- What is a neuropsychologist?
- What is a neuropsychological assessment?
- I was referred for one of these, but I’m not really sure why. Why do people get neuropsychological assessments?
- What is a psychologist?
- I have problems concentrating. Does that mean I have ADHD? Can I take a test that will diagnose ADHD?
- I keep hearing about “executive functioning.” What does that mean? What is an Executive Functioning Disorder?
- What is “working memory”?
- I have problems with my memory. Does that mean I am developing Alzheimer’s disease?
- My child is scheduled for a neuropsychological evaluation. How should I explain it to him or her?
- What is a learning disability? Does it mean that someone is not smart?
- How can I learn more about the laws governing special education?
- What are the tests like? Will they be hard?
- I get very tired sitting for a long time. Can I take breaks?
- How long does testing take?
- How do I prepare for my evaluation?
- What do I need to bring with me?
- What if I need to cancel? Do you have a Cancellation Policy?
- How long does it take to get the report?
- Will I have a chance to discuss the test results with Dr. Imber?
- Do I need to stay on-site during my family member’s evaluation? Where can I go?
- Can a family member be in the room during the tests?
- Where can we get lunch?
- My child had an evaluation at school. Was this a neuropsychological assessment?
- Is Dr. Imber available to attend my child’s team meeting at school?
- What is the difference between an IEP and a 504 Plan?
- Why don’t you accept private insurance any more?
- Does a neuropsychologist prescribe medication?
- Tell me more about Cognitive-Behavioral Therapy. I’m not sure I want to be “in therapy” and I’d like to know more about what it means.
- I already have a therapist. Can I still participate in Cognitive-Behavioral Therapy for my ADHD?
- I’m looking for a therapist to treat something besides ADHD. Can Dr. Imber help me?
- I’ve read some conflicting things about working-memory training programs lately. Does Cogmed really work?
Don’t see your question? Suggest that we add it to the FAQ.
Q: What is a neuropsychologist?
A: A neuropsychologist is a doctor with specialized training in the diagnosis, interpretation, assessment, rehabilitation, and treatment of brain-behavior relationships. Neuropsychology is a sub-specialty of clinical psychology; clinical neuropsychologists are licensed psychologists with advanced training in brain functioning and its interaction with human behavior. For a more detailed definition, please see the National Academy of Neuropsychology’s Position Paper “Definition of a Neuropsychologist.”
Q: What is a neuropsychological assessment?
A: A neuropsychological assessment is a way of learning more about a person’s mind, brain, emotions, and learning style by asking that person to participate in several different tasks. These tasks test many kinds of abilities, such as problem-solving, language skills, visual/spatial skills, organization / planning, reasoning, attention / concentration, and memory. In addition, the neuropsychologist (who is also a clinical psychologist) will conduct a clinical interview to learn more about symptoms, medications, medical and psychiatric history, and other important areas. The neuropsychologist will often spend several days analyzing the data, reviewing records, and writing a report that explains the reasons for the testing, the person’s history, test results (including a person’s strengths and weaknesses), and recommendations / referrals for future treatment.
Q: My doctor referred me for an evaluation, but I’m not really sure why. Why do people get neuropsychological assessments?
A: People seek neuropsychological assessment for many different reasons. Some people are referred by their physicians to get more information about a problem they have described with their memory or attention, or to find out how a medical or psychological problem may be affecting their brain health. Parents may seek assessment for their children to better understand their child’s behavior and learning profile. Adults sometimes seek assessments to see whether they have undiagnosed learning disabilities and/or ADHD. People of all ages can benefit from an assessment after there has been a change in brain health, such as a stroke, traumatic brain injury, or dementia. Neuropsychological assessment can help with diagnosis and can provide key information about a person’s strengths and weaknesses, ability to complete daily tasks, and treatment needs.
Q: What is a psychologist?
A: Psychology is the study of mind and behavior. A psychologist has a doctoral degree (usually a Ph.D., Psy.D., or Ed.D.) in psychology. Different psychologists may do different types of work, including teaching, research, consultation, clinical care, or a combination of these. In order to practice as a clinical psychologist who provides health care services, a practitioner must complete specialized predoctoral and postdoctoral training in the field of psychology and be licensed by the state(s) in which he or she practices. See also the American Psychological Association’s definition of Psychologist.
Q: I have problems concentrating. Does that mean I have ADHD? Can I take a test that will tell me whether I have ADHD?
