The Clinical Neuropsychologist

ISSN: 1385-4046 (Print) 1744-4144 (Online) Journal homepage: https://www.tandfonline.com/loi/ntcn20

Communication is key: the utility of a revised

neuropsychological report format

Katherine T. Baum, Christian von Thomsen, Megan Elam, Christel Murphy,

Melissa Gerstle, Cynthia A. Austin & Dean W. Beebe

To cite this article: Katherine T. Baum, Christian von Thomsen, Megan Elam, Christel Murphy,
Melissa Gerstle, Cynthia A. Austin & Dean W. Beebe (2018) Communication is key: the utility of
a revised neuropsychological report format, The Clinical Neuropsychologist, 32:3, 345-367, DOI:
10.1080/13854046.2017.1413208

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The Clinical Neuropsychologist, 2018
VOL. 32, NO. 3, 345–367
https://doi.org/10.1080/13854046.2017.1413208

Communication is key: the utility of a revised

neuropsychological report format
Katherine T. Bauma , Christian von Thomsenb, Megan Elamc, Christel Murphyc,
Melissa Gerstlec, Cynthia A. Austinc and Dean W. Beebec
a
Children’s Hospital of Philadelphia, Philadelphia, PA, USA; bHelios Klinik Leezen GmbH, Leezen, Germany;
c
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

ABSTRACT ARTICLE HISTORY

Objective: The neuropsychological report is a critical tool for Received 8 August 2017
communicating evaluation results to multiple audiences who have Accepted 26 November 2017
varying knowledge about neuropsychology and often have limited
KEYWORDS
ability to review long, complex reports. Considerable time is spent Pediatric; clinical; writing;
writing these reports and challenges persist related to readability, neuropsychology
length/complexity, and billable clinical time (which may be capped
by third-party payors or families’ ability to pay). Methods: This quality
improvement effort systematically evaluated the redesign of pediatric
neuropsychological reports in an outpatient clinic serving primarily
medical populations. Results: Revised reports were shorter, with
improved readability, structure, and effectiveness in communicating
results and recommendations. Improved clinical efficiency was also
observed. Conclusions: We suggest that adaptation to efficient,
readable, and effective reports is possible within the practice of
neuropsychology. Findings encourage replication in other settings.
Through collaboration with key stakeholders, providers can identify
their populations’ and audience’s unique needs and set report targets
accordingly. To encourage that practice, we summarize our general
process, provide a set of guidelines that can be adapted across
multiple settings, and include an appended sample report.

Neuropsychological evaluations are an important part of clinical care for individuals with
diseases and medical treatments that affect the brain. Arguably the most valuable aspect
of such evaluations is the communication of a case formulation and pragmatic recommen-
dations, rather than test scores and specific cognitive data (Postal & Armstrong, 2013; Postal
et al., 2017). In pediatrics, the written report has been rated by parents as the most useful
part of their child’s evaluation (Farmer & Brazeal, 1998). The report often becomes part of
the patient’s permanent medical record and serves as the primary means of communication
between the neuropsychologist and other care providers. The written report can augment
verbal interactions with the patient and his/her family. In some cases (e.g. when the patient
or family is unable or unwilling to meet for feedback), the report serves as the primary source
for information and treatment recommendations.

CONTACT Katherine T. Baum baumk@email.chop.edu

© 2017 Informa UK Limited, trading as Taylor & Francis Group
346  K. T. BAUM ET AL.

To be effective, neuropsychologists must ensure that each report is clearly understood

by readers while maximizing quality within limited billable clinical time. The American
Psychological Association (APA) Ethics Code emphasizes that psychologists use ‘language
that is reasonably understandable to the person assessed’ (APA, 1992, 2002, pp. 1060–1073).
With respect to billing, while the Ethics Code warns only against exploitative billing practices,
there is often pressure to limit billing that stems from third-party payors and from patients
and their families due to high ‘flow through’ costs (e.g. due to high deductibles).
The Ethics Code provides a set of professional standards, but the actual implementation
of these guidelines varies widely. Neuropsychological report styles greatly vary in length,
format, sophistication of writing style, as well as reporting of clinical, historical, and interpre-
tive information. Stylistic differences are due, in part, to the referral question, the clinical
presentation of the patient, the needs and knowledge base of the target audience, and the
clinician’s training and background (Baron, Fennell, & Voeller, 1995; Donders, 2001; Vasserman
& Baron, 2016). While it is clear that no single report writing format or organizational style
will meet all needs, pediatric reports have a reputation for being long, turgid, full of jargon,
overly focused on minutiae of test results, and lacking in meaningful and specific recommen-
dations (Armstrong & Lundy, 2016; Baron et al., 1995; Donders, 2016). Long, tedious writing
can lead to reports going unread and patients not receiving appropriate follow-up care.
Donders (1999, 2016) has suggested that briefer reports that focus on clinical interpre-
tation and implications of results rather than history and test scores may be more meaningful
and user-friendly, allowing for more efficient use of both the clinician’s and the reader’s time.
He further proposed that focused reports would enhance the utility of the document as new
insights and targeted recommendations supported by the data are often of more interest
to readers (Donders, 1999). Consistent with Donders (1999) hypotheses, providers do not
read reports in their entirety. A survey of 424 physicians and 726 neuropsychologists found
that 84% of neuropsychologists did not believe that referral sources consistently read their
reports in full, and only about half of physicians reported reading entire reports, with the
most commonly read sections relating to diagnosis and recommendations (Postal et al.,
2017; Postal & Armstrong, 2013). Even so, many reports are long, with pediatric and reports
averaging 11–12 single-spaced pages (Postal et al., 2017). Not only can excessive length
hamper clinical care (Postal et al., 2017), reimbursement constraints in managed health care
systems have limited the amount of time neuropsychologists can bill or placed limits on the
number of hours they will reimburse. Writing long reports may result in unreimbursed effort
(Kanauss, Schatz, & Puente, 2005; Sweet, Peck, Abramowitz, & Etzweiler, 2003).
Brief reports demand that the writer be more organized. Certain formats and structures
of reports allow neuropsychologists to focus on the most important content and organize
details in a systematic way, rather than providing a comprehensive, detailed account of all
qualitative and quantitative data. One suggestion relates to bulleting; in one large survey,
the vast majority of physicians indicated they preferred bulleted information in the diagnoses
(72.5%) and recommendations sections (86.5%; Postal et al., 2017). Tables and charts also
allow for less text and draw attention to particular quantitative data of interest. Suggestions
are offered about how to incorporate tables and charts, but no consensus has emerged on
how best to use them in reports (Donders, 2016; Naugle & McSweeny, 1995; Vasserman &
Baron, 2016).
Beyond report length and organization, Baron and colleagues (Baron, 2004; Baron et al.,
1995) also recommended that neuropsychologists simplify complex terms and tailor the
 THE CLINICAL NEUROPSYCHOLOGIST  347

