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Neuropsychological evaluations · Honolulu and Hawaiʻi Kai
Homework takes the whole evening. Deadlines keep slipping. You’re putting in the effort, but the same problems keep coming back. Dr. Tolly and Dr. Reilly examine what’s making these situations difficult, then explain the findings in a report with recommendations for school, work and home.
You don’t need to know which tests to ask for. Start with what you’re noticing.
What you receive
Knowing someone’s score is different from understanding their experience. A neuropsychological report connects testing with history and everyday life, exploring not just what is difficult, but when it becomes difficult, what helps, and which explanations best fit.
Someone can understand the material and still struggle to start, organize, or finish the work. Your report looks at the difference between what you’re capable of and what you can reliably put into practice.
Doing well in a quiet testing room doesn’t erase difficulties at school, work, or home. When test results and everyday experiences differ, those differences deserve an explanation, not dismissal.
“Try harder” or “get organized” isn’t much of a plan. Useful recommendations identify where things break down and connect specific supports to the findings, your strengths, and the demands of daily life.
The feedback meeting is more than a presentation of results. We discuss how we reached our conclusions, what remains uncertain, and how the findings fit your experience, with room for your questions.
No single score settles the question. The value is in understanding the pattern, including the pieces that don’t neatly agree.
Clinical interview · Executive functioning testing · qEEG brain mapping
Leads the clinical interview and brings every piece of the evaluation together into a clear, meaningful picture, with practical recommendations families can use at home and school.
IQ and other cognitive testing · Behavioral testing
Brings extensive expertise to cognitive and behavioral testing, with a calm, easygoing style that helps everyone feel comfortable, understood, and engaged.
Starting, organizing, remembering, or finishing things is taking more effort than it seems to take other people.
Reading, writing, or schoolwork feels harder than expected, and you want to understand why.
Worry, frustration, or behavior changes are affecting daily life, and the reasons aren’t clear.
Several explanations seem possible. You want an evaluation that considers how the pieces fit together.
Not sure what fits? Tell us what you’re noticing.
Dr. Tolly leads the clinical interview to understand your concerns, history, and what you hope to learn.
Dr. Reilly completes IQ and other cognitive testing, along with behavioral testing. Dr. Tolly completes executive functioning testing and, when appropriate, optional qEEG brain mapping. Measures are selected for your needs; not everyone receives every test.
History, observations, questionnaires, and testing inform the report. We consider possible explanations and connect the conclusions to practical recommendations.
We review the report with you, explain what the findings mean, and make room for your questions.
Typically 2 to 3 testing visits. Ask about the report timeline before testing; we’ll confirm what to expect for your evaluation. qEEG is optional and is never used on its own to make a diagnosis.
See the pieces come together
These fictional examples, with invented scores, illustrate how findings inform recommendations.
Maya, age 15, Grade 10 · Fictional composite
Maya's parents and teachers had wondered for years whether her difficulties came from anxiety, motivation, or ADHD. Grades were inconsistent, assignments were often completed but not turned in, and she described rereading the same page several times without retaining it.
Attention on direct testing fell at the 3rd percentile, while response control was average on that task. Maya, her mother, and her teacher also described attention difficulties across daily settings; the anxiety ratings shown here were not elevated. The evaluation brought those observations together with developmental history, the persistence of symptoms, and their impact on school and daily life. Taken together, the fictional findings supported ADHD, Predominantly Inattentive Presentation. Neither the computer task nor the questionnaires establish that conclusion on their own, and ratings in the typical range do not settle every anxiety question.
The results helped explain why Maya often understood what she needed to do but had difficulty starting, sustaining, and completing the work consistently. Her recommendations target those everyday points of friction, not simply the lowest test score.
Selected invented findings. These are not the complete evaluation.
Impaired performance in this structured sample of sustained attention. Interpreted alongside history and everyday functioning, not as a stand-alone ADHD diagnosis.
Average response control during the task. This result does not establish how impulsivity appears in every setting.
Clinically significant elevation on this problem scale, reflecting the parent's report of everyday attention difficulties.
At-risk elevation on this problem scale, adding information about attention in the classroom.
Clinically significant elevation on this problem scale, capturing Maya's own experience of attention difficulties.
Anxiety ratings were not elevated in this example. The line represents the range across raters, not an average score or a confidence interval.
Percentiles show where a score falls compared with others the same age; the 50th percentile is the middle.
For the BASC-3 scales shown, higher T scores mean more reported difficulty: 60 to 69 is at-risk, 70 and above is clinically significant.
A single score and a range across raters are different kinds of information. No single score determines a diagnosis.
Clinical interview, history and daily functioning
Connect the test findings to developmental onset, persistence, settings, impairment, and other possible explanations for attention difficulties.
