Easy way to describe psych testing vs. neuropsych testing?

[DrSoon2016]

I'm having a hard time figuring out how in easy simple terms I could explain the difference between psych testing and neuropsych testing to clients/friends/family, could anyone help me with this?

Thanks!

---

Members don't see this ad.

 

[Justanothergrad]

The referral question?

 

[FreudianSlippers]

I don't know what you mean by "psych testing." I guess any time you ask a client a question about their background or give them a questionnaire is technically "psych testing" because you are trying to gather information.

Neuropsych testing is used to assess various strengths and deficits of specific cognitive functions in order to track one's symptoms over time, to develop appropriate accommodations and/or create a tailored treatment plan. Its a broad category and can be used for many different concerns including brain functioning after an injury or disease, academic functioning (developing 504 or IEP), ADHD/LD concerns, etc.

 

[Justanothergrad]

I don't know what you mean by "psych testing." I guess any time you ask a client a question about their background or give them a questionnaire is technically "psych testing" because you are trying to gather information.

I (and the assessment community by in large) would disagree - not everything is psychological testing. Gathering information alone is not sufficient to warrant being called testing.

 

[DrSoon2016]

I don't know what you mean by "psych testing." I guess any time you ask a client a question about their background or give them a questionnaire is technically "psych testing" because you are trying to gather information.

Neuropsych testing is used to assess various strengths and deficits of specific cognitive functions in order to track one's symptoms over time, to develop appropriate accommodations and/or create a tailored treatment plan. Its a broad category and can be used for many different concerns including brain functioning after an injury or disease, academic functioning (developing 504 or IEP), ADHD/LD concerns, etc.

Thank you for your response. that is extremely helpful. What if the referral question is diagnostic clarification, but in that report i am going to administer some cognitive batteries. Would that be considered a psych assessment or neuropsych testing?

 

[WisNeuro]

diagnostic clarification for what?

 

[Peacemaker36]

I have never had the impression that there is consensus in the field about the difference between psychological and neuropsychological testing.
Maybe I've been asking the wrong people?

 

[WisNeuro]

I would say there is a clear consensus among HCG trained neuropsychologists about the difference between psychological and neuropsychological testing.

 

[Peacemaker36]

Interesting. What do you think is the reason that there is so much confusion about it in the field?

 

[WisNeuro]

Poor training. People that want to practice outside of their scope/willful ignorance. Probably a few things.

 

[Justanothergrad]

I would say there is a clear consensus among HCG trained neuropsychologists about the difference between psychological and neuropsychological testing.

I'd be curious about how you would describe the differences but I assume its going to largely boil down to issues related to scope of evaluation/referral issues.

 

[PsyDr]

Bigler wrote about the differences in the Handbook of Rehabilitation Psychology. The key difference was in HOW the tests were used. Description of performance levels was different than inferring neuropathologies from test patterns.

 

[WisNeuro]

What PSYDR said. I'd also add the key part of a neuropsychological evaluation is the knowledge and expertise of the neuropsychologist. A trained dog can administer most tests, and they are largely the least important part of the eval. Knowledge of neuroanatomy, neuropathology, psychometrics is where it's at. The tests are just supporting information for what you already suspect.

 

[Justanothergrad]

Yeh, that makes sense. In my mind I conflate how something is used with the referral question at hand.

 

[psychedaboutpsych123]

Jumping in here- would a battery designed to assess for LD//ADHD be psychodiagnostic or neuropsych?

 

[WisNeuro]

We'd technically consider it diagnostic and psychoeducational. If you needed to also consider neuropathological differentials, it's be neuropsych, but also a very different eval

 

[Sanman]

In addition to what others have said, I do recall somewhere in my training a discussion about the fact that neuropsych testing should be assessing at least two domains of functioning.

 

[AbnormalPsych]

inferring neuropathologies from test patterns.

This. I hear people say they are "doing neuropsych testing" all the time, but they are not neuropsychologists and not doing this. They are simply doing cognitive and academic testing. Linking scores, profiles, interview to specific neuroanatomy and neuropathology is the difference maker (at least how I explain to trainees).

 

[psychedaboutpsych123]

Thank you all for that! That's been a blurry line for years and no one seems to ever have a clear cut answer.

