Neuropsychological Assessments for 2e Learners with Dr Jessica Snowden Patel

https://www.youtube.com/watch?v=OGsevLMED_A

Dr. Jessica Snowden Patel, who wrote an amazing guide for assessments for REEL, speaks about neuropsychological assessments/evaluations, including: when to get an assessment, why 2e learners don't often get assessed by school, what are different types of evaluations, why it can be important to get an assessment, what will be tested, and what questions to ask.

Transcript

0:00

For coming tonight. Oh, there we go. Um, thank thank you all for coming tonight. Um, you know, Real asked me to write a guy, well, they asked me to write a blog about um, neurosychological evaluations or evaluations and questions parents may have, and I am very long- winded and it turned into a complete guide. And so, I know tonight I have um, about 15 minutes and I could talk probably for hours on this topic. So, I'm going to try to streamline it the best that I can. And um you can also if you know I'm going to try to kind of highlight some things. Again, you can check out the full guide and then I definitely want to leave time for questions too. I'm sure a lot of you have had your kids have evaluations. Some of you may not have had that too.

0:48

Um, and just for my perspective, you know, going over some of the big things are like one of the big questions parents have are when do when should I consider an evaluation? This could also be a re-evaluation as well. You know, one of them is I always say, you know, you are the parent and you do know your kids well. So, really trust your gut. If you're asking the question about should I get an evaluation, oftentimes the answer is yes because there's some reason why you're questioning it. Um, oftentimes I will hear parents say too that they were kind of invalidated when they're asked maybe their pediatrician or a teacher or friends about getting an evaluation. I think this happens a lot, especially for our two ears. I also have two myself and um, you know, things look very different. They may compensate really well. They may mask really well in different environments. But if you are seeing something with them, especially at home or at school, and you feel like it would be benefit from clarification, like that can be the right time to have an evaluation. Any evaluator you talk to should talk through that with you though, too. There are people who contact me and I'm like, "Hey, you know, you're describing a lot of maybe sensory concerns. You can always start with OT and circle back around. Of course, I'm happy to, you know, work with your family or do a full evaluation, but they should be willing to talk through that process with you as well.

2:07

Um, you know, it's really hard to do a comprehensive evaluation when someone is in an acute crisis because if we're thinking about evaluations, we're often trying to look at like IQ and academics and things like that. And if there's like a big crisis or a lot of trauma or things like that going on in the moment, it can be sometimes hard to get a good lay on some of or good kind of pulse on some of the other things going on just because just like us as adults, you know, if we're really stressed out, there's a lot going on, maybe something traumatic happened, we're not going to necessarily be at our kind of best level of functioning. And so there are times where maybe there is a acute crisis where you decide to wait or you decide to have a more targeted evaluation to kind of answer some questions. And so that is always a consideration as well.

2:56

Um transition points are often a really big time too to consider an evaluation and this might be a re-evaluation as well. So thinking about like going into middle school, you know, a lot has may have changed for your child since they were very young. And that I will say that with two years, that's a lot of times when I see kids for the first time is at a big transition. Like things seem to go well, kids could really compensate. They hit middle school, wheels fall off the bus, they need support and parents like how can we support them? um or even college, people going off to college and then kind of the other supports go away and then realizing like, hey, I think I'm autistic or, you know, an auditor or I'm dyslexic. And sometimes the answer is yes and they've just been compensating really, really well. Other things to consider are sometimes if evaluations are older to get accommodations for ACT, SAT, college, there are specific timelines that they require updated evaluations to happen. So those are also some of the points um at what you may consider it. But again, anyone you ever reach out to about an evaluation should be willing to talk through that with you of like, hey, does this make sense now? And what will you or won't you get out of the evaluation at that point in time? There's no magic age. I see very very young kids um as well. Like I might see two or three year olds for specific developmental concerns and I see, you know, many older people as well. It just really depends on what's going on at that point in time.

