1st Neuro-psych test: what age?

[Anonymous]

My ASD child turns 5 soon. At what age should I be seeking her first neuropsych evaluation?

I had heard age 6, but I recently contacted a neuropsych testing practice to inquire about the wait times (as I didn't know whether to schedule her appointment 2 months in advance or over one year ahead), and they encouraged me to get her tested soon -- at age 5. So I'm now confused.

Thanks.

[Anonymous]

we did a neuropysch at Stixrud at 5 and 2 months.

[Anonymous]

Anonymous wrote:My ASD child turns 5 soon. At what age should I be seeking her first neuropsych evaluation?

I had heard age 6, but I recently contacted a neuropsych testing practice to inquire about the wait times (as I didn't know whether to schedule her appointment 2 months in advance or over one year ahead), and they encouraged me to get her tested soon -- at age 5. So I'm now confused.

Thanks.

Hi OP - Hindsight being 20/20, here is what I would tell my friends if they asked for advise -

.......I wouldn't trust any doctor that makes you feel panicked that you MUST hurry NOW to get the evaluation...not even Stixrud. They run a business, just like everyone else. Last thing they are going to do is turn anyone away. Unless your DS has a very unique situation or is harming himself or others or is completely unmanageable.

My DS was 6.5 at his first evaluation. Huge mistake. We should have waited another year at a minimum. His DX was ADHD + LDs. He was way too young to really understand the "what's and why's" of the testing, and he was un-medicated at the time making the test results fairly unreliable. That was an expensive waste of time, and all it did was cause us a lot anxiety. Fast forward 6 yrs, he is due for another evaluation - different doctor this time. First thing out of her mouth was "he was too young when you did his first evaluation, and the tester should have told you that". This is coming from a highly-regarded Psych that is referenced quite often on this forum.

I would slow down, take a deep breath. Don't let anyone make you feel anxious or panicked. Call both Children's and Kennedy Krieger and get on their wait list now for their Autism Centers. They will tell you that the wait list is 3 months long but they have cancellations all the time. This happened to us. I called KKI, got on their waitlist and a day later they called with an opening for that following Monday. Let their very skilled Developmental Pediatricians evaluate your son. Then, depending on what the Developmental Pediatrician tells you - schedule an educational evaluation around 1st grade if LDs are suspected. Or even if you suspect he might be gifted. This will help you determine if he requires an IEP or even private school.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My ASD child turns 5 soon. At what age should I be seeking her first neuropsych evaluation?

I had heard age 6, but I recently contacted a neuropsych testing practice to inquire about the wait times (as I didn't know whether to schedule her appointment 2 months in advance or over one year ahead), and they encouraged me to get her tested soon -- at age 5. So I'm now confused.

Thanks.

Hi OP - Hindsight being 20/20, here is what I would tell my friends if they asked for advise -

.......I wouldn't trust any doctor that makes you feel panicked that you MUST hurry NOW to get the evaluation...not even Stixrud. They run a business, just like everyone else. Last thing they are going to do is turn anyone away. Unless your DS has a very unique situation or is harming himself or others or is completely unmanageable.

My DS was 6.5 at his first evaluation. Huge mistake. We should have waited another year at a minimum. His DX was ADHD + LDs. He was way too young to really understand the "what's and why's" of the testing, and he was un-medicated at the time making the test results fairly unreliable. That was an expensive waste of time, and all it did was cause us a lot anxiety. Fast forward 6 yrs, he is due for another evaluation - different doctor this time. First thing out of her mouth was "he was too young when you did his first evaluation, and the tester should have told you that". This is coming from a highly-regarded Psych that is referenced quite often on this forum.

I would slow down, take a deep breath. Don't let anyone make you feel anxious or panicked. Call both Children's and Kennedy Krieger and get on their wait list now for their Autism Centers. They will tell you that the wait list is 3 months long but they have cancellations all the time. This happened to us. I called KKI, got on their waitlist and a day later they called with an opening for that following Monday. Let their very skilled Developmental Pediatricians evaluate your son. Then, depending on what the Developmental Pediatrician tells you - schedule an educational evaluation around 1st grade if LDs are suspected. Or even if you suspect he might be gifted. This will help you determine if he requires an IEP or even private school.