A: Trouble concentrating can definitely be a symptom of ADHD, but it is also a common symptom of many other conditions and one that we all experience when we are tired, ill, or distracted. There is no one test that will diagnose ADHD—a detailed clinical interview reviewing your history is the most important tool in understanding why you may be having trouble concentrating, and whether this could be due to ADHD. However, a neuropsychological evaluation can be very valuable for those who have ADHD, because the disorder can be a little different for every person who has it. Neuropsychological assessment will enable your clinician to go a step beyond diagnosis, by explaining how ADHD affects your thinking and behavior in different types of situations.
Q: I keep hearing about “executive functioning.” What does that mean? What is an Executive Functioning Disorder?
A: Good question! The term “Executive Functioning” is used to describe a set of high-level cognitive skills that help us to achieve goals and accomplish tasks in the world. Because of their complexity, executive functions require cooperation among multiple areas of the brain (especially frontal, subcortical, and cerebellar brain networks, for those of you who like to know about brain anatomy!). These functions are complicated and are highly vulnerable to disruption in the case of neurological disease, developmental disorders like ADHD, or even minor ailments such as fatigue or the common cold. Examples of executive functions are attending selectively to one item rather than another (like screening out distracting noises from the environment); paying attention over a sustained period of time (without “zoning out” or daydreaming); organizing and planning a task; sequencing (putting information or steps in order); initiating an activity when it is appropriate (“getting started”); inhibiting inappropriate or impulsive behavior; stopping an activity when necessary; transitioning between activities or ways of thinking; thinking abstractly and creatively; and processing information rapidly and efficiently. These processes are central to most cognitive tasks; therefore, problems with attention and executive functioning can affect other areas such as memory, comprehension, and the orchestration of skilled movements. Some people can have a disorder of executive functioning as the result of a developmental condition such as ADHD, but it can also show up in neurological and psychiatric illness, as the result of a brain injury, or in other situations.
Q: What is “working memory”?
A: Working memory is the cognitive function, usually considered one of the executive functions (see above), which allows us to hold and manipulate information in mind while we perform some activity. We often must mentally resist distraction in order to keep this information in our thoughts. For instance, in order to understand what you are reading, you need to understand the meaning of the words on the page; you then need to hang onto this information while you read the next sentence, paragraph, and page. Your working memory is the ability that lets you keep this information in mind so you can follow the author’s thoughts, keep track of what’s happening in a story, or understand the “big picture” of what the author is trying to communicate. Working memory has been described as a “memory buffer” among folks who like computer analogies, or a “mental scratchpad” among cognitive scientists. Working memory limitations underlie the cognitive deficits in many disorders that affect executive functioning, including ADHD.
Q: I have problems with my memory. Does that mean I have Alzheimer’s disease?
A: Like attention, memory is a vulnerable brain function that can be affected by a lot of different things. Most people who notice memory problems are not developing Alzheimer’s disease. An evaluation, including a detailed history, can be a very helpful way to get information about the cause of your memory problems and what types of treatments can help to improve your memory and your day-to-day functioning.
Q: My child is scheduled for a neuropsychological evaluation. How should I explain it to him or her?
A: Dr. Imber will spend a little time at the beginning of the interview talking with your child about why people get neuropsychological assessments, but it’s a good idea for you to talk with your child first. Kids can be pretty insightful and usually know when something is wrong in school or at home, even if they don’t know the exact reason why there is a problem. It’s usually best to be honest with kids about the reasons for the assessment. For example, “You know how frustrated you get when you have to do writing for school? We want to understand why it’s hard for you and how we can help to make it easier.” Many children are worried that they are being asked to take the tests because someone thinks they are “dumb.” Other kids fear that the tests will be painful or involve needles. Reassure your child that these kinds of tests don’t involve needles. Most of the tests will be like puzzles; some will be like games; a few will be like tests in school, but with no grades. Some of it might be boring. The testing is a partnership—it only works if a child cooperates, and no one can force him or her to take the tests. If there are troubles with handwriting or fine-motor control, he or she may be relieved to hear that Dr. Imber will do most of the writing! Also reassure your child that everyone’s brain works a little bit differently, so people of all ages want to take these tests to learn more about how they think, and what they are good at as well as the areas where they need help. If your child has specific concerns about the evaluation, please tell Dr. Imber so that she can address them.
Q: What are the tests like? Will they be hard?
A: Many people picture “tests” as classroom examinations, or the SAT®. Actually, the tests given at a typical neuropsychological assessment are varied, and most are not very much like school tests. You will be completing most of them working together with the examiner. You may be asked to write or draw a little bit, but many of the tests are oral and interactive. Some tasks require you to manipulate objects on the testing table, or to look at a computer screen and press buttons. Some of the tests will seem easy, while some will seem very hard or complex. This is normal. No one is expected to have all of the answers, and everyone has areas of strength (things they are better at) and weakness (things that are harder for them). It is important to simply do your best. People who like puzzles and games may enjoy the tests; you may find them interesting or even fun! Most of them are fairly short; if you do not like one task, be patient, as you may prefer the next.
