What is a neuropsychologist?

Clinical Neuropsychology is a specialty profession that focuses on brain functioning. A clinical neuropsychologist is a qualified Clinical Psychologist accredited by the British Psychological Society, with expertise in how behaviour and skills are related to brain structures and systems.  A very detailed assessment of abilities is done, and the pattern of strengths and weaknesses is used in important health areas, such as diagnosis and treatment planning. The Clinical Neuropsychologist conducts the evaluation and makes recommendations. He or she may also provide treatment, such as neuro-rehabilitation, behaviour management, or cognitive behaviour therapy.

What is neuropsychological cognitive testing?

Neuropsychological assessment is an appraisal of the brain's psychological, that is cognitive and behavioural, functions.  An assessment usually consists of 3 equally important parts. 

Firstly, taking a comprehensive history from interviews with the patient, where appropriate, a close relative, and gathering information from medical records and school reports.  This first stage allows us to gain a picture of the type and severity of injury to the brain, what the person was like before the illness and how they have progressed. 

The second stage involves the use of standard psychological tests to examine how specific functions of the brain are working.  The main areas of cognitive functioning which should be assessed are attention, memory, visual perception, reasoning and verbal ability.  For each function a number of different tests should be used.  There is no point relying on just one test of attention, for example, when attention is such a complex system and is known to have different areas and levels of working within the brain - for example, speed of thinking, sustaining concentration, keeping to one thing at a time, being able to work in a busy or noisy environment with other things going on around you.

An individual's IQ (intelligence quotient) has little relevance to brain function or neuropsychological assessment.  However, the standard tests of intelligence, which are used to calculate the IQ, can be very useful if their results are interpreted in terms of brain function, rather than numerical estimates or lQs.  An appropriate and comprehensive neuropsychological assessment yields information on how the brain is working, information which cannot be obtained in any other way. 

The third part of assessment is the Psychologist's opinion and report.  The test results are now considered in relation to the person's history - both before and since the illness.  For example, do the test findings make neurological sense?  Does the pattern of difficulties shown fit with what one would reasonably expect to find?  If not, were there any problems before the illness, such as dyslexia, learning or behaviour difficulties, or other injury to the brain, which may have increased the person's vulnerability and caused disproportionately severe symptoms?  The effects of two or more injuries to the brain, whatever their cause or severity, will be cumulative.

Having decided on the person's present condition, the Psychologist should then be in a position to make recommendations for helping further rehabilitation or education, for example.  The so­-called "strengths and weaknesses" of the person's assessment should indicate the main problem areas (e.g. attention and memory), the nature of the difficulty (e.g. distractibility) and, by logical application of knowledge on how brain functions are organised, the best ways in which to approach the problems (e.g. working in a quiet room; one-to-one practice in learning how to learn).

In children, a neuropsychological assessment must take into account effects on normal developmental processes and for this reason repeat assessments at life transition points (such as preparing for transition to secondary school or further education) are appropriate in order to plan appropriate education interventions.