London · Clinical Symposium

Beyond the Diagnosis

The Prospect Hill Model

Integrating neuropsychological assessment into residential treatment. Understanding how the brain functions to build a more precise path to recovery.

Dr. Lindsy WagnerCo-Founder · Prospect Hill Recovery & Wellness

One symptom.
Many possible causes.

Clients often arrive with overlapping diagnoses and failed treatments, with no clear answer for what is actually driving their difficulties.

DepressionTraumaADHD AnxietySubstance UseSleep Disruption Medication EffectsNeurological Conditions
“What diagnosis does this client have?”
↓
“Why is this client struggling, and what does their brain-behavior profile tell us about how to treat them?”

Not a test score.
A map.

Assessment examines thirteen areas of functioning to build an individualized map of strengths, vulnerabilities, and treatment needs.

Intellectual Abilities
Attention & Concentration
Processing Speed
Executive Functioning
Learning & Memory
Language
Visual-Spatial Functioning
Problem Solving
Cognitive Flexibility
Impulse Control
Emotional Functioning
Personality Functioning
Behavioral Patterns

The same symptom.
Different roots.

“Difficulty concentrating” could reflect:

ADHD·Depression·Anxiety·PTSD·Substance Effects·Medication Effects·Sleep Disturbance·Executive Dysfunction·Neurological Change

“Memory complaints”→may actually be caused by poor attention
“Impulsivity”→may reflect executive dysfunction, not lack of motivation
“Emotional instability”→may interfere with cognitive performance

Better diagnostic clarity leads to more precise treatment.

The whole person.
Not just the diagnosis.

Psychiatric

Diagnosis, medications, symptoms & treatment history

Medical

Physical health, laboratory findings, sleep & medical contributors

Substance-Use

Use patterns, withdrawal, relapse history & consequences

Psychological

Personality, trauma, mood & behavioral functioning

Nutrition & Wellness

Nutrition, exercise, sleep & lifestyle

Family & Social

Relationships, developmental history & support system

The assessment shapes
how treatment is delivered.

Executive dysfunction→Increased structure & organization
Working-memory weakness→Written instructions & repetition
Attention difficulties→Shorter, focused interventions
Slow processing speed→Adjusted therapeutic pacing
Poor impulse control→DBT & behavioral interventions
Emotional dysregulation→Regulation skills & psychiatric intervention

The treatment adapts to the client, not the client to the program.

Not just what to treat.
How to treat it.

Individual Therapy
CBT
DBT
ACT
EMDR & Trauma-Focused Care
Addiction Treatment
Motivational Interventions
Group Therapy
Family Therapy

Strong verbal reasoning with weak executive functioning calls for a very different approach than slowed processing with memory difficulties.

Neuropsychological findings personalize the therapeutic strategy.

Cognitive symptoms
don’t occur in isolation.

The multidisciplinary team considers how cognition may be affected by:

Psychiatric Illness·Medications·Substance Use·Withdrawal·Sleep·Nutrition·Hormonal & Metabolic Factors·Medical Conditions·Chronic Stress·Trauma

Brain health, mental health, and physical health are interconnected.

Where testing
meets real life.

Memory in Everyday SituationsOrganizationImpulse Control Emotional RegulationSocial InteractionFrustration Tolerance Decision-MakingCravings & Triggers

Residential treatment shows us how those findings translate into real life.

Treating the brain beyond the therapy room.

Neurofeedback & Biofeedback

Attention, physiological regulation & stress management

Nutrition

Supporting overall brain & physical health

Exercise & Fitness

Routine, physical health & behavioral activation

Yoga & Mindfulness

Attention, awareness & emotional regulation

Sleep & Structure

Restoring routines essential to functioning

Experiential Activities

Practicing skills outside traditional therapy

Substance use is the visible behavior, not the underlying problem.

Trauma→ Emotional Dysregulation→ Executive Dysfunction→ Impulsivity→ Maladaptive Coping→ Substance Use
“How do we stop the substance use?”
↓
“What is driving the need to use, and what needs to change for recovery to last?”

What looks like “won’t”
is sometimes “can’t.”

“He doesn’t listen.”→may involve attention or working-memory difficulties
“She doesn’t follow through.”→may involve executive dysfunction
“He knows better but keeps doing it.”→may involve impaired inhibition & impulsivity
“She just isn’t motivated.”→may reflect depression, trauma, or cognitive overload

Understanding the reason for a behavior doesn’t eliminate accountability. It helps us intervene more effectively.

A blueprint for
long-term functioning.

Ongoing Psychotherapy
Psychiatric Follow-Up
Medication Management
Executive-Function Supports
Family Involvement
Recovery Community
Continued Trauma Treatment
Neurofeedback
Lifestyle & Nutrition
Relapse Prevention

Not simply a list of follow-up appointments. A personalized plan for what comes next.

Neuropsychology provides the roadmap.
Residential treatment gives us the opportunity to use it.

Assessment→ Diagnostic Clarity→ Clinical Formulation→ Integrated Care→ Wellness→ Observation & Adjustment→ Continuing Care

We don’t simply identify what someone is struggling with. We seek to understand why, and build treatment around that understanding.

St. Croix, U.S. Virgin Islands · prospecthillwellness.com
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