Are there instances where a neuropsychologist evaluation. would be inappropriate?

[whatamess]

Five years ago, my son's neurologist recommended we get a neuropsychologist evaluation. done. I looked into it and found that the amount of time it would take to administer the tests and the fact that I wouldn't be allowed in the room with my son made me decide not to do it. The reason I would want to be in the room is that he has tremendous anxiety around new people; he will not look at them and actually often hides inside his shirt, he will not speak to them (he will grunt or squeak or stick out his tongue). If the testers 'forced' testing (either by verbally insisting on compliance or getting more people in the room to gain compliance passive-aggressively) he would likely become very agitated and might lash out by spitting or trying to get away.
The reason I am curious about testing is that his IQ has seemed to drop each time he is tested (age 4, age 6, age 8) and I believe that is because he was emotionally abused in his school setting from grade k-grade 2. I want to know if his drop in scores is really due to limited exposure to academics in school or if he really has a borderline IQ. I just don't think it likely they will be able to access those answers if he is anxious/defiant during testing. I also think it would be helpful to discern what other diagnosis's are affecting him as many suggestions have been made, but no firm diagnosis on some...Pervasive Developmental Disorder (PDD)-not otherwise specified, autism, asperger's, bipolar, adhd, anxiety, odd, tourette's, learning disability, sensory processing disorder, cognitive disability...you get the idea-just a little more precise information would be helpful.

 

[totoro]

For K' first one I sat in a corner in the room no questions asked. If they are afraid of you messing up the results I don't know?
After about 15 minutes she didn't even acknowledge me. This was 3 days of about 3 hours sometimes of testing.
For the last one the nuero-psychiatric did her testing out of her home and had it set up so wonderfully that there was never a worry about anxiety. So I was able to go for walks for the 2 hours of testing... 16 hours total!

If the tester is good they should be able to get through and see the real kid even if it takes a bit longer. I left the room halfway through K' testing on her first evaluation.
Our kids can amaze us with what they are capable of when not with us!
by the way K was up on the table socks off spinning by the time the first evaluation was almost done!LOL

 

[totoro]

I guess I didn't answer your question LOL I really don't know of a time when it would be inappropriate but maybe if the tester wasn't good, not a good fit. Know what I mean??

 

[Farmwife]

Are there instances where a neuropsychologist is not appropriate?


I would think that the only way to know that for sure is if you take the test and find that it wasn't helpful, in hindsight. Not too helpful, I know...

I found the neuropsychologist to be so very important and revealing. The people who administer them generally know their stuff and have seen all sorts of kids and behaviors. I would think him acting like himself, anxiety and all would actually be good in this case because they get the whole picture and that can only lead to a more clear diagnosis.

Had you considered going to childrens hospital or some other facility that is geard toward being comfortable for kids with maybe a soft welcoming environment if it helps the process? (unless a blank room is important to rule out distractions??)

At my sons neuropsychologist I was given a lot of time to go over details with them and they asked soooo many questions of me. You will more than likely have ample opportunity to express your concerns and how you are worried the results could get skewed. They will take all that into account when determining what they think is the issue at hand.

If you have been waiting 5 years and noticing a slow drop off it really is time to act. Your difficult child is at such a pivotal age where the proper diagnosis and treatment plan can make a world of difference. The results are so incredibly insightful in ways you would never imagine. Even if the IQ portion can't be determined with certainty the remainder of the information really is priceless. Even if you have a solid diagnosis already the neuropsychologist goes so much deeper. I cannot sing the praises of a neuropsychologist enough!! Later if you decide it was all hogwash you can disregard it but why risk possibly losing out on a chance to get a whole truck load of answers? The anxiety will fade but the help will last for years.

 

[BusynMember]

His behavior is sort of like my son's when he had the neuropsychologist testing and how he acts toward the neuropsychologist is part of the evaluation. He actually sounds like he could easily be a Spectrum kid. A neuropsychologist is NOT just for testing IQs. They do complete evaluations based on behavior and ability to perform tests of various kinds...I really think the testing was worth it and can't think of any reason not to do it.
Everything that was said about the evaluation screams SPECTRUM KID. That's pretty much what my son's report looked like. His main diagnosis. was Pervasive Developmental Disorder (PDD)-not otherwise specified/high functioning autism. It is common for Spectrum kids to score lower IQs than they actually have. My son's IQ in school was 75, but the neuropsychologist tested him at 107. It took my son several sessions to sort of loosen up to the neuropsychologist...and I mean sort of.

