Meet The Team
Licensed Psychologist, Clinical Neuropsychology
Director, NCC of South Florida
Licensed Psychologist, Child Clinical and School Psychology
NCC of South Florida
Types of Evaluation
Several types of evaluations are offered by Neurocognitive Consultants in order to understand an individual’s strengths and weaknesses and make an accurate diagnosis.
A Developmental Evaluation provides a thorough understanding of a child’s early developmental status and milestone acquisition in order to define areas or conditions in need of attention or services.
An Autism Screening aids families with regular developmental surveillance as well as confirmation of pervasive developmental delays to aid in the treatment of Autism Spectrum and Disorders (ASD).
Gifted Testing identifies students eligible for gifted and talented programs and provides feedback to guide the educational process.
A Psychoeducational Evaluation analyzes the mental processes underlying a child’s academic performance, such as attentional difficulties or learning disabilities.
A Psychodiagnostic Evaluation identifies the presence of disorders, such as Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder (ADHD), Anxiety Disorder, Depression, Thought Disorder, or Personality Issues.
A Neuropsychological Evaluation investigates an individual’s cognitive, emotional, and behavioral functioning, specifically related to intellectual abilities, speed of mental processing, attention/concentration, planning and organizational abilities, language processing, learning and memory, sensory-perceptual functions, visuospatial processing, adaptive functioning, and motor speed, strength, and coordination.
A Disability Evaluation determines the severity of an individual’s impairment(s) and assesses whether their impairment(s) results in marked or severe functional limitations.
A Forensic Evaluation evaluates parties in criminal or civil cases regarding mental health issues related to their case.
Through the use of developmental, intellectual, academic/educational, psychological, and neuropsychological assessments, Neurocognitive Consultants can offer a variety of diagnostic services for all ages.
Our areas of specialization for children include:
Learning Disorders and Dyslexia
Non-verbal Learning Disorders
Attention-Deficit/Hyperactivity Disorder
Developmental Social Disorders, such as Autism Spectrum Disorders
Intellectual and Developmental Disabilities
Gifted and Talented Assessments
Neurodevelopmental Disorders and Genetic Syndromes
Prematurity and Low Birth Weight
In Utero Exposure to Substances
Congenital Heart Defects
Brain Injuries, including Sports Concussion Injuries
Hydrocephalus
Brain Hemorrhage
Brain Tumors
Epilepsy
Cancer/Leukemia
Anxiety/Mood Disorders
Speech & Language Disorders
Stuttering
Parent/Caregiver Education
Forensic Psychological or Neuropsychological Evaluation
Our areas of specialization for adults include:
Brain Injuries, including Sports Concussion Injuries
Hydrocephalus
Brain Hemorrhage
Brain Tumors
Epilepsy
Cancer/Leukemia
Anxiety/Mood Disorders
Alzheimer’s Disease and Other Dementias
Autism Spectrum Disorder
Attention Deficit Hyperactivity Disorder
Learning Disorders and Dyslexia
Forensic Psychological or Neuropsychological Evaluation
Vocational Rehabilitation
Frequently Asked Questions
What is the purpose of a comprehensive diagnostic evaluation?
Evaluations increase our understanding of cognitive, emotional, and behavioral functioning in relation to difficulties that an individual is experiencing, whether at home, school, or in the workplace. This information augments or goes beyond what can realistically be obtained via clinical observations, interview material, or medical findings. Through an interactive assessment combining standardized paper-and-pencil tasks, hands-on activities, questionnaires, and computer “games,”a greater awareness about present functioning and future risk factors is gained.
Once an individual’s unique profile is understood, including areas of relative strengths and weaknesses, specifically tailored recommendations for direct interventions and accommodations are provided. These recommendations are often essential for the development of optimal treatment, educational, or placement plans, or for qualifying for necessary services.
Diagnostic evaluations are also instrumental in re-evaluating current or past clinical impressions or identifying the presence of previously unrecognized pervasive developmental delays (PDD) and autism spectrum disorders (ASDs), language or nonverbal processing deficits (NVLD), learning disorders (LDs), attentional difficulties (ADHD), and a variety of emotional and behavioral problems, e.g., depression, anxiety disorders, and thought disorders. Lastly, these evaluations can be utilized to track clinical and/or educational progress over time.
