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How is Neuropsychological Assessment Different from Cognitive Testing?

1/8/2015

11 Comments

 
Corwin Boake, PhD, ABPP/CN
Division 40 representative to APA Council of Representatives
Neuropsychologist, TIRR/Memorial Hermann, Houston, TX
Clinical Associate Professor, Dept. of Physical Medicine & Rehabilitation, University of Texas-Houston Medical School
corwin.boake@uth.tmc.edu


Cady Block, PhD

Chair, Association of Neuropsychology Students in Training (http://www.div40-anst.com/) Clinical neuropsychology postdoctoral fellow, TIRR/Memorial Hermann and Dept. of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX
cady.block@bcm.edu
 
With an extensive educational, clinical, and research training background in brain-behavior relationships, neuropsychologists are uniquely qualified in the conceptualization and assessment of cognitive problems in persons with brain disorders. From this perspective, all cognitive abilities arise from neurocognitive functions and thus would appear to fall within the expertise of the neuropsychologist. However, most clinical cognitive testing is performed by professions other than neuropsychologists or even by psychologists in general. More cognitive assessments are performed by physicians, educators, and rehabilitation therapists than by neuropsychologists. Cognitive assessment for educational recommendations is a major contribution of psychologists to schools.  But since these professionals use some of the same tests as do neuropsychologists, is it accurate for evaluations by these other professionals to be represented as neuropsychological assessment? What differentiates neuropsychological assessment from the cognitive testing conducted by these other professions?

The distinction between neuropsychological assessment performed by a clinical neuropsychologist and brief cognitive assessment as performed by physicians is formally recognized in the current revision of the Diagnostic and Statistical Manual of Mental Disorders. DSM-5 states that determination of cognitive impairment, as needed for the diagnoses of Mild and Major Neurocognitive Disorder, should be “preferably documented by standardized neuropsychological testing” (p. 602).  According to DSM-5, a key advantage of neuropsychological assessment over other forms of cognitive testing is to provide “quantitative assessment of all relevant domains” (p. 610), a feature that is particularly useful for diagnosis and for detecting change.

Another area in which this distinction has been clearly made is in guidelines for management of sports concussion. A recent consensus statement (4th International Conference on Concussion in Sport, Zurich, November 2012; McCrory et al., 2013) states, “It is recognized, however, that abbreviated testing paradigms are designed for rapid concussion screening … and are not meant to replace comprehensive neuropsychological testing which should ideally be performed by trained neuropsychologists that are sensitive to subtle deficits that may exist beyond the acute episode; nor should they be used as a stand-alone tool for the ongoing management of sports concussions” (p. 90).

The distinction between neuropsychological assessment and cognitive evaluations by psychologists in other specialties is also clearly made in the documentation on user qualifications that accompany many neuropsychological tests.  For example, the manual for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) states that while other professionals
“may engage in some initial interpretation of performance on RBANS, the test results should ultimately be interpreted only by individuals with appropriate professional training in neuropsychological assessment for diagnostic purposes” (Randolph,  2012, p. 9). Furthermore, the manual for Advanced Clinical Solutions for WAIS-IV and WMS-IV states that, “When ACS is to be used for a neuropsychological assessment, the examiner should have appropriate training in neuropsychology and neuropsychological assessment” (Pearson, p. 8).  These test qualifications make clear that administering neuropsychological tests is not equivalent to neuropsychological assessment. Specialized interpretation competencies are necessarily part of practicing neuropsychology.

These interpretation competencies are clearly outlined in the description of the clinical neuropsychology specialty published by the American Psychological Association Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP).  The CRSPPP description (http://www.apa.org/ed/graduate/specialize/neuro.aspx) states that core competencies in clinical neuropsychology include not only the use of specialized neuropsychological assessment techniques, but also “the ability to integrate neuropsychological test findings with neurologic and other medical data, psychosocial and other behavioral data, and knowledge in the neurosciences,” as well as “an appreciation of social, cultural and ethical issues.”  

For comparison, the CRSPPP description of the geropsychology specialty (http://www.apa.org/ed/graduate/specialize/gero.aspx) states that core competencies include “cognitive and functional performance testing, integration of interdisciplinary assessments (e.g., medical, neuropsychological, social service).” This description implies that cognitive testing, while listed as a competency of this specialty, is distinct from neuropsychological assessment.
Recognition of clinical neuropsychology as a professional psychology specialty, rather than as a proficiency, indicates that the specialty’s core competencies should be practiced by psychologists who have undergone the education and training required of that specialty.  The large and expanding knowledge base required of clinical neuropsychologists explains the need for specialized postdoctoral training for two years, as outlined by the Houston conference guidelines.  Relevant areas of knowledge include (but are not limited to) neuropsychological assessment, psychometrics, diagnostic statistics, neuroanatomy and neurophysiology, brain-behavior relationships, and brain imaging.