So a battery that measures cognition, achievement, and EF would be psychodiagnostic NOT neuro, correct?

 

[AbnormalPsych]

Not neuro. Could be psychodiagnostic. Your referral question would determine this.

 

[AcronymAllergy]

Thank you all for that! That's been a blurry line for years and no one seems to ever have a clear cut answer.

So a battery that measures cognition, achievement, and EF would be psychodiagnostic NOT neuro, correct?

As mentioned above, it depends on what you're doing with, and saying about the results of that testing (especially since "cognition" is a broad term). And perhaps more importantly, who's doing the evaluation. Neuropsychological assessments can encompass achievement and/or psychoeducational testing, depending on the practitioner and intent of the evaluation.

But if we're talking "cognition" in the sense of adding a SB-5 or WAIS-IV on top of, say, a WJ Achievement with the intent of assessing for a learning disorder, I'd say that's probably psychoeducational. If you're starting to infer specific brain-behavior relationships, you're venturing into neuropsychology.

 

[erg923]

Whats the purpose of this beyond academic musing?

 

[PsyDr]

Thank you all for that! That's been a blurry line for years and no one seems to ever have a clear cut answer.

So a battery that measures cognition, achievement, and EF would be psychodiagnostic NOT neuro, correct?

Not necessarily. The Reitan Indiana Aphasia Screening Test has spelling and math in it. It's neuro.

The entire initial point of neuropsych is to differentiate psych from neuropathologies (i.e., organic vs non-organic). Back in the day, people were psych hospitalized for acting funny. Some of them dropped dead. Psychologists were asked if their tests could differentiate tumors from psychopathologies. They did. If you read the original Reitan manuals, the subjects in there were hilariously obviously neurological (e.g., hemiparesis). This is why the HRB original scale was designed only to differentiate organic vs not. Had zero to do with performance level.

The differentiation between "organic" vs "non-organic" then moved to localization. This is the hey day when neuropsych tests were used to plan neurosrugery. If you read Ruff's stuff, neuropsych was literally on call in major hospitals because neurosurgery. This is still the days skull x-rays. One of the reasons the LNNB had localization scales. Arguably this is also when neuropsych started to want to describe performance levels, not just say organic vs not. There are some extremely impressive things from this era, including ways to determine not only the location, but the type of tumor.

The advent of CT basically destroyed the entire point of localization. Neuropsychs moved to describe performance more, because that was what was left. You'll see more moves towards rehab planning in this era of literature. And a TON of in house fighting. AND a ton of attempts at stretching to apply neuropsych to new areas (e.g., minimal brain dysfunction, LD stuff, etc.). AND a ton of arguing about who is a real neuropsych. Wise people will notice the financial motivations here.

You'll notice nothing has really progressed since. Some tried to get MRI, fRMI, and even PET going. No one helped. A lot of successful professions stagnate for 40 years, right? Oh.....

This. I hear people say they are "doing neuropsych testing" all the time, but they are not neuropsychologists and not doing this. They are simply doing cognitive and academic testing. Linking scores, profiles, interview to specific neuroanatomy and neuropathology is the difference maker (at least how I explain to trainees).

Not really. If the purpose of the exam is diagnostic, then some cases have almost zero need for formal testing.

The entire scores thing is some throwback to how academia trains students. If one reads the literature about what is expected from families and patients, the point of the 15 page report becomes questionable at best.

 

[WisNeuro]

The entire scores thing is some throwback to how academia trains students. If one reads the literature about what is expected from families and patients, the point of the 15 page report becomes questionable at best.

Reviewed a report for a re-evaluation in which the author spent an entire page detailing family history, with report of early childhood attachment to parents, and a genogram. This was for a straightforward dementia eval.

 

[spo0fyspoof]

@PsyDr Very cool history lesson. Had NO idea that np had this kind of history. Do you think np people are going to have a harder time in the future to find jobs just because of how niche it is becoming? Or, they'll probably fend well because of how much np's generally charge for a full np battery.