Why are individuals referred for evaluations?
Evaluations can be particularly helpful when an emerging learning disability, attentional disorder, developmental delay, pervasive developmental disorder (PDD) or autistic spectrum disorder, behavioral problem, motor delay, memory problem, or language and communication delay is suspected or requires additional verification. They are also indicated when anxiety or social/emotional difficulties are interfering with an individual’s functioning or when it is important to understand the psychological and/or cognitive ramifications of medical conditions (e.g., epilepsy, cancer, or Alzheimer’s). Individuals often self-refer or are referred for assessment by a parent, doctor, teacher or other professional because of one or more of the following reasons:
• Difficulty in learning, attention, behavior, socialization, or emotional control
• Teachers or work supervisors report persistent difficulties
• Poor work performance despite adequate attendance and seemingly good attention and effort
• Problems with retention of information and needs frequent redirection
• Inadequate achievement in school or at work despite sufficient effort
• History of neurological or developmental difficulties known to affect the brain and/or brain systems (e.g., epilepsy, toxic exposure, metabolic disorder, autism spectrum disorder, or ADHD)
• Suspected developmental delay (e.g., language, motor, etc.) which may or may not be accompanied by other areas of impairment
• Traumatic brain injury or significant illness that impedes cognitive development.
• Specific medical disease or congenital developmental problem that affects brain functioning
• Proper documentation of giftedness or other special educational need is required
• Documentation is desired regarding an individual’s current level functioning (baseline) or an individual’s progress or change after treatment or previous evaluations (re-evaluation or follow-up evaluation)
What types of assessments are available?
Several types of evaluations are offered by Neurocognitive Consultants in order to understand an individual’s strengths and weaknesses and to make an accurate diagnosis.
Developmental Evaluation- Provides an understanding of a child’s early developmental status and milestone acquisition in order to define areas or conditions in need of attention or services
Gifted Testing – Identifies students eligible for gifted and talented programs and provides feedback to guide the educational process
Psychoeducational Evaluation – Analyzes the mental processes underlying a child’s academic performance, such as a learning disability or attentional difficulties
Psychodiagnostic Evaluation – Identifies the presence of disorders, such as an Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder (ADHD), Anxiety Disorder, Depression, Thought Disorder, or Personality Issues
Neuropsychological Evaluation – Investigates an individual’s cognitive impairments and functioning, specifically related to intellectual functioning, speed of mental processing, attention/concentration, planning and organizational abilities, language processing, learning and memory, sensory-perceptual functions, visuospatial processing, and motor speed, strength, and coordination
Social-emotional Evaluation – Distinguishes social-emotional strengths and needs
Disability Evaluation – Determines the severity of an individual’s impairment and assesses whether their impairment(s) result(s) in marked or severe functional limitations
Forensic Evaluation – Evaluates parties in criminal or civil cases regarding mental health issues related to their case
At what age should an evaluation be considered?
It is best to conduct evaluations as soon as possible, especially for children. Nearly all professionals agree that early intervention plays a significant and vital role in the treatment of developmental needs and facilitation of long-term progress. Further, diagnostic evaluations and the resulting reports serve as important tools for documenting the development and pattern of cognitive strengths and weaknesses over time.
Evaluations are appropriate for individuals over 2 years of age, although children under 2 years of age may be seen as well, depending on the specific circumstances and referral questions. Dr. Lyons is highly experienced in the assessment of infants and children with developmental delays, Autism Spectrum Disorders, and general medical conditions. She has the requisite training to monitor infants as young as 6 months of age, but standardized assessments can only begin later, in some cases after 12 months of age.
What are the typical parts of the evaluation process?
The team at Neurocognitive Consultants personally conducts each component of the evaluation process. Most evaluations include the following:
Initial Intake:At the first appointment, the psychologist meets with the patient and/orhis/her family in order to gain an understanding of the reason for referral and toobtain a detailed developmental, medical, psychological, educational and, depending on age, occupational history.
