Psychological & Neuropsychological Assessment:
A Helpful Way of Understanding Diagnosis & Facilitating Treatment
Samuel Justin Sinclair, Ph.D.
Assistant Professor, William James & College &
Owner, Samuel Justin Sinclair, Ph.D. PLLC
345 Boston Post Road, Suite 3U
Sudbury, MA 01776
www.Dr.JustinSinclair.com
Introduction
According to the National Institute of Mental Health (NIMH, 2014), roughly 1 in 5 (18.1%) adults have struggled with some type of mental illness (excluding substance abuse) over the last year alone. Approximately 1 in 24 (4.2%) have battled severe mental illness, impacting functioning in more significant ways. For children between the ages of 8 and 15, 13% will have met criteria for a psychiatric disorder in the last year, the most common being Attention Deficit Hyperactivity Disorder (ADHD) & various types of Mood Disorders. Perhaps more striking, lifetime prevalence rates for adolescents between the ages of 13 and 18 are 46.3% for any type of mental disorder and 21.4% for more severe psychiatric disorders. This is complicated even further by the large proportion of people diagnosed with one psychiatric disorder who will also meet criteria for a secondary diagnosis (for example, having both an underlying mood and substance use disorder), which highlights the unique role that complexity may have in diagnosing and treating mental illness.
People struggling with mental health difficulties will often seek formal treatment, most frequently in the form of pharmacotherapy (medicine), and individual & group psychotherapy. However, accurately diagnosing mental health conditions can be challenging even for seasoned clinicians, and this has meaningful implications in terms of providing effective care. For example, an emerging body of research has begun to demonstrate a relationship between certain types of antidepressant medications (targeting depression) and treatment emergent mania / hypomania (often associated with Bipolar-spectrum illness) in a small subsection of patients, which may reflect an underlying diagnostic vulnerability / heterogeneity that is not easy to capture in briefer evaluations. Although an initial consultation with a mental health provider is a good first step in establishing care, psychological and/or neuropsychological assessment may be especially useful in situations where diagnosis is not immediately clear and/or may involve multiple clinical considerations.
What is Psychological Assessment?
Psychological assessment is a specialty area within the field of psychology, which incorporates a multi-method data collection approach as a means of informing diagnosis and treatment planning. Most evaluations begin with a comprehensive clinical interview, where practitioners ask questions about an individual’s background – for example, early developmental, academic and work, social & interpersonal, and medical & psychiatric history. Depending on the specific referral questions, a battery of neurocognitive and psychometric tools is then administered, which evaluates functioning across a myriad of domains. For example, in cases where Attention Deficit Hyperactivity Disorder (ADHD) is suspected, the test battery is likely to include measures of attention, processing speed, working memory, and executive functioning – as a means of evaluating performance within this domain specifically. In other situations, where mood and/or anxiety may be the central questions, various psycho-diagnostic instruments are typically used to gauge not only where difficulties may exist, but also the magnitude or severity of symptomatology.
Psychological assessment evaluations typically last 4-8 hours, depending on the battery of tests that is administered. Once the evaluating clinician collects this information, the tests are typically scored using available normative / reference data. For example, most existing measures of cognitive functioning generate percentile scores, which allow you to see where a given score falls in the general population. As a person’s scores are then organized within and across domains (e.g., Attention, Memory, Depression, Impulsivity, etc.), the evaluator is then able to identify patterns of strength and weakness, which in turn inform diagnosis. Likewise, other psychometric instruments typically provide clinical benchmarks, which are used to infer clinical significance. For example, as someone reports both elevated levels of depression and features of mania, an underlying bipolar-spectrum illness becomes more likely. However, the science of psychological assessment is not rooted in the interpretation of singular test scores, but more in how all of the information is then integrated (i.e., interview information, neurocognitive test performance, psychometric findings) in a way to provide a much clearer picture of someone’s psychological functioning and diagnosis. Typically, this information is summarized in a comprehensive report, which provides important background information, test results, clinical impressions and likely diagnoses, and recommendations for treatment. These reports are provided both to the clients and referring medical professionals, and are then used by the medical team to enhance quality of care.
How Can Psychological Assessment be Helpful?
Psychological assessment can be helpful in a myriad of ways. For example, these evaluations are frequently useful in identifying underlying learning, developmental, psychiatric, and/or neurocognitive vulnerabilities in children, which may impact upon academic and social performance. In addition to informing the various types of medical / psychiatric interventions that may be helpful, these types of assessments also play a critical role in directing the kinds of academic / social accommodations that are provided within the school system itself. With these types of treatment and support systems in place, children are much more likely to thrive academically and socially.