impressions and recommendations to the intended audiences. Those audiences vary in

reading level, education, socioeconomic status, and neuropsychological knowledge. The
target audience is determined, in part, by the referral source. In most cases, physicians are
referring for evaluations (Kanauss et al., 2005). However, pediatric reports are usually read
by parents, teachers, and other school staff. In addition, social workers, lawyers, therapists,
and young patients themselves may read the report.
Given the varied reading levels and medical and neuropsychological knowledge of multiple
audiences, readability is an important consideration. Hundreds of studies have documented
the wide gap between the reading levels of written health information and the level of adult
reading abilities (for overviews, see Rudd, Colton, & Schact, 2000; Zorn, Allen, & Horowitz,
2004). The problem of limited literacy in general is compounded in the health care arena
specifically by the complex concepts and specialized vocabulary terms often used. A wide
gap between reading levels of reports and the reader’s literacy may result in poor understand-
ing of the patient and missed or poorly implemented recommendations (Institute of Medicine,
2004; Vernon, Trujillo, Rosenbaum, & DeBuono, 2014; Zhang, Terry, & McHorney, 2014).
Although many pediatric neuropsychologists have attempted to optimize the readability,
organization, and length of their reports and, in general, the vast majority of clinicians are
motivated to make changes to reports (Postal et al., 2017), there have been no systematic
studies of the impact of such attempts. Studies have shown that multiple audiences (e.g.
patients, parents, referring physicians) value the reports (Bennett-levy, Klein-Boonschate,
Batchelor, McCarter, & Walton, 1994; Bishop, Temple, Tremont, Westervelt, & Stern, 2003;
Bodin et al., 2007; Donofrio, Piatt, Whelihan, & DiCarlo, 1999; Farmer & Brazeal, 1998; Temple,
Carvalho, & Tremont, 2006; Tremont, Westervelt, Javorsky, Podolanczuk, & Stern, 2002).
However, there have been no published studies to show that it is feasible, let alone helpful,
to alter pediatric neuropsychological reports toward more readability.
The purpose of this study was to evaluate the effectiveness of a revised report writing
format that was implemented within a hospital-based pediatric neuropsychology group
working with children who have primarily medically based conditions. Based upon the exist-
ing literature as well as semi-structured interviews with several primary stakeholders in
patient care, the revised format focused on (1) brevity, (2) organization and structured for-
matting, and (3) readability. Although the ‘report renovation’ initiative was undertaken as a
clinical endeavor, the archival nature of reports allowed for careful post hoc study. This paper
summarizes the revised format and statistically examines changes in report characteristics
and utility over time across clinically and demographically similar pediatric patients.

Method
The initiative was undertaken purely for clinical reasons; thus, post hoc approval was obtained
by the Institutional Review Board at Cincinnati Children’s Hospital Medical Center prior to
evaluation of the reports.

Summary of clinical initiative

The goal of the clinical initiative was to maximize the effectiveness of reports generated by
the Neuropsychology Service at Cincinnati Children’s Hospital Medical Center, a large ter-
tiary-care pediatric hospital located in southwest Ohio that attracts patients from across the
348  K. T. BAUM ET AL.

country and internationally. The service focuses on children and adolescents with diagnosed
neurological conditions and/or other medical conditions in which either the primary medical
issue or its treatment carries neuropsychological risk. Developmental disabilities and psy-
chological concerns are common in such populations, and children with these concerns are
seen if they also have a plausibly contributing medical/neurological diagnosis. Those without
a medical/neurological diagnosis but with suspected Attention-Deficit Hyperactivity Disorder
or other psychiatric conditions or those with primary concerns for profound intellectual
disabilities or moderate to severe autism spectrum disorder are generally seen through other
specialty hospital services.
The overall clinical initiative involved both inpatient and outpatient services and applied
to all reports regardless of the child or family’s spoken language. However, to promote a
focused study, the current paper examines reports from ‘traditional’ outpatient neuropsy-
chological assessment with English-speaking patients/families, which comprised the large
majority of referrals fielded by the service over the study period. Evaluations were generally
conducted over 2–3 sessions; in most cases, the child attended only 1 session (testing and
child interview) while parents attended all sessions including an initial interview and
post-testing feedback session. As described below, the timing of subsequent report com-
pletion varied but usually followed the final parent session. Only one primary report was
generated per evaluation, except in rare cases in which clinical necessity warranted separate
versions of reports. This report was then provided to the family/guardians and, with consent,
to relevant care team members (e.g. referring physician, primary care physician, therapist,
school intervention coordinator who acts as a liaison between the hospital and school).
Given our setting, school psychologists and teachers were considered an important read-
ership, though how the report was given to the school varied (e.g. routed through the family,
mailed directly, via a school intervention coordinator).
Core principles, concerns, and targets for the clinical initiative are outlined in Table 1.
These were based upon converging input from published guidance available at the planning
phase of the initiative (2012) and qualitative expert input. Specifically, we culled information
from: (1) the small professional literature at the time on neuropsychological report writing
(Axelrod, 2000; Donders, 1999, 2001); (2) written guidance on how to design patient-friendly
written materials to improve health literacy (e.g. Kaphingst et al., 2012; National Institutes
of Health, n.d.; Weiss, 2007); (3) the broader professional literature on how to write in ‘plain
English’ or ‘plain language’ (e.g. Center for Disease Control, 2009; Cutts, 2010; Stephens, 2010);
(4) a 1-hour group problem-solving session led by several hospital-based school intervention
coordinators; and (5) 30–45-minute semi-structured interviews with key stakeholders, includ-
ing referral sources (e.g. physicians, nurse practitioners), school intervention coordinators,
and a psychologist outside of the neuropsychology service whose child had been assessed.
The semi-structured interviews were founded on three pairs of reports of children with
varying conditions, each pair comprised of a ‘long’ version (the de-identified version of a
typical report) and a version of the same report that had been shortened and/or reformatted
using differing strategies (e.g. editing or omitting sections, different heading/labeling con-
ventions, omitting or differing embedded tables). Given the context within the clinical ini-
tiative, data were gathered in a narrative fashion rather than a highly structured format;
however, there was strong agreement across sources on the information contained in
Table 1. A disguised version of a ‘new format’ report is also provided in Appendix B to offer
the reader a concrete example.
Table 1. Revised format rationale, stakeholder sample quotes, and targets/goals.
Domain Concern Stakeholder quote New format target
Literacy/Reading Level Writing style too difficult for many readers ‘I understand it because I’ve worked with you, but I’d • Reduce or eliminate jargon
have to explain it to my ex-husband if it was about • Use short, declarative sentences
our child’ • Use active (not passive) verbs
• Speak directly to the reader
• Choose common and brief expressions over
low-frequency or long words

