Brain-Behaviour Relationships

Board certification is a voluntary process and the last step in professional credentialing. It is designed to assure competent neuropsychological practice through peer evaluation of essential knowledge and skills. Board certification and diplomate status are granted to clinical neuropsychologists who successfully complete four stages of an intensive peer-review process to include credentials review and vetting; a written examination to assess the breadth of knowledge, submission of work samples for review; and an oral examination of the candidate by board-certified neuropsychologists.

A neuropsychologist is a licensed psychologist specializing in the areas of brain functioning and the relationship between the way the brain is functioning and behavior. Although a neuropsychologist has a doctoral degree in psychology, they do not just focus on emotional or psychological problems. The neuropsychologist has additional training in the specialty field of clinical neuropsychology. That means a neuropsychologist is educated in brain anatomy, brain function, and brain injury or disease.

The neuropsychologist also has specialized training in administering and interpreting the specific kinds of tests included in your neuropsychological evaluation. As a part of the required education, a neuropsychologist also has years of practical experience working with people who have had problems involving the brain. You can learn more about clinical neuropsychology from the National Academy of Neuropsychology website (www.NANonline.org).

A neuropsychological evaluation is an individualized examination by a neuropsychologist that helps answer specific questions about brain functioning. Common reasons for a neuropsychological evaluation may include, among others:

• To find possible problems with your brain functioning
• To help lead to a diagnosis
• To determine how well your brain is functioning compared to others your same age and educational level
• To define your brain-related strengths and weaknesses
• To guide treatment for your personal, medical, educational, or vocational needs, and make relevant recommendations to your other health care provider(s), or
• To document possible changes in your functioning over time

A neuropsychological evaluation typically involves assessment (testing) with a group of standardized tests sensitive to the effects of brain dysfunction. Unlike CT or MRI scans, which show abnormalities in the brain structure, or EEG, which shows electrical abnormalities in the brain, neuropsychological assessment is used to show how a person can or cannot perform certain functions or tasks dependent upon brain activity.

These functions or tasks (for example, memory and learning) form the necessary building blocks of successful living in the individual’s daily life. Impairment in many of these functions may exist because of brain abnormalities that cannot be detected on CT or MRI scans. Therefore, neuropsychological assessment is a procedure with a unique purpose; it can be used to reveal or diagnose brain dysfunction when no structural brain abnormalities can be seen. Furthermore, when structural abnormalities have been found, the neuropsychological assessment provides a way to determine what functions may be impaired because of the structural defects and determine the degree to which they may be impaired.

The standardized tests used in a neuropsychological evaluation typically assess functioning in the following areas:

• Attention and memory
• Problem-solving and other complex abilities
• Visual-spatial functions
• Language functions
• Sensory perceptual functions
• Motor functions
• Mood
• Personality

Assessment of academic skill development and emotional functioning, while not exclusive to neuropsychological evaluation, is typically performed. The neuropsychologist's perspective is frequently requested to understand subtle brain-related factors involved in memory problems, academic failure or impaired emotional functioning, even when no biological causes are suspected. However, the specific areas assessed depend upon the referral questions presented. This type of examination can shed light on the nature of difficulty a person is experiencing and strategies for compensating for neuropsychological problems.

The core testing will be performed by the neuropsychologist (Dr. Begali). Occasionally, select tests may be administered by a trained staff member. The neuropsychologist or a staff member will also spend some time talking with you about your medical, personal, and school history. An interview with the individual and/or family members is typically included. Most of the tests will involve questions and answers, paper and pencil, special materials, and sometimes a computer.

Observations in other settings, such as school or hospital, and review of school/medical records also may be included in the evaluation process. The tests you will take depend upon the questions you and your physician or case manager have. The tests are not invasive; that is, they do not involve attaching you to machines or using X-rays. Most of the tests will involve questions-and-answers or working with materials on a table. The total time involved in your evaluation will depend upon the questions you and your doctors have. The examination may take between 3-7 hours.

There are at least two ways you might expect to hear about the results of this evaluation. Dr. Begali will want to schedule a follow-up appointment to go over the results with you. With your permission, she will send the results to the doctor or healthcare provider who referred you for the evaluation. The evaluation findings will guide your treatment, increase your understanding of your intellectual potential, attention and memory skills, mood, and personality, or help you in your daily life otherwise.