How Dr. Cooper Evaluates Cognitive and Emotional Health

What steps do you take to evaluate whether a worker’s reported cognitive or emotional difficulties are a direct result of a workplace incident, and how does this inform your recommendations?

Answer:

There are many components involved in evaluating whether a worker’s reported cognitive and/or emotional difficulties are directly related to a workplace incident. I take a structured, evidence-based approach that integrates information from numerous sources.

A detailed clinical interview allows me to gather the worker’s account of the incident, their perspective of symptom onset and course, and current cognitive and/or emotional functioning. I also utilize a semi-structured, standardized clinical interview both to ask the same types of questions in different ways and to ensure that symptoms that are reported align with diagnostic criteria.

I leverage standard, evidence-based cognitive and emotion-focused assessments to objectively evaluate a worker’s reported difficulties. These tools help determine the nature and severity of symptoms, and allow for comparison to normative data. Consistency, or lack thereof, between reported symptoms and test performance provides valuable information regarding the credibility of alleged difficulties. The patterns of data within and across tests and questionnaires are analyzed to identify whether the presentation is consistent with known profiles in the scientific literature, validity levels, and response styles, thereby helping to distinguish genuine impairment from inconsistent/invalid presentations.

A review of available records helps provide temporally relevant information about symptoms and presentation of a worker in healthcare offices across time, context related to working relationships and workplace performance, and other historical information (e.g., legal history) that aids in understanding the worker.

The integration of these data helps determine the extent to which the reported difficulties are causally related to the workplace incident, which in turn informs my diagnostic impressions and answers questions related to recommendations for treatment or workplace accommodations.

Question:

PTSD has specific diagnostic criteria that must be met for a formal clinical diagnosis. In cases where an injured worker’s symptoms appear to meet these criteria, but there are also signs of possible underreporting or exaggeration, what steps do you take to carefully evaluate and determine whether a true PTSD diagnosis is warranted?

Answer:

When evaluating potential PTSD, I use structured diagnostic interviews and standardized measures that align with DSM-5-TR criteria. I always incorporate multiple validity measures and cross-validate self-reported symptoms with behavioral observations and record review to interpret the accuracy, consistency, and contextual relevance of the worker’s reported difficulties, ensuring that conclusions are grounded in objective evidence rather than subjective report alone. The goal is to distinguish genuine trauma-related symptoms from non-credible, amplified, or inconsistent presentations. Findings are interpreted cautiously and within the broader psychosocial and medical context to ensure that any PTSD diagnosis is supported by reliable, convergent evidence.

Question:

For claims purposes, how do you distinguish between an Independent Psychological Evaluation and an Independent Neuropsychological Evaluation, and when would one be recommended over the other?

Answer:

An Independent Psychological Evaluation (IPE) focuses on emotional, behavioral, and psychiatric functioning, assessing conditions such as depression, anxiety, PTSD, or adjustment disorders. It primarily relies on clinical and semi-structured interviews and standardized psychological tests. IPEs usually take 2–4 hours.

An Independent Neuropsychological Evaluation (NPE), on the other hand, provides a more detailed assessment of cognitive domains (e.g., attention, memory, executive function, processing speed) in addition to emotional functioning. An NPE is typically recommended when there are concerns about cognitive impairment due to head injury, neurological illness, or other medical conditions that could affect brain functioning, whereas an IPE is indicated when cognitive impairment is not the primary concern. NPEs typically take 6–8 hours.

Question:

What information do you find most helpful to have before conducting a neuropsychological evaluation?

Answer:

Before conducting both psychological and neuropsychological evaluations, it is most helpful to have:

• Reason for referral and presenting concerns: A clear understanding of the specific questions being asked and the functional issues prompting the evaluation. The Injured Worker’s Statement (from the ROI) is also helpful in many cases.

• Medical history: Information about any prior or current medical conditions, injuries, neurological events, or relevant treatments.

• Psychological history: Details regarding mood, behavior, and prior mental health diagnoses or treatments.

• Previous testing or evaluations: Access to prior neuropsychological assessments for comparison and continuity.

• Occupational functioning: Current and past employment information, work requirements, statements from other workers/supervisors (often obtained in the Release of Information, or ROI).

Having this information in advance allows for assessment of consistency of the worker’s presentation and provides context in which the results can be interpreted, as well as meaningful responses to questions posed regarding recommendations for the worker’s recovery.

Dr. Shanna Cooper, PhD, ABPP-CN, is a board-certified clinical neuropsychologist with extensive experience in adult and forensic neuropsychological assessments. She serves as an Assistant Professor of Psychiatry at Oregon Health & Science University (OHSU), specializing in evaluations related to cognitive and emotional functioning, including trauma and workplace incidents.

Want to ask one of our physicians a question? Now is your chance! If you are a legal or claims professional, you can ask a claims-related question informally by clicking here.

A Previous "Ask the Doctor" Response
In our previous "Ask the Doctor" blog, Dr. Nonweiler discusses how his background in sports medicine shapes his approach to conducting an IME.