The Role of the Neuropsychologist in Baseline Testing: When an Athletic Trainer Isn't Enough

Computerized cognitive tests like ImPACT are screening tools — they efficiently measure several domains of cognitive function and provide composite scores useful for clinical comparison. But they are not comprehensive neuropsychological evaluations, and there are clinical situations where a screening tool isn’t sufficient.

What a full evaluation includes

A full neuropsychological evaluation, conducted by a licensed neuropsychologist (PhD or PsyD in clinical neuropsychology), is a 2–3 hour comprehensive assessment of cognitive function using standardized clinical instruments. It evaluates domains that computerized tests don’t fully capture: executive function (planning, problem-solving, cognitive flexibility), language processing, visual-spatial reasoning, fine motor coordination, personality/emotional functioning, and effort/validity across multiple convergent measures.

When a referral is warranted

A neuropsychological referral is warranted in several specific clinical scenarios: when an athlete has a history of multiple concussions and there is concern about cumulative cognitive effects; when recovery from a concussion is prolonged beyond 4 weeks without clear improvement trajectory; when pre-existing conditions (ADHD, learning disabilities, autism spectrum disorder, mood disorders) complicate the interpretation of standard screening tools; when there is a discrepancy between test scores and functional performance (the athlete’s scores look normal but they’re clearly struggling); when academic accommodations beyond basic return-to-learn provisions are needed and require formal documentation; or when the family or clinician has concerns about long-term cognitive effects that require thorough evaluation.

Cost and coverage

The cost of a full neuropsychological evaluation typically ranges from $1,000 to $5,000, and it may be partially covered by health insurance when medically indicated. It is not necessary for every athlete — the vast majority of concussions can be managed effectively with standardized screening tools and clinical assessment by trained concussion professionals. But for complex cases, a neuropsychologist provides a level of diagnostic specificity that screening tools cannot achieve.

How we coordinate referrals

At Headquarters, we maintain referral relationships with neuropsychologists in our service area for cases that require comprehensive evaluation. We coordinate baseline data transfer so the neuropsychologist has full access to the athlete’s longitudinal testing history. See also prior concussions and baseline testing.

Frequently asked questions