Frequently Asked Questions

Here are some of our FAQs.  If you can’t find the answer below, feel free to reach out to us via phone or online contact form.

Bellow is a list of separate FAQ  per condition, or the frequent questions in general.

What is neuropsychology?

Neuropsychology is the study and practice of the brain and how its functioning affects cognition and behavior. Often, neuropsychologists conduct evaluations on children and adults who are having difficulty in some aspect of their lives to determine if there is a biological and neurocognitive basis for their problems. A neuropsychological evaluation may be appropriate for children displaying developmental delays, individuals with traumatic brain injury or concussions, or older patients who are experiencing cognitive decline.

What is a neuropsychological evaluation and how long does it take?

The length of a neuropsychological evaluation depends significantly on the purpose and setting. Some neuropsychologists conduct brief inpatient neuropsychological evaluations for individuals who have undergone surgery or experienced a neurological event. These evaluations can be as brief as 30 minutes or shorter. Alternatively, a comprehensive neuropsychological evaluation for a child displaying multiple deficits can take as long as several days.

Is there a difference between neuropsychological and psychological evaluations?

There are many areas in which neuropsychological and psychological evaluations overlap, but there are also some important distinctions. Medically, one of the main distinctions is the focus on the brain behavior relationship in a neuropsychological evaluation. Instead of simply focusing on general cognitive abilities (i.e., what is the person’s IQ), a neuropsychologist uses their understanding of brain functioning and structure to interpret test results and formulate an understanding of an individual’s profile.

In addition, neuropsychological evaluations are often more comprehensive and involved than a psychological evaluation. This is largely due to the fact that understanding functions of the brain as distinct yet interconnected domains requires assessment of many individual abilities that can affect a person’s overall output.

How is a neuropsych evaluation different from evaluations done at school?

There are some overlaps between school evaluations and neuropsychological evaluations, but the main differences between the evaluations are the purpose and focus. In general, it is a “what” versus “why” difference: a school evaluation focuses on what the child’s abilities are whereas a neuropsychological evaluation focuses on why they are struggling. For many school evaluations, the child is given a short intelligence test followed by an assessment of their academic abilities. This leaves out many potential factors that are important in understanding the child’s learning pattern.

For example, the school evaluation will often omit testing:

How the student memorizes and learns information
How their language and communication ability impacts what they understand and can express
How their visual perception and motor coordination function independently, as well as integrate into being able to process what they see and write effectively
How they can organize and plan to fulfill responsibilities that they have in their executive functioning
How they can inhibit or guide their behavior to follow rules that are constantly changing in their environment.

These are a few of multiple areas which are assessed in a neuropsychological evaluation but not in a general school evaluation.

In addition, there is also a significant distinction between the outcomes from these evaluations. As schools often only evaluate basic cognitive skills and general academic functioning, they often will avoid giving a diagnosis due to the lack of comprehensive understanding provided by the evaluation.

In a neuropsychological evaluation, on the other hand, the overall focus is to gain a complete understanding of the cognitive profile and whether there is a biological basis for the problem. This is also why recommendations are so integral to the neuropsychological report and are even omitted altogether in some psychological reports.

How do I know if my child should have an evaluation?

It is difficult to give a general guideline on when a child should be evaluated, but earlier intervention assessment and intervention can be critical to a child’s future development. As development and education are cumulative processes, regression in these areas can have a cumulative effect in which a child continues to fall further behind their peers due to a lack of proper intervention and assessment of their abilities.

Here are some important questions to ask yourself:

Is my child having ongoing difficulties that do not appear to be resolving independently?
When I look at my child compared to other children their age, do they appear different in a critical area?
Does some aspect of how they are functioning strike me as inconsistent with their overall abilities?
Do I hear from my child’s teachers or other adults that my child is falling behind others or showing problematic signs?

How should I prepare my child for a neuropsychological evaluation?

For younger children, it can be helpful to explain that they are going to a doctor but are not going to get any shots or have their ears or throat checked. Instead, the doctor is going to ask a lot of questions and play games to see what the child is good at.

For older children in school, it can be helpful to compare the experience to going to school with some important differences. The evaluation is similar to class in that the child has to sit at a desk and work on various activities. However, there are some important distinctions. Unlike school, most parts of the evaluation will be on tasks that the child has never seen before and may feel uncomfortable not knowing whether they are doing it correctly. Also unlike school, the tasks will often start out easy, but they will eventually become harder until the child is no longer able to answer the items correctly.

