Understanding Neuropsychological Evaluations at School

A neuropsychological evaluation conference can be a psychological/therapeutic event, indeed the assessment process itself can be viewed as the beginning of treatment. "Therapeutic Assessments", as they are often called, have been discussed by others in the field (eg. Krishnamurthy, Finn, & Aschieri, 2016). Martin and Turret (2023) call them “empathy magnifiers'' that help clients and their families better understand their strengths and challenges. Most commonly requested by a parent at the suggestion of a teacher or school learning specialist, they could also be requested by an adult for themselves. The patterns revealed will help understand the child/client’s strengths and challenges, while also providing both a measure of hopefulness and a road map going forward. Hopelessness is the enemy of progress.

Parent Conference/Feedback Sessions

Parents and caretakers should carefully review the evaluation, either as a draft prior to meeting with the evaluator or in a collaborative process together in a meeting. The goal is to make sure the evaluation accurately captures the student: does it feel like the evaluator understood the struggles they were concerned about?

If possible, it’s best that both parents attend the conference so that they can hear the same thing. This both helps avoid misunderstandings and lets them get a chance to ask questions. Additionally, students should always receive some interactive feedback from the evaluator about their learning profile. Evaluators do this differently, but it is essential that students are given age-appropriate feedback about their performance. The Brooklyn Learning Center, for example, creates a brief brochure specifically for the child, targeted at the correct level for their comprehension, that reviews strengths, challenges, and strategies they can use. A copy of their form can be found in Learning Disorders Across the Lifespan: A Mental Health Framework, (2023) edited by myself and Amy Margolis.

Factors to consider in deciding whether the child/adolescent should attend the conference with the parents include the age and maturity of the child. The number one priority is that the parents feel free to ask any question without worrying about the child’s reactions. However, you are also hoping to engage the child’s agency and curiosity regarding how their mind works. This is the beginning of a long process. All possible combinations should be considered and individualized to the specific needs of the family.

A collaborative conference begins by reviewing what prompted the referral. What were the main concerns/questions raised by the parents? Have any new questions or concerns emerged? Are there any relevant updates on the child? Next, review the academic data in terms of absolute and relative strengths and challenges, sometimes using a normal curve or other visual referents to aid understanding. It’s important to contextualize the results so that they are an accurate reflection of the child’s abilities, including whether the results may be low or high estimates, given how the testing proceeded, i.e., tiredness, motivation, anxiety, etc. The parents should be able to report back on and correct any misconceptions to increase the data’s accuracy, and if needed, ask for adjustments to be made to the report.

The cognitive data is used to help the family understand the relationship and meaning of each score and between the scores and different tests. One tries to create a shared understanding of why their child was struggling and what support their child needs. Lastly, a plan is created for the next steps together.

It is common for a test report to end with recommendations tailored to the specific child's strengths and weaknesses. This is often overwhelming for parents, so recommendations should be short and specific. Attention should be paid to the potential economic impact on the family, with an eye toward helping them decide what should come first. Examples of specific tips for parents and professionals for working with students with learning disabilities are included in Broitman et al. (2020).

Feedback meetings for students

The content and format of a feedback meeting for students will vary depending on the student’s age and desires. In general, we recommend students be given the choice of having some part of the meeting without their parents present. During this individual portion of the feedback meeting, the evaluator can discuss the child’s strengths and difficulties without the use of scores or labels, if appropriate.

It is helpful to link the information to the child’s self-assessment and to begin with strengths. First, review what the student did well and easily and how they view their own performance. Then discuss difficulties, trying to tie this to the student’s personal experience. For example, “During the puzzles we did when you had to put blocks together to build a target design, you said: ‘This is really hard,' but when we added a grid over the design, you were able to solve the puzzles!” Then you can discuss how analogous strategies can be put into place for students at home for homework, in school, or in social settings (Broitman et al. 2020).

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Students can be given a personalized brochure that outlines their strengths, challenges, and strategies that they use, and recommends new strategies to help overcome difficulties. The more specific to each child this can be the better. If a child has a particular concern at the outset of testing about school, homework, or social activities, it is ideal to provide a strategy or solution for this problem on their feedback brochure.

Evaluations for Families with Limited Resources

It can be difficult to arrange evaluations and services for families with limited resources. Families are already stressed because their children are facing academic and emotional difficulties; the additional financial stressors associated with supporting a child with special needs can be hard to manage. By law (as defined by Individuals with Disabilities Education Act), every child is entitled to a free assessment completed by the school district if parents believe that the child is exhibiting problems and the school concurs. However, parents need to understand that the evaluation then becomes a part of their child's special education record. This removes their option to control the information, which is sometimes preferred by families. If the school disagrees, a special education advocate and/or lawyer can help appeal their decision.

Parents also have the right to request an independent educational evaluation (IEE) funded by the school district if the initial evaluation does not address their concerns. There are not-for-profit organizations that can help parents request these IEEs if they need help. IEEs are extremely helpful and often correctly identify needed accommodations and services for children. Additionally, parents can obtain compensatory services for children which can address gaps in learning and are often delivered by a provider of the family’s choosing. Low-fee assessment resources can be found online through websites (some listed below), or in Broitman et al. (2020).

Therapy starts with the evaluation

The evaluation process is the beginning of an important therapeutic relationship and should be handled collaboratively, and with care. By the time a child comes in for testing, they are likely to have been struggling for some time. Families will have a variety of feeling about the process and results, including relief, anxiety, fear, and guilt. They often realize that also they suffer from similar challenges and might want to also be tested. Frequently, referrals should be made for supportive services.

Next up: What are the supportive services available for children or adults with learning disorders?