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Considered a necessary exception to in-person administration during the time of the pandemic, remote neuropsychological assessment services have remained an option for clients over the years.  While these services may at times offer benefits, they are not without limitations that are important to consider.  In the great majority of cases, in-person assessments remain the gold standard to ensure comprehensive, accurate, and reliable evaluations. The ability to observe non-verbal cues, control testing conditions, build rapport, and make immediate clinical judgments are just a few of the reasons why in-person evaluations are far often the more appropriate choice. 

The team at ClearView is happy to offer remote assessment services when appropriate and will carefully evaluate whether or not this is an appropriate option for interested clients.  Accordingly, there are a few things to consider:

Given the complexity and the depth of these evaluations, it is crucial to capture a robust spectrum of data and clinical observations.  Many tests require equipment, environments, or conditions of administration that can be difficult or impossible to replicate remotely and many cannot be administered at all.  As a consequence, there are several areas of functioning that cannot be sufficiently measured or measured at all remotely.  

Good administration is dynamic and involves adjusting the pacing or sequencing of an assessment based on the client’s responses or emotional state. In-person assessment allows us to make these adjustments seamlessly, ensuring that the evaluation process is both thorough and tailored to our client.  It also allows us to observe non-verbal cues and interpersonal interaction; to see how our client behaves in real-world conditions and to note any potential barriers that might influence their performance, such as discomfort or distraction in the environment.

The quality and dependability of technology and environment is also important.  In-person assessments ensure a controlled environment, where we can ensure testing conditions are optimal. This level of control is crucial for accurate results, as even small deviations from the standardized testing environment can affect performance and reliability.

Finally, a critical aspect and one that has a substantial impact on the quality of our work is our ability to build and maintain rapport with our clients.  Often our clients are anxious about being tested and need time to be comforted, reassured, and to feel they can trust us.   In-person interactions allow the opportunity to develop this key foundation with our clients. Remote interaction inevitably creates a degree of distance that may leave clients feeling less comfortable, trusting, open, or able to  communicate as effectively as they would otherwise.

As mental health awareness grows, so does the recognition that young people face unique and complex challenges. From academic pressures to social struggles, the difficulties they experience can sometimes be dismissed as typical growing pains. However, in many cases, what appears to be a behavioral issue or mood shift may be a sign of an underlying neuropsychological concern. This is where the importance of neuropsychological assessment comes into play.

At ClearView Psychological Services, we believe that understanding the full scope of a young person’s mental health needs requires more than just an observation of their symptoms. We emphasize the value of neuropsychological assessments—tools that go beyond simple diagnoses to uncover the intricate cognitive, emotional, and behavioral factors that contribute to a young person’s overall well-being.

What Is Neuropsychological Assessment?

A neuropsychological assessment is a comprehensive evaluation that looks at the relationship between the brain and behavior. This means considering how factors like attention, memory, executive function, processing speed, emotional regulation, and social cognition influences everyday functioning. It’s a detailed approach that paints a clearer picture of why a young person might be struggling and helps to identify the root causes of mental health challenges.

In contrast to more traditional psychological assessments, which often focus on symptom checklists and interviews, neuropsychological assessments take a deep dive into the cognitive aspects of mental health. This involves standardized tests, observational methods, and detailed feedback from family and school environments.

Why Is Neuropsychological Assessment Crucial for Treatment?

1. Identifying Hidden Challenges

Many people experience struggles that aren’t immediately apparent. ADHD, learning disabilities, or subtle cognitive delays may not show up on the surface but can cause significant challenges in a child’s life. Without a neuropsychological assessment, these issues may be misinterpreted as behavioral problems, leading to incorrect or insufficient interventions. For example, a child who has trouble focusing in school might be labeled as inattentive or lazy when the root cause could be ADHD or a learning disorder.

