Pediatric and Young Adult Neuropsychological Assessment: The Big Picture

Karen Shiltz student“My son has trouble reading simple words. He guesses and substitutes words when he reads. Daniel calls himself ‘stupid.’ He will be in the third grade next fall. Something is wrong. I need help.”

“I guess my granddaughter always had problems with focus. She had a snowboarding accident two years ago and was unconscious for about an hour. That was her third accident. Christina is now 14 years old. She had problems with attention before the first accident. Everything seems to have gotten worse. We need to help her in school. Christina is getting very frustrated.”

“Sarah tells me that she always turns in her assignments. This is so upsetting because her teachers are telling me that this is not true. I keep after her night after night. How can her assignments be missing when we complete them every night and they are in her backpack? I think I’m chasing after Sarah with a broom and I just can’t take it anymore.”

“I can’t focus in class. It’s worse in history and English. The teachers go on and on. My dad tells me I need to work harder. I just can’t. I think my brain is not right. I feel different. No one works as hard as me and it’s not getting me anywhere.”

What is a neuropsychological assessment?

Neuropsychological assessment is one of the procedures that your child’s pediatrician, psychiatrist, neurologist, tutor, educational remediation specialist, or even teacher may request. A comprehensive evaluation is critical in order to understand the “big picture” of your child’s strengths and challenges.

This assessment surveys many areas, which could be potentially affecting your child’s learning, thinking, and emotional functioning. It provides a “blueprint” by assessing the following areas:

  • Intellect
  • Achievement (reading, spelling, written expression, math)13235690_ml
  • Social-emotional levels  (anxiety/depression, ability to manage stress and mood)
  • Cognitive skills (attention and concentration, language, motor skills, verbal and visual reasoning skills, visual processing skills, memory, executive skills, i.e., planning and organization, time management, working memory, problem solving skills)
  • Social communication (ability to initiate and maintain a friendship, navigate through conflict, ability to pick up, process, and understand social cues)
  • Regulation (ability to attend and concentrate at home, school, and in other public situations)
  • Adaptive levels (how your child/young adult functions on a day-to-day basis at home, school, and in other public situations concerning their ability to take care of daily grooming functions, social skills)

The neuropsychological assessment is very comprehensive because it includes not only the testing data but also input from parents, other caregivers as needed, teachers, and medical/educational/testing records. The neuropsychologist, in assessing all aspects of a child/young adult’s functioning, is able to integrate the information obtained and describe how the child approaches learning overall and why he/she is experiencing struggles.

11049229_mlA comprehensive assessment will help you understand what your child really needs in order to succeed in school and in the workplace. All conclusions are based on a systematic and organized manner of assessment using a scientific approach.

Physicians such as psychiatrists, neurologists, and pediatricians as well as educational therapists use the assessment as a “roadmap” to target intervention goals and objectives.

Similarly, therapists such as psychologists, speech-language therapists, occupational therapists, and educational remediation therapists use the neuropsychological “roadmap” to identify specific goals and objectives so that the intervention proceeds in a systematic and explicit manner.

You can think of neuropsychological assessment as creating an integrated blueprint for intervention.

Who is trained to administer a pediatric/young adult neuropsychological assessment?

A clinical neuropsychologist is a professional psychologist who is trained in assessment and intervention as it relates to normal and abnormal functioning of the brain. Training involves the following:

  • Successful completion of a fellowship (post Ph.D.) in neuropsychology and neuroscience
  • Two or more years of supervised training applying neuropsychological services in a clinical setting
  • Licensing and certification to provide services to the public by the laws of the state in which he/she practices
  • Review by one’s peers as a test of competence
  • Functions in areas such as in the fields of research, clinical, criminal, forensic, and education

What are the limitations of a pediatric/young adult neuropsychological assessment?

An assessment typically takes time and cooperation not only from the child/young adult but also from their parents, caregivers, and teachers. Specifically, parents and teachers are asked to complete rating scales designed to assess a student’s overall behavior, social-emotional, social communication, academic, and regulation, i.e., attentional and concentrational skills, across home and school contexts.15400072_ml

Typically, assessments on an outpatient basis will take six to eight hours of face-to-face testing time. Feedback with parents is not immediate because the neuropsychologist must interpret all data and write a report so that all information is understandable. In addition, not all insurance companies will pay for a neuropsychological assessment if a physician does not authorize the evaluation as a medical necessity.

The lifelong consequences of learning and social disabilities as well as an acquired injury such as a head injury can be quite alarming. Society depends, for the most part, on an individual’s ability to read and write, manage their attention and emotions, and get to school/work on time. The neuropsychological assessment is a critical part of the diagnostic and intervention process when a student presents with challenges.

Thank you, Eran, for inviting me to post on your educational blog. Your blog is a valuable source of information to parents, teachers, and health care professionals who are invested in maximizing a child’s potential in life.

Dr. Karen ShiltzKaren L. Schiltz, Ph.D., is a clinical psychologist in private practice, specializing in the clinical and forensic neuropsychological assessment of children, adolescents, and young adults.  She is an Associate Clinical Professor (Voluntary) at the David Geffen School of Medicine within the Department of Psychiatry and Biobehavioral Sciences, an appointment she has held since 2004. Prior to that, Dr. Schiltz held an appointment as an Assistant Clinical Professor within the same department (1993-2004).

Dr. Schiltz supports a comprehensive team approach in the assessment and remediation of children, adolescents, and young adults who struggle with cognitive, learning, behavioral, social, and emotional difficulties. In addition to her private practice in Calabasas, California ( over the past 30 years and academic supervisory duties, Dr. Schiltz has written, co-written, and/or presented over 81 papers, manuscripts, and publications. She wrote Beyond The Label:  A Guide to Unlocking a Child’s Educational Potential (Oxford University Press, September, 2012) with Amy Schonfeld, Ph.D. and Tara Niendam, Ph.D. She lives with her husband and 16-year-old daughter in Westlake Village, California.

Karen L. Schiltz, Ph.D.
Psychologist (CA PSY 9508)
Private Neuropsychology Practice of Karen Schiltz Ph.D. and Associates
Associate Clinical Professor (Voluntary)
Medical Psychology Assessment Center
Semel Institute for Neuroscience and Human Behavior
Department of Psychiatry and Biobehavioral Sciences
David Geffen School of Medicine at UCLA