Pediatric Neuropsychological Evaluations
If you’re concerned about your child’s learning, attention, behavior, or emotional functioning, and you want a clearer understanding of what is driving those challenges, a pediatric neuropsychological evaluation can be an excellent next step. We begin with a thorough parent interview and review of relevant records, followed by testing tailored to your child’s age and referral questions, with breaks built in to support comfort and stamina. After testing, we meet for a feedback session to explain results in clear, supportive language and provide practical, school-ready recommendations, followed by a comprehensive written report.
Conditions We Evaluate
Every child is different, and so is every evaluation. Below are some of the most common reasons families in Michigan and beyond seek a pediatric neuropsychological evaluation at Brush Neuropsychology Services. Each section provides an overview of the condition, what to look for, and how testing can help. If you don’t see your specific concern listed, please reach out. We are happy to discuss how an evaluation may be a helpful next step for your child.
Pediatric Evaluations
- ADHD and Executive Dysfunction
- Anxiety and Avoidance
- Autism and Social Communication
- Cancer-Related Cognitive Changes
- Capacity
- Concussion and TBI
- Depression
- Dyscalculia
- Dysgraphia
- Dyslexia
- Epilepsy and Seizure Disorders
- Fetal Alcohol and Prenatal Substance Exposure
- Genetic Disorders
- Giftedness
- High-Stakes Testing Accommodations
- Intellectual Disability and Developmental Delay
- IQ and Cognitive Assessment
- Language and Communication Disorders
- Learning Disorders and Academic Skills
- Long Covid
- Motor, Visual-Motor, and Sensory-Based Difficulties
- Obsessive-Compulsive Disorder (OCD)
- PTSD and Trauma
- Twice-Exceptional
ADHD and Executive Dysfunction
What is ADHD?
Attention-Deficit/Hyperactivity Disorder (ADHD), also previously referred to as ADD, is a neurodevelopmental condition that affects attention regulation, impulse control, and executive functioning skills such as planning, organization, task initiation, and time management. ADHD can present differently across the lifespan. In children, it may show up as restlessness, difficulty following directions, and inconsistent academic performance. In teens and adults, it often looks like chronic disorganization, missed deadlines, difficulty sustaining effort on routine tasks, and mental overload.
Common signs and symptoms
- Distractibility or difficulty sustaining focus
- Disorganization, losing items, forgetting tasks or deadlines
- Trouble starting tasks, procrastination, difficulty estimating time
- Executive dysfunction
- Impulsivity in conversation or decision-making
- Restlessness or difficulty staying still
- Strong ability with inconsistent output
Common look-alikes and co-occurring concerns
Inattention is not specific to ADHD. Anxiety, depression, sleep problems, learning disorders, concussion history, medication effects, and chronic stress can mimic or worsen ADHD-like symptoms. Many individuals also have overlapping learning differences or emotional concerns that affect daily functioning.
How a neuropsychological evaluation helps
A neuropsychological evaluation clarifies whether ADHD is the best explanation for ongoing difficulties using more than just questionnaires. Evaluation identifies the specific mechanisms contributing to symptoms (for example, working memory limits, slowed processing speed, weak inhibition, or reduced sustained attention). Formal evaluation is often required to receive necessary accommodations, guide treatment, and results can support school planning, workplace accommodations, and a practical strategy plan.
What an ADHD evaluation typically includes
A typical evaluation includes a detailed interview and history review, record review when available, and standardized testing across attention, executive functioning, processing speed, learning and memory, and other domains as needed, along with thorough questionnaires.
Anxiety and Avoidance
Why anxiety is evaluated in neuropsychology
Anxiety can significantly affect cognitive efficiency. When the brain is in a heightened threat state, attention becomes harder to sustain, working memory becomes overloaded, processing speed slows, and test performance becomes less consistent. Anxiety can also lead to avoidance, which reduces learning opportunities and increases stress over time.
Common signs and concerns
- Persistent worry, perfectionism, or fear of making mistakes
- Avoidance of school, assignments, or social situations
- Physical complaints such as headaches or stomachaches
- Panic symptoms or shutdown under pressure
- Difficulty speaking in certain settings (selective mutism)
- Inconsistent performance that worsens with evaluation demands
- Restlessness or difficulty relaxing
Common look-alikes and overlaps
Anxiety can mimic ADHD or amplify learning problems. It can also co-occur with ADHD, learning disorders, and depression. A neuropsychological evaluation helps clarify whether cognitive concerns are primarily skill-based, attention-based, anxiety-driven, or a combination.