2. Tailored Treatment Plans

Understanding a person’s cognitive and emotional profile allows clinicians to design more effective, individualized treatment plans. Rather than simply offering generalized counseling or medication, neuropsychological assessments help identify the specific cognitive skills that need attention. This could include things like improving working memory, enhancing emotional regulation, or supporting executive functions like planning and problem-solving. By tailoring interventions to a client’s unique needs, therapists can help them achieve meaningful progress.

3. Tracking Progress Over Time

Neuropsychological assessments offer a clear baseline to track changes over time. As a young person works through treatment, these assessments provide measurable data that can show whether they’re improving or if modifications to their treatment are necessary. This ongoing feedback loop ensures that the treatment process remains dynamic and responsive to the evolving needs of the individual.

4. Better Outcomes in Academic and Social Settings

Clients with cognitive and emotional difficulties often struggle in school, work, and social environments. With a neuropsychological assessment, the client’s community can better understand how their brain functions and how it affects their behavior. This insight leads to better academic and work accommodations and improved strategies for managing social interactions. The result is a stronger sense of self-efficacy and confidence as they navigate their educational and social worlds.

5. Reducing the Risk of Misdiagnosis

Mental health diagnoses can be tricky. Symptoms of depression, anxiety, and other conditions can overlap with cognitive issues, such as those caused by trauma or learning disorders. Neuropsychological assessments help provide clarity by differentiating between what’s caused by a mental health condition and what’s driven by cognitive or developmental factors. This reduces the risk of misdiagnosis, ensuring that people receive the appropriate treatment for their specific needs.

Neuropsychological Assessment as a Comprehensive Approach

At ClearView Psychological Services, we see neuropsychological assessment as a critical tool for getting to the heart of a person’s mental health needs. When these assessments are part of a comprehensive mental health treatment plan, they provide crucial insights that can change the trajectory of a person’s life. The goal is not just to treat symptoms but to understand the cognitive, emotional, and behavioral factors at play and offer a pathway towards meaningful improvement.

Incorporating neuropsychological assessment into the mental health treatment process ensures that we are not just addressing what’s visible on the surface but are instead providing holistic care that supports the long-term well-being of our clients. Whether it’s academic and work struggles, social difficulties, or emotional challenges, the right insights lead to the right interventions—and ultimately, to a brighter future.

What is your story?

Written by: Dr. Sean D. Seabridge, PhD

Emphasis on Narrative and History

Traditional psychological evaluations often prioritize identifying symptoms and categorizing them into diagnostic criteria. This process, while clinically valuable, can sometimes reduce the client’s experiences to a list of symptoms and diagnostic labels, overlooking the richness of their personal story and the context in which their challenges have developed.

At ClearView, we recognize that every individual’s journey is unique, and our evaluations reflect this belief as we strive to tell our clients’ story in every report we write. By adopting a narrative style in our reports, we ensure that the client’s story is front and center. This narrative approach allows us to delve deeper than the surface-level symptoms and diagnoses. It enables us to explore the various dimensions of an individual’s life experiences, their struggles, triumphs, and the nuanced shades in between that contribute to their current psychological state. It’s not just about understanding what challenges they face but comprehensively grasping who they are as people.

This narrative style of reporting weaves together a comprehensive life story, including developmental milestones, academic history, family dynamics, personal achievements, and traumatic experiences, offering a fuller understanding of the individual. This approach acknowledges the client as a whole person, not just a case with a diagnosis.

The Importance of Context and History

Conventional evaluations often have a primary focus on diagnosis, aiming to classify the client’s symptoms within a specific disorder as defined by the DSM-5. While diagnosis is crucial for treatment planning and insurance purposes, it can sometimes limit the understanding of the client to their pathology.

Our methodology at ClearView extends beyond the present to meticulously examine the past. By constructing a detailed timeline of an individual’s life, we gain insights into the pivotal events and experiences that have shaped them. This historical context is especially crucial for individuals with complex trauma or those being assessed for neurodevelopmental concerns. Understanding a person’s early development, family dynamics, and critical life events provides a richer, more accurate picture of their mental health.

