Most people may not be familiar with what the differences are between the major types of evaluations psychologists provide. The following aims to answer some of the most common questions people might have, such as:
- What is the difference between a psychological, psychoeducational, developmental, and neuropsychological evaluation?
- Who is qualified to perform each of these evaluations?
- Which type of evaluation would be most appropriate given my child’s need?
Psychological evaluations often focus on identifying and diagnosing a specific neurodevelopmental disorder (e.g., ADHD, Autism Spectrum Disorder, etc.) or psychiatric disorder (mood or anxiety disorder, conduct disorder, etc.). Such evaluations involve obtaining a detailed history of the patient’s developmental, medical, social, school, and psychological functioning along with behavioral observations and a series of standardized parent, teacher, or self-report measures, personality tests, and sometimes tests of general cognitive functioning. Psychological evaluations are performed by licensed clinical psychologists, while certain components (e.g., assessing the emotional, behavioral, and social functioning of a child in the school setting) may also be conducted by school psychologists.
Psychoeducational evaluations focus on academic achievement and general cognitive (or intellectual) abilities of school-age children and college-age adults. These evaluations are conducted by licensed clinical psychologists and school psychologists. When they are conducted within the school setting, the purpose is to determine whether or not a student qualifies for special education services and accommodations for a specific learning disability. School evaluations are not conducted to diagnose disorders or their underlying causes, but rather to determine the eligibility of a student for services provided through the public school system as mandated by federal law.
Developmental evaluations focus on early childhood development and are typically requested for infant, toddlers, and preschool children to determine whether or not development is occurring at expected rates in the areas of cognitive, language, motor, social, and adaptive functioning, or whether “developmental delays” exist that warrant early intervention services. Developmental evaluations may be performed by a variety of healthcare providers (e.g., licensed clinical psychologists, developmental pediatricians, speech pathologists, occupational therapists, etc.), as well as by school psychologists.
Neuropsychological evaluations are performed by licensed clinical psychologists who have specialized training in neuropsychology. A neuropsychological evaluation focuses on learning and behavior in relation to an individual’s brain, involves the use of standardized, norm-referenced tests and behavioral observations, and incorporates knowledge of brain development, organization, and functioning into the evaluation findings. Neuropsychological evaluations are considered the most comprehensive type of evaluation, and typically include psychological and psychoeducational testing components, but the major difference is that neuropsychological testing goes a step further to understand the relationship between behavioral, cognitive, and functional deficits and underlying brain functions. Neuropsychological evaluations measure cognitive abilities and processes such as attention and executive functions, reasoning, language, memory and learning, and visual-spatial/visual-motor abilities. Thus, by looking at a patient’s functioning and abilities comprehensively, one can better understand not just “what” the problem is, but “why” there is a problem. For instance, a child may struggle to accurately answer questions about what he/she just read. Whereas a standard psychoeducational assessment might determine “IF” the child qualifies for special education services for reading comprehension problems, a neuropsychological evaluation would investigate “WHY” the child is having reading comprehension problems. For example, is the child’s difficulty due to visual processing difficulties (such as visual-perception or visual attention/visual scanning problems), weakness in working memory, receptive versus expressive language deficits, or even performance anxiety, etc.. A clearer understanding of “why” problems exist and their underlying cognitive abilities or processing deficits, as well as emotional and behavioral factors, is crucial in determining the most effective, individually-tailored intervention plan. Patients may be referred for neuropsychological evaluations in cases involving known neurological conditions (e.g., seizures, neurofibromatosis, brain tumors) and injuries (e.g., concussions), as well as exposure to toxins (e.g., lead poisoning, alcohol and substance exposure prior to birth) and medical conditions and factors which increase risks for brain injury (e.g., history of complicated pregnancy, delivery, and prematurity). Neuropsychological evaluations are also recommended for assessment of complex neurodevelopment disorders (such as ADHD and learning disorders). For instance, a patient with ADHD may fail to respond to standard treatment efforts, and comprehensive testing may be necessary to determine the severity of deficits so that expectations can be more appropriately tailored, and to determine the presence of co-existing disorders and problems which may be hampering treatment progress. In other cases, very bright individuals with ADHD and/or learning disorders may be presenting unique challenges to parents and educators. These “twice exceptional” students often benefit from comprehensive evaluations to fully understand their range of strengths and weaknesses so that the appropriate combination of enrichment, accommodations, and treatments can be developed.
By Hellen A. Lewis Streicher, PhD, LCP, PLLC
MINDWORKS PEDIATRIC NEUROPSYCHOLOGY