 

[TerryJ2]

how he acts toward the neuropsychologist is part of the evaluation

I totally agree.

If you are in the room, especially at this age, his true colors will not come out and the testing--which includes all aspects of emotional, cognitive and neurological conditions--will not be thorough or accurate.

So what if he "loses" 2 or more IQ points on the "testing" if it helps identify the underlying problem? IQ tests can be retaken--and yes, actually studied for. I would worry about that part later.

Best of luck.

 

[whatamess]

I think I know he would be too anxious to perform well on an IQ test, my worry really stems from how anxious and then manic or defensive he could get, and I mean to the point of them having to restrain him. I fear putting him into that position. That amount of escalation would likely not occur if I were there. Case in point, was a summer program he participated in a few weeks ago. I shadowed and was essentially told by staff that he would be fine, I should have stuck with my instincts because the next day I let him go on a field trip and they restrained him.

 

[BusynMember]

They need to see how bad he can get in order to evaluate him. I didn't stay with my son and I didn't care how he behaved because that was all part of the evaluation process. Seeing the way he reacts to things helps the professionals figure out what is going on, even if it's way over-the-top. You can not be with him all the time for his en tire life. He needs to learn how to adjust without you there and in my opinion it's never too soon. You also can't help him if you aren't sure what is going on with him. So in my opinion he does need to see a NeuroPsyc alone...even if it makes him worse for a few days after. I know it's hard. Good luck

 

[Wiped Out]

When we first started thinking of a neuropsychologist exam we met with one and he said he would do it but agreed with us that it might be accurate to get an accurate result due to difficult child's extreme lack of attention. We decided to wait but later that year went back and decided to try it. To make things better for difficult child he did his testing in 3 shorter settings so results would hopefully be more accurate. I'm so glad we decided to have him tested. The doctor who did the testing was very thorough in his report and mentioned the testing scenario and wrote about how difficult child really did try his best during the testing. We all ended up feeling it was a valid testing.

I think I would find a neuropsychologist and pose your concerns to him/her to see what they think.

 

[Marguerite]

It depends on what you're looking for.

To get a measure of his potential - what he could do if he was able to focus all his faculties and fully understand - then he needs to be calm and to feel safe. He also needs to have the test given in a form he can comprehend. For example, giving a written test to a kid with dyslexia, will give you a false low result that is more an indication of the reading difficulty, than an accurate measure of ability. difficult child 3's first assessment was the opposite problem - he didn't understand the spoken word, he needed to be tested in writing. He also was marked down on some tests requiring him to draw with accuracy. They weren't actually testing his ability to draw accurately, but the accuracy was needed for him to show he could solve the problem. His brain had the answer, but his poor motor skills resulted in a false low score.

If your son is likely to be non-compliant due to anxiety, that information is useful but any actual IQ testing is going to give a false result. However, it should be possible for him to be given time to get to know the staff, so he can feel safe.

I've sat in on evaluations with my kids. I was in the next room for difficult child 3's first evaluation, but all the others had me present (except for school-based tests). I don't believe my presence influenced the test. However, in one case at least, my absence meant lower compliance. difficult child 1 was especially anxious and if I had been there, I could have reassured him just by my presence. His anxiety was not scored, however. His test was scored as if he had been compliant and completed the test, then I was told that his actual school marks were higher than his IQ score meant was possible. In other words, with his score, he shouldn't have been able to do so well in class. But rather than seeing the flaws in her testing, the assessor attacked me and claimed I was pushing difficult child 1 to succeed and this high achievement of his was a bad thing! Mind you, nobody can push anybody to achieve higher than their capability. It's a contradiction in terms.

So it will depend on how things are being tested, and what is being tested. Talk to them, maybe ask around for someone who will be more flexible and will work to gain difficult child's assurance first. Otherwise the results will be inaccurate.

Marg