Our team extends the evaluation to explore a wide array of factors, including emotional, social, and environmental influences that contribute to the individual’s mental health. This comprehensive scope ensures that the evaluation captures the client’s strengths, coping mechanisms, and potential areas for growth, alongside their struggles. It’s a more holistic view that appreciates the complexity of human behavior and experiences.

A Personalized Approach to Diagnosis

Traditional evaluations might follow a more one-size-fits-all approach, relying heavily on standardized tests and measures. While these tools are scientifically validated and essential, they can sometimes miss the nuances of an individual’s unique experiences and cultural background.

While identifying a diagnosis is an essential step in the evaluation process, at ClearView, it is the starting point, not the endpoint. We delve into the subtleties of each client’s experiences, recognizing that symptoms and behaviors can evolve over time. For instance, behaviors that might indicate autism in early childhood could look different in adolescence due to the individual’s adaptation or masking efforts. Similarly, symptoms that appear to align with one diagnosis might, upon closer examination of the client’s life story, suggest a different or additional diagnosis. By focusing on these nuances, we ensure that our evaluations lead to more accurate and personalized diagnoses.

In recognizing the limitations of a purely standardized approach, ClearView tailors each evaluation to the individual. This customization allows for a deeper dive into the person’s history, current life situation, and future aspirations. By integrating this information, the evaluations are not just about diagnosing but about understanding the person in their entirety, which in turn informs more personalized and effective treatment plans.

Building a Timeline: A Key to Healing

While acknowledging the importance of developmental history, standard practices may not always delve deeply into early childhood experiences or consider how individuals adapt or mask symptoms over time, especially in cases of neurodevelopmental disorders.

Our emphasis on constructing a detailed timeline that includes early development offers a more nuanced understanding of the individual. This aspect is particularly crucial for accurately diagnosing conditions like ADHD and autism, which may present differently as the person ages. Such thorough historical analysis can uncover significant insights that guide diagnosis and treatment, distinguishing ClearView’s evaluations from more conventional approaches.

The act of building a timeline is not just a diagnostic tool; it’s a therapeutic one. For individuals grappling with trauma, revisiting and understanding the sequence of events that led to their current state can be a crucial step in their healing journey. This process of reflection and acknowledgment helps validate their experiences and feelings, fostering a sense of understanding and empathy. It’s about piecing together the puzzle of their life, not just to label each piece but to see the whole picture in its complexity and beauty.

Guiding Treatment with Depth and Understanding

Treatment recommendations following traditional evaluations are often directly tied to the diagnosed disorders, focusing on symptom management and standard treatment protocols.

The comprehensive understanding we strive for at ClearView does more than inform diagnoses; it guides treatment. By considering the full spectrum of a client’s life experiences and developmental history, we can tailor treatment approaches that address not just the symptoms but the underlying issues and their broader impacts on the individual’s life. This depth of understanding ensures that our treatment recommendations are not only effective but deeply resonant with our clients’ personal histories and current needs.

With the rich narrative and comprehensive understanding of each client, ClearView is positioned to offer treatment recommendations that are not only aligned with best practices but also deeply personalized. This approach ensures that the treatment is not just about alleviating symptoms but also addresses underlying issues, supports personal growth, and enhances overall well-being, making it a transformative experience for the client and fostering a path towards healing that honors their entire journey.

In conclusion, at ClearView, when we ask our clients, “What is your story?” we’re inviting them into a process of discovery that transcends the conventional boundaries of psychological evaluation. Our distinctive approach, focused on narrative depth, comprehensive understanding, and personalized care, aims to honor and illuminate the full spectrum of our clients’ experiences. Unlike standard practices that may prioritize diagnosis above all, we seek to understand the chapters of your life that have led you to where you are now, recognizing that every facet of your journey—your challenges, adaptations, and triumphs—plays a crucial role in shaping who you are. By integrating these elements into our evaluations and treatment plans, we not only answer the question of “What is your story?” but also help you to understand and navigate your narrative with newfound insight and clarity. This commitment to capturing and respecting the uniqueness of your story is what sets ClearView apart, ensuring that our evaluations are not just assessments, but pathways to deeper self-understanding and meaningful change.

