The purpose of any good evaluation is to answer the referral question, identify strengths and weaknesses, and offer specific, clear and realistic recommendations. Often, there are questions regarding diagnostic formulation (e.g. Traumatic Brain Injury, Attention Deficit Hyperactivity Disorder, Learning Disorder, Anxiety, Depression, Social deficits, etc.), the need for academic accommodations, pharmacological support, and psychotherapy (individual, group, family, and biofeedback).

Areas assessed and reported in a comprehensive Neuropsychological Evaluation:

• Background information and relevant history
• Functioning prior to any injury (history of adaptive functioning)
• Developmental and academic functioning
• Attention and concentration
• Auditory processing
• Information processing speed
• Language
• Executive functioning (self-regulation and reasoning)
• Intellectual functioning
• Sensoriperceptual ability
• Fine and gross motor skill
• Learning and memory
• Visuospatial
• Academic achievement
• Social/emotional
• Behavioral control

Geared for the preschooler, ages 2-5, to detect early:

• Developmental disorders
• Attentional deficits
• Cognitive delays
• Speech and language delays
• Social/emotional problems
• Autistic spectrum disorders

The process of this evaluation requires a detailed analysis of milestone acquisition of motor, articulation, language, cognitive, self help, and social/emotional skills. Additional data is obtained through questionnaires of parents and caregivers, observation of child behavior, medical records, and neurodevelopmental testing.

Results and recommendations are shared with parents. Often parents request that this information be shared with others (teachers, pediatrician, etc.)

Adults referred for a neuropsychological evaluation have or are suspected of having cognitive and emotional difficulties in one or more of the following areas:

• Attention, arousal, and concentration
• Learning and memory
• Language
• Reasoning and problem solving
• Visuospatial functioning
• Emotional, social, or behavioral regulation

Individuals may be referred following a traumatic event (motor vehicle accident) or a neurodegenerative disease (e.g. Alzheimer’s, Parkinson’s, stroke, Multiple Sclerosis, brain tumors, epilepsy, etc.). The purpose is to identify cortical functioning and limitations. It is an invaluable tool to document and quantify normal and impaired brain functioning.

It is a lengthy process, but it is the only standardized method for assessing cortical functioning and the neuroemotional and affective symptoms that influence recovery. Neuroimaging studies (CT and MRI) provide information about the brain structure, but not function. Neuropsychological testing does!

The neuropsychological evaluation leads to a comprehensive report that contains information about:

• Reason for referral
• Presenting problems
• Review of symptoms
• Relevant background/medical history
• Effort during testing
• Attention and concentration
• Processing speed
• Premorbid/current intellectual functioning
• Executive skills (self-regulation/reasoning)
• Language/verbal skills
• Sensoriperceptual/motor skills
• Visuospatial abilities
• Emotional and personality functioning

Dr. Inwald’s dissertation focused on memory functioning in the elderly. He continues to actively participate in the assessment and treatment of this population. A frequent referral question is to differentiate dementia, mild cognitive impairment, and pseudodementia (depression). Reversible and irreversible dementias are studied at Neurobehavioral Consultants. Primary care physicians, neurologists, and psychiatrists frequently seek out collaboration in diagnostic formulation, assessment of driving skills, medicolegal competence, and the assessment of psychological functioning (e.g. anxiety, depression, psychosis, etc.).

The assessment for dementia includes examining memory, executive functioning, abstract thinking, visuospatial skills, language, social/occupational functioning, presence of agitation and changes in personality. There are numerous causes and types of dementia including Alzheimer’s Dementia, Vascular, Parkinson’s Dementia, Huntington’s Dementia, Lewy Body Dementia, etc.

At Neurobehavrioal Consultants we also provide therapy, if indicated, to the patient or his family. Communication with and between family, caregivers, attorneys, and physicians is sometimes difficult but is invaluable. It is helpful to identify supportive services, the possible need for cognitive rehabilitation or compensation and to support/educate the spouse and family in any expected changes.

The purpose is to identify strengths and weaknesses of the student. This information may be used for proper placement (gifted, special education) or accommodations. The structure of the assessment varies according to the student and the referral question. Standardized administered intellectual, academic, and memory testing are frequently required by school boards and standardized test boards (ETS) when taking standardized tests (e.g. ACT, SAT, GRE, LSAT, MCAT, Bar Exam, COMPLEX). The American Disability Act recognizes that students with documented learning disabilities are allowed accommodations. The Educational Testing Service requires evaluation by a trained psychologist specializing in neuropsychology.

Some accommodations include:

• Extra time
• Quiet environment
• Essay only or no essay
• Not computer administered
• Orally presented
• Scribe assistance
• Broken up in parts

Psychoeducational testing may be required for students being considered for gifted instruction.

