Psychological tests offer a formal way to measure traits,
feelings, beliefs and abilities that can lead to peopleís
problems. Some tests assess the presence of certain conditions,
such as depression, anxiety, anger control or susceptibility
to stress. Other tests measure general well being and provide
an overall picture of a personís personality. A typical psychological
assessment includes an interview with a mental health practitioner
and one or more formal psychological tests. The person may
be able to complete some tests on his own; others may be completed
with an examiner.
referral for psychological testing, one should recognize that
the intent is to gain a deeper, more complete understanding
of the problem than can be gained from a brief office visit.
Such a referral does not mean that the problem is particularly
serious, difficult to understand or complex. It just means
that additional information is needed before designing the
best approach to address the problem.
If a referral
for testing is made, knowing why such a referral is being
made is important to know. Becoming generally familiar with
what to expect is also important. Often, an appointment for
psychological testing requires several hours of time to complete
questionnaires or engage in face-to-face paper and pencil
active consumer before, during and after psychological testing.
To get started, ask any professional referring someone for
a psychological assessment the following questions:
will conduct the assessment?
is being measured?
long will testing take?
materials should the individual bring to the test? (e.g.,
glasses, other records)
will have access to the results? (e.g., medical doctor,
family, the court, teachers, research teams)
will the tests be taken? (e.g., verbal responses, paper
and pencil, computer)
much will this cost? (Will insurance cover this?)
are examples of only a few questions. It is important to ask
any question that will increase comfort level with the test
or testing procedure
About Psychological Testing
is qualified to perform psychological testing?
clinical psychologists, counseling psychologists and school
psychologists are typically qualified to perform psychological
assessments. The activity of these professionals is regulated
by appropriate state statutes and licensing boards. It is
wise to check to make sure the assessing professional is licensed.
If in doubt, ask the professional to describe her qualifications
to perform the evaluation.
are the results of a psychological evaluation shared with
the referring doctor or the patient?
an evaluation, the results are scored and interpreted and
a formal report is usually written. This report is then sent
to the referring professional. Some psychologists may also
have a discussion with the referring doctor to facilitate
understanding of results. The referring doctor usually decides
if, and how, the results will be communicated to the patient.
In some cases, the referring doctor will ask the psychologist
who performed the evaluation to discuss the results with the
patient in a feedback session. In all cases, the patient is
entitled to an explanation of results in language that he
the latest versions of psychological tests always be used
the practice of psychological assessment has a long history,
many of the tests in current use have gone through several
revisions. In general, appropriate practice dictates that
the most current versions of these tests should be used. In
some cases, however, earlier versions may be used if the professional
wants to compare current results with those obtained on an
evaluation conducted much earlier in the personís life.
the patient allowed to see the results of her psychological
patient is entitled to a clear explanation of the results
of psychological testing. Depending on the individual situation,
it may be better simply to discuss the results rather than
give the report. The doctor or mental health professional
should be consulted about the results and about the best ways
a patient can learn about them.
has access to assessment results?
most cases, the results are sent to the referring doctor or
agency requesting the evaluation. If an insurance company
pays for the assessment cost, a review doctor or nurse working
for the company also has a right to see the report. Otherwise,
the report will be released to third parties only with the
patientís written permission, and there are strict rules of
confidentiality that are followed. Be aware that there may
be some circumstances (e.g., court-ordered psychological evaluation)
where the rules of confidentiality do not apply. It is wise
to clarify who will have access to the results of the evaluation
tests may be able to describe my current situation, but how
good are they at predicting behavior?
and neuropsychological tests can predict general trends and
behaviors, but are not designed to predict future actions,
thoughts, feelings or behaviors. For example, the ability
of psychological tests to predict violence or suicide is limited,
though suspicion might be raised by specific test findings.
Such predictions are improved by establishing an ongoing relationship
with a professional over a longer period of time.
accurate are the results of my assessment?
psychological and neuropsychological tests are reasonably
accurate within a specified range. Each test is subject to
measurement error, and the size of such errors is known through
test development research. Thus, though a specific IQ or depression
score is obtained, a "true" score should be thought
of as falling close to the measured score. Many psychological
assessments contain more than one measure of the same ability
or personality trait. If the measures agree, more confidence
can be placed in the results. A discussion of the issue of
accuracy and stability of the test results with the professional
who conducts the assessment is important.
much do psychological assessments cost?
and other mental health professionals usually charge on a
per-hour basis for psychological and neuropsychological testing.
Tests that do not require a lot of face-to-face effort on
the part of the professional (e.g., questionnaires that a
patient completes by herself) are less expensive than those
the psychologist must administer. The per-hour fee varies
widely depending upon the setting. It makes sense to determine
beforehand what the estimated total cost of the evaluation
(including report and whether feedback session is included)
insurance pay for psychological assessment?
depends. Some insurance policies have mental health benefits
that will pay for a limited amount of psychological testing.
Medical insurance policies may cover all or part of psychological
testing if it can be shown to be "medically necessary."