How testing helps
Evaluation identifies how anxiety affects cognition and access to learning. Results can inform school recommendations that reduce impairment, improve predictability, and support performance without reinforcing avoidance. It also helps guide next-step referrals and provides a clear explanation of why the individual is struggling.
Autism and Social Communication
What is Autism Spectrum Disorder?
Autism Spectrum Disorder involves differences in social communication and patterns of restricted or repetitive behaviors, interests, or routines. Many individuals with autism also experience sensory sensitivities, differences in flexibility, and executive functioning challenges. Presentations vary widely; some people have obvious social communication differences from early childhood, while others are identified later when academic, social, or emotional demands increase.
Common signs and concerns
- Difficulty interpreting social cues or navigating peer relationships
- Differences in conversation reciprocity or pragmatic language
- Preference for predictability, routines, and sameness
- Distress with unexpected changes or transitions
- Intense interests, repetitive behaviors, or repetitive speech
- Sensory sensitivities (noise, textures, light) or sensory seeking
How neuropsychological testing helps
A neuropsychological evaluation builds a detailed profile of strengths and needs across attention and executive functioning, learning and memory, language and pragmatic communication, visuospatial skills, adaptive functioning, and emotional functioning. The goal is not just a label but a clear explanation of how the person processes information and interacts with their environment, with recommendations that translate directly to home, school, and community settings.
Cancer-Related Cognitive Changes
Why cancer and treatment can affect cognition
Cognitive changes can occur during or after cancer treatment due to chemotherapy, radiation, surgery, fatigue, sleep disruption, stress, mood symptoms, and medication effects. Many people describe “brain fog,” reduced stamina, or difficulty returning to prior levels of efficiency at work or school.
Common concerns
- Slowed processing speed and reduced mental stamina
- Difficulty concentrating and multitasking
- Word-finding inefficiency
- Memory inefficiency, especially under fatigue or stress
- Increased effort required for routine cognitive tasks
How neuropsychological testing helps
A neuropsychological evaluation characterizes cognitive strengths and weaknesses and clarifies contributing factors such as sleep, fatigue, stress, and mood. Results support practical strategies and accommodations when needed, including return-to-work planning, workload modification recommendations, and compensatory approaches. Baseline testing can also help monitor change over time.
Capacity
What is a capacity evaluation?
A capacity evaluation assesses whether an individual has the cognitive ability to make a specific decision or perform a specific function at a particular point in time. Capacity is not all-or-nothing and is not a global label. A person may have capacity for some decisions and not others, depending on the complexity of the task, cognitive status, and available supports.
Common referral questions
- Ability to understand and make medical decisions
- Ability to manage medications safely
- Ability to handle financial tasks and budgeting demands
- Ability to live independently with or without supports
- Ability to continue driving
- Decision-making abilities during cognitive decline or medical illness
How neuropsychological testing helps
A comprehensive evaluation measures cognitive abilities directly relevant to the capacity question (memory, attention, reasoning, executive functioning, language), assesses functional skills and practical judgment, identifies supports that may enhance functioning, and provides clear documentation describing findings, reasoning, and recommendations.
Concussion and TBI
What is a concussion or traumatic brain injury (TBI)?
A traumatic brain injury (TBI) is an injury to the brain caused by an external force, such as a fall, motor vehicle accident, sports injury, or other force to the head. Mild TBI, or concussion, can temporarily affect attention, processing speed, memory efficiency, sleep, and emotional regulation. The impact of any TBI can vary widely depending on injury severity, medical complications, and factors such as sleep, pain, stress, and mental health.
How neuropsychological testing helps
Neuropsychological testing clarifies which cognitive systems are affected and which remain strengths, identifies factors that may be amplifying symptoms (such as sleep disruption, pain, anxiety, or depression), and translates findings into practical recommendations including return-to-learn and return-to-work planning, pacing strategies, and rehabilitation planning when recovery is more complex.
