How Neuropsychological Testing Can Support Therapy

Did you know that neuropsychologists sometimes use games and puzzles to assess how the brain is functioning? Some of these would include activities such as connecting dots, matching shapes, remembering pictures, or figuring out what comes next in a sequence. They may seem straightforward, but the activities we often see in games and puzzles can involve a surprising number of our mental processes. Neuropsychological testing involves using tasks similar to the ones explained above, designed to examine different aspects of how we think, remember, pay attention, solve problems, and process information. But what exactly are these tests, and why do we use them in therapy? In this sketch, we’ll explore what neuropsychological tests are, the different types of tests neuropsychologists use, and how they can support the therapeutic process.

What is Neuropsychological Testing?

Neuropsychological assessments involve tests, questionnaires, and other techniques used to understand different aspects of cognitive functioning, including thinking, perception, attention, language, memory, and more. In simple terms, they help us understand how we think, process information, remember, and make sense of the world around us.

These assessments can be used when evaluating conditions such as dementia or Alzheimer’s disease, after a brain injury or stroke, or with neurological conditions such as multiple sclerosis. Testing can also help us and our specialist track recovery or changes over time and, in some cases, may be required for safety-sensitive jobs, such as pilots, where cognitive functioning is especially important. 

These assessments can also provide valuable diagnostic information, help our specialist differentiate between possible diagnoses such as autism and ADHD, and offer insight into our treatment.

While a neuropsychological evaluation may sometimes involve a brief cognitive or psychological assessment that helps us better understand your concerns, it can also be much more comprehensive and specialized, depending on your needs and the questions we are trying to explore. In other words, there is no single way a neuropsychological evaluation looks. It can range from a focused assessment of a particular concern to a more detailed evaluation of how different aspects of your cognition and functioning work together.

Below are some of the key components commonly included in the neuropsychological evaluation process:

Examination of records:

A neuropsychological evaluation usually begins with looking at the person’s history. Neuropsychologists may review the individual’s and family’s medical, neurological, and psychiatric history, as well as laboratory and neuroimaging results. They can also look at any previous neuropsychological evaluations, medication and substance use history, and, importantly, the reason for the referral. All of these pieces help create a clearer picture of what may be happening and where to look more closely.

Clinical interview with the individual and a family member:

The next step is often a clinical interview with the individual and, when appropriate, a family member. This conversation helps the neuropsychologist understand the person beyond the test results. They may explore developmental factors that could be affecting the current condition, as well as emotional, personality, and background factors that may be relevant. The interview also looks at how symptoms are affecting everyday life, when they first appeared, and how they have changed over time. In addition, the neuropsychologist pays attention to signs and behaviors that may help clarify the nature of the neurological symptoms.

Neuropsychological testing:

The testing process gives the neuropsychologist or the administering specialist a closer look at how different areas of thinking and functioning might be working. The individual completes a series of tests that assess areas such as memory, attention, language, processing speed, and other cognitive abilities. Once testing is complete, the neuropsychologist looks for patterns in the results. These patterns can help determine whether there are particular areas of cognitive strength or difficulty and, in some cases, whether the pattern may be consistent with a specific neurological condition or brain lesion. The test results are then considered alongside what was learned during the interview and from the person’s history. Finally, the raw test performance is scored and converted into standardized statistical scores, which allow the neuropsychologist to understand the results in relation to appropriate comparison groups.

Feedback:

Once the evaluation is complete, the neuropsychologist meets with the individual and sometimes also with the family if applicable, again to talk through the findings and answer their questions. The goal is to help us make sense of what the results mean in everyday life.

The neuropsychologist may also communicate the findings to the referring clinician, including diagnostic impressions and possible treatment plans. Together with the individual, they may discuss practical strategies and treatment recommendations that can support the person moving forward.

Who Can Conduct Neuropsychological Testing?