 

[WisNeuro]

It will be harder for newer people in some areas. Also, it may be harder for people who are not boarded. It's going to be more about your networking and your perceived competency with referral sources. I've taken a big chunk of work from a few people in my area by getting in good with a Neurology practice, who now send me 100% of their referrals.

But, there will always be money out there for the incompetent providers, or those who are knowingly swindling people by offering evaluation and "treatment" for mTBI, ADHD, etc using qEEG and similar things.

 

[Sanman]

It will be harder for newer people in some areas. Also, it may be harder for people who are not boarded. It's going to be more about your networking and your perceived competency with referral sources. I've taken a big chunk of work from a few people in my area by getting in good with a Neurology practice, who now send me 100% of their referrals.

But, there will always be money out there for the incompetent providers, or those who are knowingly swindling people by offering evaluation and "treatment" for mTBI, ADHD, etc using qEEG and similar things.

Depends on how far down the line people are looking and where technology ends up going. If medical imaging takes a leap and dementia evals dry up I can see neuropsych and rehab running smack into each other. There will still be specialty areas where it is called for in adults. but bread and butter cases may be more difficult to come by for some people. I feel as if peds neuropsych has always leaned more towards the academic end of things, but that may be the way I was trained. Many of the referrals were from private schools for placement/ academic planning and particularly difficult to pin down cases (gifted,LD combos, a dysgraphia case I dxed that stands out in my mind, etc).

 

[WisNeuro]

More integration into rehab is definitely the way to hedge. I've already advocated for setting up things like a multidisclipinary clinic with neuroonc to help identify deficits and guide rehab with other specialties.

 

[erg923]

@PsyDr Very cool history lesson. Had NO idea that np had this kind of history. Do you think np people are going to have a harder time in the future to find jobs just because of how niche it is becoming? Or, they'll probably fend well because of how much np's generally charge for a full np battery.

1. Unless you are cash or forensic in some way, you get what the insurance industry ultimately agrees to pay you. Some carriers are pretty biased toward authorizing test batteries over a specific time-threshold (regardless of clinical question and complexity), and I think the new codes that came out this year are designed to discouraged the financial incentive for lengthy test batteries. That said, some carriers aren't, or don't even review neuropsych testing requests due to parity laws (which are very confusing and have multiple loop-holes), and one can thus get almost any much time as they desire to do a neuropsych eval.

2. Compensation for psych/npsych testing labor has increased little, considering inflation, since the late 1980s so far as I know. Not to mention the increasing cost of our tests and their associated materials. There is also increasing (seemingly) updated/revised versions of our fav tests, which we seem to be obligated to use due to guild ethics, even though they are only marginally better normed/constructed, if at all. I really like aspects of MMPI-Revised Form, but aside from this...it seems like a bit a mafia racket at this point.

3. Jobs will continue. Fewer compared to 10, 15-20 years ago? I'd say yes? Impact and relevance in the long-term? Eh, not so sure. I wouldn't actively discouraged it if its your true passion (and you know this from experience), but I would probably steer my children away from a PhD/Psy.D (various other reasons too).

 

[FreudianSlippers]

3. Jobs will continue. Fewer compared to 10, 15-20 years ago? I'd say yes? Impact and relevance in the long-term? Eh, not so sure. I wouldn't actively discouraged it if its your true passion (and you know this from experience), but I would probably steer my children away from a PhD/Psy.D (various other reasons too).

@erg923 care to elaborate on the last bit? Would love to hear your thoughts.

 

[erg923]

@erg923 care to elaborate on the last bit? Would love to hear your thoughts.

The "last bit" as in not encouraging my children to go into this profession? If so, that's another thread entirely.

In brief, I would just say that if one is committed to working hard, they can come out better as a moderately successful plumber, on average.
If one desires a "life of the mind" (as Meehl used to say), I might encourage similar, but frankly different careers. Personalty factors of course dictate alot of this, but I'm not even sure @Ollie123 is super happy....and he is about as hardcore academic as it gets? I briefly did SLAC, and I'm glad some posters here are happy/fulfilled in that role. But I wasn't. And, for me, it was hard to find a middle ground between clinical practice careers and academia that I could fit into or enjoy. And The VA did not seem like something I could move up in and do for another 25 years. And I even had a 20% clinical carve-out as the internship TD at the VA here.

