The Influence of Demographic and Child Characteristics on Referral for Neuropsychological Evaluation

Objective: A number of studies have documented the benefits of neuropsychological evaluation as a tool for understanding brain-behavior relationships in various childhood disorders; however, little is known about the process by which children are referred for neuropsychological evaluation. From a systems perspective, it is important to understand whether there are identifiable referral patterns, and if so, how being aware of such patterns could shape the behavior of providers making those referrals. We aim to examine child characteristics that influence referral for neuropsychological evaluation. Methods: Retrospective chart review of 773 children who received neuropsychological evaluation and were diagnosed with autism, attention-deficit/hyperactivity disorder, and/or anxiety was completed. Children were divided into groups based on referral source (professional or caregiver) and compared on demographic, behavioral, and medical characteristics. Results: Overall, professionals were more likely than caregivers to refer children for neuropsychological evaluation. Though standardized measures suggested children referred by professionals and caregivers were similar, their clinical presentation appears to be different (i.e., those referred by professionals had more comorbidities and were more likely to be prescribed psychotropic medication than those referred by caregivers). Also, children with public insurance were more likely to be referred by a professional than by their caregiver. Conclusions: Findings highlight the important role of professionals in identifying "at-risk" children and supporting families through the process of receiving further evaluation when indicated. This information can be used to create a more efficient system for evaluating children and developing treatment plans, providing neuropsychologists with direct information to share with referral sources.