I'm confused about why you said that his being un-medicated makes the test results fairly unreliable. We had testing done at almost age 8 for ADHD, and my dd was not on meds. How would ADHD be diagnosed while the child is on meds?

[Anonymous]

I thinkit depends on why your child is being tested. My child had a brain tumor. After multiple years of chemo, we wanted a good baseline so we did it at almost 5, right before the start of pre-k. We wanted to find out if she had deficits and needed accommodations. Why is your child getting it done? I realize that many people have kids with ADHD and autism so I can't give any advice for that scenario, only for ours.

They did a great job at Stixrud. The best reason being we did it over 3 days so it was not done to the point of my child being exhausted. If necessary, they would have done it over more sessions was what we were told. At Children's and KKI (I believe), they only test for the period that the insurance will cover it.

[Anonymous]

I would do it at the point that you would get actionable information. We did it at 7.5, when academic issues were becoming more apparent and we needed it for making school decisions. I'm not at all sorry we didn't do it earlier because we wouldn't have gotten as full a picture.

[Anonymous]

Anonymous wrote:I would do it at the point that you would get actionable information. We did it at 7.5, when academic issues were becoming more apparent and we needed it for making school decisions. I'm not at all sorry we didn't do it earlier because we wouldn't have gotten as full a picture.

I agree. You can wait until 6 or do it now if you are applying to schools for example. (Called psycho-educational evaluation at age 5.)

[Anonymous]

Unless you're in a situation like 12:11 (hope everything turned out well), I agree that it's not usually necessary until the child is older. Two of my kids participated in NIH research studies for ASD/developmental delays - more thorough than the typical evaluation by a developmental pediatrician and less than a neuro-psych (We've had both so I can compare). The oldest was 5 at the time and the youngest was 2. My oldest has not had a neuro-psych eval because his challenges haven't been as significant and his challenges are as subtle/complex. The younger had his first neuro-psych at age 8. It was done by Stixrud and it was very thorough. It was so comprehensive that our private SLP told us we didn't need additional speech/language testing because what Stixrud had done was so comprehensive.

At age 5, unless you're looking to tease out some issues and get some differentiation, I would start with a global evaluation from a dev ped. If the results of that evaluation lead to you think a neuro-psych would be beneficial, you can schedule it later. Those evaluators would appreciate having the results from the dev ped evaluation as well as any other evaluations.

[Anonymous]

I'm confused about why you said that his being un-medicated makes the test results fairly unreliable. We had testing done at almost age 8 for ADHD, and my dd was not on meds. How would ADHD be diagnosed while the child is on meds?

Typically, a neuro-psych evaluation isn't the starting point for someone seeking an evaluation. It's the most thorough, comprehensive, peering in the crevices type of evaluation. By the time you reach the point of needing one, a child has typically already been diagnosed with ADHD. It would be overkill to start with a neuro-psych.

Evaluators want the child to be on her ADHD medication when being evaluated because they want the child at her best so they can get a better picture of how her mind works (or doesn't). Medication doesn't always eliminate the symptoms/challenges of ADHD but it mitigates them and allows a better idea of the child's functioning/capability/strengths/challenges. It helps the evaluator tease out impairments due to ADHD and impairments caused by other disorders.

[Anonymous]

NP here. This is so confusing! I have a 6.5 year old diagnosed with ADHD but based on pediatrician / teacher checklists. School is challenging although semi-manageable. Have a prescription for meds but have not filled it. I was debating getting a neuro-psych evaluation at close to 7 and prior to 2nd grade. I doubt we are looking at other LDs, just the attention and resultant executive function issues.

[Anonymous]

Anonymous wrote:NP here. This is so confusing! I have a 6.5 year old diagnosed with ADHD but based on pediatrician / teacher checklists. School is challenging although semi-manageable. Have a prescription for meds but have not filled it. I was debating getting a neuro-psych evaluation at close to 7 and prior to 2nd grade. I doubt we are looking at other LDs, just the attention and resultant executive function issues.