Evaluation: If a comprehensive evaluation is determined to be in the individual’s best interests, testing sessions will be scheduled over one to three sessions, depending on the age of the patient and the presenting behaviors of concern.During testing, standardized measures are administered in a systematic manner in an appropriate environment. The same tests are not given to every patient, but rather our team devises an individualized battery targeting areas of personal strength and weakness. Tests generally include a series of interactive activities that assess language and perceptual processing abilities, attention and memory, school-based learning, cognitive skills, emotional functioning, and behavior. Emerging skills can also be assessed in very young children. Parents and/or family members are usually not in the room during testing, although they may be asked to be present with very young children or on a case-by-case basis. The time required of testing depends on the patient’s age and problem. An evaluation may take 8or more hours and may spread across several sessions, depending on the needs of the patient. The evaluation of infants or preschool children is usually shorter in duration.Informal feedback may be provided to family members at the end of each session, as appropriate and relevant to the process.
During the course of the evaluation, the following areas may be assessed:
• General Intelligence
• Academic Achievement
• Attention / Concentration
• Executive skills, such as organization, planning, inhibition, and flexibility
• Learning and Memory
• Language and Communication Skills
• Visual-spatial Skills
• Motor coordination
• Social Interaction Skills
• Play Skills
• Adaptive Functional Skills
• Social-emotional Functioning
• Behavior
• Personality and other psychological factors
Some areas of functioning may be measured in more detail than others, depending on individual needs.
Feedback Session: Approximately three weeks after the initial testing session, a feedback session will be scheduled. This timeline allows the psychologist time to obtain and score teacher report measures and to integrate and interpret all of the results gathered in the interview, testing session(s), and self-report measures and/or parent and teacher checklists. During the feedback session, each assessment that was completed and the subsequent results will be discussed. Based on the individual’s performance, individualized recommendations will be offered that draw upon the individual’s strengths and needs. Skills and other areas requiring intervention will be identified, and specific strategies and referrals will be offered, as necessary.
Report: A comprehensive written report documenting the evaluation results, corresponding diagnostic findings, and subsequent recommendations will be provided upon completion of the testing.
Families are also offered consultation services both before and after the evaluation process, as needed. Reports are disclosed to other persons, professionals, or agencies upon appropriate written authorization, unless specifically contra-indicated by legal or ethical concerns.
What are some of the benefits of an evaluation?
An evaluation is useful in:
• Providing or confirming accurate diagnosis and greater understanding of an individual’s learning, cognitive, emotional, and behavioral profile.
• Determining the effects of developmental, neurological and/or medical problems on cognitive and emotional functioning (e.g., epilepsy, autistic spectrum disorder, ADHD, dyslexia or a genetic disorder).
• Identifying specific clinical or developmental syndromes or symptoms of disorders as well as how patients may make progress in various treatment regimens
• Obtaining a baseline assessment of functioning against which to measure treatment outcomes or positive or negative changes over time
• Assessing the effectiveness of current treatments and interventions
• Determining whether academic difficulties are due to cognitive problems, motivational difficulties, learning disability, or psychiatric problems.
• Differential diagnosis, which means clarifying why an individual is experiencing a particular problemthat has a variety of potential explanations (e.g., an individual may have difficulty conversing in social situations because of a language disorder, an anxiety disorder, or an Autism Spectrum Disorder).
• Determining whether a child qualifies for special education services or accommodations on standardized tests.
• Outlining individualized recommendations to help patients develop remedial or compensatory strategies for their difficulties.
What tests do you use in an evaluation?
Please see the table below for examples of the areas typically assessed as well as standardized tests commonly used by Neurocognitive Consultants.