Q: What is a learning disability? Does it mean that someone is not smart?
A: Nope! Not at all. Actually, a learning disability may be clinically diagnosed when there is a significant difference between a person’s intelligence and his or her ability to make progress in school, despite good motivation and good opportunities to learn. For example, if someone is very bright and is working hard but can’t seem to get the hang of reading, he or she may be diagnosed with dyslexia (reading disorder).
Q: How can I learn more about the laws governing special education?
A: A special education law called IDEA 2004 changed the way that the educational system recognizes learning disabilities, so that the new definition is somewhat different from the clinical definition. You may wish to read more about the IDEA 2004 definition of specific learning disabilities as compared with prior definitions, or click here for further resources about IDEA 2004.
Q: I get very tired sitting for a long time. Can I take breaks?
A: Yes, in most cases a test can be stopped if you need a break. There will also be natural pauses between tests. It’s just fine to stop and get a drink of water, or use the bathroom, or have a snack—whatever keeps you at your best. Most testing sessions will last past lunchtime, in which case we will take a lunch break.
Q: How long does testing take?
A: Testing can take different amounts of time depending upon the problem being assessed. Usually the neuropsychologist will conduct an interview, which might include the patient as well as a family member such as a parent, spouse/partner, or child. The patient will also be interviewed separately. (Your interview will probably be completed at a separate appointment, with additional follow-up questions on the day of testing as needed.) The testing involves the patient only, and can take anywhere from two to seven hours. Plan on a full day for the evaluation, to allow enough time for interview, testing, and breaks.
Q: What do I need to bring with me?
A: Please see this page about how to prepare for your evaluation. Meanwhile, here is a checklist of what to bring to the appointment:
□ Completed History and Administrative Forms (if you have not already sent them in—please fax if you can)
□ Medical & Academic Records (such as CT/MRI, school or TEAM evaluation reports, reports from a neurologist, results of prior testing, etc., if you have not already sent these in—please fax if you can)
□ Glasses or contacts, if needed
□ Hearing aid, if needed
□ Medications that you take during the day (take all medications as usual, including those for ADHD)
□ Lunch and snacks, or money for lunch and snacks
□ Layered clothing / extra sweater (it may be extremely warm or cold in the testing room; the heat and A/C are strong)
□ Insurance card, or a photocopy of the front and back
□ Payment/Co-Payment (due on date of service): Make your check payable to Michelle L. Imber, Ph.D., or pay with MasterCard, Visa, or Discover. Debit cards and Flex Spending Account cards may also be accepted, depending upon network.
Q: What if I need to cancel?
A: Call 617-487-8910 as soon as you can and leave a message that you need to cancel or reschedule. One or more days of a neuropsychologist’s time may be reserved for each assessment. This generally includes the face-to-face appointment as well as the additional time for tasks such as record review, interpretation, scoring, and report preparation. Once an appointment is scheduled, you will be expected to pay for it unless you provide five (5) business days’ advance notice of cancellation (or unless we both agree that you are unable to attend due to circumstances beyond your control). It is important for you to know that your insurance company will not provide reimbursement for cancelled sessions. If you “no-show” for a testing appointment without sufficient notice, you will be charged $500 to cover a portion of the reserved time. If you “no-show” for your therapy appointment without at least 24 hours’ notice, you will be charged half the cost of the scheduled session.
Q: How long does it take to get the report?
A: Report time can vary depending upon the complexity of the case, tests administered, clinical urgency, and several other factors. Expected turnaround time is around one month, although your report may be completed sooner or later than that. Please let Dr. Imber know if you have a deadline such as a medical appointment or school meeting for which this information is needed. While she cannot guarantee that your report will be completed by a particular date, she will make an effort to accommodate your needs.
Q: Will I have a chance to discuss the test results with Dr. Imber?
A: Yes; it is important that you understand the results of your evaluation. You have several options for doing this, usually once you have received and read the report. The flat-rate evaluation fee includes the cost of one hour of follow-up. If additional time is required, such sessions are billed at the hourly rate. If you are using Medicare, note that these sessions are often covered with your usual copayment. Please discuss any problems or concerns with Dr. Imber; it is important to her that you understand the test results.
Q: Do I need to stay on-site during my family member’s evaluation? Where can I go?