Please get a neuropsych evaluation or see a developmental pediatrician. I would not give medication based just on checklists b/c a lot of things can look like ADHD. You may be medicating unnecessarily. I would also switch pediatricians.

[Anonymous]

Anonymous wrote:

I'm confused about why you said that his being un-medicated makes the test results fairly unreliable. We had testing done at almost age 8 for ADHD, and my dd was not on meds. How would ADHD be diagnosed while the child is on meds?

Typically, a neuro-psych evaluation isn't the starting point for someone seeking an evaluation. It's the most thorough, comprehensive, peering in the crevices type of evaluation. By the time you reach the point of needing one, a child has typically already been diagnosed with ADHD. It would be overkill to start with a neuro-psych.

Evaluators want the child to be on her ADHD medication when being evaluated because they want the child at her best so they can get a better picture of how her mind works (or doesn't). Medication doesn't always eliminate the symptoms/challenges of ADHD but it mitigates them and allows a better idea of the child's functioning/capability/strengths/challenges. It helps the evaluator tease out impairments due to ADHD and impairments caused by other disorders.

A neuropsych evaluation is a logical place to start for many people. If a child has been previously been diagnosed as having ADHD by a developmental pediatrician for example, then they might already be on medication that would allow them to focus better if doing a neuropsych evaluation or repeating testing usually every three years.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP here. This is so confusing! I have a 6.5 year old diagnosed with ADHD but based on pediatrician / teacher checklists. School is challenging although semi-manageable. Have a prescription for meds but have not filled it. I was debating getting a neuro-psych evaluation at close to 7 and prior to 2nd grade. I doubt we are looking at other LDs, just the attention and resultant executive function issues.

Please get a neuropsych evaluation or see a developmental pediatrician. I would not give medication based just on checklists b/c a lot of things can look like ADHD. You may be medicating unnecessarily. I would also switch pediatricians.

+1. Start with a developmental pediatrician. Please don't medicate your child before this. 6.5 is still young and it could be that your son is just immature or not in the right school setting.

[Anonymous]

Typically, a neuro-psych evaluation isn't the starting point for someone seeking an evaluation. It's the most thorough, comprehensive, peering in the crevices type of evaluation. By the time you reach the point of needing one, a child has typically already been diagnosed with ADHD. It would be overkill to start with a neuro-psych.

Evaluators want the child to be on her ADHD medication when being evaluated because they want the child at her best so they can get a better picture of how her mind works (or doesn't). Medication doesn't always eliminate the symptoms/challenges of ADHD but it mitigates them and allows a better idea of the child's functioning/capability/strengths/challenges. It helps the evaluator tease out impairments due to ADHD and impairments caused by other disorders.


A neuropsych evaluation is a logical place to start for many people. If a child has been previously been diagnosed as having ADHD by a developmental pediatrician for example, then they might already be on medication that would allow them to focus better if doing a neuropsych evaluation or repeating testing usually every three years.

That's just what the PP said. If a child has already seen a developmental pediatrician, then the neuro-psych isn't the starting point, it's following the dev ped evaluation.

[Anonymous]

OP here. Thanks everyone for the very thorough responses.

My soon-to-be five-year-old has ASD, on the higher functioning end of the spectrum. She's doing fine at her present public school, so, while I make no predictions about her future, I'm not applying to schools for the fall and thus don't need an exam for those purposes.

Her developmental pediatrician is Dan Shapiro, who suggested the neuropsych exam at age 6 (or even a few months thereafter). But he didn't know how long in advance I'd need to schedule it.

I called Stixrud to inquire and the initial intake guy said they could schedule my daughter within two months and that age 5 was not too soon. So I'm scheduled to have a more comprehensive intake interview next week -- which is free.

I guess I'll hear what they have to say, and if they make a compelling case about why sooner is better than later, ask Shapiro for his input again. But I'm not inclined to spend $3,000 or so for an exam just for the sake of it, when, as a PP indicated, there's no actionable event or need that warrants one.

Thanks.