Intellectual Functioning
Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV)
Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV)
Wechsler Nonverbal Scale of Ability (WNV)
Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV)
Wechsler Abbreviate Scale of Intelligence (WASI)
Woodcock-Johnson III Normative Update Tests of Cognitive Abilities
Stanford-Binet Intelligence Scales, Fifth Edition (SB5)
Kaufman Assessment Battery for Children, Second Edition (KABC-II)
Leiter International Performance Scale, Third Edition
Academic Achievement
Woodcock-Johnson III Normative Update Tests of Achievement
Wechsler Individual Achievement Test, Third Edition (WIAT-III)
Gray Oral Reading Test, Fifth Edition (GORT-5)
Gray Silent Reading Test (GSRT)
Wide Range Achievement Test, Fourth Edition (WRAT4)
Kaufman Test of Educational Achievement, Second Edition (KTEA-II)
Attention/ Executive Functioning
Conners’ Continuous Performance Task, Second Edition (CPT II)
A Developmental Neuropsychological Assessment, Second Edition (NEPSY-II)
Delis Kaplan Executive Function System (DKEFS)
Wide Range Assessment of Memory and Learning, Second Edition (WRAML-2)
Test of Everyday Attention for Children (TEA-Ch)
Wisconsin Card Sorting Test (WCST)
Visual Search ad Attention Test (VSAT)
Paced Auditory Serial Addition Test (PASAT)
Behavior Assessment Scales for Children, Second Edition (BASC-2)
Conners Behavior Rating Scales, Third Edition (Conners-3)
Behavior Rating Inventory of Executive Function (BRIEF)
Language Processing
Mullen Scales of Early Learning (MSEL)
Peabody Picture Vocabulary Test, Fourth Edition (PPVT-4)
Expressive Vocabulary Test, Second Edition (EVT-2)
A Developmental Neuropsychological Assessment Second Edition (NEPSY-II)
SCAN-3:C Tests for Auditory Processing Disorder for Children (SCAN-3:C)
Boston Naming Test
Comprehensive Assessment of Spoken Language (CASL)
Oral and Written Language Scales, Second Edition (OWLS-II)
Learning and Memory
Wide Range Assessment of Memory and Learning, Second Edition (WRAML-2)
A Developmental Neuropsychological Assessment, Second Edition (NEPSY-II)
Wechsler Memory Scale, Fourth Edition (WMS-IV)
California Verbal Learning Test (CVLT)
Rey-Osterrieth Complex Figure
Speed of Processing
Wechsler measures
Woodcock-Johnson III Normative Update Tests of Cognitive Abilities
Symbol Digit Modalities Test – Written and Oral
Sensorimotor Functioning
Index Finger Tapping
Grooved Pegboard Task
Hand Grip Strength
A Developmental Neuropsychological Assessment, Second Edition (NEPSY-II)
Beery-Buktenica Developmental Test of Visual-Motor Integration (BEERY VMI)
Visuospatial Processing
Rey-Osterrieth Complex Figure
Judgment of Line Orientation
Hooper Visual Organization Test
Wechsler measures
A Developmental Neuropsychological Assessment, Second Edition (NEPSY-II)
Beery-Buktenica Developmental Test of Visual-Motor Integration (BEERY VMI)
Social Functioning
Autism Diagnostic Observation Schedule (ADOS)
Screening Tool for Autism in Toddlers and Young Children (STAT)
A Developmental Neuropsychological Assessment, Second Edition (NEPSY-II)
Autism Diagnostic Interview, Revised (ADI-R)
Autism Spectrum Rating Scales (ASRS)
Social Responsiveness Scale (SRS)
Social Communication Questionnaire (SCQ)
Childhood Autism Rating Scale (CARS)
Gilliam Autism Rating Scale: Second Edition (GARS-2)
Adaptive Behavior Assessment System, Second Edition (ABAS-II)
Behavior Assessment Scales for Children, Second Edition (BASC-2)
Conners Behavior Rating Scales, Third Edition (Conners-3)
Emotion / Personality
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
Millon Clinical Multiaxial Inventory (MCMI)
Millon Adolescent Clinical Inventory (MACI)
Personality Assessment Inventory (PAI)
Beck Depression Inventory (BDI)
Beck Anxiety Inventory (BAI)
Revised Children’s Anxiety and Depression Scale (RCADS)
Yale–Brown Obsessive Compulsive Scale (YBOCS)
Yale Global Tic Severity Scale (YGTSS)
Detailed Assessment of Post-traumatic Stress (DAPS)
Behavior Assessment Scales for Children, Second Edition (BASC-2)
Rorschach
Thematic Apperception Test (TAT)
Children’s Apperception Test (CAT)
What is a standardized test?