IVA-2
Computerized testing provides a structured sample of sustained attention and response control rather than relying only on reported symptoms.
BASC-3
Standardized ratings from Maya, a parent, and a teacher describe attention, emotion, and behavior across settings. Differences between raters are interpreted rather than averaged away.
Six practical recommendations for Maya. Each one connects the findings to daily life.
Share the report with Maya's pediatrician or another qualified prescriber to discuss behavioral treatment, coaching, school supports, and whether medication may be helpful. Use the findings and Maya's priorities to guide an individualized discussion.
Discuss a 504 Plan and supports such as written directions, chunked assignments, teacher check-ins, reduced-distraction testing, and extended time when appropriate. The school determines eligibility and the specific plan; the report supplies evidence and practical recommendations.
Record assignments, due dates, and completed work in one shared digital system rather than several platforms or verbal reminders. Include a visible submitted check so finished work does not stop short of being turned in.
Identify one concrete first step, set a short timer, and begin before reviewing the entire assignment. Keep the routine brief enough to use on ordinary school days and adjust the focus block to what Maya can sustain.
Divide projects into smaller deadlines with brief check-ins so missing one step does not derail the whole assignment. Put the checkpoints in the same assignment system used for daily work.
Use a brief checklist to confirm assignments are recorded, materials are packed, and completed work is submitted. Track which part of the routine still needs support, and reduce adult prompting as consistency improves.
Fictional case with illustrative scores. Not a patient record, a self-test, a prediction, or individual clinical advice. These selected findings are not the complete evaluation.
Selected findings, not the complete evaluation. Not a patient record or individual clinical advice.
Kai, age 8, Grade 3 · Fictional composite
Kai's parents sought an evaluation because reading was not keeping pace with his other learning. He avoided reading aloud, reading homework took much longer than expected, and he had started describing himself as less capable than his classmates.
Overall reasoning was in the high-average range, while awareness of speech sounds, unfamiliar-word decoding, and word reading were weaker. Reading comprehension was somewhat stronger than basic reading skills, but identifying words still placed an extra burden on understanding text. In this fictional example, the integrated reading profile and developmental and educational history supported Specific Learning Disorder with impairment in reading, commonly called dyslexia. Identification is not based on an IQ-reading gap alone: a real evaluation also examines whether difficulties are persistent despite appropriate instruction, response to intervention, and other factors that may affect learning. Those details are not all reproduced in this brief excerpt.
The results helped explain why Kai could understand ideas more easily than he could access them through print. His plan combines direct reading instruction with ways to keep learning grade-level content and rebuild confidence while reading skills develop.
Selected invented findings. These are not the complete evaluation.
High average overall reasoning. This is contextual information about the learning profile, not a required IQ threshold for identifying dyslexia.
Below-average performance on tasks involving awareness and manipulation of the sounds within spoken words.
A marked weakness in efficiently decoding unfamiliar printed words. This description explains the finding in plain language rather than assigning a universal score category.
Low average word reading under the measure's descriptive categories. The significance is understood alongside the persistent reading concerns and other findings.
Low average. Understanding written passages was somewhat stronger than basic word reading, but reading effort remained relevant to the overall picture.
Percentiles describe position within the test's comparison group; the 50th percentile is the middle. They are not percentages of questions answered correctly.
Descriptive categories differ by measure; each finding carries its own description, and the overall explanation matters more than any single number.
A difference between reasoning and reading scores may help describe a learning profile, but an IQ-reading discrepancy is not sufficient or required by itself to identify dyslexia.
Developmental and educational history
Places current reading skills alongside language development, instruction, intervention response, school experience, and the persistence of difficulties.
WISC-V
Examines reasoning and related cognitive abilities to understand the broader learning profile. A reasoning score alone neither confirms nor rules out dyslexia.
CTOPP-2
Examines phonological processing. The selected finding here concerns awareness and manipulation of sounds within spoken words.
TOWRE-2 and WIAT-4
Provide complementary information about reading efficiency, decoding, word recognition, reading comprehension, and other academic skills selected for the evaluation.
Six practical recommendations for Kai. Each one connects the findings to daily life.
Use explicit, sequential instruction in phonemic awareness, phonics, decoding, and reading fluency with a provider trained in structured literacy. Set the frequency and intensity around Kai's needs and response, with enough guided practice to develop accuracy and automaticity.
Discuss an IEP evaluation when specially designed instruction may be needed, or a 504 Plan where appropriate. Consider extended time, audiobooks for grade-level material, reduced copying demands, and alternatives to unprepared reading aloud. Accommodations improve access but do not replace reading instruction.
