can occur in some conditions and
in some populations, such as children where "latent" deficits may be seen
as they mature.
What is involved
An assessment usually consists of 3 equally important parts.
Firstly, taking a comprehensive history from interviews with the person affected
by encephalitis and their close relative, and gathering appropriate information
from the medical records, This first stage allows us to gain a picture of the type
and severity of injury to the brain, what the person was like before the illness
and how they have progressed.
The second stage involves the use of standard psychological tests to examine how
specific functions of the brain are working. The main areas of cognitive functioning
which should be assessed are attention, memory, visual perception, reasoning and
verbal ability. For each function a number of different tests should be used.
There is no point relying on just one test of attention, for example, when attention
is such a complex system and is known to have different areas and levels of working
within the brain - for example, speed of thinking, sustaining concentration, keeping
to one thing at a time, being able to work in a busy or noisy environment with other
things going on around you.
An individual's IQ (intelligence quotient) has little relevance to brain function
or neuropsychological assessment. However, the standard tests of intelligence,
which are used to calculate the IQ, can be very useful if their results are interpreted
in terms of brain function, rather than numerical estimates or lQs. An appropriate
and comprehensive neuropsychological assessment yields information on how the brain
is working, information which cannot be obtained in any other way.
The third part of assessment is the psychologist's opinion and report. The
test results are now considered in relation to the person's history - both before
and since the illness. For example, do the test findings make neurological
sense, does the pattern of difficulties shown fit with what one would reasonably
expect to find after this type and severity of illness. If not, were there
any problems before the illness, such as dyslexia, learning or behaviour difficulties,
or other injury to the brain, which may have increased the person's vulnerability
and caused disproportionately severe symptoms? The effects of two or more
injuries to the brain, whatever their cause or severity, will be cumulative.
Having decided on the person's present condition, the psychologist should then be
in a position to make recommendations for helping further rehabilitation or education,
for example. The so-called "strengths and weaknesses" of the
person's assessment should indicate the main problem areas (e.g. attention and memory),
the nature of the difficulty (e.g. distractibility) and, by logical application
of knowledge on how brain functions are organised, the best ways in which to approach
the problems (e.g. working in a quiet room; one-to-one practice in learning how
to learn).
How long does it take?
It varies depending on what the purpose of the assessment is, how quick the patient
is able to respond, how they cope with fatigue and their age. On average,
a comprehensive assessment takes about 2 - 4 hours.
How to get a Neuropsychological Assessment
From a Chartered Clinical Psychologist who specialises in neuropsychology.
Every health district will have a Psychology service, not all will have someone
who specialises in neuropsychology, but many will.
How you get to see the person may vary from one Psychology service to another but
will usually need a referral from a doctor.
For children, ideally you aim for a Chartered Clinical Psychologist who works with
children and specialises in child neuropsychology. Realistically you are more
likely to see a child psychologist who has some experience of neuropsychology.
You can check that a psychologist is properly qualified using The Register of Chartered
Psychologists.
You can look for someone who is a Chartered Psychologist and offers neuropsychological
assessments in the Directory of Chartered Psychologists (both available from The
British Psychological Society, St Andrews House, 48 Princess Road East, Leicester,
LEI 7DR). Some of those people listed in this offer to see people privately-
those who only work for public services give the contact details for that service.
What to do with a Neuropsychological Assessment
Try to gain an understanding of what aspects of someone's thinking have changed
and in what way.Pass this understanding on to anyone else who has regular contact.
For example - relatives., friends, ?colleagues or boss, teachers', doctors, social
services, benefits agency.
Plan any appropriate rehabilitation using the assessment.
Plan for future - education, employment, living arrangements, legal arrangements.
In some circumstances, have another assessment after a year and compare the two
to see if anything is changing.
Treat it with a bit of caution - it is one of the best sorts of evidence that can
be gained about how someone's thinking is working, but it never comes with a 100%
guarantee of accuracy.Neuropsychological Assessment
This paper was prepared by the Encephalitis Society with advice from David
A Johnson, Consultant Neuropsychologist, Royal Hospital for Sick Children, Edinburgh
What is it?
NeuropsychologicaI Assessment is an appraisal of the brain's psychological, that
is cognitive and behavioural, functions.
Who does it?
Neuropsychologists are psychologists who have special training and experience in
the field of neuropsychology. Neuropsychology is a distinct field of knowledge
and skill which bridges the neurosciences and psychology.
Neuropsychologists are trained in understanding how a person's behaviour, intellect,
memory and emotions are related to the status of their brain.
Expertise in Neuropsychology takes many years of special training and experience
with a range of patient groups. It complements clinical psychology, educational
psychology and neurology but offers additional and specific information to understanding
and managing an individual who has sustained some brain insult.
