Clinical neuropsychologists can provide detailed and objective assessment of an individual’s brain functioning to assist in the assessment, identification and diagnosis of central nervous system disorders and associated psychological conditions for children through to the elderly. The assessment provides an overview of a person’s current cognitive functioning and covers a broad range of areas including: intellectual capacity, attention, speed of information processing, language, new learning and memory, visuospatial skills as well as more complex skills such as reasoning, judgment and planning abilities. This information is used to indicate and assist in the diagnosis and to differentiate organic and non organic causes of any brain impairment. The neuropsychologist can describe the nature and severity of any cognitive impairment and provide cognitive strategies to assist with these.
Common conditions which neuropsychological assessments can assist in the diagnosis of include:
- acquired brain injury including stroke and traumatic brain injury
- neurological conditions including epilepsy,
- neurodegenerative disorders and types of dementia
- intellectual disability
- developmental disorders (such as attention deficit hyperactive disorder, dyslexia and other learning disorders)
- psychiatric illness and mood disorders including schizophrenia and depression
- brain impairment due to substance abuse
In addition to diagnostic issues, a clinical neuropsychological report can assist with:
- mental capacity and issues related to guardianship and financial management
- work and study capacity
- cognitive strengths and weaknesses profiling to develop treatment, rehabilitation or management plans
- baseline assessment prior to medical intervention or for future re-evaluation
Formal comprehensive reports are provided to the individual and/or referring clinician to assist in the diagnosis and treatment of the individual. Reports may be useful also for teachers, employers and other individuals associated with the individual to assist them in the appropriate settings. We are able to tailor our reports for the individuals needs and can provide both written and oral feedback to explain and work through our findings.
Acquired brain injury
Some individuals may be born with an innate cognitive difficulty, such as an intellectual disability while others may incur changes to the brain following an accident or medical event, for example after a stroke, traumatic brain injury or during the course of a neurodegenerative illness. These individuals may experience difficulties in their thinking abilities. Assessing the cognitive profile of an individual following an acquired brain injury is an important step to understanding the effect of the injury in terms of nature and severity. A neuropsychological assessment can then provide cognitive strategies to assist the person manage their impairment. Repeat neuropsychological assessment can also be helpful in assessing the degree of recovery and/or any further cognitive deterioration. Dr Susan Pulman and Associates have experience and accreditation to conduct assessments under the Compulsory Third Party (CTP) Scheme and the Lifetime Care and Support (LTCS) Scheme, the Motor Accident Authority (now the State Insurance Regulatory Authority SIRA) and WorkCover NSW.
Neurological conditions including epilepsy
A wide range of neurological conditions such as epilepsy, Huntington’s disease and Parkinson’s disease can cause changes in brain functioning and cognitive difficulties. Neuropsychological assessment can assist in comprehensively evaluating the impact of a neurological condition on a person’s cognition and possibly indicate or contraindicate certain treatment options as well as objectively assess change over time.
Neurodegenerative disorders and types of dementia
There are several different types of dementia with different causes, patterns of cognitive impairment and progression. Neuropsychological assessment can sometimes detect changes which are not evident on other forms of testing including clinical examination, cognitive screening and neuroimaging. Neuropsychologists are able to assist with diagnosis and provide detailed information about an individual's current cognitive state. Over time, neuropsychologists can map even subtle changes in a person's cognition. Assessments of dementia may be used for assessing decision making relating to a range of issues including accommodation and lifestyle, financial management and medical treatment.
Psychologists can provide an objective measure of an individual’s level of intellectual functioning utilising well established and validated tests. Accurate interpretation of psychometric testing is crucial to ensure correct diagnosis and is a fundamental component of the diagnostic criteria for intellectual disability.
Developmental disorders including ADHD
A large percentage of the offender population has a history of learning disorders and/or ADD or ADHD, which can persist into adulthood. Often such conditions need to be diagnosed at any early age. Neuropsychologists have extensive training in the detection of learning disorders and are able to use a range of objective tests to assess these conditions. Often the true cause or nature of impairment can be misunderstood or misdiagnosed in the absence of a comprehensive assessment that allows for the analysis of several different common causes. While it is often hard to make such a diagnosis in adulthood, a neuropsychologist is able to assess this using multiple techniques, in conjunction with medical history and school records. They are able to provide information on the current level of impairment and discuss its implications including return to work or study options, implications for court proceedings and treatment options.
