Behavioral Observations

Physical appearance is inspected, including symmetry of anatomical features, facial expression, manner of dress, and attention to personal hygiene. The patient is asked specific questions regarding unusual sensory or motor symptoms. Affect and mood are assessed with respect to range and modulation of felt and expressed

Clarification of Referral

■ Who referred the patient?

■ What is the presenting problem?

■ Why is the evaluation requested now?

■ Any collateral documentation relevant to assessment?

Interview

■ Discuss nature of the assessment with patient and family

■ Assess the patient's understanding of current symptoms

■ Collect information about current symptoms, medical history, development, education, vocation, social functioning mood

■ Assess insight, judgement, affect, social conditioning through observation during interview

Test Administration

■ Administer battery of tests according to specific approach

■ Assess motivation, speed of processing, frustration tolerance, insight, judgment, interpersonal skills, affect, comportment, distractibility, alertness through observation of testing behavior

Integration and Interpretation

■ Integrate information from patient interview, medical history, development, education, current psychosocial status, testing, and collateral data (i.e., MRI, EEG)

■ Develop differential diagnosis based on converging data supporting the presence or absence of specific conditions

■ Use relevant scientific knowledge and base rate statistics to determine the most probable explanation for the patient's presentation

Neuropsychological Report

Construct a written document that clearly conveys the findings of the evaluation to the referring provider and/or patient, as appropriate

■ Support conclusions with specific examples, as appropriate

■ Include specific recommendations for remediation or intervention based on the conclusions of the evaluation

Patient Feedback

Discuss findings of the evaluation with patient or caregiver, as appropriate ■ Educate patient or caregiver, as appropriate, about diagnosis, prognosis and treatment as relevant

Figure 1 Schematic of neuropsychological evaluation.

emotions and their congruence with concurrent ideation and the contemporaneous situation. Interpersonal comportment is assessed in the context of the interview. Specifically, attention is paid to whether the patient's behavior reflects a normal awareness of self and other in the interaction. Whether the patient is motivated and complies with examination requests, instructions, and test procedures. An appreciation of the patient's level of motivation to participate in the evaluation and comply with examination instructions is crucial to assessing the validity of the test data. General level of arousal or alertness is determined by observing the patient's degree of drowsiness, tendency to yawn or fall asleep during the interview, level of interpersonal engagement, and speed of response in conversation. Environmental and diurnal factors can modify arousal, and an attempt should be made to assess whether this is relevant in the case of a particular patient by inquiring about the consistency of arousal level and any fluctuations that the patient or caregiver has observed.

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