Psychological Testing Division

Psychological Testing Division

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 written 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, thought disorders.  Lastly, these evaluations can be utilized to track clinical and/or educational progress over time.

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)
Assessment Type Description
Developmental Assessment 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 Assessment Analyzes the mental processes underlying a child's academic performance, such as a learning disability or attentional difficulties

 

Psychodiagnostic Assessment Identifies the presence of disorders, such as an Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Anxiety Disorder, Depression, Thought Disorder, or Personality Issues

 

Neuropsychological

Assessment

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 Assessment

 

Distinguishes social-emotional strengths and needs
Disability Assessment Determines the severity of an individual’s impairment and assesses whether his/her impairment(s) results in marked or severe functional limitations

 

Forensic Assessment Evaluates parties in criminal or civil cases regarding mental health issues related to their case

 

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 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 two 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.

NBI’s team of psychologists and neuropsychologists personally conduct each component of the evaluation process. Most evaluations include the following:

Initial Intake: At the first appointment, the psychologist meets with the patient and his/her family in order to gain an understanding of the reason for referral and obtain 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 will usually begin immediately after the initial interview.  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. 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 up to eight 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 abilities 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 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 test 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 test 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.

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 problem that 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.

Please see the table below for examples of the areas typically assessed as well as standardized tests commonly used by NBI Psychological Testing Division.

Domain Test Measures
Intellectual Functioning Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV)Wechsler Intelligence Scale for Children-IV (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 Scale, Fourth Edition

 

Academic Achievement Woodcock-Johnson III Normative Update Tests of AchievementWechsler Individual Achievement Test (WIAT)

Gray Oral Reading Test, Fifth Edition (GORT-5)

Gray Silent Reading Test (GSRT)

Wide Range Achievement Test, Fourth Edition (WRAT4)

 

Attention/Executive Functioning Conners’ Continuous Performance Task, Second Edition (CPT-2)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

 

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 measuresWoodcock-Johnson III Normative Update Tests of Cognitive Abilities

Symbol Digit Modalities Test - Written and Oral

 

Sensorimotor Functioning Index Finger TappingGrooved 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 FigureJudgment 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)

 

A standardized test is a measure that is administered and scored in a consistent manner and 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, utilize, and interpret standardized tests.

Our team is trained to assist children with adjusting to the testing 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 trying memory 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 them with 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.

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 doe 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.

NBI is considered an out-of-network provider by insurance companies. 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.

School based assessments (also known as psychoeducational assessments) are typically performed with one goal in mind: to determine if a child qualifies for special education programs or therapies to enhance school performance. These evaluations focus almost exclusively 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. Generally, school assessments do not diagnose learning or behavior disorders caused by altered brain function or developmental problems. Moreover, although this type of evaluation suffices for some children, it is difficult for a professional to responsibly diagnose any difficulty other than a clear specific learning disability with the limited amount of clinical data typically gathered in a school evaluation.

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 NBI’s Psychological Testing Division, has obtained intensive training in clinical neuropsychology, as outlined above.

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.

The 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 NBI’s Psychological Testing Division, 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.