For some children, this is difficult as they are used to doing well on assignments, and preparing them prior to the appointment can be critical in decreasing their frustration and anxiety when working on the tests of the evaluation. Another main difference is that during the evaluation, the child can take breaks whenever they need to, even if they just want to walk in the hallway for a brief period to give themselves a breather.

Often, one of the most important things that parents can prepare their child with is that they need to try their best throughout the evaluation. It can even be helpful to incentivize the child to do this, as their effort has a large impact on the findings and interpretability of the scores.

What can I expect during an at-home appointment?

At home appointments are generally conducted for individuals who have difficulty traveling to the office or would be better assessed in their home environment due to their developmental level or behavioral concerns. One should expect that the evaluation will be done in a quiet, distraction-free part of the house and will often take several hours.

The neuropsychologist will bring all necessary materials (sometimes including a table and chairs where necessary), but it is often helpful for the child to have writing or coloring utensils, something to eat or drink, and appropriate clothing for the evaluation. In addition, it is necessary to prepare a child before the evaluation to make sure that they are ready when the neuropsychologist arrives.

How long are appointments?

This largely depends on the purpose of evaluation, but most at home evaluations are relatively short when compared to full-day in-office evaluations. In general, evaluations at home last from one to three hours.

What happens after the evaluation?

After all of the evaluation sessions are complete, the neuropsychologist will go through all of the data, score the appropriate tests, and interpret the findings. Then, the neuropsychologist will meet with the child’s parents (and often the child him or herself) to go over the findings, interpretations, and recommendations based on the results. This feedback session can be anywhere from 45 minutes to 3 hours long depending on the complexity of the case.

Afterwards, the neuropsychologist will prepare the results in a comprehensive report that will be shared with the child’s parents and can be distributed to other professionals who work with the child and would benefit from having a deeper understanding of their strengths and weaknesses.

How long is an evaluation good for? (i.e. does it expire?)

There is no inherent expiration for these evaluations, but it can be important to reevaluate a child in the near future, especially if they are very young and there are significant developmental concerns.

Although these reports do not have a set expiration date, there are requirements from various agencies to have up-to-date evaluations. For example, many guidelines for testing accommodations require having these evaluations done within 2 years of the test.

How much does a Neuro-Psych Doctor evaluation cost?

This depends on the type of evaluation necessary and complexity of the case. Information on the cost of the various types of evaluation can be found on our pricing page.

Does Neuro-Psych Doctor accept health insurance?

As many insurances do not cover these types of valuations, Dr. Malkin is not in network with insurance. Nevertheless, some individuals are able to be reimbursed by their insurance provider if they have out-of-network benefits. In addition, some individuals are able to use self-direction funds provided by Medicaid Waiver to pay for these evaluations.

Autism

When should children be screened for ASD?

According to the American Academy of Pediatrics, all children should be screened for ASD when they are at their 18- and 24-month well-child visits in addition to regular developmental surveillance and screening. This enables children to be identified as early as possible and allows for intervention when the child is most amenable to instruction.

In addition, children should be screened if the parent has concerns about their social, communication, or behavioral functioning. This includes problems with eye contact, social interactions, speech and language development, hyper or hypo sensitivity, repetitive or restrictive behaviors, or fixations.

These screening tools include:

  • Ages and Stages Questionnaires SE-2 (ASQ-SE2)
  • Pervasive Developmental Disorders Screening Test-II (PDDST-II)
  • Communication and Symbolic Behavior Scales (CSBS)
  • Modified Checklist for Autism in Toddlers – Revised with follow-up (M-CHAT-R/F)

What causes ASD?

Autism is a relatively common childhood disorder as it affects over 2.7% of children in the United States. However, the cause of autism remains highly elusive for researchers.

In trying to understand what brings about autism spectrum disorder (ASD), it is important to distinguish between causes and risk factors. Causes are external events or biological factors that cause a child to develop ASD symptoms. To determine specific causes, scientists need to control experiments and conduct random controlled trials (RCT’s). To date, there have been no studies of this kind that have demonstrated a cause of autism in a controlled manner.

Despite this lack of direct causal connection, there have been significant advances in understanding the risk factors associated with ASD. It is unclear how these risk factors are associated with ASD as many people have these factors but do not express symptoms of ASD. Nevertheless, it is diagnostically and therapeutically important to understand these factors in helping children with autism spectrum disorder. These risk factors fall into 2 major categories: genetic and environmental:

Genetic factors

The heritability of ASD has varied in the literature, but a more recent large scale study estimated the genetic component to account for over 50% of the variance in ASD.
Even with this evidence, researchers are still unable to link genetic variants to the expression of the disorder.

