Teacher and parents say a first-grader isn't retaining information from day to day. What assessment would you suggest?

This is a pretty common type of referral — having to do with information retention, particularly in young kids — but it’s important to understand that what parents and teachers describe as “not retaining information” could be many different things. The child may not be learning the information in the first place, or she may know it but not be able to demonstrate it, among other options.

I think this case would be a good candidate for a neuropsychological evaluation, precisely because there could be so many issues at play.

When I approach an evaluation like this I have a couple of hypotheses I’ve already generated based on the information I have — she could have a specific learning disability in reading. She could have attention or executive function problems. She may be bright but process things much more slowly than her peers. She could have anxiety that interferes with her academics. There could be other factors at play that are completely separate from school, such as difficulty sleeping or medical issues that derail the learning process. There are so many things that could be leading to this final common pathway of trouble with information retention.

And that’s exactly what a neuropsychological evaluation is designed to tease apart. In addition to directly evaluating her thinking and learning skills, we talk to the child and parents, we interview teachers and doctors, we review records. Sometimes we observe the child at school. We put all the pieces together, like a detective, to figure out what’s going on and how best to help the child both in and outside of school.

So, I would recommend an evaluation, or at least a preliminary meeting with a neuropsychologist as a first step. Sometimes if families aren’t sure what sort of testing or services they need we invite them in to do an initial interview in order to get the lay of the land. Then we’re more comfortable saying, “You should have a neuropsychological evaluation,” or conversely, “You really need this treatment or this therapy,” based on the information we have.