Use audiobooks and parent read-alouds so vocabulary, background knowledge, and enjoyment of stories keep growing while decoding improves. Let Kai discuss ideas at his level of understanding without making every learning activity a test of reading speed.
Allow keyboarding, speech-to-text, and reduced penalties for spelling when spelling is not the skill being measured. Keep direct instruction and feedback for tasks where spelling or written expression is the actual learning goal.
Agree with the reading specialist on regular checks of decoding accuracy and fluency, using consistent measures rather than homework time alone. Review progress at planned intervals and adjust the intervention when growth is limited.
Explain dyslexia in clear, age-appropriate language. Reinforce that reading difficulty is not a measure of intelligence, recognize effort and areas of ability, and give Kai specific evidence of skills he is gaining.
Fictional case with illustrative scores. Not a patient record, a self-test, a prediction, or individual clinical advice. These selected findings are not the complete evaluation.
Selected findings, not the complete evaluation. Not a patient record or individual clinical advice.
Ethan, age 6, Kindergarten · Fictional composite
Ethan's teacher noticed that he often played alongside classmates without joining their play, became upset by unexpected transitions, and frequently returned to a narrow range of favorite topics. His parents wondered whether these differences were part of his personality or whether he needed additional support.
Cognitive ability was in the average range. Structured observation, parent and teacher ratings, and adaptive behavior information each added a different perspective on social communication, flexibility, restricted interests, and everyday social functioning. During testing Ethan engaged readily with materials but made fewer attempts to share enjoyment or sustain back-and-forth interaction. Together with developmental history, this pattern supported Autism Spectrum Disorder in the fictional example. The rating-scale categories and ADOS cutoff do not by themselves establish the diagnosis or determine a person's level of support needs. Those needs are described through the full clinical assessment, not read off one number.
The results gave Ethan's family and school a shared explanation and a starting point for support: make communication and transitions more accessible, respond to sensory needs, and build participation around his interests and strengths.
Selected invented findings. These are not the complete evaluation.
Average overall cognitive performance. An average cognitive score does not eliminate meaningful social, communication, or adaptive support needs.
An observation-based classification, not a percentile or a DSM support level. A separate comparison score and module are not supplied in this excerpt, so no comparison-score severity category is assigned here.
Severe range on this rating scale, reflecting the parent's report of autism-related social difficulties. This is a scale category, not a stand-alone diagnosis or overall support level.
Moderate range on this rating scale. The classroom perspective contributes to the cross-setting picture rather than replacing direct observation or developmental history.
Moderately low everyday social functioning under this measure's descriptive categories. Adaptive findings help identify practical support needs outside the testing room.
For SRS-2 Total scores, the publisher's ranges are 59 or below within typical limits, 60 to 65 mild, 66 to 75 moderate, and 76 or above severe. Higher scores indicate more reported difficulties; BASC-3 thresholds must not be substituted.
An SRS-2 category is not the same as a DSM support level. The ADOS-2 classification is also not a percentile and is not plotted on the percentile or T-score lines.
For performance and adaptive measures, percentiles describe position within that measure's comparison group. Descriptive categories vary by test.
Developmental history and clinical observation
Connect current behavior with early development, daily functioning, communication, interests, and support needs across settings.
WPPSI-IV
Examines cognitive abilities in young children and helps place communication and everyday functioning within a broader developmental picture.
ADOS-2
A standardized, interactive observation of communication, social interaction, play, and restricted or repetitive patterns. Its results are interpreted with other independent information.
SRS-2 and Vineland-3
Add information about autism-related social behavior and everyday adaptive functioning beyond the structured testing setting.
Six practical recommendations for Ethan. Each one connects the findings to daily life.
Provide the report to the school and request an IEP evaluation focused on social communication, flexibility, classroom participation, and adaptive functioning. School eligibility and services are determined through that process, with the report helping document needs.
Use naturalistic, play-based support for shared attention, back-and-forth interaction, and flexible play within activities Ethan already enjoys. Follow his communication signals and prioritize participation and connection over making him look like other children.
Use visual schedules, first-then language, and brief advance warnings before changes in activity. Show what is ending and what comes next, and allow processing time rather than relying on repeated verbal reminders.
Identify common sensory stressors and provide access to movement, a quieter space, or noise reduction before distress escalates. Teach a simple way to request a break and honor that communication.
Practice minor, planned changes to familiar routines with clear explanations, reassurance, and predictable support. Adjust to Ethan's distress signals; the goal is safer participation and coping, not removing helpful routines or forcing tolerance of overwhelm.
Use similar language, visual supports, and meaningful target skills across settings. Share what is helping, what is stressful, and where support should change, while keeping Ethan's interests and preferences central.