A: It is preferable that you remain in the immediate neighborhood while your family member is being evaluated, in case of emergency or if your family member simply wants some company during a break. This is especially important for younger children. There is a waiting area on the 2nd floor; coffee shops and park benches are available downstairs for a change of scene. Dr. Imber cannot be held responsible for accompanying patients to the restroom, supervision of eating, supervision of break times, etc., so please plan accordingly. Please provide a cell phone number or other way of reaching you if you will be leaving the 2nd floor.
Q: Can a family member be in the room during the tests?
A: No, in most cases it is very important that the neuropsychologist and the patient work together without anyone else in the room, to avoid distraction and to make sure that the test results are valid and useful. With young children or other folks who may be anxious, Dr. Imber will usually spend some time at the beginning of the assessment with everyone in the room together. That will enable us to get to know each other and answer any questions about the testing experience.
Q: Where can we get lunch?
A: The office is located in the heart of Newton Highlands, with several shops and restaurants within a one-block radius. Local coffee shops can be found downstairs and one block down Walnut Street. Special dietary restrictions may be accommodated at Walnut Grille, a vegetarian restaurant about two blocks away. Across Lincoln Street, there is a small specialty/international grocer (Walnut Market) with lots of choices for individuals with dietary restrictions. A small kitchenette with a fridge and microwave is located down the hall from Dr. Imber’s office. In nice weather, you may choose to picnic on a park bench downstairs. Please note: to keep the test materials and workspace clean, eating in the testing room is not permitted.
(Note: Dr. Imber does not specifically endorse other businesses, but is pleased to let patients know of area options that may meet special needs. Please clarify your allergies and any other restrictions with the individual locations to ensure that they can meet your needs.)
Q: My child had an evaluation at school. Was this a neuropsychological assessment?
A: Possibly, but probably not. Most school districts do not employ neuropsychologists. Your child probably had a “CORE” or “TEAM” evaluation, which may have included some tests that neuropsychologists also use. School districts rarely have doctors such as neuropsychologists or licensed psychologists administer these evaluations, which are more often conducted by academic specialists such as special education staff or school psychologists. Academic evaluations are conducted for a specific purpose, usually to identify areas of academic weakness or other disability that may qualify a student for special educational services or accommodations offered by the district. This type of assessment is not usually designed to provide broad information about diagnoses, treatment suggestions, or other clinical information about a child’s brain-behavior functioning. If your child has had a school evaluation, please share the results with Dr. Imber; these findings can be incorporated into the neuropsychological evaluation report and may spare your child from repeating the same tests. It may also be helpful for Dr. Imber to confer with school personnel, who can provide detailed input about your child’s school performance and behavior.
Q: Is Dr. Imber available to attend my child’s team meeting at school?
A: Unfortunately, Dr. Imber’s schedule will not permit her to attend IEP meetings in person. Sometimes she can arrange to be there by telephone. Please note that these services are never covered by insurance and will therefore be billed at the hourly rate. The reports are designed to be comprehensive, with clear recommendations, in order to make the best use of time and resources.
Q: What is the difference between an IEP and a 504 Plan?
A: These are both types of plans that can be granted to a student to enable him or her to have fair access to the curriculum. Simply stated, an IEP (or “Individualized Educational Plan”) usually is implemented when the student requires direct services and specialized instruction (for example, extra help in reading or math; pull-out speech therapy sessions). By contrast, a 504 Plan is implemented when a student’s disability requires reasonable accommodations (such as preferential seating or extended time on testing), but there is no need for specialized instruction. For more information, see this web page at the Massachusetts Department of Education.
Q: Why don’t you accept private insurance?
A: Until recently, this practice did deal directly with private insurance companies. Unfortunately, many carriers do not cover all the hours required to complete a full assessment, on top of which they have made steep cutbacks to the rate at which the assessment is covered. Literally hours of a psychologist’s time can be spent on insurance-related administrative tasks for each patient, filling out forms, filing appeals, and following up on unpaid claims. This time is never reimbursed by insurance companies. Sometimes an insurance carrier will pre-authorize services but fail to follow through on their agreements after services are complete. In order to continue providing high-quality, thorough assessment services with individual attention paid to each patient, it is simply not possible for this practice to continue accepting private insurance at the present time. Dr. Imber volunteers her time to advocacy efforts in the hope that unfair insurance practices can be reduced and access to services can be increased for more consumers. Meanwhile, our practice does accept some public insurance, including Medicare.
Q: Does a neuropsychologist prescribe medication?