Paragraph structure The most important information can be lost due to ‘If a paragraph is longer than 2 inches, I skip it or • Focus on main points, omitting less important
fatigue skim it’ detail
• Summarize common information within categories
(e.g. all scores are ‘normal’ in single domain of
functioning)
• Use brief bullet points to focus both you and the
reader on key takeaway points.
• In recommendations, lead with the requested
action. If you need to elaborate, do so afterwards

Layout/labeling Too difficult for readers to find key information ‘While I’d love to have stuff for me come first, this • Leverage the structure offered through intentional
goes to different readers, so I’d be happy if you use of headings + sub-headings, using only a
made it clear where things are’ limited number of levels. For example, put major
‘People need help finding the good stuff’ headings in bold caps, followed by minor labels in
bold (e.g. ‘RELEVANT HISTORY’ followed by
‘Medical’, ‘Educational’ etc.)
• Limit use of bold, underline, or italics to critical
points. If you are tempted to use it more, consider
if you’ve written too much
• Use a clear and consistent format and labels across
clinicians
• Use audience-specific labels for recommendations
(e.g. ‘For Health Care’, ‘For Schools’, ‘For Family’)
(Continued)
THE CLINICAL NEUROPSYCHOLOGIST 
349
Table 1. (Continued).
350

Domain Concern Stakeholder quote New format target

Length Overwhelming; reader fatigue leads to missed ‘When I saw the short versions of reports, I thought • Critically question whether text adds or distracts
information and lost focus on the most important “oh no, how long are the long versions?”’ from key points
actions ‘Honestly, I usually skim most of it. It’s too much to • Focus on relevance. If it helps, add a qualifier to
take in anyway’ headings (e.g. ‘Relevant History,’ ‘Main Findings’)
‘You’re the expert. I trust you with the interpretation. • Take a clinically integrated approach. Score-by-
You don’t need to show all your math’ score interpretation can be done by a computer.
For most settings, your training allows a more
 K. T. BAUM ET AL.

concise, big-picture approach

• Rather than providing dozens of recommenda-
tions, focus on the most important action items to
ensure that the most important steps don’t get
passed over for less important ones.
• Set goals for length. These can flex for exceptional
cases, but without concrete goals there is often
‘drift.’
• Repeated text or references to ‘aforementioned’
text are red flags that you’ve written too much and
you’re afraid the reader has forgotten what you
wrote

Document organization Most important parts can get ‘buried’ by less ‘I’ve seen reports with page after page of numbers I • Make sections proportional to their importance
important parts don’t care about, and then there are hardly any of • Summary/Impressions and Recommendations are
what I want: answers and recommendations’ most valued by readers; the space allotted to them
should reflect such
• Consider shifting test scores to small print in an
appendix, as very few readers can interpret these
data. At our site, we uniformly adopted score
placement in such an appendix
• Aim for ~1 page of relevant history, ¼–½ page
behavioral observations, 1 page of test results,
½–3/4 page summary/impressions, and 1–2 pages
recommendations
 THE CLINICAL NEUROPSYCHOLOGIST  351

The new revised format rolled out in several steps. Initially, all attending neuropsycholo-
gists and postdoctoral fellows in the program were involved in didactic sessions that intro-
duced the need to re-examine report formatting. These didactic sessions were followed by
data gathering via readings, a didactic session with school intervention coordinators, and
semi-structured interviews with key stakeholders. Those interviews were all conducted by
the last author, with other neuropsychologists joining when their schedules allowed to max-
imize engagement. During that process, which took place in early 2012, clinicians were also
encouraged to ‘try out’ report writing styles and formats that they thought might improve
communication. In mid-2012, the last author then collated and summarized findings in a
formal presentation to the program and proposed concrete guidelines that were then refined
via group discussion. All clinicians agreed to undertake the change in format immediately,
which was then reinforced through periodic record review and feedback by the final author
as well as several one-hour ‘workshops’ that involved practice with rewording and reformat-
ting old-style (de-identified) reports.

Report sampling
Archival medical record review was used to evaluate the potential impact of this clinical
initiative. Neuropsychological evaluation reports were systematically collected from the two
years before, after, and during the clinical practice change. Two-year spans were chosen over
shorter spans to account for the fact that behavior change is gradual and to maximize our
ability to match the reports from each time span on diagnosis, sex, and age. Such matching
was deemed important to eliminate these variables as potential confounding factors since
referral patterns can shift over time.
Roughly, 1200–1400 unique assessments/reports were completed by our service during
each of the three time periods of interest: 2010–2011 (‘old format’), 2012–2013 (‘transition
years’), and 2014–2015 (‘new format’). Cases were then screened for the following inclusion
criteria: (1) traditional outpatient neuropsychological evaluation, rather than inpatient or
brief targeted evaluation; (2) final report was available in the electronic medical record; (3)
child was 6–17 years of age at the time of the evaluation; (4) test results were deemed valid
by the assessing clinician (routinely noted in reports); and (5) each child was represented
only once (in the event of re-evaluation, only the first evaluation that met other selection
criteria was included).
We then undertook stratified random sampling of eligible reports to obtain a sample of
240 reports, 80 within each of the three time periods. There were three sampling strata within
each time period. Each time period included 20 reports from each of 4 (primary) diagnostic
groups: traumatic brain injury, epilepsy, oncology (brain tumor or leukemia), or cerebral
palsy. These diagnostic groups were selected because they are commonly seen by our service
and have diverse clinical presentations and needs. Within the resulting diagnosis-by-time
period groups, stratification was then based on sex and age: within each of the 4 diagnostic
groups for each of the three time periods, the goal was to have equal numbers of elementary
school boys aged 6–11 years, girls in that same age range, adolescent boys aged 12–17 years,
and girls in that same age range. However, for a few of the strata, we lacked one or two
adolescents; in those cases, the oldest elementary school patients were selected. Although
we did not stratify further, via chart review each case was coded on race/ethnicity and
insurance coverage at the time of chart review (private insurance vs. Medicaid).
352  K. T. BAUM ET AL.