Environmental Factors:

  • Older maternal age at conception: A child born from two older parents is 3x more likely to develop autism than were third- or later-born offspring
  • Prenatal exposure to chemicals in pollution and pesticides
  • Maternal health risk factors such as obesity, diabetes, or immune system disorders
  • Birth complications such as very low birth weight, extreme preterm birth, multiple pregnancies, oxygen deprivation

In any discussion of the causes of ASD, it is important to note that scientists and researchers continue to find that vaccines do not cause autism. A user-friendly summary of this research can be found here.

Do symptoms of ASD change as my child gets older?

Like most things with ASD, there is significant variability in how an individual will develop. However, ASD symptoms tend to decrease in severity over time. This is seen mostly in maladaptive behaviors (eg. tantrums, reactions to hypersensitivity), and the level of change can depend on the child’s level of intelligence, where children with comorbid ASD and intellectual disability show smaller changes over time.

Much of the research in this realm has focused on children who were already receiving therapy and support, which may account for the decrease in symptoms. It can be difficult to know what change would be expected for a child that does not receive any additional therapy.

What post-evaluation support services does Dr. Malkin offer for ASD?

In addition to evaluations, Dr. Malkin also sees clients for individual psychotherapy. For children or adults with ASD, this therapy is largely behaviorally focused and works toward creating and implementing plans that help the individual learn appropriate behaviors in their communication, social, and activities of daily living (ADL) skills, as well as manage their expressions of maladaptive behaviors.

How is autism treated?

There are numerous treatments for autism, and it is difficult to capture them all in this short answer. The most commonly used and evidence-based approach is using Applied Behavioral Analysis as a teaching method for helping a child with ASD develop appropriate skills. In this approach, the functions of the child’s behavior are analyzed, and this information is used to set up antecedent modifications (i.e. before the behavior) and consequence modifications (i.e. after the behavior).

This method can be used by trained teachers in the classroom or provided by a psychologist or Board Certified Behavioral Analyst (BCBA), who may direct therapy administered by a behavior technician. There are also other approaches, such as the Floortime Model, which help children with ASD learn appropriate skills through engaging their play skills.

Talented and gifted

How do you know if your child should be screened for a talented and gifted program?

As every parent knows their child best, it can be difficult to answer this question in an objective manner. However, many children who are talented and gifted are overlooked because they don’t show their skills overtly. This can either be because they do not try hard in their school program or because their skills are not ones that will show up in a traditional academic setting.

One of the main reasons why children are screened for talented and gifted programs is when they become frustrated with their academic environment due to the lack of engagement or challenge. These children can be unmotivated or oppositional due to the fact that they are constantly asked to do things which are boringly simple for them. However, even when children are compliant and comfortable with school, it can be helpful for them to be screened for talented and gifted programs when they seem to excel without trying.

Is a neuropsychological evaluation required to get accepted into a talented and gifted program?

This very much depends on the specific program for talented and gifted students. Many programs have their own evaluation procedure and will not accept outside evaluations, but others will often require documentation of the child’s exceptional skills.

What are the benefits of a neuropsych talented and gifted evaluation vs an evaluation performed by the school?

Most schools will not provide any evaluation unless there is an academic weakness or problem. As such, it can be difficult for a child who is talented and gifted to get a proper evaluation in their school.

Also, evaluations done at a school level are generally brief and do not cover all the areas that are assessed during a neuropsych evaluation. This can be critical for children whose talents and gifts are outside of the general areas that are covered by the school evaluations.

What documentation do you provide as part of a talented and gifted recommendation?

The neuropsych report is often the most essential documentation for children who want to qualify for talented and gifted programs. The report goes through a detailed analysis of the child’s abilities and compares them to other children their age, which provides the basis for their talented designation.

Can you help with the application process and/or provide testimony to help a child get into a talented and gifted program?

In addition to the neuropsych report, there are often forms or letters that need to be written to help a child get into a talented and gifted program. This is included in the evaluation process. Sometimes Dr. Malkin will need to speak with the administration of the program, and this can be arranged as well.

Medical disabilities

How do you know if your child should have a neuropsychological evaluation for a medical condition?

It is difficult to define specifically when to come for a neuropsych evaluation based on a medical condition as there are a variety of medical conditions that might have neuropsychological sequela. Most often, parents or individuals consult with her primary care physician, psychiatrist, or neurologist and are referred for further evaluation. In addition, some individuals who experience difficulties with attention, memory, and cognitive speed following medical issues also seek out neuropsychological evaluations.