The distinction between neuropsychological assessment and cognitive testing is commonly accepted and is consistent with the CRSPPP description.  It follows that training of psychologists in other specialties, which may include exposure to neuropsychology, is not adequate preparation for practicing neuropsychological assessment.  Yet this does not mean that practitioners in other psychological specialties should amend cognitive assessment from their scope of practice.  Practitioners in other specialties can continue to describe their assessments as cognitive assessment or cognitive evaluation (among many possible labels) while maintaining the existing scope of specialty practice. Cognitive assessment is one of the tools that may be shared among psychological specialties but it is not equivalent to neuropsychological assessment.

REFERENCES:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual for mental disorders, fifth revision. Washington, DC: American Psychiatric Publishing
  • Houston conference on specialty education and training in clinical neuropsychology. (1997). http://www.div40.org/pub/Houston_conference.pdf
  • McCrory, P., Meeuwisse, W.H., Aubry, M. ... (2013). Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport, Zurich, November 2012. Journal of Sports Medicine, 23, 89-117. http://bjsm.bmj.com/content/47/5/250.full
  • Advanced Clinical Solutions for WAIS-IV and WMS-IV, Administration and scoring manual. (2009). San Antonio: NCS Pearson.  
  • Randolph, C. (2012). Repeatable Battery for the Assessment of Neuropsychological Status Update (p. 9). Bloomington, MN: NCS Pearson – PsychCorp.
11 Comments
John link
1/11/2017 03:15:06 pm

Wow I had no idea just how different Neuropsychological testings is from Cognitive testing. After reading the article it makes sense just how subtle and specialized testing is on a neurpsychologic level. It makes me grateful for the technology and information we have to be able to make qualitative assessments on a neuro level in order to properly treat and diagnose certain problems and disabilities.

Reply
Patricia Faro
4/23/2017 01:56:42 pm

I saw your pamphlet for parents about Neuropsychological Assessment: A Guide for Parents that I would like to have to give to parents when we recommend such evaluations.
Thank you,
Patricia Faro, School Psychologist, The Pike School

Reply
Sports Injury Treatment link
7/31/2017 05:45:22 am

Wow!Such a great content.

Reply
Fallynn Cox link
4/4/2018 09:51:29 pm

Thank you for a wonderful article, may I have permission to distribute your pamphlet? Ty

Reply
Gina Enrique
1/24/2019 02:32:39 pm

I have been told for 3 yrs that my son needs a neuro-psych evaluation. Now he is in legal trouble and instead of this evaluation the Judge has ordered a Cognitive Test to see if he understands the legal proceedings he is involved in and facing ahead. I now see these as 2 totally different tests and feel the cognitive test is not sufficient. His bio-mother was severely drug & alcohol dependent while pregnant with my son. We adopted him at age 2 mos. She also is mildly MR. he suffers from severe anger issues, ADHD, ADD, severe grief over loss of his adoptive father (my spouse) due to unexpected car accident 11 mos ago.

Reply
Ava Gardner
5/20/2019 12:05:34 am

Are you taking this test because of Child Protective Services??

Reply
Jeannette
5/21/2019 11:35:26 am

Thank you for this article. I work with a group who is studying the impact of chemotherapy for children with acute myelogenous leukemia and will be using a series of tests, both computer and psychologist administered over 5 years to determine differences in learning, behavior and cognition. There has been some debate over what to call this. Some say neurocognitive testing and others say neuropsychological testing. This article was helping in understanding the difference.

Reply
Joyce C.
6/25/2019 10:19:25 pm

Hello - Curious if neuropsych testing can ever be submitted and accepted in lieu of secondary placement testing for middle school/high schools? It appears they are much more robust than a standarized verbal and nonverbal on an SSAT. Thank you in advance.

Reply
Angela Waterford link
7/15/2019 04:36:47 pm

Wow, I didn't know that neuropsychological evaluations can help me know if my husband is suffering from a brain disorder. I think I'll take him to a professional next week so that he can be diagnosed if he has a condition. This way, I'll know if he's really had some behavioral changes that were a result of his accident.

Reply
Sarah Smith link
8/15/2019 12:37:09 pm

I didn't realize that neuropsychological tests require different qualifications than your typical physician would have. Since I am pretty sure that I have severe anxiety and think that some medication could help me feel up to going to work, I will start looking into psychiatrists in my area. Having a formal evaluation done might even show me that I have been dealing with more than anxiety.

Reply
Angela Waterford link
8/23/2019 04:59:49 pm

I believe my child has a problem in the brain. She has been suffering from some type of seizure whenever she's stressed. Thanks for clarifying that her odd behavior should be looked at by a pediatric neuropsychologist, so I might find one that we can trust.

Reply



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