Neuropsychological Assessment Is Finally Getting the Respect It Deserves
I've spent more than 25 years evaluating and treating people with complex neurological and cognitive conditions, and in that time, I've watched the field of neuropsychological assessment shift from a specialty that many clinicians and employers treated as an afterthought into something genuinely central to how we think about recovery, rehabilitation, and workplace accommodation. That shift is accelerating right now. And having evaluated over 535 adults involved in personal injury litigation, many of them with traumatic brain injury, I've had a front-row seat to both the old way and the new.
For most of my career, the process went something like this: a person sustains a brain injury, they see a physician, and if they're lucky, someone eventually refers them for a neuropsychological evaluation weeks or months later. By then, critical windows for early intervention have already closed. The evaluation often got filed away rather than used to drive a concrete rehabilitation plan. The findings informed a legal case more than they informed the patient's recovery. I lived through that model hundreds of times. It frustrated me then, and it still does.
What I'm observing now is different. Physicians, rehabilitation teams, and even employers are beginning to treat the neuropsychological evaluation as a starting point rather than an endpoint. The question is shifting from "what's wrong?" to "what's possible, and what does this person need to get there?" That's not a small change. It represents a fundamentally different orientation toward brain health and recovery planning.
Part of what's driving this is the research. When I co-authored a peer-reviewed randomized controlled trial on ADHD interventions published in the Journal of Developmental and Behavioral Pediatrics back in 2003, one of the underlying arguments was that medication alone is insufficient, and that understanding how a specific individual's brain is actually functioning produces far better outcomes than a one-size-fits-all prescription. That logic applies just as directly to traumatic brain injury. A cognitive assessment that maps memory, processing speed, attention, and executive functioning gives the treating team something concrete to act on. It tells you where the person is today and helps project a realistic recovery pathway.
I've also seen a meaningful change in how workplaces are responding to neuropsychological findings. For much of my career, an employer receiving an accommodation request tied to a brain injury would push back, question the severity, or simply not understand what the evaluation results meant in a practical sense. That's starting to change. Employers in healthcare, technology, and professional services are increasingly willing to look at what specific cognitive deficits actually require in terms of workflow adjustment, reduced auditory load, or structured task-sequencing. The evaluation stops being a document and starts being a tool.
That said, I want to be honest about how much further we still need to go. The gap between what a thorough neuropsychological evaluation can reveal and what the average recovery plan actually incorporates remains wide. I still encounter cases where someone has sustained a significant TBI and their rehabilitation plan addresses physical recovery with real precision, but their cognitive and emotional functioning has been treated as secondary. The brain isn't secondary. It's where the person lives.
My work across more than 25 years has convinced me that the most important thing a neuropsychologist can do is translate findings into action. A battery of tests that produces a 40-page report serves no one if the recommendations inside it aren't connected to real treatment decisions, real accommodations, and real support systems. That's why I've organized my practice around evidence-based recommendations that speak directly to what's needed: whether that's neurological rehabilitation, academic and workplace accommodations, or targeted clinical treatment.
The trajectory I see from here is one where neuropsychological assessment becomes fully integrated into both medical care and workplace policy from the earliest stages after injury. The science already supports this. My book, due out in early 2027, will build out many of these arguments with cases that show what that integration actually looks like in practice. The field is ready for this conversation. I intend to keep pushing it forward.