Depending on the type of assessment, different professionals may be trained or qualified to administer specific neuropsychological tests, including physicians, neurologists, psychiatrists, clinical psychologists, and neuropsychologists. The scope of training and professional practice can vary depending on the specific test, the professional’s qualifications, and local regulations.

Types of Neuropsychological Testing

Neuropsychological testing helps us measure and understand how the brain is working in different areas. It looks at different abilities that we use in everyday life, from remembering information to staying focused, solving problems, and communicating with others. These areas often include:

• Memory: Memory testing looks at how well a person can learn, store, and remember information. This can include short-term, long-term, visual, and verbal memory. For example, the California Verbal Learning Test (CVLT) involves hearing 16 words from four different categories and being asked to remember them several times. After waiting for 20 minutes, you are then asked to remember the words again.
• Attention: Attention testing looks at how well a person can stay focused, shift their attention, and also deal with distractions. For example, the Trail Making Test (TMT) has two parts. In the first part, the participant connects numbers from 1 to 25 as quickly as possible. In the second part, they alternate between numbers and letters, such as 1-A-2-B, which gives us a sense of how well they can shift their attention.
• Executive functioning: Executive functioning refers to the cognitive abilities we use to plan, solve problems, organize, make decisions, and control impulses. One example test that helps us assess our executive functioning is the Wisconsin Card Sorting Test (WCST), which looks at problem-solving and how well a person can adjust their approach when the rules change. The participant sorts cards according to different rules and uses the practitioner’s feedback to figure out how to continue.
• Language: Language testing may look at abilities such as naming, understanding language, and finding the right words. For example, the Boston Naming Test (BNT) includes 60 drawings of objects, starting with easier ones and becoming more difficult. We would then be asked to name each object within 20 seconds.
• Motor skills: Motor testing looks at things such as how well a person can control and coordinate their movements. This can include simple tasks such as finger tapping or measuring grip strength.

How Do Neuropsychological Tests Support Therapy?

Neuropsychological tests help us better understand how a person’s thinking, emotions, behavior, and everyday functioning are connected. They can help differentiate between diagnoses such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and learning disabilities. They can also help us evaluate conditions such as dementia and Alzheimer’s disease.

Neuropsychological tests do not necessarily replace the therapeutic or other kinds of support an individual needs, but rather guide this process toward more accurate treatment and care planning. This information can then be used to guide therapy and treatment. What we learn from neuropsychological tests can help our therapist or specialist choose strategies that fit our specific needs, build on our strengths, and work around areas of difficulty with proper accommodations. In some cases, the results can also guide cognitive rehabilitation or other practical strategies for managing difficulties in everyday life.

Takeaways

• Neuropsychological tests help us understand how different areas of thinking and functioning work, including memory, attention, language, problem-solving, and motor skills.
• These assessments can help evaluate conditions such as dementia, Alzheimer’s disease, brain injury, ADHD, autism, and learning disabilities, and can guide our treatment planning.
• The evaluation may include reviewing our history, a clinical interview, different tests and tasks, and a feedback session to understand the results.
• Neuropsychological tests can support therapy and treatment by helping therapists understand our strengths and difficulties and choose strategies, accommodations, or rehabilitation that can fit our needs and support our treatment planning.

References

• American Academy of Clinical Neuropsychology. (2007). Practice guidelines for neuropsychological assessment and consultation. The Clinical Neuropsychologist, 21(2), 209–231.
• Harvey, P. D. (2012). Clinical applications of neuropsychological assessment. Dialogues in Clinical Neuroscience, 14(1), 91–99. https://doi.org/10.31887/DCNS.2012.14.1/pharvey
• Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th ed.). Oxford University Press.
• Michels, T. C., Tiu, A. Y., & Graver, C. J. (2010). Neuropsychological evaluation in primary care. American Family Physician, 82(5), 495–502.
• Schroeder, R. W., Martin, P. K., & Walling, A. (2019). Neuropsychological evaluations in adults. American Family Physician, 99(2), 101–108. https://www.aafp.org/afp/2019/0115/p101

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At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma, and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy. 

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