But I found something, so I am am content now (and have a very small clinical thing on the side). But, yea, doing it over again...I may have gone to culinary school or become a meteorologist.

 

[Therapist4Chnge]

There have been a few threads obv here over the years about the outlook of the field, if people would do it again, if you regret becoming a psychologist, etc.

My short answer is meh...I probably should have kept going w my biz career, as i’d be much closer to financial freedom/retirement.

 

[Sanman]

There have been a few threads obv here over the years about the outlook of the field, if people would do it again, if you regret becoming a psychologist, etc.

My short answer is meh...I probably should have kept going w my biz career, as i’d be much closer to financial freedom/retirement.

Given, this board is comprised by a bunch of oddballs (myself included). However, it does make me curious if anyone more than 5 yrs out is still in love with the field.

 

[PsyDr]

@WisNeuro sounds like someone read allan schore's books.

@spo0fyspoof I am one of the few detractors about the future in neuropsych. If you ask most, they will tell you that they believe NP is okay for now, and that increased ways to restrict the trade (e.g., boarding as a legal requirement) is the way to save the profession. I honestly think that neuropsych, as I know it, is basically over in 20-25 years. If you read Ruff's speech ("a polite critique...") from like 2008, you'll see I'm not the only one. I know large imaging companies, with assets that far exceed anything psych companies have, are working on ways to put diagnostic neuropsych out of business. Hell, I worked for one. I believe that psych test publishers are working on ways to make psychologists into simple technicians which would ruin the idea of description of performance.

I don't know much about "jobs". Hopefully I'm wrong. I believe Wisneuro is right about rehab skills being s hedge. I also believe that people will always pay for their kids’ services which is a huge area of security. I’m banking on none of the above. I’m playing my own game. Follow the money, find untapped markets that have it. This is a job, not a priesthood.

 

[psychedaboutpsych123]

Thank you to everyone for clearing that up for me!

 

[LadyHalcyon]

The new codes help in terms of understanding what tests fall under the neuropsych testing category. However, the new codes for evaluation, interpretation, etc are more unclear because a mental status exam (for example) incorporates neuro.

 

[LadyHalcyon]

I completely disagree with this mentality. We need MORE psychologists so we can have MORE power, instead of being the red-headed stepchild of the medical profession

@erg923 care to elaborate on the last bit? Would love to hear your thoughts.

 

[WisNeuro]

I completely disagree with this mentality. We need MORE psychologists so we can have MORE power, instead of being the red-headed stepchild of the medical profession

No we don't, many areas are oversaturated as it is. The real problem is that psychologists in general have been apathetic and cheap. Content to bitch about situations and leadership, but not willing to do anything active about it, or willing to pay a meaningful amount for lobbying and advocacy. If the field is dying, it's due to inflicted wounds, not a shortage of people.

 

[Sanman]

I completely disagree with this mentality. We need MORE psychologists so we can have MORE power, instead of being the red-headed stepchild of the medical profession

More psychologists will not fix the red-headed stepchild issue. We will always be a drop in the bucket compared to the physician, nursing, etc workforce because we are a single specialty.

Power happens through money, advocacy, and legislation. The problem I think is more than apathy and cheapness. It is that the design and identity of the profession was never agreed upon from the beginning. Professors and scientists have different interests than therapy professionals who have different interests from neuropsychologists. There is little to unite behind.

Physicians for all their faults are fairly united in prescribing meds and performing surgeries. There are not 5 schools med prescribing. We need to define and advocate for whatever our bread and butter service will be. First we need to agree. As it is, we do a lot of naval gazing as a profession. ABA folks figured this out and people are banging down doors.

 

[NeuroTrope]

I'm five years post post-doc and loving my career as a neuropsychologist. It's the perfect fit for my personality and the pay is better than expected. But I admit I may be a bit of weirdo.

The point is this profession seems to be a great match for a few and an okay match for many. Happy to share more thoughts if anyone wants to PM me.

 

[psych.meout]

I completely disagree with this mentality. We need MORE psychologists so we can have MORE power, instead of being the red-headed stepchild of the medical profession

So, become the legal serves field? That sounds like a great idea!