A Conversation with Cynthia Austin: Chief of Pediatric Neuropsychology

Pediatric neuropsychology plays an increasingly important role in multidisciplinary neuroscience care, providing cognitive and behavioral insights that inform diagnosis, treatment planning, and long-term outcomes across a wide range of neurological conditions. Under the leadership of Cynthia Austin, PhD, ABPP, chief of pediatric neuropsychology, our program has expanded its clinical and research capabilities while developing innovative models of integrated neuropsychological care.

In this interview, Dr. Austin discusses the evolution of the field, the team’s contributions to multidisciplinary care, and how embedding research within clinical practice is advancing pediatric neuroscience.

How did you decide to become a neuropsychologist?

Before graduate school, I worked as a mental health liaison in rural schools, where I saw firsthand how learning and behavioral struggles at school are often shaped by circumstances outside the classroom. I also learned how helpful proper identification and support can be in helping children access the services they need. That experience led me to UT’s school psychology program, where I found the perfect fit in neuropsychology. I wanted to understand not only a child’s difficulties with attention or memory but also the underlying brain processes that might explain them.

In pediatric medical settings, every case involves layering medical conditions onto ongoing development, family systems, and culture—and then figuring out how to measure and understand the impact of those overlapping influences. That ever-changing puzzle is what I find fascinating.

How does your neuropsychology team contribute to the pediatric neurosciences program and to multidisciplinary decision-making?

I’m excited to say our team will grow to 10 neuropsychologists this fall, giving us unusual breadth for a pediatric neuropsychology service. Our role is to inform and refine clinical decision-making by working with teams to determine whether a child’s cognitive difficulties reflect the medical condition itself, treatment effects, co-occurring developmental conditions, or other factors that may indicate different approaches. Those insights inform care conferences, team discussions, joint visits, and longitudinal follow-up. For example, in epilepsy surgery planning, neuropsychologists work with the medical team to weigh seizure outcomes alongside potential effects on language, memory, processing speed, and broader cognitive functioning. Ultimately, we help teams and families understand how a child’s medical course may influence their functioning and future trajectory.

How do you encourage and promote the group’s scholarly contributions?

I try to promote scholarship by building it into clinical care from the beginning, an approach that grew out of my early training in program evaluation. We’ve developed workflows that capture neuropsychological data during routine care and link those data with condition-specific research databases. That infrastructure supports collaborative research while allowing neuropsychology to focus on the integrity and interpretation of cognitive outcomes. For example, in mild concussion, emotional adjustment and family context can sometimes have as much of an impact—or more—on recovery as the injury itself. That observation is reflected in upcoming work with our emergency department examining cortisol biomarkers and pre-injury mental health as predictors of recovery after concussion. These partnerships allow clinical insights to shape our research questions and bring what we learn back to multidisciplinary teams through publications, lectures, and outreach.

What would you tell a young person considering neuropsychology as a career?

I’d tell them it’s a great fit if they’re interested in the art and science of measuring and interpreting human behavior. Much of neuropsychology involves distinguishing performance from ability—understanding a person’s cognitive strengths and weaknesses while recognizing that fatigue, pain, anxiety, language differences, motor challenges, and other factors can all influence performance on testing. Behavioral observations provide essential context and are often just as important as the scores themselves.

It’s also an exciting time to enter the field as demand for pediatric neuropsychologists continues to grow. Our pediatric neuropsychology fellowship started in 2021, and this year, we will have seven pediatric neuropsychology learners across fellowship, internship, and practicum levels. Seeing that momentum continue to build, along with the enthusiasm from both faculty and learners, has been especially rewarding.

What excites you most about the future of pediatric neuropsychology?

Historically, pediatric neuropsychology focused heavily on documenting cognitive outcomes associated with medical conditions. Today, many of those findings are well established, and it is exciting to see the field shift toward refining and updating models of neuropsychological care. Rather than relying exclusively on comprehensive evaluations, these more flexible approaches allow neuropsychologists to contribute earlier and more consistently across the course of care.

As a relatively young academic medical center, we have been able to build and study these pathways in real time—not only improving care and access for our own patients but also sharing what we’re learning with the broader field. We recently presented this work at the American Academy of Clinical Neuropsychology, focusing on neuropsychology’s evolving role in multidisciplinary clinics and value-based models of care.