What medical conditions might require a neuropsychological evaluation?

This difficult answer in a short form as many medical conditions may have neuropsychological sequela. However, the most common medical issues that are followed up with psych evaluations are:

  • Traumatic brain injury
  • Concussions
  • Epilepsy
  • PANDAS
  • Pediatric cancer

What documentation do you provide as part of a neuropsychological evaluation for a medical condition?

The neuropsych report is often the most essential documentation for the cognitive sequela of medical conditions. The report goes through a detailed analysis of the individual’s pattern of strengths and weaknesses as well as what areas were likely impacted by their medical condition.

What support services does Neuro-Psych Doctor offer after the medical evaluation process?

Although Dr. Malkin does not provide ongoing therapy for individuals with cognitive impairment due to medical issues, he does provide consultation and referrals to professionals who provide these services

Should you get an evaluation after the child has recovered from their condition (if applicable) to make sure they’re back on track?

If everything is going well and a child doesn’t experience any difficulty the evaluation is not necessary. However, children may appear to be doing okay at home and in school, but may be struggling to keep up. You may not know how to express what is going on or who to turn to to explain their difficulty.

Often, children in these situations may display other issues such as behavioral problems or emotional difficulties when in fact their issues come from a neuropsychological background. Because of this, it is important for teachers and parents to be very sensitive to issues going on with their children after these medical issues and seek appropriate evaluations if they have any concerns.

Learning disabilities

When should children be screened for a learning disability?

There is some debate among psychologists and educators about when to screen for a learning disability, as there are multiple developmental pathways that young children can take which may appear to be disabling but are actually effective.

In general, it’s important to get screened as early as possible so as not to overlook potential problems in a child’s learning. Children can be screened for potential learning disabilities as early as preschool, but many parents wait until kindergarten or first grade before undergoing a more comprehensive evaluation.

What causes learning disabilities?

As there are a variety of learning disabilities, there is no specific unifying cause. However, most learning disabilities arise from an underlying cognitive deficit that impairs the child’s ability to learn in that specific area.

For example, dyslexia, the most common learning disability, often arises from an underlying deficit in the child’s ability to process and manipulate sounds. On the other hand, dyscalculia, or difficulty in math, can come from underlying deficits in reasoning or visual-spatial understanding.

Both of these are overgeneralizations, as there are various types of dyslexia, dyscalculia, and dysgraphia, but there is often an underlying problem in the child’s neuropsychological makeup that accounts for the learning difficulty.

What post-evaluation support services does Dr. Malkin offer for learning disabilities?

The neuropsych evaluation process includes understanding the child’s profile and setting up a workable plan for the child. Dr. Malkin does not himself conduct academic remediation, but does provide consultation for families that need ongoing guidance.

Can you cure a learning disability?

As learning disabilities generally arise from an underlying cognitive deficit which is often relatively stable, there is generally no cure for them. Instead, there is a combination of teaching and environmental modifications as well as training for the student to be able to use their other cognitive strengths to work around their learning problems.

However, for some types of reading difficulty, the underlying deficits in phonological processing can be remediated. Combined with targeted learning styles, the child can learn to read as well as other children.

How are learning disabilities treated?

Learning disabilities are treated by adapting the child’s environment to better suit their learning style as well as teaching them techniques to work around their learning problems. Sometimes this can be done without changing the child’s academic program or classroom, but often this requires working through a special education system within the school. For children who are struggling academically, there will often be an individual education plan (IEP) set up for them through their school’s committee on special education (CSE).

What happens if my child does not have a learning disability but is still underperforming (or ‘behind’) in school?

Even without a specific learning disability, many children do struggle in school and can benefit from an educational plan that maximizes their strengths and helps them compensate for difficulties. To address this, Dr. Malkin goes through the results of every evaluation with the parents and works out an educational plan through which the child will be able to succeed educationally.

ADHD

When should children be screened for ADHD?

The general recommendation form the American Academy of pediatrics is to have children screened for ADHD starting at four years old. Before this point, many behaviors which may appear to be consistent with an ADHD diagnosis are actually neuro-typical developmentally appropriate behaviors. In extreme cases, earlier evaluation can be considered.

What causes ADHD?

Understanding the causes of ADHD has been a goal of developmental science for the last several decades. This research has enabled the field to narrow down potential causes to several key contributors. However, there are few specific causes which have been identified in the literature that can cause ADHD on their own.