Depression
How mood affects thinking
Depression can reduce energy, motivation, initiation, and cognitive efficiency. People may notice slowed thinking, difficulty concentrating, indecision, reduced mental stamina, and memory complaints. These experiences are real, and they can impact performance even when underlying cognitive abilities remain strong.
Common concerns
- Low mood or irritability, loss of interest, reduced drive
- Fatigue, low initiation, difficulty sustaining effort
- Slowed processing speed or feeling mentally “foggy”
- Concentration problems and inconsistent performance
- Sleep disruption that worsens cognitive functioning
Why neuropsychological evaluation can be helpful
Cognitive complaints can be caused by many factors. Sometimes they reflect mood, stress, sleep disruption, or burnout. Other times there is an underlying learning, attention, medical, or neurologic contributor. Neuropsychological evaluation helps clarify the most accurate explanation, identifies which cognitive systems remain strengths, and provides practical recommendations for school, work, and home.
Dyscalculia
What is dyscalculia?
Dyscalculia is a learning disorder that affects number sense, calculation, math fact fluency, and/or math reasoning. Some individuals struggle with foundational quantity concepts and math facts. Others can do math but lose accuracy or efficiency when tasks become multi-step, time-pressured, or language-heavy. Math difficulties often lead to anxiety and avoidance.
Common signs and concerns
- Weak number sense (estimating, comparing quantities, understanding place value)
- Slow or inaccurate math facts; heavy reliance on counting strategies
- Difficulty learning procedures and keeping steps in mind
- Trouble with word problems, translating language into math
- High math anxiety, avoidance, or shutdown during math tasks
How neuropsychological testing helps
Evaluation clarifies whether a dyscalculia pattern is present, separates fact fluency issues from reasoning and language-based math demands, identifies cognitive contributors (working memory, attention, processing speed), and provides practical recommendations for instruction targets and accommodations.
Dysgraphia
What is dysgraphia?
Dysgraphia refers to persistent difficulty with written expression. For some individuals, the challenge is producing written output efficiently (handwriting speed, legibility, fatigue). For others, the challenge is language-based (spelling, grammar) or executive-based (planning, organizing ideas, revising). Many people with dysgraphia have strong ideas and verbal reasoning, yet writing is slow, effortful, and does not reflect what they know.
Common signs and concerns
- Slow writing, short answers, or incomplete written work
- Hand fatigue, discomfort, or significant effort to keep up
- Poor spelling, grammar, or sentence structure
- Difficulty organizing ideas, starting writing tasks, or revising
- Avoidance of writing-heavy classes or assignments
- Written work that seems “below” verbal ability
How neuropsychological testing helps
Evaluation clarifies the roles of processing speed, working memory, and attention, identifies strengths that can support compensatory strategy use, and provides school-ready recommendations including assistive technology, reduced copying, alternative response formats, extended time, and writing scaffolds.
Dyslexia
What is dyslexia?
Dyslexia is a language-based learning disorder that affects accurate and fluent word reading and often spelling. Dyslexia is not caused by low intelligence or lack of effort. Many individuals with dyslexia understand material well when it is presented verbally, yet reading is slow, effortful, and fatiguing.
Common signs and concerns
- Slow, effortful reading; avoids reading aloud
- Difficulty sounding out unfamiliar words
- Persistent spelling challenges and inconsistent spelling patterns
- Reading fatigue, headaches, or reduced stamina with longer assignments
- Strong listening comprehension but weaker reading comprehension
- Family history of reading difficulties
How neuropsychological testing helps
A comprehensive evaluation determines whether the pattern is consistent with dyslexia, clarifies the specific mechanisms involved (phonological processing, rapid naming, decoding, fluency, orthographic processing), identifies strengths that support learning and compensation, and provides practical recommendations for intervention targets and accommodations.
Epilepsy and Seizure Disorders
Why seizures can affect cognition
Epilepsy and seizure disorders can affect thinking in ways that vary by seizure type, seizure frequency, sleep disruption, medications, and the brain systems involved. Some people notice consistent changes; others experience fluctuations tied to fatigue, stress, or seizure activity.