Understanding Cognitive Splits

Written by: Dr. Lauren Linford, PhD

In the complex world of treatment, psychological assessments emerge not just as tools, but as bridges—connecting our client’s internal world with the tailored care they desperately need. Among the varying concerns that our assessments capture, a cognitive split is a presentation that stands out.  Often unidentified as a child develops, due to dynamics described below, we at ClearView refer to such a presentation as a “secret struggle” that, without proper assessment, goes undetected. But what exactly is a cognitive split, and why does it demand our attention and understanding?

Cognitive splits, or significant disparities in an individual’s cognitive abilities, can often be the silent culprits behind a range of social, emotional, educational, and behavioral issues faced by our clients. By diagnosing and understanding cognitive splits, we can begin to offer individualized care that not only acknowledges but supports the complexity of one’s cognitive landscape.

What are Cognitive Splits?

Cognitive splits refer to significant discrepancies within an individual’s intellectual profile, as assessed by four key domains: Verbal Intelligence, Non-verbal/Spatial Intelligence, Working Memory, and Processing Speed. Such imbalances can range from a pronounced divide between verbal and non-verbal intelligence to distinct contrasts like slower processing speed or sluggish working memory compared to other cognitive abilities.

These varying cognitive presentations, determined by a combination of genetics, environmental factors, and personal history, shape a unique intellectual landscape for every client. For instance, one may have a flair for articulating thoughts, but struggle with tasks requiring visual-spatial skills or non-verbal understanding. Conversely, another may have strong spatial abilities yet falter with verbal and written communication tasks. Current research and clinical insights indicate that cognitive splits are more widespread than previously acknowledged (Margolis et. al, 2020). These intellectual disparities often lurk behind overt behaviors or are obscured by the individual’s own compensatory strategies.

Impact on the Individual

Disparities inherent in cognitive splits extend beyond academic achievement, and can deeply influence one’s social interactions, self-esteem, and emotional well-being. A pattern we see often in the clients we assess is what we refer to as “verbal mind dominance,” where verbal abilities are markedly strong—sometimes registering as superior—while non-verbal skills are average or below average. This relative difference means that their non-verbal abilities, though perhaps not deficient on a normative scale, trail behind their exceptional verbal skills.

This high verbal/low non-verbal split can manifest in various ways. Socially, these adolescents may excel in debates, storytelling, or any arena that values linguistic skill. However, they tend to be overly-literal and may falter in reading body language, understanding spatial relationships, or “reading between the lines”—all skills which are crucial for relationships and non-verbal communication. They might not pick up on subtle facial expressions or social cues, leading to misunderstandings. While they can discuss complex concepts, their ability to ‘read the room’ is compromised, which can lead to social disconnect and isolation.

Even without a formal, normative deficit in non-verbal skills, the relative disparity between verbal and non-verbal abilities can still impact their overall functioning. Socially, these individuals might appear awkward or out of sync with their peers, which can be misinterpreted as disinterest or aloofness. Academically, they may underperform in subjects that require strong visual-spatial abilities, like math, despite their strong verbal reasoning.

This type of discrepancy, where a relative cognitive deficit creates a sort of bottleneck for other cognitive abilities, can result in a pattern of underachievement and disengagement from both academic and social spheres, while fueling a chronic cycle of overwhelm, frustration, and insecurity. For educators and caregivers, recognizing the signs of cognitive splits can be challenging, as these adolescents often develop sophisticated coping mechanisms that mask their difficulties. These discrepancies and accompanying compensatory strategies can lead to mislabeling of these individuals as lazy or unmotivated, further entrenching their struggles.