A: Generally not. Neuropsychologists, like other clinical psychologists, do not have prescription privileges in most states (including Massachusetts). A few states do have specialized training programs that certify psychologists to become prescribers, and a few neuropsychologists also have training in other areas that permit them to prescribe medication; in general, though, the types of treatment offered by a neuropsychologist are behavioral interventions and therapy. Neuropsychologists do have specialized training and knowledge about the effects of psychoactive medications and may make recommendations for your prescribing doctor (such as a psychiatrist or neurologist) to consider.
Q: Tell me more about Cognitive-Behavioral Therapy. I’m not sure I want to be “in therapy” and I’d like to know more about what it means.
A: Cognitive-Behavioral Therapy (CBT) is probably different from other kinds of talk therapy you may have heard about or tried. It is very focused, goal-oriented, and structured. It is also educational; in some ways it is more like taking a class than being in treatment. Instead of coming in and talking about the problems that are bothering you on a given day, you and Dr. Imber will likely be following a schedule to address particular issues during a given session. For example, let’s say you are working on becoming more organized. Each session will have a different goal to help you learn organizational strategies. You’ll leave each session with a homework assignment. The following week, you’ll review the results of the assignment with Dr. Imber and troubleshoot any problems that occurred. CBT uses a scientific, problem-solving approach to treatment. It is very collaborative and will require you to be an active participant in the therapy. It won’t work unless you are willing to work at it!
Q: I already have a therapist. Can I still participate in Cognitive-Behavioral Therapy for my ADHD?
A: Generally, yes. If you are seeking insurance reimbursement for your work with Dr. Imber, you will need to check with your insurance carrier to find out whether you will be reimbursed out-of-network for this type of treatment. It is also important for Dr. Imber to coordinate with your therapist in order to figure out the best way to be of help to you, without interfering in your long-term therapy. Please let Dr. Imber know if you are already in psychotherapy of any kind.
Q: I’m looking for a therapist to treat something besides ADHD. Can Dr. Imber help me?
A: At this time, Dr. Imber is only offering CBT for the treatment of ADHD. If you’re looking for a psychotherapist, you have several options. One is to contact your insurance company (usually there is a “behavioral health” or “mental health” phone number) to find out who is in your provider network and what your therapy benefits are. Some plans will let you go out-of-network for an additional charge, while other plans require that you seek treatment from someone who participates in your health plan. If you are having trouble finding someone in-network, your health plan may be required to let you go out-of-network to get the treatment that you need in a timely fashion. Health plans do not usually know what a practitioner’s specialties are, so if you are looking for a treater to address a particular kind of problem, you may want to visit a local or national organization’s website. Some great options are the American Psychological Association’s Psychologist Locator, the Massachusetts Psychological Association’s Find-a-Psychologist Page, or a consumer group that addresses your condition (see the Resources Page for a listing of various consumer groups; most of these have links to help you find a provider in your area). If you are having a psychiatric emergency (such as thoughts of harming yourself or others), visit your local psychiatric or general emergency room and ask to speak to the psychologist or psychiatrist on call.
I’ve read some conflicting things about working-memory training programs lately. Does Cogmed really work?
A: There is a growing body of research about Cogmed Working Memory Training that suggests it is very effective. About 80% of people who complete the program will see significant improvements in their day-to-day functioning. In my opinion, and in the opinion of others, we still need more studies designed to understand HOW it is effective, since it can help different people in different ways–and most of the research we have so far has not separated out the many different types of benefits that people have described. At this point in time, Cogmed is supported by more peer-reviewed research than any other program of its kind–this means it has been looked at independently by scientists who don’t work for the company, to evaluate its claims objectively. The reason that I offer Cogmed and no other working-memory training programs in my practice is because I feel that the evidence for this program is very strong, but that we just don’t have enough evidence yet showing that other types of brain-fitness programs are worthwhile. I also respect that Cogmed has been very careful not to advertise any claims until there is solid research behind them.
There has been some controversy over recent review articles that lumped Cogmed in with some of its less-validated competitors and drew the conclusion that working memory training may not be effective. I, and many other scientists, think that the studies were flawed; that this conclusion does not apply to Cogmed; and that further studies are warranted to understand the way Cogmed works to improve daily functioning for individuals. Cogmed (the company) has itself compiled a list of concerns about the articles, which can be found in even more detail here in case you’d like to read more about this discussion for yourself.
In short, yes: research suggests that Cogmed does work for most people, but we cannot yet predict which individuals will see exactly which results. A good Cogmed provider–which, hopefully, is any Cogmed provider–will work with you to ensure the program is a good match before you invest your time and money in it.