Common concerns
- Memory inefficiency or inconsistent recall
- Attention lapses and reduced cognitive stamina
- Word-finding difficulty or slowed language efficiency
- Slowed processing speed
- Academic or work performance changes
How neuropsychological testing helps
Neuropsychological evaluation provides a detailed profile of cognitive strengths and weaknesses, clarifies functional implications, and helps identify contributors such as sleep, mood, and medication effects. It can support school and workplace recommendations and provide objective baseline data for monitoring change over time.
Fetal Alcohol and Prenatal Substance Exposure
What is prenatal substance exposure in a neuropsychology context?
Prenatal exposure to alcohol and other substances can affect brain development and later functioning. Fetal Alcohol Spectrum Disorders (FASD) include a range of possible impacts on cognition, behavior, learning, and adaptive functioning. Some individuals have obvious early developmental concerns. Others present later with attention, executive functioning, learning, or emotional regulation difficulties that become more noticeable as demands increase.
Common signs and concerns
- ADHD-like symptoms, impulsivity, and inconsistent attention
- Executive functioning difficulties (planning, organization, time management)
- Learning and memory inefficiency, trouble generalizing skills
- Social judgment challenges and vulnerability in peer relationships
- Emotional dysregulation, frustration tolerance concerns
- Adaptive functioning difficulties that do not match verbal ability
How neuropsychological testing helps
Evaluation characterizes strengths and weaknesses across attention, executive functioning, learning and memory, language, processing speed, and adaptive skills. It clarifies overlapping diagnoses and translates findings into practical recommendations for school, home routines, and daily supports.
Genetic Disorders
Why neuropsychology evaluates genetic conditions
Genetic conditions can influence brain development and learning in distinct ways. Neuropsychological evaluation helps clarify the cognitive profile, learning style, and adaptive functioning needs that guide educational programming, therapies, and long-term planning. Even within the same diagnosis, strengths and challenges can vary widely.
Common reasons for referral
- Clarifying strengths and needs for school services and planning
- Learning and memory concerns, slower processing speed, attention difficulties
- Language development differences and communication efficiency
- Executive functioning challenges affecting daily routines
- Adaptive skill development and independence planning
- Monitoring development over time, especially during transitions
How neuropsychological testing helps
Evaluation describes cognitive strengths and weaknesses, clarifies learning style and best instructional approach, assesses adaptive functioning, supports school programming decisions and transition planning, and establishes a baseline for tracking changes over time.
Giftedness
What does “gifted” mean in evaluation?
Giftedness generally refers to advanced cognitive abilities or exceptional strengths in specific domains such as verbal reasoning, abstract problem-solving, or learning efficiency. Gifted students may learn quickly, think deeply, and show strong curiosity. At the same time, giftedness can come with uneven development, perfectionism, intensity, or underachievement when the learning environment is not a good fit.
Common reasons families seek an evaluation
- Questions about gifted identification or placement
- A child who appears far ahead in some areas but struggles in others
- Underachievement or boredom in school
- Strong reasoning but inconsistent grades or work completion
- Perfectionism, test anxiety, or avoidance
How neuropsychological testing helps
Evaluation identifies cognitive strengths and learning style in detail, clarifies whether academic output matches potential and why it may not, provides guidance for instructional fit, pacing, enrichment, and support needs, and helps families and schools understand intensity, perfectionism, and executive skill development.
High-Stakes Testing Accommodations
Why students struggle on high-stakes tests
Many students know the material but underperform on timed or high-pressure testing. Common drivers include ADHD and executive functioning weakness, reading fluency difficulties, processing speed limitations, anxiety and panic symptoms, working memory strain, or written expression bottlenecks.
Common concerns
- Strong classroom performance but lower standardized test scores
- Running out of time despite knowing answers
- Slow reading, re-reading passages, difficulty finishing sections
- Losing focus mid-test, careless mistakes under speed pressure
- Severe test anxiety, freezing, or shutdown
How neuropsychological testing helps
Evaluation identifies the cognitive and emotional factors limiting performance, distinguishes skill-based issues from anxiety-driven inefficiency, documents functional limitations, and clarifies which supports are likely to improve access to testing conditions. While no evaluation can guarantee accommodations approval, a comprehensive assessment provides clear evidence about how a disability affects test performance.
Intellectual Disability and Developmental Delay
What is developmental delay or intellectual disability?