A standardized test is a measure that is administered and scored in a consistent mannerand then compared with the appropriate age and/or group norms. They are designed in such a way that all questions,materials, and conditions are consistent across administrations. One must possess specific professional credentials to purchase,to utilize, and to interpret standardized tests.
In regard to a child, what should they be told about the evaluation?
Our team is trained to assist children with adjusting to the evaluation process once they arrive at the office. Regardless, it is often helpful to prepare a child in advance. Most often, it is best to keep explanations brief and simple.For example, an older child might be told that they are going to be tryingmemory games, puzzles, learning tasks and “brain teasers.” Younger children and toddlers can be told they are going to play puzzles and “thinking games.” If a child asks, “Why do I have to do this?”, they may be informed that these activities help to identify what they do best and also what is hard for them. A further explanation may be given about trying to find ways to help themwith difficult skills, such as paying attention, solving math problems, or organizing homework. Some children find it helpful if explanations are related to a problem that the child is familiar with (e.g., “feeling frustrated with school”). If the child seems anxious about performing “well,” reminding him or her that their only job is “trying” is often beneficial.
Is there anything else I should know before I come into the office for our testing appointment?
Since comprehensive evaluations often take an entire day, it is important to make sure there has been adequate sleep the night before an evaluation and that the person does not arrive to the session without eating. If special language needs are evident, it is important to be sure that the psychologist is well aware of these. Similarly, if the individual wears glasses, a hearing aid, or any other device, please make sure to bring them. If any medications are prescribed, do not refrain from administering them on the day of testing. If a child has had previous school testing, an individual educational plan (IEP), or has related medical records, please bring copies of these documents to the appointment for the case record. See our intake packet for additional information.
What is a neuropsychologist?
A neuropsychologist is a licensed psychologist that specializes in studying brain-behavior relationships. Neuropsychologists receive extensive training in evaluating learning, cognition, and behavior in relation to neurological structures and systems. By objectively testing various skills, such as attention, memory, and/or language skills, neuropsychologists are able to assess an individual’s complexities of global brain functioning in areas that cannot be measured by scans or laboratory tests (e.g. information processing, abstract reasoning, or memory functions). In order to be considered a neuropsychologist, major professional organizations, such as the APA, NAN, and INS, have outlined specific training guidelines. Specialization in clinical neuropsychology begins at the doctoral (Ph.D. or Psy.D.) level. In addition to gaining essential core academic knowledge, skill competencies must be further developed by completing an APA approved internship with extended specialty preparation in clinical neuropsychology. Additionally, a neuropsychologist must complete a supplementary two-year post-doctoral training experience. With this intensive training, psychologists are considered to have attained an advanced level of competence in clinical neuropsychology. Dr. Lyons, the Director of Neurocognitive Consultants, has obtained intensive training in clinical neuropsychology, as outlined above.
How is a neuropsychological evaluation different from testing performed at school?
When schools conduct school-based assessments (also known as psychoeducational assessments), they are typically performed to help determine eligibility for special education and related services. These evaluations focus primarily on intellectual and academic achievement skills needed for academic success, whereas comprehensive psychological and neuropsychological evaluations provide detailed information regarding a child’s strengths and weaknesses across a variety of cognitive domains. By objectively testing various skills, neuropsychologists are able to assess an individual’s overall cognitive, developmental, and psychological functioning, leading to a diagnostic formulation and to recommendations linked with that individual’s unique profile of results. School assessments do not diagnose learning or behavior disorders caused by altered brain function or developmental delays. Moreover, although this type of evaluation suffices for some children, it may miss the more nuanced learning problems of other children.
I think my child is gifted. Can you assess if my child meets eligibility for gifted education at school?
Yes, our team at Neurocognitive Consultants can identify students eligible for gifted and talented programs and provide feedback guiding the educational process. Our team is trained in both clinical and school psychology. As such, we are highly knowledgeable about district procedures and programs, Next Generation Sunshine State Standards, and curriculum and instructional practices.