Measures
The body of each report, excluding any data tables, was then extracted from the medical
record, converted into a Microsoft Word document, and stripped of Protected Health
Information (e.g. names, dates, medical record numbers) prior to storage and analyses. Two
sets of measures were then extracted: one using objective metrics and the other using
qualitative metrics. Primary objective metrics included report length (as measured by word
count), reading level of report (per the Flesch-Kincaid readability metric as generated by
Microsoft Word), and the percentage of the report’s length dedicated to an integrative sum-
mary and impressions section and specific recommendations (since the diagnostic summary
section and recommendations are the most commonly read sections of reports and arguably
the most valuable to referral sources; Postal et al., 2017). These objective metrics were cal-
culated excluding all data tables or appendices to avoid distorting contrasts between report
formats (e.g. text length) that might result from changes in table contents or placement.
Secondarily, chart review allowed for objective examination of concurrent changes in
billing and case flow since, at least in theory, shorter reports might reduce billing and report
generation time. Although a number of factors play into both of these outcomes including
changes in institutional expectations and increased use of technological tools to minimize
non-clinical activities, we explored the differences in total hours billed for each evaluation,
and time delay from completion of testing to finalization of report (i.e. report turnaround
time).
To complement these objective metrics, a subset of reports was evaluated for quality
based upon the expert review of two hospital-employed school intervention coordina-
tors. Those raters, who are third and fourth authors on this paper, both have graduate
level education (master’s or doctoral degrees) with training and education in special
education law as well as extensive experience working with schools, families, and pedi-
atric patients. Each rater evaluated 16 de-identified reports, 8 from the ‘old’ report format,
and 8 from the ‘new’ report format, with 1 report from each of the four diagnostic, age,
and sex groups in each time period. Reports from the ‘transition years’ were omitted from
this quality assessment because the goal was to compare perceptions of reports that
typified the old and new formats. Full reports, including any data tables or appendices,
underwent these quality reviews. Raters were blinded to the time period from which
reports were derived, though the clear shift in format may have made it impossible to
maintain that blinding. Five reports were reviewed by both raters to allow for interrater
reliability analyses.
Quality ratings were recorded on a questionnaire designed for this study to assess impres-
sions regarding communication of findings and recommendations. Because no comparable
measure has been previously published, we developed a 20-item form (see Appendix A)
that uses a Likert-type rating scale with responses ranging from 1 (strongly disagree) to 5
(strongly agree). Items were designed to assess report elements that educators deemed
most relevant to determining the effectiveness of the neuropsychological report. A com-
posite score based on the full 20-item scale showed strong internal consistency within each
of the two raters (.80 and .94); however, the intraclass correlation coefficient (ICC) was weaker
(.55) due to an outlier. We then extracted a subset of 10 items that focused on quality inde-
pendent of specific targets of the clinical initiative (i.e. report length, format, and readability).
These 10 items included assessment of overall understanding (e.g. ‘I understand the content’)
 THE CLINICAL NEUROPSYCHOLOGIST  353

and utility and applicability for the school intervention audience (e.g. ‘The recommendations
fit with the child’s needs; It would help me to advocate for the patient’s needs’). This 10-item
subscale had an internal consistency of .72 for one rater and .93 for the other; the ICC was
strong (.86).

Statistical approach
Preliminary analyses compared the samples for the three time periods on age, gender, race,
insurance, and primary medical diagnosis using one-way analyses of variance (ANOVA) and
Pearson chi-square tests. One-way ANOVA evaluated change in the objective metrics, using
post hoc Fisher’s least significant difference tests to follow up on significant ANOVAs. Finally,
‘old format’ versus ‘new format’ reports were compared on the full 20-item and abbreviated
10-item report quality metrics using independent-samples t-tests.

Results
As shown in Table 2, there were no differences in demographic variables (i.e. sex, age, race,
ethnicity, and percent with public insurance) between the three time periods.

Objective metrics
Consistent with the goal of the clinical initiative, primary objective metrics differed across
the three time periods. Specifically, differences were seen in the total word count of reports
(F(2, 237) = 61.01, p < .001), readability of reports (F(2, 237) = 79.01, p < .001), and the per-
centage of the report dedicated to the impressions and recommendations sections (F(2,
237) = 7.02, p < .001). Compared to the ‘old’ report format (2010–2011), both the ‘transition’
years format (2012–2013) and the ‘new’ report format (2014–2015) had fewer total words
and a lower reading level (p < .001; see Figures 1 and 2). Length changed quickly, while
readability improved in a stepwise fashion across the three time periods. The percentage of
report dedicated to impressions and recommendations increased between the first time
period (2010–2011) and the third time period (2014–2015) and between the second and
third time periods (see Figure 3). The first two time periods did not significantly differ (p = .10).
To ensure that results could not be explained by staffing changes over time, we also explored
whether these effects were evident for the three providers who generated reports across all
three time periods; findings mirrored those for the complete data-set.

Table 2. Demographic comparisons between time periods.

2010–2011 (n = 80) 2012–2013 (n = 80) 2014–2015 (n = 80) p
Age-M(SD) 11.63 (2.95) 11.84 (3.50) 12.14 (3.57) .63
% Male 50 50 50 1.00
% Caucasian 81.3 75 75 .70
% Non-Hispanic 100 96.3 95 .15
% Public Insurance 27.5 28.8 36.7 .40
Diagnosis n n n
Epilepsy 20 20 20 1.00
Traumatic Brain Injury 20 20 20 1.00
Oncology 20 20 20 1.00
Cerebral Palsy 20 20 20 1.00
354  K. T. BAUM ET AL.

Figure 1. Report word count by year.

**p < .01.

Figure 2. Readability of reports by year.

**p < .01.

Figure 3. Percent of report dedicated to impressions and recommendations.

*p < .05; **p < .01.
 THE CLINICAL NEUROPSYCHOLOGIST  355

Although not direct targets of the initiative, secondary analyses also indicated that fewer
hours were billed over time for the testing portion of the evaluation (F(2, 237) = 4.27, p < .05)
and for the total evaluation including interviews and feedback (F(2, 237) = 12.34, p < .001).
Figure 4 depicts these data. As shown in Figure 5, the time from test date to report (i.e. report
turnaround) also significantly decreased across the three time periods (F(2, 237) = 4.10, p = .05).

Quality metrics
Given the 5-point Likert scale, possible scores were 20–100 for the 20-item report quality
measure and 10–50 for the 10-item subscale. There was a clear preference for the ‘new’ report
format (M = 83.50, SD = 9.74) over the ‘old’ format (M = 71.81, SD = 6.25) based on the overall
20-item score on the measure (t(30) = −4.04, p < .001) and using the 10-item subscale that
omitted areas directly targeted by the clinical initiative (‘old format’ M = 36.06, SD = 3.49;
‘new format’ M = 41.44, SD = 4.90; t(30) = −3.57, p < .01).

