Dr. Nicholas Gelbar & Dr. Sara Renzulli

When it is recommended that your child be evaluated by a psychologist, it is often difficult for parents to know what type of evaluation is needed.  Various types of assessment are completed by different types of psychologists, each with different training and experiences.  There are three types of child psychologists who conduct evaluations:  1) school psychologists, 2) child clinical psychologists, and 3) child neuropsychologists.

Psycho-educational v. Psychological Evaluations

School psychologists either have a specialist degree (a Master’s and a graduate certificate, such as a Sixth Year Certificate in Connecticut) or have completed a Doctoral degree (a Ph.D. or Psy.D).  Both types of school psychologists can be certified to work in schools.  School-based evaluations are typical called psycho-educational evaluations and traditionally include measures of intellectual ability (i.e. IQ testing) and behavior rating scales, asking parents and teachers to evaluate a child’s behavior.  Sometimes, school psychologists also administer academic achievement testing.  Recently, some school psychologists have also begun to add other forms of testing to their evaluations such as tests of memory/learning or executive function.  These measures were more traditionally utilized, in the past, by child neuropsychologists.  In Connecticut, school psychologists with either a specialist’s or doctoral degree can also conduct private psycho-educational evaluations as long as these evaluations reflect the practices they would use in school settings. 

            Both child clinical psychologists and child neuropsychologists have earned doctoral degrees and are licensed psychologists.  Some doctoral-level school psychologists also complete the requirements to be licensed.  Only licensed individuals can: 1) bill insurance and 2) call themselves psychologists.  Licensed school psychologists and child clinical psychologists often title their evaluations as psychological evaluations.  The main difference between psycho-educational evaluations and psychological evaluations is that licensed professionals can provide medical diagnoses.  This means that their evaluations indicate what, if any, their diagnoses for the child. Psychological diagnoses can also mean that an individual qualifies for special services (e.g. different therapies). 

In order to provide these diagnoses, psychological evaluations often use broader additional measures such as academic achievement assessments or personality assessments.  The other main difference between psycho-educational and psychological evaluations is that psychological evaluations tend to have more robust recommendations for services outside of the school setting.  Child clinical psychologists receive extensive training regarding child psychopathology (i.e. the medical diagnosis of psychological disorders) and also, regarding hospital-based and community-based psychological interventions.  They also are trained in personality assessment, which is broader than the behavior ratings scales utilized by school psychologists. This training enables them to diagnose a broader range of psychological conditions versus licensed/certified School Psychologists.  Beyond personality assessment, child clinical psychologists are also likely to have experience working with children/adolescents in hospital-based or community-based settings. In these settings, they can assess a broad range of psychological conditions that are negatively affecting a child’s functioning and can recognize how these conditions are manifesting in home and community settings.

School psychologists’ training in these areas is often not as robust as child clinical psychologists, but licensed school psychologists can receive additional training that is comparable.  School psychologists receive extensive training on school-based laws and practices and have to complete at least 600 hours working in schools before they can be certified or licensed.  Child clinical Psychologists and child neuropsychologists do not receive this school-focused training, which may impact whether their recommendations can be translated to school settings. 

Psychological v. Neuropsychological Evaluations

The line between psychological and neuropsychological evaluations is even more blurry than the distinction between psych-educational and psychological Evaluations.  Child neuropsychologists are a subset of child clinical psychologists, who complete additional and different types of training.  They are usually Board-certified (meaning they have passed a national examination and provided documentation of specific training experiences) in addition to being licensed and the examinations to become Board-certified reflect the additional and different training they receive. The main distinction between psychological and neuropsychological evaluations is that child clinical neuropsychologists are trained to evaluate data from psychological measures and consider whether specific areas of the brain are responsible for the function/dysfunction being observed.  For children who have experienced a brain injury or have seizures, these can be particularly beneficial. 

There is also a tendency for neuropsychological evaluation reports to be more integrated than traditional Psychological Evaluations.  Traditional psycho-educational and psychological evaluations reported the results of each measure separately and then provided a summary of the data.  Traditional neuropsychological valuations integrate results from across psychological measures as they go.  The style of reports often has little bearing on the conclusions that are offered.

Neuropsychologists are also trained to assess the process by which a child is responding to test items whereas school psychologists and child clinical psychologists historically have been more concerned with analyzing whether their answer is correct.  Neuropsychologists can observe qualitative information regarding how a child is developing answers in addition to the quantitative data regarding their performance relative to other children (i.e. the scores that are reported; known as Process Assessment).  This can allow them to observe subtle dysfunctions in how children approach and solve problems and are especially germane to children who have a form of acquired brain injury or whose brain is not thought to be developing similar to typical children.  Neuropsychologists historically also have used broader psychological measures that included assessments of language, executive function, learning/memory, personality assessment, etc., but many of these measures have also historically been utilized by child clinical psychologists.  Currently, all child clinical psychologists and many school psychologists utilize the breadth of psychological measures traditionally used only by child neuropsychologists.

Conclusion

Over the last few decades, several of these distinctions have blurred as many child clinical psychologists are now trained in both process assessment and writing integrated reports. Some school psychologists are also being trained to write more integrated reports, meaning that the same measures can be used by all three types of psychologists though each may approach the assessments differently.  This means that for some children, it may not matter which type of psychologist assesses them as the results and recommendations will be extremely similar.

  That being said, the breadth of psychological measures utilized in psychological or neuropsychological evaluations can be a major advantage of these approaches in particular compared to school-based evaluations.  In schools, each discipline conducts assessments in their area and writes a report.  For example, the school speech/language pathologist conducts language assessments and writes a report of the results and recommendations based on these results.  Psychological or neuropsychological evaluations can connect information in ways that inform both diagnosis and the resulting recommendations.  For example, a child may have difficulties in oral language that affects their ability to comprehend what they read so they may need speech/language support in addition to interventions to help them to improve their reading comprehension.

To summarize, psychological assessments are typically broader than psycho-educational assessments though this distinction has become blurrier over time, as more school psychologists are receiving training where they can develop competencies in these areas and utilize these practices in school-based psycho-educational assessments.  The main distinction tends to be that psychological evaluations can lead to medical diagnoses of psychological conditions. 

Neuropsychological evaluations can detect more subtle forms of dysfunction and offer specific hypotheses regarding the areas of the brain responsible for these dysfunctions.  But, many school psychologists are able to offer more practical suggestions regarding school-based programs and services.  Child clinical psychologists and neuropsychologists may also provide better suggestions for community-based supports and recommendations for children who have more complex disabilities and challenges. While the lines delineating the boundaries between different types of child evaluations are blurry, different forms of evaluation are appropriate for different children.  This means that it is often important for parents to talk with potential evaluators concerning how they approach assessment and offer recommendations to determine which type of evaluation is most appropriate for their child. 

Some school-based school psychologists also call their evaluations psychological evaluations even though they do not include medical diagnoses. These can be regarded as psycho-educational in nature, which is likely a source of confusion for many families.