faqs
COGNITIVE EVALUATION
Dr. Anderson is a professional member of the National Academy of Neuropsychology and has received specialized, two-year post-doctoral neuropsychological supervision. While not currently board certified, he is working towards board certification. Board certification is a vital, multi-year process that signals to the medical community that the pre-requisite education and supervision has been attained for competency above and beyond the typical psychometric instruments that clinical psychologist are trained to administer. Per the ethics code, Dr. Anderson regularly consults with board certified neuropsychologists.
How long is the evaluation?
Typically, evaluations are conducted in 1/2 a day. If needed, the patient can return on a second day, but travel distance may not allow this. Whatever the case, we go at the pace of the patient.
How long before I can get in?
There is generally a wait list from three to four weeks.
How long before I get the results?
We try to get people scheduled sooner than most clinics. Once the testing is completed, results and recommendations are written within four to six weeks, depending on demand. IPS also follows up with each patient to inquire if they desire a consultation about findings.
What will the day of testing look like?
Prior to beginning the evaluation, Dr. Anderson explains to the patient who referred them, what they’re being referred for, how long they should expect to be together, the timeline for completion, and their opportunity for a follow-up. Dr. Anderson explains to the patient that the scores are based on how well they do compared to others their age, as well as where their strengths and weaknesses are.
I’m no good at tests, so no matter what I’ll do bad.
This is not a “test” in the way that most of us know from elementary or high school. There is no “passing grade”. Rather this is a formal way of measuring how well the individual performs on different hands-on tasks. There is no passing grade. We just ask that you be sincere and give your best effort.
How does all this help you determine a diagnosis?
Diagnosis and recommendations are based on patterns that emerge which are then combined with observations, self-report via interview, reports from those who know the patient well, and record review. The results are forwarded to the referral provider and to the patient and/or their guardian.
We all lose a step as we age. So what?
Yes. That’s true. Later in life there are some abilities we are not as strong as, while we grow in strength in other abilities. However, this testing compares you against others your age and is sensitive to possible areas of impairment. Cognitive problems that get in the way of daily life are important to address so that the individual can plan their life and make the most of it. Also, this testing can help relieve anxiety some people may have about their cognitive health. Without it, speculation may lean negative!
I already had imaging (MRI, CAT scan, PET scan, etc.). How is this different?
Neuropsychological testing is as informative as medical imaging. It helps your medical provider get a glimpse how well you are functioning, and possible alternative reasons for why you may be struggling, compared to others your age. Different regions of the brain are responsible for more than one behavior, so we must measure many things and see if patterns emerge.
What will you be looking at?
Evaluations measure the following domains:
1. Perceptual-motor functions
2. Language
3. Learning and memory
4. Social functioning
5. Executive functioning
ATTENTION DEFICIT HYPERACTIVITY DISORDER
How long is this appointment and what will I be doing?
The evaluation takes approximately four hours and can be done in one appointment. You will meet with the psychologist, and you will fill out several questionnaires, complete some computerized activities, and get a baseline of your intellectual functioning.
Who gets my report and will we meet again?
The report is forwarded to your referring physician. A follow-up can be completed by your physician or with the psychologist.
What is ADHD?
ADHD is a developmental disorder that includes cognitive impairments that affect daily functioning. The cognitive impairments can include problems with attention, focus, or impulsivity. Essentially, it is a dysregulation of how dopamine travels in the brain. Dopamine is a neurotransmitter responsible for both feeling good and focus.
I have problems with attention and focus. Does that mean I have ADHD?
There are many reasons that someone may struggle with attention and focus, such as depression, anxiety, intellectual delay, learning disabilities, head injury, poor diet, and life stress.
What are the side effects of stimulant medication??
Side effects can include personality changes in children, sleep problems, decreased appetite and weight loss, increased blood pressure, dizziness and headaches, and moodiness. There are different types of stimulant medication, so if side effects arise, tell your doctor and try another class.
If there are other reasons for problems with attention and focus, how do you tell what is ADHD and what is not?
A series of tests are performed that measure intellectual and cognitive ability, personality features, and personal history. A proper diagnosis of ADHD is arrived at only after other conditions are ruled out. Filling out a screener is not enough. Also, objective, personal opinion is not enough. Several points of data need to be considered. If the clinician does not assess for these other factors, then a child may not receive the educational help they need, a controlled substance may fall into the hands of someone who is manic rather than having a developmental problem, and the effects of a head injury may be missed.
I’ve taken Adderall (or similar) and my attention improves. That means I have ADHD.
This is no more true than saying if Xanax calms you, you must have anxiety. Most anyone would benefit from a stimulant. Medications designed to treat symptoms of ADHD are powerful, controlled substances. If in the wrong hands either because of a misdiagnosis or abuse, then side effects can occur. Also, medication alone rarely solves the problem. Unless one plans to remain medicated their entire life, it is best to also learn other coping strategies.
What are some alternatives to medication, or additional strategies I can try to improve my attention and focus?
Behavior therapy can improve organization and design a reinforcement schedule. Often times individuals with ADHD struggle with feeling “different”. Talk therapy can help them understand themselves. Family therapy can help improve communication. In Europe, ADHD is rarely diagnosed, and caffeine is used as medication, even with children. Improving diet is strongly recommended. Decrease fatty foods, additives and sugar. Increase high fiber foods, nuts, Omega-3, zinc, protein AND PHYSICAL ACTIVITY.
BARIATRIC PRESURGICAL EVALUATION
Why am I here?
