Neuropsychological testing was initially developed as a way for psychologists to determine what cognitive or behavioral skills were missing in people who suffered severe head trauma — people who were missing pieces of their brain because of accidents or violence. Over time, as knowledge grew, neuropsychologists began to be able to not just document lost skills when the extent of the injury was already known but also work backward and infer the location and extent of the damage. With further progress, neuropsychologists could provide critical information about cognitive functioning and behavior in people with fundamentally intact brains.
The extent and localization of brain damage are still the province of the most highly trained neuropsychologists, who often assess people with complicated medical histories at risk for compromised brain function. However, their assessment tools have become meaningful lenses to examine more subtle and commonplace cognitive strengths and weaknesses in intact brains. While in common parlance, this, too, is called neuropsychological testing, it does not require the highly specialized training and certification process that certified neuropsychologists undergo. Well-trained specialists in learning differences and cognitive assessment can diagnose dyslexia, dyscalculia, dysgraphia, ADHD, giftedness, and Specific Learning Disabilities (SLDs). This is done using intelligence and academic tests with or without specialized neuropsychological tests. When neuropsychological tests are included in an evaluation for learning differences, most consumers and psychologists consider this a neuropsychological assessment, even though it is a far cry from the way this term was initially conceived. Commonly used neuropsychological tests, like the Rey, Wisconsin Card Sort, WRAML, and D-KEF, examine areas of function like visual and auditory memory, cognitive switching, visual-motor skills, executive functioning, and other cognitively essential functions that are valuable areas of study but are not fundamental to the diagnosis of learning differences.
Neuropsychological testing adds breadth and depth to the understanding of a person’s cognitive strengths and weaknesses and, as such, has real value for those who have the resources to obtain this kind of testing. In particular, it can help plan appropriate interventions for children, teens, and adults in areas where they struggle. However, it is a common misconception that neuropsychological testing is necessary to diagnose learning differences. Neuropsychological testing with a certified neuropsychologist is only necessary to help localize brain injury and describe compromised functioning for those with medically complicated histories that include suspected or documented central nervous system compromise. With regards to learning differences, people do not need specialized neuropsychological testing to identify learning differences and qualify for academic accommodations. Less exhaustive testing can identify critical delays in particular academic subjects and/or discrepancies between overall abilities and academic performance. In the case of healthy children, teens, and adults struggling at school or work, individuals can choose how extensively to be tested based on pragmatic considerations like time, convenience, and cost. They do not need to worry about obtaining substandard care if they do not get neuropsychological testing. Neuropsychological testing in this context may be best viewed as a luxury rather than a necessity.
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