When should a new neuropsychological assessment be done?

As a neuropsychologist, I am often asked this question: does a child who has already undergone a first neuropsychological assessment need to be evaluated again, and if so, when?

There is more than one answer to this question. In fact, a reassessment is not always necessary. If a child develops well following the first assessment and the methods employed adequately compensate for the challenges, there is no need for a new evaluation.

On the other hand, if the assessment has been made at an early age and the child now appears to be able to control the challenges without any help, some parents prefer to use a new evaluation to better understand where their child's abilities are now. This approach may indeed be worthwhile in order to be able to specify a diagnosis, such as differentiating between a developmental delay and a specific disorder, which will require long term accommodation.

Similarly, a reassessment is recommended if the child's abilities seem to be diminished or if new challenges arise. Indeed, it is recognized that some diagnoses come with an increased likelihood of receiving a second diagnosis linked to related neurological weaknesses. For example, a child diagnosed with ADHD will often be more likely to have a learning disability or to have difficulties in school.

Questions/answers dealing with attention deficit disorder, with or without hyperactivity (ADHD)

What are the symptoms of attention deficit disorder, with or without hyperactivity (ADHD)?

• The child must display at least 6 attention deficit symptoms or 6 hyperactivity symptoms
• The symptoms must persist for at least 6 months to a degree that is maladaptive and inconsistent with the child's developmental level
• The symptoms must not be identifiable as due to another mental illness
• The presence of the symptoms must significantly alter a variety of aspects of one's life (social, professional, school, etc.)
• Finally, certain symptoms must be present before the age of 7.

A list of attention deficit symptoms follows:

• Unable to pay attention to details, or makes careless mistakes on his/her school homework, work or other activities;
• Often finds it difficult to maintain focus on the task at hand or during games;
• Seems like he/she is not listening, when spoken to directly;
• Does not conform to the rules and cannot complete his/her homework, house work or professional obligations (this is not due to difficult behavior, nor due to their incapacity to understand the rules);
• Has a difficult time organizing his/her work or activities;
• Avoids, is adverse to, or completes tasks against his/her wishes – ones that require sustained mental effort (like school work or homework);
• Often loses his/her necessary tools to complete his/her work and/or activities (toys, workbooks, pencils, book or tools);
• Is easily distracted by outside stimuli;
• Is forgetful in his everyday life.

A list of hyperactivity/impulsivity symptoms follows:

• Fidgets with his/her hands or feet, or squirms in his/her seat;
• Often gets up during class or in other situations that require him/her to be seated;
• Runs or climbs everywhere, in situations where it is deemed inappropriate (for teens or adults, the symptom could be limited to feelings of subjective or inner restlessness);
• Experiences difficulty remaining calm during play time;
• Acts like he/she is "driven by a motor" or as though he/she is "mounted on springs"
• Speaks too often.