It is important for parents to know that School districts consider many variables when determining that a student needs a special advanced academic program; intellectual functioning is only one aspect that they consider when determining whether or not your child would benefit from advanced curriculum.The State of Florida indicates that students must not only be of superior intellectual development (with an Intellectual Quotient [IQ] two or more standard deviations above the mean on a standardized test of intelligence), but should also meet the following criteria for gifted programming: need a special program, display characteristics of gifted children according to a standard scale or checklist, and/or meet criteria for Plan B of the Revised Gifted Rule for Underrepresented Populations for low socioeconomic students and English Language Learners [ELL]. Neurocognitive Consultants offers an abbreviated evaluation to parents wanting to determine whether or not their child is eligible for gifted education programming. Our gifted evaluations are comprehensive though and include a parent interview, intellectual testing, and behavior rating assessments. After testing is complete and the report is prepared, a feedback session takes place. In this session, the report, which outlines the child’s intellect, clinical risks and adaptive strengths, is reviewed. Neurocognitive Consultants is skilled in preparing reports that are useful for school districts and can help you navigate the educational system to ensure that your child receives an optimal education; however, the Educational Plan (EP) Team in each school reviews the student’s data and makes the final determination of whether or not the child meets eligibility criteria for the gifted program.
My child’s teacher recommended an evaluation for ADHD. What is an ADHD assessment?
Neurocognitive Consultants tailors evaluations to meet the individual needs of each patient, but in general our ADHD battery includes an assessment of intellectual and academic functioning as well as an investigation of other neurocognitive functions, such as auditory and visual attention, impulse control, cognitive flexibility, memory, motor skills, and visuospatial functioning. Each assessment also includes parent and teacher forms to report on the patient’s emotional, behavioral, and social functioning outside of the testing session. Once the evaluation is complete and the data have been analyzed, we prepare an integrated written report outlining the relevant background information, assessment results and interpretations, and recommendations. We develop specific recommendations for intervention, accommodations, and modifications for each child that are not only linked to the child’s unique profile but also supported by research. Parents and other stakeholders have the opportunity to provide feedback on the intervention and strategies recommended and to make contributions to the overall report because our team seeks your expertise in this collaborative process.
While the team at Neurocognitive Consultants provides screenings for Attention-Deficit/Hyperactivity Disorder (ADHD), it is usually recommended to complete a full battery in order to consider common co-existing disorders, such as learning disabilities, motor deficits, social difficulties, and executive dysfunction. Additionally, by undergoing a comprehensive evaluation, you will ensure that your child’s symptoms are not due to other disorders, such as Anxiety, Auditory Processing Disorder, or Seizure Disorder.
How do I find out if my child is learning disabled?
In order to determine whether or not your child suffers from a learning disability, formalized testing and/or data collection will be necessary. First, a parent may want to contact their child’s principal to discuss their observations and concerns. A meeting should then be arranged with the child’s teacher and other service providers in order to see if others also suspect a learning problem. If everyone agrees the child is struggling academically, the school may initiate the Response to Intervention (RtI) method, data collected in response to various levels of academic supports and interventions. A psychoeducational evaluation might also be started.
Parents can also elect to seek out private psychoeducational or neuropsychological evaluations.Psychoeducational evaluations focus primarily on intellectual and academic achievement skills necessary for academic success, whereas neuropsychological evaluations focus on educational issues as well as altered brain function or developmental problems causing learning or behavioral difficulties. A significant part of both assessments is investigating the child’s IQ, information processing, and academic achievement. In a neuropsychological evaluation, the clinician might also specifically examine cognitive functions, such as attention capacity, motor skills, or language functioning. In addition to formal testing, both evaluations will include a clinical interview as well as parent, teacher, and self-reports of functioning outside of the testing session to clarify whether the learning difficulties are resulting from another attentional and/or emotional issue. Once the results of testing are analyzed, the clinician will perform a detailed feedback session with the parents/caregivers in order to review the specific areas of strength and weakness identified in testing. The diagnostic impressions are reviewed, and we educate the parents about any available special programs offered by the school, such as a 504 plan or the Exceptional Student Education (ESE) program. Individualized treatment recommendations and corresponding referrals are given based on the findings. A detailed report of this information is also offered.
