the utility of a comprehensive neuropsychological evaluation conference/annual... · the utility of...
TRANSCRIPT
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The Utility of a Comprehensive
Neuropsychological Evaluation
Jillian Bennett, Ph.D., BCBA-D, LABA
Kevin A. Domingos, Ph.D. – Clinical Director
Michael A. Fearing, Ph.D.
Boston Neuropsychological Services, LLC.
687 Highland Avenue, Second Floor
Needham, Massachusetts 02494
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Learning Objectives
1. Identify when to refer for an evaluation
2. Identify the utility of a neuropsychological
evaluation
3. Identify types of evaluations based on age and
pathology
4. Resources and recommendations based on
evaluation
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• Mild TBI (even if imaging does not show brain abnormalities)
• Difficulty with learning, attention, behavior, socialization, language,
and/or emotional control
• Regression in skills, slow progress, or complete lack of progress
• Current interventions ineffective & need more specific
recommendations
• Not sure if the educational setting is appropriate
• No diagnosis or inappropriate diagnosis
• Several diagnoses and diagnostic clarification is needed
When to Refer for an Evaluation
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• Inpatient
• Outpatient
• F/U Re-Evaluation
Evaluation Settings
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• Establish baseline
• Track decrements and/or improvements over time
• Slow progress, complete lack of progress, or regression
• Transition points in child’s education or development
• Interventions have been unsuccessful
• Change in functioning at any point
When to Refer for a Re-Evaluation
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The Utility of a
Neuropsychological Evaluation
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Neuropsychological Approach
Research Project with an N=1
Ho Generation and Assessment
An Excuse to Collect Data
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• Baseline functioning:
• Developmental milestones
• Social functioning
• Behavior
• Academic functioning
• IQ
• Work History
• Post-TBI functioning:
• Social, Behavioral & Academic Functioning
History Section
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• Inattention
• Orientation
• Non-compliance
• Trouble understanding directions
• Expression/Comprehension
• Anxiety
• Fatigue
• Problem solving process
Behavioral Observation Section
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Assess Many Domains
• Intellectual functioning
• Language
• Visual-Spatial/Motor Skills
• Learning and Memory
• Academic Achievement
• Attention and Executive Functioning
• Social, Emotional, and Behavioral Functioning
• Adaptive Functioning
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Functional Domains
Executive Functioning
Learning and Memory
Language & Spatial
Attention Basic sensorimotor/perception
Level of Consciousness – Alert - Orientation
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• Tracking
• Visual Field Testing (Cuts, Blind Spots, neglect-multiple
domains)
• Visual Acuity (eye chart) – R/L/both
• Hearing
• Tactile
• Balance - Proprioception
Sensory Processing
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• Upper/Lower - Grip Strength - Quad strength and transfers
• Apraxia (Wave, throw, hammer, blow out match)
• Hand-eye coordination
• Manual Dexterity/Motor Speed
• Finger tapping or grooved pegboard
Motor Skills
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• IQ is a construct
• Why is it important?
• Premorbid
• Declines?
• Limitations
Cognitive Test Results
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• Interview
• Digit Span Forward (Simple Auditory Attention)
• Digit Span Backward (Working Memory component)
• Trail Making Part A (Visual Attention and Scanning)
• Response to instructions and directions
• Behavioral observations (looking out window, scanning room,
distracted by noises, etc.)
Attention Test Results
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• Repetition
• Comprehension of simple instructions
• Comprehension of simple questions
• Reading (WTAR)
• Assess premorbid verbal intelligence
• Confrontation Naming (Boston Naming Test)
Language Skills Test Results
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PLEASE COPY THIS DESIGN
Visual Spatial Processing Test
Results
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PLEASE DRAW THE DESIGN YOU JUST COPIED
Visual Spatial Memory Test
Results
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Visual Spatial Processing Testing
Example
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Visual Spatial Memory Testing
Example
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• Attention and concentration
• Immediate recall
• Learning and improvement with repetition
• Recall after distraction/interference
• Recall after delay
• Recognition
• Forced Choice
Auditory/Verbal Memory Test
Results
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• Visual Perception
• Graphomotor abilities
• Planning
• Sequencing
• Working Memory
• Abstraction
• Language (Following directions)
Executive Functioning Test Results:
Clock Drawing
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1. Draw a large clock.
2. Put in all of the numbers.
3. Set the time to 15 after 7.
Clock Drawing Exercise
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Executive Functioning Testing:
Clock Drawing Example
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Executive Functioning Testing:
Clock Drawing Example
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• Initiation
• Word Generation
• Perseveration
• Phonemic vs. semantic
Executive Functioning Test Results:
Word List Generation
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• Trail Making Test Part A
• Visual attention and scanning
• Graphomotor speed
• Trail Making Test Part B
• Mental flexibility
• Muli-tasking
• Complex cognitive abilities
Executive Functioning Test Results:
Trail Making
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Executive Functioning Testing:
Trail Making Example
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• Depression
• Effects effort on other tests
• Creates cognitive impairments in memory, executive function, etc.
• Anxiety
• Self induced pressure can lead to failure
• Impacts processing speed
• Impacts executive functioning
Emotional Functioning Test Results
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Test Results Data
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• Not just about the numbers
• Example: Poor Math Test Results
• Spatial Organization Errors: Misaligning columns
• Visual Detail Errors: Misreading the sign or misplacing small details
(e.g., decimal points)
• Procedure Errors: Failing to complete all steps in a problem or
completing them in the wrong order
• Memory Errors: Failure to remember a particular math fact
• Graphomotor Errors: Caused by poor handwriting
Test Results:
The “Why” is Important
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• Ties everything together
• Symptoms vs. diagnosis
• Etiology guides treatment (e.g., TBI vs Developmental)
Diagnostic Impression Section
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Rank ordered
Summarizes test results
Guides recommendations
Strengths & Limiting Factors
Section
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• Specific
• Individualized
• Match parent & teacher/other provider concerns
• Guided by history, behavioral observations, and test results
• Provides resources
Recommendation Section
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• Cognitive Rehabilitation – (e.g., Community Rehab Care)
• Occupational Therapy
• Physical Therapy
• Speech and Language Therapy
• Counseling
• Driving Evaluation
Recommendation Section
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• Psychiatry and Psychopharmacological
Therapies
• Sleep Clinic
• Pain Clinic
• Brain Injury Organizations and Support Groups
Recommendation Section
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Review Learning Objectives
1. Identify when to refer for an evaluation
2. Identify the utility of a neuropsychological
evaluation
3. Identify types of evaluations based on age and
pathology
4. Resources and recommendations based on
evaluation
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Boston Neuropsychological Services, LLC
687 Highland Avenue, Second Floor
Needham, Massachusetts 02494
www.bostonneuropsych.com
Phone: (781) 559-8444
Fax: (781) 559-8117