Why have a Neuropsychological Assessment?
It can offer the person; their family; their colleagues; their school and their
treating doctors and therapists additional information to help place any difficulties
they are having in the proper context. Knowledge of a person's strengths and
weaknesses, how brain damage or injury may have affected specific aspects of their
thinking ( and left others intact ), what areas need to be compensated for or be
given rehabilitation, and what the likely impact of those problems might be in life
is a valuable tool for managing and coping with disability.
Sometimes, neuropsychological assessments are used to help plan return to work or
school, apply for special resources or to assist in medical management of problems
( e.g. adverse side effects from antiepileptic drugs, etc.)
Neuropsychological assessments can help to chart the process of change. Improvement
over time is important to document as resources and plans may need revision.
So too is any apparent worsening over time which can occur in some conditions and
in some populations, such as children where "latent" deficits may be seen
as they mature.
What is involved
An assessment usually consists of 3 equally important parts.
Firstly, taking a comprehensive history from interviews with the person affected
by encephalitis and their close relative, and gathering appropriate information
from the medical records, This first stage allows us to gain a picture of the type
and severity of injury to the brain, what the person was like before the illness
and how they have progressed.
The second stage involves the use of standard psychological tests to examine how
specific functions of the brain are working. The main areas of cognitive functioning
which should be assessed are attention, memory, visual perception, reasoning and
verbal ability. For each function a number of different tests should be used.
There is no point relying on just one test of attention, for example, when attention
is such a complex system and is known to have different areas and levels of working
within the brain - for example, speed of thinking, sustaining concentration, keeping
to one thing at a time, being able to work in a busy or noisy environment with other
things going on around you.
An individual's IQ (intelligence quotient) has little relevance to brain function
or neuropsychological assessment. However, the standard tests of intelligence,
which are used to calculate the IQ, can be very useful if their results are interpreted
in terms of brain function, rather than numerical estimates or lQs. An appropriate
and comprehensive neuropsychological assessment yields information on how the brain
is working, information which cannot be obtained in any other way.
The third part of assessment is the psychologist's opinion and report. The
test results are now considered in relation to the person's history - both before
and since the illness. For example, do the test findings make neurological
sense, does the pattern of difficulties shown fit with what one would reasonably
expect to find after this type and severity of illness. If not, were there
any problems before the illness, such as dyslexia, learning or behaviour difficulties,
or other injury to the brain, which may have increased the person's vulnerability
and caused disproportionately severe symptoms? The effects of two or more
injuries to the brain, whatever their cause or severity, will be cumulative.
Having decided on the person's present condition, the psychologist should then be
in a position to make recommendations for helping further rehabilitation or education,
for example. The so-called "strengths and weaknesses" of the
person's assessment should indicate the main problem areas (e.g. attention and memory),
the nature of the difficulty (e.g. distractibility) and, by logical application
of knowledge on how brain functions are organised, the best ways in which to approach
the problems (e.g. working in a quiet room; one-to-one practice in learning how
to learn).
How long does it take ?
It varies depending on what the purpose of the assessment is, how quick the patient
is able to respond, how they cope with fatigue and their age. On average,
a comprehensive assessment takes about 2 - 4 hours.
How to get a Neuropsychological Assessment
From a Chartered Clinical Psychologist who specialises in neuropsychology.
Every health district will have a Psychology service, not all will have someone
who specialises in neuropsychology, but many will.
How you get to see the person may vary from one Psychology service to another but
will usually need a referral from a doctor.
For children, ideally you aim for a Chartered Clinical Psychologist who works with
children and specialises in child neuropsychology. Realistically you are more
likely to see a child psychologist who has some experience of neuropsychology.
You can check that a psychologist is properly qualified using The Register of Chartered
Psychologists.
You can look for someone who is a Chartered Psychologist and offers neuropsychological
assessments in the Directory of Chartered Psychologists (both available from The
British Psychological Society, St Andrews House, 48 Princess Road East, Leicester,
LEI 7DR). Some of those people listed in this offer to see people privately-
those who only work for public services give the contact details for that service.
What to do with a Neuropsychological Assessment
Try to gain an understanding of what aspects of someone's thinking have changed
and in what way.Pass this understanding on to anyone else who has regular contact.
For example - relatives., friends, ?colleagues or boss, teachers', doctors, social
services, benefits agency.
Plan any appropriate rehabilitation using the assessment.
Plan for future - education, employment, living arrangements, legal arrangements.
In some circumstances, have another assessment after a year and compare the two
to see if anything is changing.
Treat it with a bit of caution - it is one of the best sorts of evidence that can
be gained about how someone's thinking is working, but it never comes with a 100%
guarantee of accuracy.
Last modified: October 2009