Neurocognitive Consultants is highly skilled in preparing reports that are useful to school districts. We encourage parents to share our evaluation report with the child’s school for consideration for accommodations, modifications, and services to address any found learning disabilities or educational needs. Since we hope to help children function at their optimal level in all facets of their lives, Neurocognitive Consultants will support you in any way while you navigate the school process. We are available in person or by phone to educate school personnel about our test findings and recommended interventions, accommodations, and/or supports.
What is an autism diagnostic evaluation? I have been told that my child needs a “gold standard” assessment for Autism, like the ADOS or ADI, but I am not sure what that means.
The “gold standard” for assessing and diagnosing autism spectrum disorders across ages, developmental levels, and language skills includes an interview with extensive developmental history with a parent/caregiver as well as observation of the patient in a semi-structured assessment designed to elicit information in the areas of communication, reciprocal social interactions, play, and restricted and repetitive behaviors or interests. Two diagnostic procedures, the Autism Diagnostic Interview – Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS), have become standard means of this type of direct assessment for individuals with Autism Spectrum Disorders in research and clinical practice alike. The ADI-R is a standardized clinical interview that focuses on three functional domains: language and communication, reciprocal social interactions, and restricted, repetitive and stereotyped behaviors and interests. The ADOS is a standardized observational method in which a clinician creates a social context and observes behaviors directly related to a diagnosis of ASD, including the quality of engagement with the examiner, patterns of communication, appropriateness of play, as well as the presence of stereotypic, repetitive, or atypical behaviors and interests.
Following highly standardized procedures, clinicians code the behavioral descriptions offered during an ADI and/or the behaviors observed directly during an ADOS. Scores are then compiled in algorithms that yield classifications of Autism Spectrum or Non-Spectrum. Although both measures have been shown to be highly effective in differentiating autism from other developmental disabilities, scores should not be used alone in diagnosing Autism and other ASDs. Instead, the scores and cut-offs should be thought of as providing important information to support diagnosis, identify behaviors for intervention, monitor growth or progress, and/or aid in the development of individualized educational goals. Thus, the ADOS and ADI are thought of “gold standard” tools used in an overall evaluation and diagnosis of Autism or other ASDs, along with additional information obtained from other sources, such as parent concerns, teacher report of behavior, and data from paraprofessionals directly working with the child.
Who can administer these “gold standard” assessments for Autism? Should the examiner have any specific training or credentials?
he authors of the ADOS, ADOS-2 and ADI-R clearly state that these instruments should be used by professionals who are very familiar with Autism Spectrum Disorders. Since these diagnostic measures are intended to aid in diagnosis, they should only be used by professionals qualified to give medical, psychiatric or psychological diagnoses. When treatment planning or evaluation is necessary, the measures may be given by a wider array of clinicians (e.g., school psychologists, speech and language pathologists, occupational therapists) who have education, training and experience in using individually administered test batteries and additionally have training and experience in the treatment of Autism. ADOS or ADI assessors must attend a clinical training workshop, at a minimum, in addition to having education, training and experience in testing and ASDs. Note that in all cases, however, simple attendance at a training workshop is not sufficient to ensure competence in the use of these measures and does not alone qualify someone to administer and interpret findings yielded from these instruments. Learning standardized methods of administration, providing consistent accuracy in scoring, establishing competency or achieving research level reliability can only be achieved through repeated practice and ongoing support and supervision.
As noted above, clinicians must attend a special clinical training workshop to obtain essential competence on the ADOS and ADI. Clinicians may attend a course that includes a combination of large group lecture, demonstration, and scoring of the materials at the university laboratory of one of the test authors or at another venue with a certified independent trainer from the test authors’ teams. Western Psychological Services (WPS) also offers a training package that may serve as a substitute for the clinical training, although it must be noted that this type of training does not fulfill the initial training requirement for those pursuing reliability for research purposes.