Discussion
This archival study was the first to systematically document the feasibility of generating
outpatient reports in a hospital-based, multi-clinician pediatric neuropsychological practice
that are shorter, more readable, and more heavily focused on the components of the report
most valuable to readers: the impressions and recommendation sections (Donders, 1999;
Farmer & Brazeal, 1998; Postal & Armstrong, 2013; Postal et al., 2017). This change was done
without sacrificing quality; indeed, the reformatted report was preferred by an important
audience, school intervention coordinators.
There is little debate that patients and most readers of neuropsychological reports would
be best served by minimizing complex medical terminology and jargon while maximizing
readability (Baron, 2004; Baron et al., 1995; Donders, 1999, 2016). Poor readability is a per-
vasive issue in health care given the wide gap between the literacy levels of most adults
and the written health information they are routinely provided (Zorn et al., 2004). In several
federal reports, including the National Adult Literacy Survey, it was noted that nearly half
of all American adults have limited ability to read, understand, and use information from

Figure 4. Hours billed for neuropsychological evaluation by year.

Notes: ‘Hours billed for testing’ includes testing hours and professional fees. ‘Total hours billed’ includes these testing hours,
as well as child and parent interviews and follow-up feedback sessions.
356  K. T. BAUM ET AL.

Figure 5. Days from testing date to finalization of report by year.

*p < .05; **p ≤ .01.

text, charts, and tables (Kirsch, Jungeblut, Jenkins, & Kolstad, 1993), scoring at ‘basic’ or
‘below basic’ levels of literacy. Further, the stress and anxiety associated with managing
one’s own or a family member’s health care needs can make deciphering text-heavy doc-
uments even more daunting. Yet, data show that our ‘old report’ format was consistently
written at a college level, far exceeding many audiences – a phenomenon that seems to
be persistent in the field of neuropsychology. Results from this initiative suggest that pedi-
atric neuropsychologists can certainly write more readable reports without compromising
quality of information, offering a powerful case for other sites to consider similar
initiatives.
Time is another constraint on the readership of neuropsychological reports (Dugdale,
Epstein, & Pantilat, 1999), and both a report’s length and the format or structure can impede
a reader’s ability to access relevant information. Physicians – the primary referral source for
neuropsychology (Kanauss et al., 2005) – often have limited time to dedicate to reviewing
evaluation results. Time constraints pose barriers in educational and home settings as well.
Classroom teachers and other school professionals increasingly feel the pressure and
demands of standardized testing, teacher performance evaluations, and the burden of indi-
vidualizing educational programming. These educational pressures translate into reduced
availability for reading lengthy reports for single learners. Other readers, such as parents
and the patients themselves, operate in a busy, fast-paced world where efficient consumption
of information has become the norm. When information is dense, jargon-filled, or lengthy,
readers’ attention lapses (Liu, 2005; Postal et al., 2017). While some populations may require
reports with different emphases (e.g. greater emphasis on history and symptom presentation
for an autism spectrum disorder), it is worthwhile for clinicians to reflect on their practices
and whether or not they best serve the patient, family, and professionals working with them.
Certainly, in a medically oriented setting, current findings clearly point to the feasibility of
writing shorter reports that use structured formatting to emphasize portions of the report
that are most important: the summary/impressions and recommendations (Postal et al.,
2017).
Although the main focus of this clinical initiative was to improve the length, readability,
and structure of reports, decreased billing and faster report turnaround were also achieved
over the time frame of the study. Billing changes were primarily driven by fewer hours
 THE CLINICAL NEUROPSYCHOLOGIST  357

charged for the testing portion of the evaluation, which included time spent on the clinical
integration of information. It is important to acknowledge that both clinical billing time
and report turnaround time are affected by many factors. However, our experience has
been that, after an initial adjustment period in which efficiency is temporarily disrupted,
clinicians can be taught to write shorter, more concise reports, and spend less time doing
so. Development of briefer reports translates into improved cost-effectiveness (due to
decreased billing) and improved clinical effectiveness (quicker reports lead to quicker
interventions) – both key targets in a changing health care system. In managed health
care environments that follow capitation models, these efficiencies can also result in less
unbillable clinician effort (c.f. Sweet et al., 2003) and quicker patient access to care. From
a clinician’s perspective, quicker turnaround improved ability to integrate data from mul-
tiple appointments into a single document. However, we share Donders (1999) caution
that efficiency should not be sought at the cost of individualization. For example, while
the use of templates or boilerplate report sections may aid in reducing clinician time spent
on reports, these can inadvertently lengthen reports by forcing in information that is irrel-
evant for a given case and yield nonspecific conceptualizations and recommendations
that are of limited utility for individual children, families, schools, and health care
providers.
It is perhaps even more important to demonstrate that changing report length and read-
ability results in clinical care that is as good as or better than the prior practice. Fortunately,
one key audience indicated a clear preference for the revised report format. As with other
major pediatric medical centers, school intervention coordinators in our institution are
uniquely responsible for guiding families and schools around educational intervention plan-
ning, a sizeable proportion of which is guided by neuropsychological evaluation reports.
Our study showed these liaisons can more easily understand and readily identify appropriate
content of reports when the reports are shorter, written in a more reader-friendly language,
and are structured to maximize communication of the clinician’s impressions and recom-
mendations to specific audiences. Armed with this information, the liaisons may be more
effectively able to advocate for a child’s needs and feel confident the school staff and parents
know what next steps to take. Although not systematically evaluated, we have received
similar feedback from referral sources, school staff, and parents who experienced reports
written in different formats at different time points.

Limitations and future directions

It is important to note that these archival data were collected in the context of a clinical
initiative, not an experimental study. Because there was no random assignment to conditions,
a causal relationship cannot be proven between this report writing initiative and the
observed changes. Nevertheless, given the lack of data on report writing in pediatric neu-
ropsychology and in neuropsychology more broadly, the current findings substantially add
to the current literature. Further, the focus on archival documentation has several advan-
tages: data are highly applied and authentic, clinician reactance and Hawthorne effects are
minimized, consistency in the nature of the data being collected across the time periods is
maintained, and sufficient opportunities for case stratification by demographic and diag-
nostic factors are provided, thereby minimizing potential confounding factors.
358  K. T. BAUM ET AL.