This is most commonly true for neuropsychological assessment
of a patient who has cognitive problems related to a documented
medical condition. Insurance reimbursement is generally better
for physician-referred assessments. It is standard practice
for the professional to obtain pre-authorization from the
insurance company before the assessment begins. Prior to making
an appointment for testing, call the insurance company and
verify benefits for psychological or neuropsychological testing.
Russell Bauer, PhD. All rights reserved.
University of Florida Brain Institute
as the heart and lungs are critical in bringing oxygen to
other internal organs, the brain is the key player in the
nervous system. When disease affects the heart and lungs,
the complex mechanisms that affect oxygen delivery break down,
leading to damage in other organ systems. Similarly, when
disease affects the brain, the functions normally controlled
by the central nervous system, including thinking, emotions
and behavior, begin to break down. Recent research has shown
that many mental disorders, including anxiety, depression,
schizophrenia, obsessive-compulsive disorder and certain personality
disorders, as well as cognitive and behavioral impairments,
may result from disturbances in brain functioning. As a result,
techniques for evaluating brain function as it relates to
these problems have gained wide use in the mental health field.
are a number of ways to measure brain functioning. Imaging
techniques like computed tomography (CT) or magnetic resonance
imaging (MRI) scans look for structural abnormalities in the
brain. Tests like an electroencephalogram (EEG) are designed
to look for abnormalities in the electrical activity of the
brain. Neuropsychological tests offer another alternative:
in these tests, the brain is evaluated by putting it to work
and measuring specific abilities like memory, language, perceptual
ability, problem-solving and motor and sensory functions.
tests involve paper/pencil and mechanical procedures, are
painless, are not invasive and carry little if any risk to
the patient. They normally involve direct, face-to-face work
with a psychologist or her staff member. A comprehensive neuropsychological
examination may take 6-8 hours and involves a broad range
of tests and activities. A briefer, more selective evaluation
may be performed, depending upon the individual case.
tests are performed by psychologists and other mental health
professionals who have specific educational and practical
training. Not all psychologists are trained to perform neuropsychological
tests, and it may be worthwhile to ensure that the assessing
professional is properly trained to give and interpret neuropsychological
tests. The clearest indication of proper training is board
certification in clinical neuropsychology. When a referral
is made, the professional or her staff should be contacted
for specific instructions. Typically, the individual is encouraged
to take customary medications, get a good nightís rest the
night before, and to bring glasses or contacts if vision correction
MRI or EEG procedures, which follow relatively standardized
protocols, there are a variety of approaches to neuropsychological
assessment. The neuropsychological examination usually begins
with a clinical interview to enable the psychologist to become
more familiar with the clientís problems and to elicit any
signs and symptoms of psychiatric or neurological illnesses.
After the interview is completed, formal testing begins. Some
neuropsychologists perform this testing themselves, while
others use trained neuropsychological technicians. Both approaches
are appropriate, since it is the psychologist who will ultimately
be responsible for interpreting these test results. Some professionals
use a standard battery approach in which the same group of
tests is given to all patients regardless of the presenting
problem. The clearest example of this approach is the Halstead-Reitan
Neuropsychological Battery. This battery consists of a
number of validated tests of brain function. Other professionals
use a flexible battery of tests that are selected based
on the patientís specific problem. For example, an elderly
patient with suspected Alzheimerís disease might get a slightly
different group of tests than a young patient after a closed
head injury. While the Halstead-Reitan is the most widely
used fixed battery of tests, most neuropsychologists use some
version of the flexible battery approach. In general, it is
a good idea to inquire about the psychologistís general approach
and how the tests will be used in making diagnostic decisions.
the content of individual neuropsychological evaluations may
differ, the evaluation typically includes measures of intellectual
functioning and some assessment of emotional/personality functioning.
In addition, several domains of cognitive (thinking) ability
The client will be asked to learn and remember new information
(short stories, word lists, geometric designs and faces)
and to recall them later. Ability to recall information
learned in the past may also be assessed.
Ability to name objects, comprehend and follow directions,
speak, read, write and repeat may be assessed in different
and perceptual: Ability to analyze visual designs, assemble
puzzles or appreciate spatial relationships may be measured
with specific tests.
and concentration: Ability to pay attention for short or
long periods of time may be assessed using tests of mental
arithmetic, speeded writing or other abilities. Ability
to concentrate while distracted may also be assessed through
tests requiring one to perform two tasks at once.
Real-life or abstract problems to solve will be given. How
these problems are analyzed and solved may be evaluated.
and sensory abilities. One may be asked to perform some
tasks in which fine motor coordination is assessed or to
respond quickly to sensory input. Many neuropsychological
examinations also contain measures that are designed to
ensure that the patient is putting forth her best effort
in performing the tasks.
tests can be quite useful in defining cognitive and behavioral
strengths and weaknesses as well as in diagnosis of specific
medical conditions. If the results are abnormal, this does
not necessarily mean that the person is cognitively impaired.
Various emotional conditions (depression, anxiety, confusion
and mental dullness) can impair neuropsychological test performance.
Because of this, the neuropsychologist takes into account
all reasonable explanations of the profile in interpreting
the results. In most cases, the results will also lead to
specific recommendations for treatment or management of the
Russell Bauer, PhD. All rights reserved.
University of Florida Brain Institute
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