Fictional case with illustrative scores. Not a patient record, a self-test, a prediction, or individual clinical advice. These selected findings are not the complete evaluation.
Selected findings, not the complete evaluation. Not a patient record or individual clinical advice.
Jordan, age 28 · Fictional composite
Jordan came in wondering about ADHD. Work took longer than it should, emails were reread repeatedly, and unfinished tasks followed them home. The interview revealed another thread: more than a year of difficult-to-control worry across work, finances, and family, with muscle tension, restless sleep, and a mind that rarely felt off duty.
Attention testing fell in the average range, while the anxiety questionnaire showed substantial distress and the interview explained its duration, breadth, and daily cost. History and records did not establish childhood-onset ADHD, and the concentration problems tracked the escalation of worry and disrupted sleep. Taken together, the fictional evaluation supported generalized anxiety disorder as the best explanation. Average attention testing alone does not settle the question of ADHD, and the two can coexist. The questionnaires describe symptom burden; their totals do not independently establish a diagnosis.
The report explained both the conclusion and its limits: address anxiety and sleep, track daily functioning, and revisit attention concerns if they persist. The recommendations focus on reducing the worry-related demands consuming attention while preserving appropriate care and accuracy.
Selected invented findings. These are not the complete evaluation.
Average performance in this structured sample of attention. This result adds information but cannot prove the absence of ADHD.
Average response control during the task. Daily-life concerns still require their own clinical context.
Severe symptom range on this screening and monitoring questionnaire. A total score, not a percentile or a stand-alone diagnosis.
Mild symptom range on this screening and monitoring questionnaire. A total score, not a percentile; individual responses and clinical context remain important.
Percentiles describe position within the test's comparison group; the 50th percentile is the middle. Average attention performance on its own does not settle the question of ADHD.
GAD-7 and PHQ-9 totals use their own symptom-severity ranges. They are not T scores, percentiles, percentages of illness, or diagnostic probabilities.
Screening totals and test performance are interpreted alongside history, duration, daily impact, and other possible explanations.
Clinical interview and history
Connected the onset of concentration difficulties with persistent worry and poor sleep; the history and records in this example did not establish a childhood ADHD pattern.
GAD-7 and PHQ-9
Brief questionnaires describing the recent burden of anxiety and mood symptoms. They support screening and monitoring but are not stand-alone diagnoses.
IVA-2
A structured computerized sample of attention and response control. Average performance contributes to the picture without overriding persistent concerns or developmental history.
Six practical recommendations for Jordan. Each one connects the findings to daily life.
Begin with a therapist trained in cognitive behavioral therapy for anxiety, with goals tied to work and home life and skills practiced between visits. Define progress in terms of functioning and distress, not simply completing worksheets.
Agree on a realistic review standard: a brief checklist, a planned review, and a clear point to send. Safety-critical work keeps all required checks; the goal is to reduce anxiety-driven repetition, not necessary quality control.
Translate 'finish the project' into one concrete next action, a short focus block, and an external place to capture intrusive worries for later. Review with the therapist which strategies improve follow-through without becoming another checking ritual.
Build a consistent wake time and a practical wind-down routine. Discuss persistent sleep difficulties and caffeine use with a clinician, and avoid making perfect sleep a new performance requirement.
Share the report with the therapist and primary-care clinician or prescriber so any medication discussion is individualized. Include the history, sleep concerns, daily impact, and Jordan's preferences rather than relying on a screening total alone.
Track fewer repeated checks, timelier task completion, better sleep, and less worry. If attention difficulties remain, revisit the developmental history and consider further assessment instead of assuming every remaining problem is anxiety.
Fictional case with illustrative scores. Not a patient record, a self-test, a prediction, or individual clinical advice. These selected findings are not the complete evaluation.
Selected findings, not the complete evaluation. Not a patient record or individual clinical advice.
What families say
“Both doctors were wonderful throughout our child’s evaluation: incredibly detailed and thorough, while staying warm and approachable, which made all the difference in helping our child feel comfortable.”
Parent of a former patient · Read more
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No. Tell us what has been difficult and what you hope to understand. We can discuss whether our evaluation service fits your questions.
Testing is usually spread over a few visits, and reports are typically 20 to 30 pages. We’ll discuss the timing of testing, the report, and your feedback meeting before you begin.
Tell us the name of your plan. Please do not send an insurance card or member number through this form. We’ll discuss coverage questions and expected costs before testing. Coverage depends on your individual plan and the services involved.
The report can help you discuss learning needs, workplace supports, and treatment with the relevant people. Schools and employers make their own eligibility and accommodation decisions; an evaluation does not guarantee a particular service or outcome.
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