Importantly, the described report format may not work for all clinicians or settings and
was designed in our program with our outpatient medical population in mind. Stylistic dif-
ferences have evolved in the field, in part, due to varying demands. The purpose or intended
audience of the evaluation and report may warrant greater emphasis on some elements of
a report and diminished emphasis on others. Our initiative and subsequent study is not
intended to be prescriptive, but rather to shed light on the important topic of intentional
and flexible communication in neuropsychological reports, and to encourage each clinician
and group to re-examine their report-writing format and process. Clinicians can and should
take a step back to analyze the needs of their populations and specific audiences and, in
cooperation with them, develop more focused and more readable reports, minimizing jargon
and wordiness. In our case, we had the luxury of invested referral sources and school inter-
vention coordinators to assist. In other settings, other stakeholders may be more important
and/or available (e.g. educational lawyers).
The sample of reports used for assessing quality was relatively small due to pragmatic
constraints. To minimize deleterious effects of this limitation, the cases studied were drawn
at random from each stratum within the ‘old’ and ‘new’ formats, increasing confidence that
findings are generalizable. Further, while the small sample might bias findings toward the
null due to diminished statistical power, effect sizes were nonetheless large enough to reach
statistical significance. The quality ratings were also based upon a scale developed for this
study, as no similar measure previously existed in the literature. Of note, the school inter-
vention coordinators who rated individual reports were also involved in initially developing
the rating scale, which may have introduced bias. However, as school intervention coordi-
nators and consumers of our reports, these raters seemed best suited to characterize the
value components of pediatric neuropsychological reports. Psychometric analyses were
promising, and it was reassuring that findings remained robust when eliminating items that
were overtly linked to the targets of our clinical initiative. However, it will be important to
further assess the psychometrics of the report quality scale and to replicate these findings
in larger samples. Additionally, future studies should include the changes in clinician time
needed to generate reports; we hypothesize that there will be an initial learning curve that
may result in more time needed to implement the new format, but that this will level off and
give way to greater efficiency after a short adjustment period. This remains to be studied in
more detail, however.
Finally, these rating data show the shorter, more readable, and more focused reports are
more understandable and usable to school intervention coordinators. This is an important
audience, as they are responsible for integrating neuropsychological reports with informa-
tion from school meetings and parents’ reports, and advocating for interventions in the
school system. Future work should evaluate the report preferences of other audiences, such
as patients, school personnel, and referring clinicians. Parents are also an important stake-
holder group that should be more heavily considered in future work. We were concerned
about family burden and inadvertent breaches of confidentiality (e.g. social networks can
develop around families dealing with medical conditions, so even a de-identified report
might include enough contextual information as to ‘out’ a child), though there may be ways
of balancing such concerns with the need to gain this input (e.g. focus groups with fictional
or heavily disguised exemplar reports).
 THE CLINICAL NEUROPSYCHOLOGIST  359

Conclusions
There likely is not a single report style, length, or format that will be well-suited to the needs
of all readers or to all settings. However, in a medical outpatient pediatric neuropsychology
program, it is feasible to write reports that are more focused, written in a way that minimizes
jargon and complex terminology, and are not overly wordy or long. Preliminary evidence
further suggests that doing so optimizes the utility of the report for the reader and, we
believe, benefits the child. While our revised report format was optimized to a specific (med-
ical) setting, we assert that clinicians in other settings can and should re-examine their
reports. If our experience holds true, in doing so one can simultaneously maximize quality
of care while reducing clinician burden.

Disclosure statement
No potential conflict of interest was reported by the authors.

ORCID
Katherine T. Baum http://orcid.org/0000-0003-4754-5852

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 THE CLINICAL NEUROPSYCHOLOGIST  361

Appendix A. Neuropsychology Report Evaluation Form

Please rate the degree to which you agree with each statement for the report you just read. There
are no right or wrong answers. Please feel free to ask if you have questions about the rating process.

Strongly disagree Disagree Neutral Agree Strongly agree

1. I read all of it 1 2 3 4 5
2. I understand the content 1 2 3 4 5
3. I understand how the content would apply 1 2 3 4 5
to my work with this patient/student
4. It was free of jargon and complex 1 2 3 4 5
language
5. It oversimplified or understated the 1 2 3 4 5
child’s needs and history
6. It was complex and difficult to 1 2 3 4 5
understand
7. The length was suitable for the content 1 2 3 4 5
8. It was too brief to effectively communicate 1 2 3 4 5
the child’s history/needs
9. It gave a comprehensive overview of this 1 2 3 4 5
student/patient
10. The length was distracting or 1 2 3 4 5
burdensome
11. The format was easy to follow 1 2 3 4 5
12. It was easy to find what I needed to 1 2 3 4 5
know
13. The recommendations are feasible/ 1 2 3 4 5
practical
14. The recommendations show an under- 1 2 3 4 5
standing of school guidelines/processes
15. The recommendations fit with the child’s 1 2 3 4 5
needs
16. I would implement the recommenda- 1 2 3 4 5
tions or treatment plan
17. The recommendations are 1 2 3 4 5
comprehensive
18. It would help me to advocate for the 1 2 3 4 5
patient’s needs
19. School staff would know what to do 1 2 3 4 5
next
20. Parents would know what to do next 1 2 3 4 5

Appendix B. Sample Neuropsychology Report

Note: This appendix is intended to illustrate the semi-structured report format described in this paper. The
case was chosen because it was readily disguised, and concussion is a relatively high base-rate condition.
The reader is cautioned to focus on the overall format, as key details have been changed to protect confi-
dentiality. These changes might result in some mismatch of findings, impressions and/or recommendations.
Note that our format varies somewhat based on clinical needs. Sample report statistics: Word count = 2484;
Readability = 9.9 grade level.

John Doe is a 16-year, XX-month-old right-handed male with a reported history of multiple concus-
sions. He was previously seen through our service in Month 20XX. He was referred by Thomas Smith,
MD, for re-evaluation of his neurocognitive functioning to update his intervention plan. This report
is based on a review of available medical records and information gathered on the following dates:
XX/XX, XX/XX, and XX/XX/20XX. Intervention planning was discussed with John and his mother on
the last of these dates.
362  K. T. BAUM ET AL.

RELEVANT HISTORY

Developmental/Medical: John was born full-term following an uncomplicated pregnancy, labor, and
delivery. He was a healthy child until Month 20XX when he sustained his first concussion. He had addi-
tional concussions in Month 20XX and Month 20XX. All three were sports-related and involved brief
alterations in consciousness, followed by headache and concentration problems that resolved within a
week. In Month 20XX he sustained his latest concussion after hitting his head on a table. He did not lose
consciousness, but he experienced increased headaches/migraines and nausea/vomiting. He missed
the entire second quarter of school but was eventually able to return for half-days. He continued to
struggle to attend school and missed at least 1 day weekly due to migraine.

His medical history also includes attention problems, which were longstanding but first treated after
his 20XX concussion. He now takes Concerta. However, his mother reported ongoing difficulties with
focus/concentration and forgetfulness. She said he struggles to remember tasks he needs to do and
forgets to complete and turn in homework. She also reported that it has been difficult to get John to
take his medications if she is not there to remind him. He has told her that he would like to stop taking
all medication. Previous medication includes Ritalin (stopped because of low appetite). There are no cur-
rent concerns with hearing, vision, sleep, appetite or growth. He also denies current headaches or pain.