Neurobehavioral Consultants provide comprehensive services that include evaluation, medical record review, and consultation with attorneys, probation officers and judges. Following an evaluation, a comprehensive report is generated. Often expert testimony is offered by affidavit, deposition, or trial testimony.

Neuropsychological evaluations involve studying the relationship between brain functioning and behavior through scientifically validated methodology.

Problems Treated

Medical/Organic Traumatic Brain Injury Mild Cognitive Impairment Dementias Neurodegenerative Disorders (e.g. MS, Parkinson’s, Vascular) Brain Tumors Chronic Pain Headaches Fatigue Disorders Epilepsy/Seizures ADHD/LD Memory Problems

Adjustment/Psychological Anxiety Depression Eating Disorders Self-destructive Behavior Coping with Medical Illness (self or others) Substance Abuse Social Isolation Obsessive/Compulsive Behavior Coping with Significant Life Events Marital/Relational Difficulties Behavioral Dysregulation (e.g. Anger Management)

Treatment Modalities

• Individual Psychotherapy
  • Supportive
  • Insight oriented
  • Cognitive Behavioral Therapy
• Group Psychotherapy
  • TBI
  • Chronic Pain
  • Anger Management
• Family Therapy
• Marriage Therapy
• Neurofeedback and Biofeedback
  • The use of operant conditioning principles to modify an individual’s brain and body activity to enhance cognitive (e.g. concentration, memory, etc.) and behavioral functioning

Psychotherapy Philosophy

• We understand and appreciate that we are “hired” to assist individuals in a very personal and difficult, but rewarding journey.
• Assessment of the problem through open discussion of perceived problems, test data, and information from significant others.
• Mutually decide on goals and frequency of treatment.
• Methods to identify progress are mutually agreed upon by both parties.
• We rely on solution focused, usually short term, and evidence based principles.

Child Psychotherapy Philosophy

• We do our homework! Prior to seeing a child we collect data from a variety of sources. History, records, and questionnaires are reviewed.
• Call and talk to us about our years of experience, orientation of treatment and personal background before we see your child.
• Child centered. Even young children know what problems they are experiencing. If asked the right way, they often know why.
• Parent focused. We often serve as consultants to parents to help them help their children. After all, parents know their children best and spend the most time with them.
• We utilize our knowledge of brain-behavior relationships to understand why difficulties are occurring and how to remediate them.
• We welcome the opportunity to talk to educators, attend conferences, or even observe children outside the office (school or home).

Medical/Neurodevelopmental Traumatic Brain Injury Chronic Pain Attention Deficit Hyperactivity Disorder Asperger’s Seizures/Epilepsy Headaches Learning Disabilities Memory Problems Coordination and Movement Disorders Sleep Disorders

Personality/Emotional Anxiety Depression Obsessive Compulsive Disorder Adjustment to Life Changes (e.g. death, divorce) Posttraumatic Stress Bipolar Disorder School or Social Avoidance Eating and Self-destructive Disorders Behavioral Dyscontrol Aggression Bullying Oppositional Defiant Behavior

Problems Treated

Medical/Neurodevelopmental Traumatic Brain Injury Chronic Pain Attention Deficit Hyperactivity Disorder Asperger’s Seizures/Epilepsy Headaches Learning Disabilities Memory Problems Coordination and Movement Disorders Sleep Disorders

Personality/Emotional Anxiety Depression Obsessive Compulsive Disorder Adjustment to Life Changes (e.g. death, divorce) Posttraumatic Stress Bipolar Disorder School or Social Avoidance Eating and Self-destructive Disorders Behavioral Dyscontrol Aggression Bullying Oppositional Defiant Behavior

Treatment Modalities

• Individual (CBT, supportive, insight)
• Family Therapy
• Group Therapy (e.g. social skills, depression, TBI)
• Parenting (Teaching of Response Cost Management)
• Biofeedback/Neurofeedback

The majority of our patients are cognitively compromised due to some cortical event. Often we help our clients improve attention and concentration, response inhibition, organize, sequence, process, and acquire and retain information.

We utilize a “coaching” instructional model that incorporates available neuropsychological data. While we teach foundational skills, applications are tied to the client’s needs. We want skills to be useful to the individual. As progress is noticed at home (where patients are strongly encouraged to practice and rehearse), motivation is increased. The goal is not to be successful only in our office but in the home, school, or work environment. It is critical that gains generalize to different skills and settings.

Some individuals require the addition of relaxation training, biofeedback, or neurofeedback.

Diagnostic groups help through cognitive rehabilitation:

• ADHD
• Learning Disabilities
• Mild Cognitive Impairment (dementia)
• TBI