To use the ADI‐R or ADOS in research, clinicians have to complete an in-person clinical workshop as well as a more comprehensive research training and reliability process to achieve “research-reliability.” When researchers refer to obtaining “reliability,” they mean that a new researcher has reached a proven level of inter-rater reliability when their coding is compared to those of other more experienced researchers. Research training and the reliability process is as follows: a clinician receives intensive instruction on the psychometrics of the instrument, works in small groups on administering and scoring, and participates in discussion and question/answer sessions about specific administration and coding issues with the test developers and their teams. The research training focuses on bringing administration and scoring skills to a high level of inter‐rater agreement with the scoring practices of the test developers to ensure consistency with well-established research centers internationally.After receiving extensive research training, practitioners may be awarded certification as a research-reliable examiner. Dr. Lyons, the Director of Neurocognitive Consultants, is certified as a research-reliable administrator of the Screening Tool for Autism in Two-Years-Olds (STAT), the Autism Diagnostic Interview (ADI), and the Autism Diagnostic Observation Schedule (ADOS). Additionally, she is an invited trainer facilitating the use of the ADOS and ADI in international research and clinical trials.
Why do I/my child need an evaluation after a concussion/traumatic brain injury? Won’t the symptoms go away on their own?
Concussion/traumatic brain injury symptoms span physical, cognitive, emotional, and fatigue-related domains. For most children, adolescents, and young adults who sustain a concussion/mild traumatic brain injury, symptoms resolve within a few weeks to a month. For some individuals, the symptoms persist and can cause significant impairment across home, school, and social settings. In either case, a neuropsychological evaluation can target areas of post-injury impairment and assist in developing a management plan for ongoing symptoms. Many times, symptoms will resolve without intervention; however, those individuals who experience a lengthy recovery may require more in-depth services to identify factors that may be complicating the injury and contributing to persistent symptoms.
Over the past 20 years, neuropsychologists have been at the forefront of scientific and clinical initiatives aimed at identifying the symptoms and problems associated with concussions/traumatic brain injuries, monitoring recovery, and facilitating return to everyday life. Neuropsychologists are uniquely qualified to assess an individual’s cognitive and psychological functioning following concussion/traumatic brain injury. Neuropsychologists can provide early intervention in the form of education and reassurance, monitor an individual’s return to school or sports, and treat emotional problems that might arise during the recovery period. Neurocognitive Consultants includes neuropsychologists with specialty training in concussion/traumatic brain injury to evaluate and treat individuals through the duration of recovery. Whether the injury has just occurred or has persisted over time, we provide comprehensive services to support an individual’s return to all aspects of daily life.
What is an independent medical examination for brain injury? How does this differ from a standard neuropsychological evaluation?
An independent medical examination (IME) is a type of evaluation performed by professional who is not involved in a patient’s care and who will not treat the patient beyond the evaluation. In the case of brain injury, an IME may be requested to better understand the relationship between the claim and level of functioning. The IME completed by Neurocognitive Consultants objectively documents the cognitive and behavioral impact of brain injury. Patients cannot prepare for this evaluation beyond a good night of rest and filling breakfast before the exam. No one gets every question correct on every test, and it is important to recognize that performance is not viewed as pass/fail, as in school. To best understand the brain’s strengths and weaknesses related to a brain injury, it is highly important that patients perform to the best of their ability. Suboptimal performance can compromise the integrity of the evaluation and limit the usefulness of the findings. Individuals seeking an IME are encouraged to contact Neurocognitive Consultants for our medicolegal fee structure.
How much do your services cost, and do you accept insurance?
Insurance companies consider Neurocognitive Consultants an out-of-network provider. Depending on the plan and deductible, reimbursement from your company for consultations and neuropsychological evaluations may be available. Patients or their families are encouraged to submit superbills to their carriers. These documents will be provided upon request. Our team will help facilitate reimbursement for the evaluation in any way feasible. Full payment is required at the time of service. Please ask our office staff to answer any questions regarding fees, documentation, or any other administrative matter.