The presurgical assessment is intended to ensure that all of your needs are met; physical and psychological. Bariatric surgery is the beginning of health change, not the end. The assessment will help identify your strengths and where you may need support after surgery, such as depression or mood swings, lack of support, or managing triggers for emotional eating.
Does my surgeon believe I have a psychological issue?
All patients are required to meet with the psychologist, not just because someone may, or may not, have psychological concerns.
Why do I have to see a psychologist for a medical problem?
The mind and the body are not separate. For instance, 10 minutes of low intensity aerobic exercise can increase energy and improve mood. Exercise has been shown to be more effective than antidepressants in reducing depression. Also, one of the chemicals responsible for feeling good, serotonin, is produced in the gut and greatly affected by what is eaten.
What is the purpose of this examination?
Human’s relationship with food is complex. Recent generations have come to know it as a form of satisfaction and enjoyment. However, physiologically our body sees food differently. Food is fuel and our body is still primed to believe it is scarce. So, when you gain weight it is out of survival, even if you eat because you are stressed or raised to “clean your plate”. We want to help you identify unhelpful eating behaviors, such as nibbling or grazing on unhealthy foods and improve stress coping.
What if I’m depressed or anxious? Will it keep me from getting the weight loss surgery?
The psychologist assesses a variety of factors that may be an obstacle to following through with medical advice. There is rarely only one factor that is considered if someone is denied. 40% of bariatric candidates have a history of depression. Medication and counseling can help manage depression so it isn’t an obstacle to reaching weight loss goals.
How long is this appointment and what will I be doing?
The evaluation takes approximately two hours and can be done in one appointment. You will meet with the psychologist, and you will fill out several questionnaires.
Who gets my report?
The report is forwarded to your referring physician and included in the necessary paperwork required before being cleared by your insurance company.
Do people fail this evaluation?
Only 4% of individuals are found to be poor candidates for surgery based on their psychological evaluation. Often psychological recommendations are provided and, if completed, the individual will qualify for the procedure.
SPINAL CORD STIMULATOR PRESURGICAL EVALUATION
Dr. Anderson completed his internship at Pacific Pain Rehabilitation Centers and his first post-doctoral education at the University of Alabama as supervisor of the pain management laboratory. Since opening his practice, in addition to working with bariatric patients, it is a natural Segway to assist those with chronic pain, teaching cognitive behavioral interventions for those with chronic pain.
Why am I here?
Insurance companies require psychological clearance before the trial period for a spinal cord stimulator.
Does my surgeon believe I have a psychological issue?
All patients are required to meet with the psychologist, not just because someone may, or may not, have psychological concerns.
What if I’m depressed or anxious? Will it keep me from getting the stimulator implanted?
Chronic pain patients are more likely to suffer from depression and anxiety than the general public. Pain relief can help with these disorders. This evaluation can offer direction on how to help diminish these feelings.
What is the purpose of this examination?
There are multiple reasons why insurance companies require clearance. They want to make sure someone is psychologically capable of operating the device that controls the stimulator and they want to identify any counterindications to success. If there is an issue that is identified, it doesn’t mean someone is permanently excluded, only that it may need to be addressed first.
How long is this appointment and what will I be doing?
The evaluation takes approximately two hours and can be done in one appointment. You will meet with the psychologist and you will fill out several questionnaires.
Who gets my report?
The report is forwarded to your referring physician and included in the necessary paperwork required before cleared by your insurance company.
Do people fail this evaluation?
While most people are cleared to have the trial stimulator, a small number are not. Of those who are not, some may be eligible after completing some recommendations.
AUTISM SPECTRUM DISORDER
What is an autism spectrum disorder
An autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts social development. Domains affected include stress coping, language development, and development of socially appropriate behaviors. The autism spectrum is wide, and while several symptoms appear to overlap with more common disorders, the neuroanatomical underpinnings of ASD are distinct.
I watched an online video and completed some screeners that all suggest I have ASD
Screeners are helpful at the beginning of a diagnostic process but are not diagnostic because of how they’re designed. Psychological testing is an intensive process that involves instruments that are normed on the appropriate populations, produce results that are compared against other results, and must include a thorough interview lasting as much as two to three hours. Many of the symptoms of ASD may look like other problems and can include additional struggles with social anxiety and depression. However, the “why” and “how” symptoms and signs are measured is not captured in screeners.
With the rise of social media, well-meaning individuals believe they are communicating clinically relevant information, and may even have a cursory understanding of certain words. However, much of the information is inaccurate and not in keeping with scientific research. The clinical utility of the shared information only goes as far as to give someone the impression that the speaker is knowledgeable using popular phrases such as “neurotypical”. However, these are not found in the diagnostic manual.
What is involved in an evaluation?
A firm grasp of how cognitive, intellectual, language, and social development typically emerges for individuals with ASD is essential for a proper evaluation. A thorough interview with caretakers or parents of adults seeking evaluation is highly important, cognitive and intellectual functioning is assessed, a thorough examination of the individuals developmental period using a structured interview (ADI-R), and in the case of children, and observation of their motor and social skills is warranted. Formal language measures are used, including social cognition and communication.
Is Autism a permanent condition?
With proper intervention, notably at younger ages, an individual can learn to overcome the social and language barriers which results in no longer meeting diagnostic criteria. For adults, while the path towards a desired goal is different than with a child, they can learn about autism, its benefits, limitations, and how to improve areas that they desire. An Autism Spectrum Disorder, as with anything, is by itself nothing to be ashamed of. While there are some limitations that naturally come with it, there are also a great many benefits. Learning to accept one’s abilities, or lack thereof, is the first part of happiness. I encourage people to focus less on the label and more on personal growth.