Psychiatric illness and Mood disorders
Chronic psychiatric illnesses such as schizophrenia and major mood disorders such as depression can subsequently result in cognitive difficulties. The degree of cognitive decline can be variable and in some cases significantly interfere with a person’s ability to function day-to-day at work and home. Sometimes there are questions about whether there may be an additional cause of cognitive impairment however this can be difficult to tease apart. A clinical neuropsychological assessment can evaluate an individual’s cognitive functioning and determine if their cognitive profile is indicative of a psychiatric disorder and/or an alternate process.
Brain impairment due to substance abuse
The effects of chronic drug and alcohol use can have detrimental impacts on an individual's cognition ranging from subtle reductions to dementia. A comprehensive neuropsychological assessment can assist in determining the nature and severity of any such changes in cognition.
Mental capacity assessment
People with a range of medical and neurological issues such as serious mental health problems, developmental disabilities, stroke and dementia may lack the capacity to make certain decisions for themselves. Decision making capacity is domain and decision specific. For example, a person may have the capacity to manage their finances day-to-day for basic bills and groceries but not a multi-million stock portfolio. Alternatively, a person may have the capacity to make decisions about where they live but not the capacity to drive a car. A trained neuropsychologist is able to target their assessment to a specific capacity and provide an opinion as to a person’s cognitive capacity at a particular point in time.
Neuropsychological assessment provides a comprehensive and objective measure of cognitive ability, and is used in conjunction with detailed interview and collateral information to give an opinion as to a person’s capacity around a number of issues including:
- Capacity to make a will
- Capacity to undertake an Enduring Guardianship
- Capacity to undertake an Enduring Power of Attorney
- Capacity to make decisions about where a person lives and lifestyle choices
- Capacity for medical treatment
- Capacity for financial management
- Capacity to drive
- Capacity to participate in research studies
Dr Pulman and Associates have expertise in conducting neuropsychological assessments to inform these questions and provide reports to the NSW Civil and Administrative Tribunal (NCAT) – Guardianship Division, who are responsible for determining mental capacity issues in NSW under the Civil and Administrative Tribunal Act 2013 (NSW). We have experience in attending and providing evidence at these hearings.
Work and study capacity
Every individual has a different composite of skills, cognitive abilities and leadership and personality styles which can impact their success in the workplace and influence their career paths. Dr Pulman has extensive experience in assessing and preparing reports for workplaces evaluating current and future employees for specific job roles.
Neurological insult, such as a brain injury, can often lead to long term or permanent changes in the brain. It can be difficult to assess whether an individual can return to work or study and, if so, what tasks they will be able to accomplish and what they will have trouble with.
For individuals who have suffered a brain injury and are now looking to try something new or return to study, they may be unsure if they will be able to cope with the new demands or if they will require additional support to undertake the task. A comprehensive neuropsychological assessment can assist with this determination and give recommendations regarding an individual's future work or study choices.
We are trained and certified in providing return to work assessments, worker’s compensation claims as well as evaluating a person’s cognition as it relates to income protection and other insurance policies.
Cognitive and weaknesses profiling to develop treatment, rehabilitation or management plans
Neuropsychological assessments are frequently used in the planning and decision making process regarding rehabilitation and treatment options. Understanding a client's cognitive strengths, weaknesses, likely difficulties or restrictions and overall behaviour - as well as assessing their psychological state - is vital to increasing the likelihood that an intervention or treatment will be successful. For example, an individual who has suffered a severe brain injury will most likely have difficulties with attention, memory and higher level thinking skills such as problem solving. In addition he or she will fatigue easily and may be suffering from depression. A treatment program will be required that takes these factors into consideration. Identification of cognitive difficulties can also assist with developing strategies to assist with a range of behavioural issues which can be confronting and upset for both the individual and their families. A neuropsychological assessment can help best match your client's needs to a suitable treatment program.
Baseline assessment prior to medical intervention or for future re-evaluation
All medical interventions carry certain risks. Sometimes these risks can be possible changes in brain functioning and cognition. Alternatively, for some treatments, cognitive changes may contraindicate a therapy, such as deep brain stimulation in Parkinson’s patients; hence a baseline assessment will assist in determining treatment eligibility. A neuropsychological assessment pre and post treatment can evaluate any cognitive changes that may have occurred as a result of the medical intervention.