• Dr. Allison Kawa

Moving the Needle: Can Meaningful Change for Your Child Come from an Evaluation?

I have talked to hundreds if not thousands of parents who are seeking evaluations for their child. Some parents are veterans, having been down the assessment path numerous times already, and others are just starting to dip a toe into the pool of testing. Regardless of the level of experience or the age of the child, one thing is constant: somebody’s baby is struggling and we need more information in order to help them. In a nutshell, that’s what an evaluation is: a fact-finding mission. Sometimes those facts are needed to dot “i’s” and cross “t’s,” such as for high-stakes testing accommodations or accommodations at school. In other cases, the child isn’t responding to supports already in place and more information is needed to figure out how to course correct. For many families, the evaluation is a starting point to help untangle the roots of why the child is having a hard time and to map out an action plan. It is important to make an informed decision about testing, including the type (e.g., comprehensive vs. neuropsychological vs. psycho-educational vs. psychological) and the timing.


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I’m Confused By the Different Types of Evaluations


If you're feeling confused trying to tell the difference between a neuropsychological assessment, a psychological assessment, a psychoeducational assessment, and an academic assessment, that's because it is confusing! A lot of the difference comes in the background and training of the assessor, because that is the lens through which they are interpreting the data. There are a limited number of standardized tests out there and a neuropsychologist, an educational psychologist, and a clinical psychologist are all buying tests from the same publishers. A neuropsychologist has an intimate knowledge of brain structures and ways that things in the brain can go awry, and that is the lens they use to make sense of test results. They will have had specialized education and training that emphasizes brain-behavior functions and how injury or illness can affect them. An educational psychologist likely has a background focused more on academic outcomes and the patterns of cognitive strengths and weaknesses that predict learning differences. A clinical psychologist’s training focuses a lot on how personalities develop across the lifespan as well as being an expert at diagnosing psychiatric problems like anxiety and depression. All three psychologists might give the exact same IQ test but get different kinds of information out of it. None of the information will be more “correct” than the other; it is simply revealing different facets of the same person.


Further complicating the issue is that a lot of providers, including all of the psychologists at LACIA, have training and expertise in one or more of these areas. Psychologists are helping professionals and a huge part of our ethical code is to “practice within the scope of competency.” That means that if we don’t know what we are doing or if we get in over our head, we have a legal and ethical obligation to be honest about it and to make sure that our patients get appropriate care. If you aren’t sure whether the provider you have been referred to does what you need, just ask! A good assessment psychologist will talk to you before you commit to working with them so that you and the psychologist can both be sure that they are the right fit for your needs.


But Testing is Scary and I Don’t Want My Child Labeled!


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I get it, and I know. Testing is a big deal. It’s a massive commitment of time, money, and emotional bandwidth. This is not like a tutoring or therapy session where, if it ends up not being the right fit, you can just try again with someone different for a relatively small financial investment. That’s why it is so important to make sure that the assessment psychologist you choose is the right one for your family and especially for your child. Make sure that their philosophy and procedure is in-line with your own. Make sure this is a person that your child will actually enjoy spending time with and with whom they will want to cooperate. This is a person your kid will be spending several hours with, so make sure it’s going to be a productive relationship!


This might sound odd seeing as how part of my job is to come up with the diagnosis, but I don’t want to label your kid either! We (meaning the scientific community) treat the brain as if it works like all the other organs in the body, but this is simply not the case. There are important nuances and complexities of a person that really shape what a specific issue looks like for that person, and this can get lost if we boil an entire human being down to a diagnosis or two. However, having a label will open certain doors, such as access to therapies or accommodations, and it is a shorthand for professionals to use so they have a general idea of how the patient will present. Essentially, I’m telling you that the label is probably going to be helpful for your kid at some point.


Now that I have said my piece about all that gets lost when we view a child simply as a diagnosis, I have great news for those who have never read a LACIA report! We have a section in every report called “Summary and Interpretation” that is typically several pages long. That is where we describe the “patient” as an actual, real-live person who has strengths and stretches, just like every other human on the planet. This is where the artistry comes into play; we are tasked with painting a picture of a person using information such as how efficiently they process things they hear or how well they solve problems using pictures. Remember, an evaluation is simply a fact-finding mission. One of the facts we uncover may be that your child meets criteria for a certain diagnosis. This is just one data point in a massive set that ultimately tells the story of a person and explains how their mind works.


What Do We Do With the Information We Discover?


At LACIA, we are going to get a TON of information about how your child’s brain works as well as a better understanding of the lens through which they are filtering their world. Our job is to take all those bits and pieces and put them together, understanding how certain cognitive profiles or information processing systems are influencing and being influenced by emotional and personality factors. Once we get a handle on this symphony of personhood, we explain it to you and to your child. In English. With examples. From real life. The information is only helpful and meaningful if it is something that everyone can get their heads around, because that will allow for decision-making that is grounded by facts. I promise, you will NOT get a confusing list of labels that basically say nothing about your specific and wonderfully unique child.


Once we have explained what we learned, the exciting part comes. We start talking about a game plan. In general, our philosophy is that we remediate things that we know will improve with intervention, and we find workarounds for things that are not likely to remediate. We become partners with you during the evaluation process because our goals are probably similar to yours: let’s figure out how to get your kid back on their path to happiness and fulfillment. That means different things for different people. For some, the issues are academic and we need to tell you how to support your child in working smarter instead of working harder. For others, the problems are psychological or emotional and we need to help you find ways to guide your child to better affect regulation and well-being. For others still, it might be that we need to triage difficulties now, and then make a stepwise plan that maps out the next several months or years. To be honest, for a lot of the people we work with, it is all of the above.


What Sorts of Things Are Included in the Game Plan?


The treatment plans we create usually span several domains. If your child is in school, we will outline supports that teachers can implement in the classroom, formal accommodations that are appropriate based on the assessment (e.g., extra time on tests, note-taking help, sitting toward the front of the room, etc.), and guidance on school placement if needed. This applies all the way through college. For emerging adults who are unsure whether they want to pursue post-secondary school, we typically give a Plan A (i.e., if you want to go to college, this is what you need to be successful) and a Plan B (i.e., if you decide not to go to college, this is what you can do to develop a career path).


The next part of the treatment plan is outside help and therapies. Based on test results, we will make recommendations for different types of therapy or medical interventions that are appropriate for your child. We firmly believe that everyone needs to have balance in their life, and that overwhelming families with appointments and costly interventions does more harm than good. For this reason, a big part of our work in this area is to help families prioritize what their child needs the most urgently while remaining sensitive to practicalities such as drive time, financial commitment, and ensuring that the child has sufficient downtime. We have curated a massive network of allied professionals so that we can help to connect you with excellent providers who will be a good fit for your child and your particular situation.


Last but not least, we give marching orders for home. This is often a mix of recommendations for parents and for children, depending on the age of the child. At any point but especially during the feedback session, parents are encouraged to voice their parenting challenges and get tools that are specific to their child and situation for handling those tough moments. We are going to help you make more informed decisions about everything from where your child does homework to what the routines in your home look like to how you handle screen time rules and weekly allowance. In many ways, having a comprehensive evaluation like the ones we provide at LACIA is like having a user’s manual for your child’s mind. The information uncovered helps to answer the questions you had going into the assessment as well as questions you didn’t even know to ask.


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