Psychological assessment can also be extremely helpful with adults who may be struggling in different areas of their lives, particularly in situations where past treatments have been sub-optimal or ineffective. These evaluations provide important information not only about where someone may be struggling specifically (e.g., depression, substance use, impulsivity, personality disorders), but also with respect to comorbidity / complexity. For example, research has suggested that roughly 6 in 10 people with a substance use disorder also struggle with other forms of mental illness. As the latter remains untreated, the likelihood of successfully treating the former declines considerably. National comorbidity studies have also demonstrated the high co-occurrence of certain clusters of psychiatric disorders – for example, depression and anxiety, or substance use and impulsivity. In cases where diagnosis remains unclear, or is indicative of multiple underlying conditions, psychological assessment can be especially useful in terms of enhancing clinical clarity, and informing subsequent interventions and treatments.
For both children and adults, the specific benefits of Psychological Assessment include:
Who Performs these Types of Services?
Psychological and neuropsychological assessment is typically performed by doctoral-level clinicians who have had both basic training in clinical psychology, as well as more advanced / specialty training in assessment. While most clinicians conducting these types of evaluations are doctoral-level psychologists, not all psychologists have the necessary specialty training to conduct these assessments. As such, when exploring these types of services, it is important to make sure that the provider has the necessary training and credentials to provide these evaluations. Many times, Primary Care Providers (PCPs) will have a list of specialists they refer to for these (and other) types of services. Often, these services are housed within the larger academic medical centers in and around Boston, and are generally easy to access - although frequently have longer waiting lists. There are also a number of local services in the metro-west region that may be useful in this respect (including my own practice):
Late Adolescents & Adults:
Samuel Justin Sinclair, Ph.D. (Sudbury, MA)
DrJustinSinclair@gmail.com
www.DrJustinSinclair.com
Pediatric / Child:
Drs. Brian Willoughby & Nate Doty (Concord, MA)
Achieve New England
https://www.achievenewengland.com
Dr. Molly Colvin (Watertown, MA)
http://www.mollycolvinphd.com
Dr. Ellen O’Connell (Concord, MA)
ehodonnell@mgh.harvard.edu
A Helpful Way of Understanding Diagnosis & Facilitating Treatment
Samuel Justin Sinclair, Ph.D.
Assistant Professor, William James & College &
Owner, Samuel Justin Sinclair, Ph.D. PLLC
345 Boston Post Road, Suite 3U
Sudbury, MA 01776
www.Dr.JustinSinclair.com
Introduction
According to the National Institute of Mental Health (NIMH, 2014), roughly 1 in 5 (18.1%) adults have struggled with some type of mental illness (excluding substance abuse) over the last year alone. Approximately 1 in 24 (4.2%) have battled severe mental illness, impacting functioning in more significant ways. For children between the ages of 8 and 15, 13% will have met criteria for a psychiatric disorder in the last year, the most common being Attention Deficit Hyperactivity Disorder (ADHD) & various types of Mood Disorders. Perhaps more striking, lifetime prevalence rates for adolescents between the ages of 13 and 18 are 46.3% for any type of mental disorder and 21.4% for more severe psychiatric disorders. This is complicated even further by the large proportion of people diagnosed with one psychiatric disorder who will also meet criteria for a secondary diagnosis (for example, having both an underlying mood and substance use disorder), which highlights the unique role that complexity may have in diagnosing and treating mental illness.
People struggling with mental health difficulties will often seek formal treatment, most frequently in the form of pharmacotherapy (medicine), and individual & group psychotherapy. However, accurately diagnosing mental health conditions can be challenging even for seasoned clinicians, and this has meaningful implications in terms of providing effective care. For example, an emerging body of research has begun to demonstrate a relationship between certain types of antidepressant medications (targeting depression) and treatment emergent mania / hypomania (often associated with Bipolar-spectrum illness) in a small subsection of patients, which may reflect an underlying diagnostic vulnerability / heterogeneity that is not easy to capture in briefer evaluations. Although an initial consultation with a mental health provider is a good first step in establishing care, psychological and/or neuropsychological assessment may be especially useful in situations where diagnosis is not immediately clear and/or may involve multiple clinical considerations.
What is Psychological Assessment?
Psychological assessment is a specialty area within the field of psychology, which incorporates a multi-method data collection approach as a means of informing diagnosis and treatment planning. Most evaluations begin with a comprehensive clinical interview, where practitioners ask questions about an individual’s background – for example, early developmental, academic and work, social & interpersonal, and medical & psychiatric history. Depending on the specific referral questions, a battery of neurocognitive and psychometric tools is then administered, which evaluates functioning across a myriad of domains. For example, in cases where Attention Deficit Hyperactivity Disorder (ADHD) is suspected, the test battery is likely to include measures of attention, processing speed, working memory, and executive functioning – as a means of evaluating performance within this domain specifically. In other situations, where mood and/or anxiety may be the central questions, various psycho-diagnostic instruments are typically used to gauge not only where difficulties may exist, but also the magnitude or severity of symptomatology.
