Our holistic approach to neuropsychology
Our holistic approach to neuropsychology
When I first met Jan, I could see that he was extremely restless. His legs were bouncing, he was tapping his fingers on the arms of his chair, and he was finding it very hard to sit still or even look at me in the eye. So, how did I assess this situation? What did I think could possibly be leading to this clearly observable behaviour? I had three hypotheses in mind:
- He was very anxious and agitated
- He was very cognitively distracted
- He was struggling with the social aspects of our communication
From merely observing Jan, I could not tease apart any of these ideas and, following a holistic model of neuropsychology, I was very aware that it could be a combination of some of them. And this is often the situation that neuropsychologists and clinical psychologists face. The good news is that we, as trained clinicians, have some useful tools up our sleeves. I set out with the goal of using these tools to formulate how best to help Jan.
First, I asked Jan to complete a series of questionnaires. These questionnaires asked Jan about his mood and anxiety levels, and whether he had noticed any difficulties with practical activities in his daily life. I also asked Jan’s partner, Steven, to complete the questionnaire about practical difficulties observed. Jan scored low on a measure of anxiety, relatively high on a measure of depressed mood, and both Jan and his partner, Steven, reported that Jan had problems with planning, problem solving and organisation on most days.
The second approach I took was to use a series of tests to measure Jan’s general intellectual and more specific cognitive abilities. Jan was clearly an exceptionally bright man, but, in line with the results from the questionnaires, he struggled with processes known as ‘executive functioning’ (i.e., those involved in planning, problem solving and organisation). He also found timed tests harder to complete and scored low on two measures of processing speed. Now, taking these results holistically, I used my understanding of his current low mood to put the results into context – it is not uncommon for people who are suffering from depression to feel slowed down and distracted, usually due to repetitive thoughts associated with rumination about the past and worry about the future. But this did not quite explain his consistent low average scores on executive functioning tests.
The final part of my assessment was a thorough clinical interview. Jan reported that despite his high intellectual abilities on the tests, he had found school challenging, passing Maths, English and Art but failing most other exams. He told me that he had made it into work as a carpenter through an apprenticeship scheme, and successfully set up his own business with his brother, who managed the finances and logistics, while Jan carried out the jobs. Recently, however, since the COVID-19 pandemic, business had been slower and Jan told me that he was concerned about how he would be able to provide for his family, including his elderly mother, who had a diagnosis of dementia and he was the main carer for. This contextual information made a lot of sense and helped me to think again about my three hypotheses. Only one had been correct – he was very cognitively distracted during his assessment with me. And I began to develop a new hypothesis that his cognitive problems were longstanding and developmental in nature. I concluded my assessment by recommending an assessment of attention-deficit hyperactivity disorder (ADHD) and referred Jan for Cognitive Behavioural Therapy (CBT) to treat his symptoms of depression, as well as to a group run by a charity for carers. Jan was happy with this outcome as he had been worried that he was developing dementia like his mother.
This is an example of multiple presentations and demonstrates the thorough approach that all our neuropsychologists and clinical psychologists take at The London Neurocognitive Clinic, and we pride ourselves on this. If you feel you could benefit from an assessment with us, please get in contact.