Academics: John recently completed 11th grade at Local High School. He earned C’s, D’s, and F’s in
his classes. He is now taking English (online course) in summer school. His mother reported that he is
frustrated with his grades, as he has been an A/B student in the past. She said that he has trouble with
daily work as well as quizzes/tests. His teachers have reported poor participation in class.

Behavioral/Emotional/Social: John’s mother reported that he has struggled with depression over the
years. He was especially upset at no longer being allowed to play sports after his previous concussions.
She noted that his mood has been better and he has not been as withdrawn since increasing his dose
of Effexor XR. She denied concerns about him harming himself or others. She expressed concern about
his coping skills. She also said that he has always tended to want things a certain way, in a certain order.
However, this has not caused problems in daily life. She denied any other anxiety.

John has many friends. He enjoys pick-up basketball and watching basketball games. His mother
reported that he recently got his driver’s license and is looking for a job.

Family: John lives with his parents, grandmother, and older brother and sister in City, State. Both par-
ents graduated high school. Recent stressors include a family member’s illness. Family mental health
history includes depression.

Prior Testing: John had a previous neuropsychological evaluation (Month 20XX), shortly following
his 20XX concussion. Results at that time indicated age-appropriate intelligence, but weaknesses in
attention, executive skills, memory, fine motor speed, and word-finding. Of note, on the day of that
prior testing he had not taken stimulant medication and reported continuous headache.

BEHAVIORAL OBSERVATIONS AND CHILD INTERVIEW

Testing: John had taken his prescribed medications the day of testing. He transitioned appropriately
to begin testing. He was quiet and reserved but pleasant. He seemed tired and had somewhat reserved
affect. He denied headache but reported a mildly upset stomach. He spoke little outside of responding
to test items, but his speech was typical for his age. His language expression and comprehension were
age-appropriate. He was cooperative with testing and seemed motivated to do well. He put forth good
effort (as supported by formal effort measures). He had good attention to tasks and persisted even on
challenging items. For paper-and-pencil tests, he used his right hand with good pencil control. Test
results are believed to be a valid reflection of his functioning.
 THE CLINICAL NEUROPSYCHOLOGIST  363

Child Interview: John described a great deal of forgetfulness. He said that he forgets a lot of aca-
demic material, no matter how much he studies. He also reported forgetting tasks he needs to do,
conversations, and recent events. He denied difficulties remembering past experiences (e.g. vacations),
people’s names, or faces. He noted that memory cues help sometimes. He reported not noticing much
difference on medication but that he does focus better. He said he is a little slow to process information.
He described poor time management skills.

John said that he has to re-take several classes from last year because of missing all of 2nd quarter. He
described English as his weakest subject and math as his strongest. He said that he forgets what he has
read so he struggles with reading comprehension. He took the ACT in Month 20XX, and reading was
his hardest section. He plans to re-take the ACT at the beginning of the school year. He said he plans
to take community college classes before applying to Local College. He expressed interest in design.

TEST RESULTS (see also appended test data page for test list and select test scores)

Intelligence: Overall intellectual skills were average. Most index scores were average to high average,
with a slight strength in visual reasoning. Processing speed was slightly weaker but broadly normal
(low-average).

Academic Skills: John’s academic skills were at or above age-expected levels. Math calculation skills
and reading comprehension were average. Single-word reading and spelling skills were high-average.

Verbal/Language: All scores in this area were average to high-average.

Visual Perception/Construction: Scores were again average to high average here, without a clear
pattern of strengths or weaknesses.

Attention/Executive: Brief attention/working memory, directed attention, sustained attention, and

impulse control were all average. His performance on tasks of complex problem solving and mental
flexibility was average to high-average. Scores on timed tests varied, but tended to be a bit weaker
than on untimed tests.

Of note, attention and executive functioning deficits may not show up on tests or in a structured testing
office and yet be evident in real-world settings. This seems to be the case for John, as parent ratings
indicated significant attention problems, even with medication. Both parent ratings and John’s own
ratings of his executive skills indicated difficulties with working memory and planning/organization.
Parent ratings also indicated mild concerns for self-monitoring.

Memory: Learning and recall of rote verbal information (word list) was average overall, and John
showed a nice learning curve. Recall of the list after a brief delay was high average, while recall after a
longer delay was superior. Recall of more complex verbal information (short stories) was average for
both immediate and delayed recall. Yes-no and multiple-choice questions did not substantively alter
his performance. Recall of complex visual material (abstract design) was average for immediate and
delayed recall. Recognition of design parts was average.

Fine Motor: Fine motor speed and dexterity were average for both John’s dominant right hand and
his left hand. Pencil control was average.

Emotional/Behavioral/Adaptive: In addition to the attention and executive concerns noted above,

parent ratings indicated difficulties with everyday communication as well as mild-to-moderate con-
cerns with physical complaints, social skills, leadership, and activities of daily living. His mother also
noted mild concerns with depression. Teacher rating forms were not returned at the time of this report.
364  K. T. BAUM ET AL.

SUMMARY & IMPRESSIONS

John is a 16-year-old right-handed male with a history of multiple concussions. He also has a history
of ADHD (treated with Concerta) and mood difficulties.

Key findings:

• Average to above average cognitive skills (consistent with 20XX test results).
• Continued relative weakness in processing speed, but this was mild and inconsistent.
• Ongoing difficulties with attention and executive skills in real-world settings.

John has numerous cognitive and academic strengths and did as well as (or better than) most people
his age on testing. Aside from longstanding attention and executive problems in daily life, he does
not display clear impairments in his thinking. He reports resolution of headaches and, in general,
appears to be recovering well from his latest concussion. He continues to show a relative weakness in
processing speed, which is an area known to be vulnerable to the effect of concussion. However, it is
unclear whether this mild relative weakness was present prior to his concussions. Importantly, if John
sustains another concussion, he could experience an even slower recovery and a longer period of difficulties.

Although John has well-developed cognitive skills, he is struggling to use these in real-world settings.
He earned C’s, D’s, and F’s in his classes when he had been an A/B student in the past. He reported
now struggling with reading comprehension, despite age-appropriate skills in this area on testing.
He described significant forgetfulness, often a sign of reduced attention, especially in light of solid
memory skills.

There are probably multiple factors contributing to his current difficulties and underachievement
at school. He and his mother described ongoing attention problems even on medication. They also
reported trouble with executive skills (e.g. planning/organization, time management), which commonly
co-occur with attention problems. It is not clear how well he is using compensatory strategies for these,
and he has been inconsistent in taking medications. Also, his extended absence from school set him
back quite a bit, making it very hard to catch up. Given his general tendency to like things a certain
way, he may have taken his disruption in school and sports especially hard. Finally, John has a history
of mood difficulties and related treatments. It is important for each of these factors to be addressed
to provide John the best opportunities for success.

