Interpreting Results from a Neuropsychological Testing Report: An Introductory Guide
Neuropsychological testing is a critical tool that can aid in assessing cognitive functions and understanding the impact of neurological, medical, psychological, and social conditions on the brain. Through administering various tests and procedures, these reports provide a detailed profile of an individual’s cognitive abilities. Interpreting a neuropsychological report requires a nuanced understanding of both the data presented and the broader clinical context in which the assessment was conducted. Unless one is experienced in this field, the report can often seem confusing or overwhelming for parents, caregivers, educators, and other professionals. This article is a brief guide for family and non-psychological professionals on understanding the testing process.
- Understanding the Context
Neuropsychological testing is often a nuanced and specific process. In order to fully understand the report, the tester and reader need to clearly identify the following:
- Referral Question: Identify the specific reasons for the referral. For example, was the evaluation conducted to assess the impact of a traumatic brain injury on brain function, diagnose a neurodevelopmental condition such as Autism or ADHD, or evaluate for learning disabilities or cognitive and academic functioning that results from psychiatric or medical conditions?
- Patient Background: Review the patient’s medical, psychological, educational, and cultural history, including any previous psychological or neuropsychological evaluations. The patient background can often contextualize the referral question and current difficulties.
- Current Symptoms: Understand the patient’s presenting symptoms and complaints. Are there issues with memory, attention, language, or other cognitive domains? Do these impact everyday living or vocational activities? Are there mood-related issues that result from these symptoms? How do these symptoms align with the results of the testing?
- Reviewing the Testing Battery
Neuropsychological assessments often involve a battery of tests, each designed to evaluate different cognitive domains. In each testing report, tests are chosen to best help answer the referral question while putting it in the context of the patient's background and current symptoms.
There are countless tests that can assess different cognitive or neuropsychological functions, and each will be chosen to provide specific and nuanced feedback. Depending on each case, tests could assess various parts of the following:
- General Intelligence
- Executive Functioning
- Attention
- Memory
- Language
- Learning/Academic Skills
- Impulse Control and Regulation
- Problem-Solving
- Abstract Thinking
- Motor Coordination
- Social Skills and Perception
- Psycho-Educational Ability (Giftedness or Learning Disabilities)
- Personality
- Mood and Psychiatric Conditions
- Many others
Most Neuropsychological tests are typically interpreted by comparing an individual’s performance on the measure normative data from a similar population, comparing their performance to those who come from a similar background, often considering factors like age, education, ethnicity, gender, and culture. This is to ensure their performance is put into an appropriate context.
- Interpreting Test Scores
Upon administering the tests, the tester must then interpret the scores. The tester will take the Raw Scores (The actual number the test taker received on the test) and convert them into Standard Scores (e.g., percentiles, T-scores, scaled scores) to compare the test-taker to the normative data. You can find a list of various scores in the table below, along with what an average score is (also called the mean) and the standard deviation (how much individual scores typically deviate from the average). For example, if the mean score on a test is 100 and the standard deviation is 15, most people's scores will fall within 15 points above or below the mean (i.e., between 85 and 115). If your score falls within 85-115, you will likely have performed within the average range.
|
Standard Score |
Mean |
Standard Deviation |
Interpretation |
|
Scaled Score |
10 |
3 |
Scaled scores have a mean of 10. Scores above 10 indicate above-average performance, while scores below 10 indicate below-average performance. |
|
Standard Score |
100 |
15 |
Standard scores with a mean of 100 are typically used in intelligence testing. Scores above 100 are above average, and scores below 100 are below average. |
|
T-Score |
50 |
10 |
T-scores are scaled such that a score of 50 is average. Scores above 50 are above average, while scores below 50 are below average. |
|
Percentile Rank |
N/A |
N/A |
A percentile rank of 50 means the individual scored better than 50% of the normative sample. Higher percentiles usually indicate better performance. |
After finding the scaled scores for all of these tests, the tester will then examine these results to identify patterns of strengths and weaknesses across cognitive domains (Such as Intelligence, Memory, Language, etc…). They will use these results to identify whether there are consistent strengths and weaknesses that could indicate a specific neuropsychological condition or whether there is just a more generalized decline/regression. The tester will also look for discrepancies between cognitive domains, which may provide clues about possible underlying conditions.
- Considering Non-Cognitive Factors
Neuropsychological testing will also take into context and explore possible non-cognitive factors that could influence these results, including:
- Mood, Affect, and Psychiatric Conditions: Depression, anxiety, and other mood/psychiatric disorders can impact cognitive performance, particularly in areas such as attention and memory. Certain tests and measures may be used to explore possible psychiatric factors.
- Motivation and Effort: Suboptimal effort or low motivation can lead to deflated scores. Certain tests can be utilized to help assess the validity of test performance and might be utilized if that is a concern. On the other side, sometimes pressure to do well on these tasks can lead to test-taking anxiety, rushed thinking, and mistakes that might not reflect how a person does in a more ‘casual’ setting. This is why reports from people who know the person well (teachers, treating therapists, parents) help in the process of evaluating a person wholistically.
- Fatigue, Medication, and Other Biological and Environmental Factors: Physical factors like fatigue, sleep deprivation, or the effects of certain medications can influence cognitive performance. Sometimes, even small factors like thirst or hunger can negatively impact results. Efforts are always made to mitigate these issues.
- Interpreting and Communicating the Results
Once the tests have been scored and non-cognitive factors considered, neuropsychological testers then try and place these results into the test-taker’s life history and context, showing how these results are consistent or not consistent with what the patient, caregivers, providers, or educators have observed. They may also utilize data obtained from personal observation of the patient’s behavior through test administration or classroom observation.
Ideally, all of this information from life history, behavioral observations, and testing data will help the tester understand the presenting issue and come to a helpful conclusion about the nature of the problem.
Afterwards, the tester will summarize their findings in a clear and succinct summary that includes the purpose of the testing, the findings, interpretations, and recommendations. It should be accessible to both the referring professional and the patient (or their family), avoiding overly technical language. The tester will review the report and these findings with the patient (and their family) and other involved parties.
- Recommendations
Perhaps most importantly, the tester will then discuss recommendations. Based on the results, these recommendations should be actionable and designed to build on the patient’s strengths while finding ways to overcome or adapt to their weaknesses. These may include further medical evaluations, psychological interventions, cognitive rehabilitation, or accommodations in work or school settings.
In school settings in particular, recommendations can often be specific for the patient, such as possible recommendations for how to study, take notes, or what classes to attend. There may also be specific recommendations that schools can accommodate, such as extended time, access to class notes, classroom positions, and others. Recommendations may also give some insight into what programs or environments may be of best interest for the patient, such as school programs, college support services, etc.
If you have any questions about the testing process, procedures, or recommendations, you can reach out to Dr. Robokos at This email address is being protected from spambots. You need JavaScript enabled to view it. or at (646) 233-0250.