Global Developmental Delay (typically used for very young children) and Intellectual Disability involve broader delays in cognitive development and adaptive functioning. Adaptive functioning refers to real-world skills such as communication, daily living tasks, social skills, and independence.
Common signs and concerns
- Delays in speech and language, learning, or problem-solving
- Difficulty acquiring age-expected academic skills
- Need for repeated instruction and high structure
- Difficulty generalizing learning across environments
- Delayed development of independence and daily living skills
How neuropsychological testing helps
A neuropsychological evaluation provides a detailed, strengths-based profile that helps families and schools understand how the child learns, what supports are needed, and which goals are realistic and meaningful over time. It can clarify the pattern and severity of cognitive delays, assess adaptive functioning, and support educational planning and service eligibility decisions.
IQ and Cognitive Assessment
What is an IQ assessment?
An IQ assessment is a standardized measure of cognitive abilities compared to others of the same age. It helps answer questions about how a person reasons, solves problems, learns new information, and processes language and visual information. IQ testing is often used as part of educational planning, admissions testing, diagnostic clarification, and identifying learning strengths and vulnerabilities.
Common reasons people request IQ testing
- School admissions or program placement decisions
- Gifted identification or clarification of uneven learning profiles
- Learning concerns where a cognitive baseline is needed
- Clarifying how cognitive strengths and weaknesses affect performance
- Establishing documentation for educational planning and supports
What IQ testing can and cannot tell you
A high-quality IQ assessment provides valuable information, but it does not directly measure many important human capacities such as creativity, kinesthetic learning, musical ability, interpersonal skills, or emotional insight. For some referral questions, pairing IQ testing with additional assessment gives a more complete picture.
Language and Communication Disorders
What are language and communication disorders?
Language disorders involve difficulty understanding language (receptive language), expressing language (expressive language), or understanding social use of verbal and nonverbal language (pragmatic language). These difficulties can affect learning across subjects, reading comprehension, writing development, and social communication.
Common signs and concerns
- Difficulty following multi-step directions
- Challenges understanding complex or abstract language
- Limited vocabulary growth or frequent word-finding pauses
- Difficulty telling a clear story or explaining reasoning
- Reading comprehension weaker than decoding accuracy
- Written work that does not match verbal ability
How neuropsychological testing helps
Evaluation identifies whether the core issue is language processing, learning, attention, memory, executive functioning, or a combination. Results guide practical recommendations for school supports and accommodations and can clarify whether referral for speech-language services may be useful.
Learning Disorders and Academic Skills
What are learning disorders?
Specific Learning Disorders are brain-based differences that affect the development of academic skills. Common areas include reading (dyslexia), written expression (dysgraphia), and mathematics (dyscalculia). These concerns are not due to low intelligence or poor motivation. Many individuals work extremely hard yet continue to struggle because foundational skills have not become efficient or automatic.
Why neuropsychological testing matters
Academic struggles can result from different pathways: a true skill deficit, language weaknesses, ADHD or executive functioning difficulties, slowed processing speed, working memory constraints, anxiety, or instructional gaps. A neuropsychological evaluation clarifies the primary drivers and how overlapping factors contribute. Results translate into practical recommendations for intervention targets, accommodations, and classroom supports.
Long COVID
Why post-viral syndromes can affect cognition
Some individuals experience persistent cognitive symptoms after viral illness, often described as brain fog. Common domains include attention, processing speed, working memory, and stamina. Symptoms are frequently influenced by fatigue, sleep disruption, autonomic symptoms, pain, mood, and other medical factors.
Common concerns
- Mental fatigue and reduced cognitive endurance
- Slowed processing speed and difficulty multitasking
- Concentration problems later in the day
- Working memory strain, losing track mid-task
- Word-finding inefficiency or slowed retrieval
How neuropsychological testing helps
Evaluation provides objective data about cognitive functioning and real-world impact. It helps determine whether the pattern reflects reduced stamina and efficiency versus a primary memory disorder, clarifies contributing factors, and generates practical strategies for work, school, and daily routines. Baseline testing can also be useful for tracking improvement over time.
Motor, Visual-Motor, and Sensory-Based Difficulties
Why output barriers matter
Some individuals understand material well but struggle to show what they know. Output barriers can include slow handwriting, fine motor inefficiency, weak visual-motor integration, processing speed limits, coordination patterns, and sensory factors that affect stamina and regulation.