RECOMMENDATIONS

Recommendations for Medical/Health Care:

1. Consider whether there may be structured physical activities or sports for which he could be
cleared. These should involve minimal risk of head injury and be enjoyable for John.
2. Consider psychological therapy to address difficulties with mood and to work with him around
attention/executive functioning coaching. If John and his parents are interested in treatment,
they can call the Department’s Intake coordinators directly (xxx-xxx-xxxx) or this provider would
be happy to make a referral.
3. Continue to follow-up with his doctor for medication management. Consider an updated
medication evaluation to determine if his current regimen best meets his needs (he has incom-
plete symptoms control right now). Also, to help improve his adherence to medication, he is
encouraged to use external supports. A few apps that might help are:
a. <list of apps omitted to avoid commercial endorsement in this publication>
4. 
In general, take a rehabilitative approach to subsequent medical issues, with the goal of staying
in school or returning to school as quickly as possible (with supports, if needed).
 THE CLINICAL NEUROPSYCHOLOGIST  365

Recommendations for School:

1. School Plan. Consider providing school supports under a 504 Plan or Service Learning Plan,
given John’s history of multiple concussions and longstanding diagnosis of ADHD. His parents
are encouraged to share a copy of this report with his school to develop such a plan.
2. Attention.
a. Allow him to take tests in a quiet location, separate from classmates, to minimize distractions.
b. Provide preferential seating (i.e. close to the teacher and board, away from talkative/dis-
ruptive students or open doors/windows).
c. Have him focus on one task at a time. Repeat and/or clarify directions as needed.
d. Check in with him periodically to make sure he is on-task and knows what he is supposed
to do.
e. Provide reminders for work completion.
f. Prompt him to use his homework agenda/planner to record assignments and due dates.
3. Organization/Study Skills. Consider offering a supervised study hall that has an explicit focus
on building his use of organization and study skills. Use his actual classwork as material, initially
making sure he understands key organization and study skills (e.g. use of an agenda, breaking
down assignments), then prompting him to use them, fading the prompts over time. Author
and Author’s book ‘Book Title Omitted to Avoid Commercial Endorsement’ offers a nicely coher-
ent and practical approach. Also reinforce the concepts recommended in the next section.

Recommendations for Family/Home:

1. To help with organization and time management: Consider the approach from Author and
Author’s book ‘Title Omitted to Avoid Commercial Endorsement.’
2. To help improve memory for facts and other information:
• Emphasize repeated exposure over multiple study sessions, rather than ‘cramming’ sessions.
• Avoid relying on simple rehearsal/repetition. Instead, actively try to tie the information into
what is already known and elaborate on new information.
• Learn new information by testing – John can quiz himself or be quizzed by a parent or tutor
on the information right after studying it.
• Take practice exams whenever possible (e.g. ask teachers for old exams, take practice stand-
ardized tests). Model study sessions after the same format as the test (e.g. true/false, multi-
ple-choice, short answer/essay, long essay).
3. These active reading strategies may be useful to improve recall of reading materials:
• Use highlighting and underlining to draw attention to main points while reading. For elec-
tronic resources, make use of highlighting tools.
• Pause after 1-2 paragraphs and briefly summarize aloud the material that has just been read.
• If unable to summarize, re-read those paragraphs. It may help to read them aloud.
• Answer questions within the chapter to check for comprehension.
• After finding the answer to a study guide question, place a Post-It note with the question
number on the page for easy identification later.
4. Strategies for taking tests (adapted from TestTakingSkills.com):
• Quickly look over the entire test so that you know how to budget your time.
• Pace yourself. Read the entire question carefully, and pay attention to details.
• Do the easiest problems first (or the questions for which you immediately know the answer).
• Prioritize the problems that have the greatest point-values (e.g. essay questions).
• Skip any problem that you are stuck on, especially when time is a factor. Go on with the rest
of the test and come back to it later. Other parts of the test may have some information that
will help you with that question.
• For essay questions, quickly outline your main ideas in the margins of the test. Use bullet
points to keep ideas short.
366  K. T. BAUM ET AL.

• If you have time left when you are finished, look over your test. Make sure that you have
answered all the questions. Watch out for careless mistakes, and proofread your essay and/
or short-answer questions.
5. When considering colleges, speak to the Student Support Services and/or the Disability Office
about possible academic accommodations and services.

Recommendations for Follow-Up Evaluation:

Follow-up is not recommended at this time unless John sustains an additional head injury or further
concerns arise.

Thank you for the opportunity to work with John and his family. Please contact me (xxx-xxx-xxxx) with
any questions or concerns.
 THE CLINICAL NEUROPSYCHOLOGIST  367

DATA SHEET & TEST LIST

Note: Only scores that are commonly used by clinical, counseling, and school psychologists are listed here,
though the full list of tests follows. These scores are included as an appendix to a full evaluation report
that integrates all findings, including clinical observations, interviews, and record review. Interpretation
by anyone other than a licensed psychologist with relevant training may be misleading.

Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV)

Composite Index SS ‰ Description
Verbal Comprehension 104 61 Average
Perceptual Reasoning 115 54 High Average
Working Memory 102 55 Average
Processing Speed 88 21 Low Average
Full Scale IQ 105 63 Average

Scaled Scaled Scaled Scaled

Subtest Score Subtest Score Subtest Score Subtest Score
Block Design 11 Similarities 12 Digit Span 10 Coding 8
Matrix Reasoning 12 Vocabulary 11 L/N Sequencing 11 Symbol Search 8
Picture Concepts 14 Comprehension 10

Wechsler Individual Achievement Test, 3rd Edition (WIAT-III)

Subtest SS ‰ Grade EQ Description
Word Reading 118 88 >12.9 High Average
Reading Comprehension 108 70 >12.9 Average
Spelling 119 90 >12.9 High Average
Numerical Operations 103 58 >12.9 Average

Beery Buktenica Test of Visual-Motor Integration, 6th Edition

Composite SS ‰ Description
VMI 100 50 Average
Motor Coordination 98 45 Average

ALL TESTS ADMINISTERED

California Verbal Learning Test-Children (CVLT-C)
Conner’s’ Continuous Performance Test II (CPT-II)
D-KEFS Color Word Interference, Tower, Trail Making, Verbal Fluency
Grooved Pegboard
MSVT
Rey Figure Copy, Recall, and Recognition
VMI-6 with MC supplement
WIAT-III Numerical Operations, Reading Comprehension, Spelling, Word Reading
WISC-IV Core
WRAML-2 Verbal Learning, Story Memory & Recognition
BASC-2 Parent
BRIEF Parent and Self-Report
Vanderbilt Parent
Teacher measures (BASC-2, BRIEF) were not returned at the time of this report