One of the most common causes of ADHD is genetics, as ADHD is often passed from parent to child. For example, parents of children with ADHD are over 25% likely to have the disorder themselves, and there are often other individuals in the family that share the diagnosis.

Aside from inborn characteristics, ADHD symptoms can also arise from prenatal exposures (e.g., alcohol nicotine), prematurity, lead poisoning, and head trauma, among other causes.

Importantly, research has identified many factors that do not cause ADHD, such as: playing video games, watching TV, immunizations, food additives, eating sugar, or allergies.

What are the benefits of getting a neuropsychological evaluation for ADHD vs. going to a pediatrician for a diagnosis?

Although many pediatricians are experts in identifying and helping parents manage ADHD, there are often cases in which a child can be misdiagnosed due to the limited experience the clinician has with the disorder or the child. This is often due to the fact that ADHD symptoms can arise from other causes, such as an underlying learning difficulty, emotional difficulty, or other neuropsychological factors.

Furthermore, as the treatment for ADHD often includes medication, parents of children with these difficulties often want to ensure that their child has the disorder before giving medication.

What support services does Neuro-Psych Doctor offer after the ADHD evaluation process?

In addition to providing evaluation for ADHD, Dr. Malkin also provides individual psychotherapy and behavioral training for families and individuals with ADHD. This includes seeing the child or adult with the disorder as well as working with the parents to learn skills and implement systems to manage the disorder at home.

Can you cure ADHD?

As of yet, there is no cure for ADHD. The various medications that are found to be beneficial for helping children manage the disorder do not change the underlying neurological structure which gives rise to the disorder.

In addition, behavioral training and modification systems are helpful in providing an environment in which the individual can succeed, but they often do not remediate the underlying problem. Some researchers refer to this as a “prosthetic environment” which the individual with ADHD will need to learn to use throughout their life.

How is ADHD treated?

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Testing accommodations

Is a neuropsychological evaluation required to get a testing accommodation?

The need for a neuropsychological evaluation in qualifying for testing accommodations depends on the type of testing accommodation and the tests that it is being used for. For some accommodations and for some standardized tests, it is possible to qualify for the accommodations by simply showing that the student is already receiving those accommodations in their school. However, for many tests, the administering company (i.e., Pearson, College Board, State Agency) requires medical/clinical documentation that demonstrates the need for the accommodations. This is where it can be essential to have a neuropsychological evaluation report to prove the need for the accommodation.

This is especially true when the student is requesting extra time for a difficulty with reading or ADHD. As these types of disorders do not have visible medical markers, testing companies will often require more than a letter or a previous diagnosis to grant the accommodation request.

Which tests can a neuropsychological evaluation be used for?

Neuropsychological evaluations can be used for practically any test in which an individual’s disability impacts their ability to display their knowledge on the test. This applies for tests at the elementary, high school, college, graduate, and post-graduate level. The most common tests for which neuropsych evaluations are requested are aptitude or admission tests, including:

  • SAT
  • ACT
  • LSAT
  • MCAT
  • GRE
  • GMAT

What materials/documentation do you provide as part of a testing accommodation recommendation?

The main documentation for the accommodations is the neuropsych evaluation report, which is generally sufficient to display the individuals deficit and need for accommodations. Often there are forms to be completed as well, and sometimes it is also necessary to write a letter specifically outlining the need for accommodations. Dr. Malkin tries to help each individual get the accommodations they need and works to ensure that this happens.

What support services does Dr. Malkin offer during the testing accommodation application process?

Individuals often have various questions when filling out the forms for testing accommodations, and Dr. Malkin works with each client to make sure that the forms are completed accurately. In addition, when necessary, Dr. Malkin will also write a letter of support or complete a necessary form to assist with the application process.

What happens if you do not recommend a testing accommodation for my child?

Although many children do qualify for testing accommodations, there are often cases in which an individual does not qualify. In these situations, it is often due to the fact that the individual does not have a demonstrable deficit or diagnosis which would require such accommodations. Because of this, the accommodation would be inappropriate as there is no medically based need. Instead, Dr. Melvin will often work with the client on developing a test-taking plan through which they can work around the difficulties that they experience during the test.

Under what conditions would a testing accommodation NOT be recommended?

Testing accommodations are only recommended when there is a demonstrable medical, psychological, or cognitive deficit that is impairing the individual’s ability to display their knowledge on the test. In some situations, it is necessary to have a specific medical diagnosis without which the individual would not be able to qualify.