Psychological assessment evaluations typically last 4-8 hours, depending on the battery of tests that is administered. Once the evaluating clinician collects this information, the tests are typically scored using available normative / reference data. For example, most existing measures of cognitive functioning generate percentile scores, which allow you to see where a given score falls in the general population. As a person’s scores are then organized within and across domains (e.g., Attention, Memory, Depression, Impulsivity, etc.), the evaluator is then able to identify patterns of strength and weakness, which in turn inform diagnosis. Likewise, other psychometric instruments typically provide clinical benchmarks, which are used to infer clinical significance. For example, as someone reports both elevated levels of depression and features of mania, an underlying bipolar-spectrum illness becomes more likely. However, the science of psychological assessment is not rooted in the interpretation of singular test scores, but more in how all of the information is then integrated (i.e., interview information, neurocognitive test performance, psychometric findings) in a way to provide a much clearer picture of someone’s psychological functioning and diagnosis. Typically, this information is summarized in a comprehensive report, which provides important background information, test results, clinical impressions and likely diagnoses, and recommendations for treatment. These reports are provided both to the clients and referring medical professionals, and are then used by the medical team to enhance quality of care.
How Can Psychological Assessment be Helpful?
Psychological assessment can be helpful in a myriad of ways. For example, these evaluations are frequently useful in identifying underlying learning, developmental, psychiatric, and/or neurocognitive vulnerabilities in children, which may impact upon academic and social performance. In addition to informing the various types of medical / psychiatric interventions that may be helpful, these types of assessments also play a critical role in directing the kinds of academic / social accommodations that are provided within the school system itself. With these types of treatment and support systems in place, children are much more likely to thrive academically and socially.
Psychological assessment can also be extremely helpful with adults who may be struggling in different areas of their lives, particularly in situations where past treatments have been sub-optimal or ineffective. These evaluations provide important information not only about where someone may be struggling specifically (e.g., depression, substance use, impulsivity, personality disorders), but also with respect to comorbidity / complexity. For example, research has suggested that roughly 6 in 10 people with a substance use disorder also struggle with other forms of mental illness. As the latter remains untreated, the likelihood of successfully treating the former declines considerably. National comorbidity studies have also demonstrated the high co-occurrence of certain clusters of psychiatric disorders – for example, depression and anxiety, or substance use and impulsivity. In cases where diagnosis remains unclear, or is indicative of multiple underlying conditions, psychological assessment can be especially useful in terms of enhancing clinical clarity, and informing subsequent interventions and treatments.
For both children and adults, the specific benefits of Psychological Assessment include:
- Clarifying the existence of specific cognitive disorders – for example, whether a child has an underlying learning / developmental disability; or whether an adult shows evidence of ADHD or memory loss, etc. For those who do struggle with certain types of cognitive disorders, these evaluations will also help inform the types of treatments that may be beneficial (for example, medications targeting inattention or memory loss), as well as the kinds of accommodations / supports that are implemented at school or at work – as a means of helping the person better thrive in their environment.
- Elucidating the specific type and/or combination of psychiatric conditions that may be present, which in turn facilitates more effective approaches to treatment (e.g., pharmacotherapy, psychotherapy, etc.). For example, in cases where someone is struggling with both depression and anxiety, as well as concurrent substance use, isolating these conditions in treatment may be necessary as a means of decreasing their level of interaction. Similarly, in situations where someone may be diagnosed with more severe bipolar disorder and polysubstance use, symptom stabilization and abstinence may need to be jointly prioritized in treatment as a means of preventing relapse.
- Assessing for certain types of personality characteristics / disorders that may impact functioning and /or treatment.
Who Performs these Types of Services?
Psychological and neuropsychological assessment is typically performed by doctoral-level clinicians who have had both basic training in clinical psychology, as well as more advanced / specialty training in assessment. While most clinicians conducting these types of evaluations are doctoral-level psychologists, not all psychologists have the necessary specialty training to conduct these assessments. As such, when exploring these types of services, it is important to make sure that the provider has the necessary training and credentials to provide these evaluations. Many times, Primary Care Providers (PCPs) will have a list of specialists they refer to for these (and other) types of services. Often, these services are housed within the larger academic medical centers in and around Boston, and are generally easy to access - although frequently have longer waiting lists. There are also a number of local services in the metro-west region that may be useful in this respect (including my own practice):
Late Adolescents & Adults:
Samuel Justin Sinclair, Ph.D. (Sudbury, MA)
DrJustinSinclair@gmail.com
www.DrJustinSinclair.com
Pediatric / Child:
Drs. Brian Willoughby & Nate Doty (Concord, MA)
Achieve New England
https://www.achievenewengland.com
Dr. Molly Colvin (Watertown, MA)
http://www.mollycolvinphd.com
Dr. Ellen O’Connell (Concord, MA)
ehodonnell@mgh.harvard.edu