Assessment and Identification

Comprehensive psychological assessments are key to uncovering cognitive splits, utilizing a range of standardized tests to evaluate various aspects of intelligence and processing capabilities. The Wechsler Intelligence Scale for Children (WISC-V), for example, provides insights into each of the four intellectual domains, offering a detailed view of where disparities lie. Our assessments take a comprehensive and nuanced approach, carefully considering our client’s developmental background, socioeducational history, and co-existing psychological issues. Within that context we paint a picture of how a cognitive split may impact their external behavior and internal world.

Identifying cognitive splits is only the first step; the real work lies in tailoring treatment and educational interventions that address these disparities. Educational strategies might include the use of visual aids for those with verbal comprehension difficulties or providing written instructions for those who struggle with processing speed. Therapeutic interventions may focus on building self-esteem, teaching coping strategies for frustration and anxiety, and improving social skills through role-playing and social stories.

Case Study

Consider the case of “Emma,” a 15-year-old who was in treatment for anxiety, difficulty with emotion regulation, and poor self-esteem. Emma excelled in language arts, but struggled in math and science classes, which her teachers attributed to an unwillingness to apply herself. Emma also faced difficulties in her relationships. She was adept at verbal communication, but would often misinterpret non-verbal signals, leading to social missteps and a sense of isolation. Her friends and family members found her to be a great conversationalist, but they also noted her insensitivity to the unspoken nuances of their interactions. Emma felt this disconnect acutely, which compounded her frustration and affected her self-esteem.

After a comprehensive evaluation, her cognitive profile revealed a verbal mind dominance. Her deficits were not due to a lack of effort, but because of her relative difficulties in grasping spatial and abstract concepts that are less reliant on verbal skills. Emma’s cognitive strengths in verbal areas suggested a mismatch between her innate abilities and the demands of environments that prioritized spatial or non-verbal skills. The bottleneck caused by her comparatively weaker non-verbal skills resulted in significant frustration, triggering a cycle of shame and self-esteem issues that further exacerbated her emotional symptoms.

Along with identifying a cognitive split, our reports always include tailored recommendations. The treatment recommendations for Emma included strategies to harness her verbal strengths and address areas of weakness. Some examples included:

• Social skills training to enhance her understanding of non-verbal cues and abstract concepts to bridge gaps in her social interactions.
• Personalized math tutoring that leveraged her verbal strengths, employing word problems and verbal explanations to bridge her understanding of mathematical concepts.
• Working with her therapist to help her to better understand her verbal mind dominance and recognize her worth as independent of this challenge, and thereby boost her self-confidence

Through this targeted approach, Emma began to see improvements in her relationships as she gained tools to better navigate her social world, recognizing and compensating for her non-verbal communication gaps. With continued support, Emma also started to improve her academic trajectory and cultivated a healthier sense of self-worth.

Conclusion

Navigating cognitive splits is a complex, yet deeply rewarding challenge. By adopting a multidisciplinary approach that values comprehensive assessment, individualized intervention, and close collaboration among other treatment and educational professionals, we can unlock the potential of these young individuals. It’s not just about bridging the gaps in their cognitive abilities; it’s about opening doors to a future where they can thrive, equipped with the understanding and strategies to navigate both their strengths and weaknesses.

References

Margolis AE, Broitman J, Davis JM, Alexander L, Hamilton A, Liao Z, Banker S, Thomas L, Ramphal B, Salum GA, Merikangas K, Goldsmith J, Paus T, Keyes K, Milham MP. Estimated Prevalence of Nonverbal Learning Disability Among North American Children and Adolescents. JAMA Netw Open. 2020 Apr 1;3(4):e202551. doi: 10.1001/jamanetworkopen.2020.2551. PMID: 32275324; PMCID: PMC7148441.