Common signs and concerns
- Slow handwriting, fatigue, or pain with writing
- Difficulty copying accurately and efficiently
- Messy spacing, inconsistent legibility, or poor visual organization
- Coordination challenges affecting tasks and sports
- Strong verbal reasoning with weak written production
- Sensory sensitivities that interfere with attention or endurance
How neuropsychological testing helps
Evaluation clarifies whether the core issue is fine motor speed, visual-motor integration, processing speed, attention and executive functioning, language organization, learning disorders, or a combination. This matters because the recommended supports differ depending on the root cause.
Obsessive-Compulsive Disorder (OCD)
What is OCD?
Obsessive-Compulsive Disorder involves intrusive thoughts and repetitive behaviors or mental rituals intended to reduce distress. OCD can consume time, narrow attention, and disrupt daily routines. Symptoms may present as reassurance-seeking, checking, repeating, fear of mistakes, or rigid routines. It also often leads to slowed efficiency, avoidance, and significant interference with work and daily life.
Common signs and concerns
- Excessive checking or repeating
- Rigid routines, fear of mistakes, “stuck” thinking
- Slow completion due to compulsions or perfectionism
- Avoidance of triggers and distress when interrupted
- Difficulty shifting attention away from intrusive thoughts
Why neuropsychological testing can help
OCD-related difficulties can resemble processing speed weakness or ADHD. Evaluation clarifies which mechanisms are driving functional difficulty and identifies strengths that can support intervention planning and day-to-day strategies.
PTSD and Trauma
Why these concerns show up in neuropsychology
Trauma exposure and chronic stress can shift the brain into a heightened threat state, affecting attention, working memory, sleep, and emotional regulation. Eating disorders can be associated with cognitive rigidity, perfectionism, reduced flexibility, impaired concentration, and slowed thinking, particularly when sleep, nutrition, and medical stability are affected.
Common concerns
- Difficulty concentrating or staying mentally organized
- Memory inefficiency under stress or during emotional activation
- Hypervigilance, shutdown, avoidance, or irritability
- Reduced stamina and worsening performance over the day
- Cognitive rigidity and trouble shifting strategies
How neuropsychological testing helps
Neuropsychological evaluation clarifies whether cognitive symptoms are primarily related to stress and regulation, medical factors, attention and executive functioning constraints, or another neurologic contributor. It identifies strengths and vulnerabilities and links results to real-world recommendations for school or workplace functioning.
Twice-Exceptional
What does twice-exceptional mean?
Twice-exceptional, often called 2e, refers to individuals who are gifted and also have a disability or condition that affects learning or daily functioning. Common combinations include giftedness with ADHD, dyslexia, dysgraphia, dyscalculia, autism, anxiety, or other executive functioning and learning differences. Because strengths can compensate for challenges, some 2e learners go unidentified for years.
Common signs and concerns
- High reasoning ability with inconsistent academic output
- Strong oral expression but weak written work
- High comprehension but slow reading or poor fluency
- Significant effort required to keep up despite high capability
- Perfectionism, overwhelm, avoidance, or burnout
How neuropsychological testing helps
Evaluation identifies gifted strengths and areas of vulnerability in a unified profile, clarifies diagnoses when symptoms overlap, provides school-ready recommendations that support both challenge and access, and guides accommodations and interventions without lowering expectations.
- ADHD and Executive Dysfunction
- Anxiety and Avoidance
- Autism and Social Communication
- Cancer-Related Cognitive Changes
- Capacity
- Concussion and TBI
- Depression
- Dyscalculia
- Dysgraphia
- Dyslexia
- Epilepsy and Seizure Disorders
- Fetal Alcohol and Prenatal Substance Exposure
- Genetic Disorders
- Giftedness
- High-Stakes Testing Accommodations
- Intellectual Disability and Developmental Delay
- IQ and Cognitive Assessment
- Language and Communication Disorders
- Learning Disorders and Academic Skills
- Motor, Visual-Motor, and Sensory-Based Difficulties
- Obsessive-Compulsive Disorder (OCD)
- PTSD and Trauma
- Twice-Exceptional