4:26

Um, another question that I often get is a lot of confusion about what type of evaluation, you know, is this a neurosych, is this a psychoeducational, should I see a DBP? Like all of these acronyms are being thrown out. And the thing is is it's not so important what it's called because I find people use terms wrongly and also interchangeably, but it's really like what is the person going to be looking at? And so most of the time when someone's talking about like a neurosychological evaluation, they're looking for a comprehensive evaluation that's looking at all areas of functioning. But one thing that a lot of people don't know is in the world of psychology and even with, you know, DBPS or other people, if you don't have specific training and specific diagnoses, for example, autism, they may not be looking at that question. And so you always want to ask an evaluator like, what are specific questions your evaluation can answer? and is there anything that you do not feel comfortable answering? So, for example, when parents come in to me, I'm like, everything's on the table. You know, we're looking at all areas of development, but that is not always the case. And what is always heartbreaking to me is when I see parents who have invested a lot of time and money in an evaluation and then end up coming in for a second opinion because they didn't realize one area that they really were hoping would be covered would be covered. they just kind of assumed it understandably and didn't know the questions to ask and the evaluator maybe didn't know that that was on their radar either. And so just making sure to have that communication. Um you can ask like what areas do you routinely include? What do you not assess? What do you not feel comfortable with?

6:01

Um if you have a 2e learner, I think it's really really really important to ask, for example, I'm going to use ADHD as an example, how they make a diagnosis of ADHD. This is something as a psychologist for 20 years and as a parent of four kids, my oldest, I could tell you, he had ADHD in kindergarten. And every year as a psychologist, the teacher's like, "He's fine. He's fine. He's fine." It's because he's gifted. So, it looks totally different. And I'll never forget the last day of third grade, teacher said he's fine. Running around, can't find his book bag. You know, all his papers are strewn about. He f he lost his yearbook that was given to him that day. All of these things are like, "Oh, you know, that's typical for him." and they're laughing. I'm like, "This is ADHD." And it took me like actually outlining from the DSM examples for him to get a diagnosis. And I'm someone who this is what I do for a living. And I know all of these things. And it was still that hard because he's 2e and he could do well in school. He could forget to turn over the paper and still get a decent grade on some of these things. And so you definitely want to make sure that for example for ADHD someone isn't just going off of a checklist and many people do that where if school isn't rating significant concerns even if you see it even if they see in the office you might not get a diagnosis. So, you want to make sure like, hey, if school is not reporting concerns and I'm worried that my child, you know, I think they may be autistic or, you know, have ADHD or whatever, will you still potentially give the diagnosis? And there are people where that's a hard no. When I was looking for someone for my own child, I asked that question and there are many people who said without school rating it, we would not consider ADHD. And that still happens like significantly. just talked to a friend this happened to last week. Um, her couldn't evaluate her child, clearly has ADHD. School isn't rating it, so they didn't make the diagnosis.

8:02

You feel free to ask those questions. If you have a really hesitant child or you have a child who, you know, maybe very strong willed or maybe resistant, you're worried they might be resistant to testing, ask those questions. How are you going to make my child feel comfortable? You know, what else do you do during the course of the evaluation? and like are you going to play games or take breaks or those kind of things like that's important you know we want it to be an enjoyable experience for the child as well and just make sure they're not just kind of like hey I have two and a half hours we need to kind of crank through these tests and make sure they have you know if you're questioning like PDA for example make sure they have experience in that and you can ask like hey what are what are some of the strategies you're going to use to help my child feel comfortable engaged and engaged I think cost always an important question like I have um clear pricing on my website most people don't some do but you want to know what is the cost you know most places don't take insurance as you know and you know what are some questions I should ask my insurance company about reimbursement and what's included in the cost as a parent getting an evaluation at the end you get results you are going to have questions you might have questions two days later it might be two months later and you want to know Hey, is that included in the cost? Is it an hourly fee? Like, how are all those kind of things handled? And another thing that some people don't do, but I think is important if it's important to you is like, is there a child-friendly feedback? How should I share this information with my child? Do you help with that process? I think it's huge for kids to learn or adults or whoever to learn how their brain works in a very affirming way and to understand, you know, labels and diagnosis because guess what? We are not kind to ourselves if there's something going on. and even small children will recognize differences so we can actually be really empowering and kind of control their narrative and make it a very positive experience so they understand what's going on with their brain. But that's tricky. And so as a parent you're going to want some support with that too.

10:04

Um, you know, the other thing that, and again, I know we're talking about diagnosis, so I'm probably preaching to the choir on this one, is there are also a lot of people who are worried about a label, but as I said, people are already probably labeling your child. Your child might be labeling themselves. And actually knowing what that is and what it truly means and not what they're like googling can be really, really, really empowering. Also, you know, don't feel discouraged. So, I'm sure as parents of two ears, again, a lot of times you'll hear like, "Oh, they seem to be doing fine or I don't think they need an evaluation." Again, you know your child the best. So, whether it's getting an evaluation, whether it's following up with recommendations from an evaluation, which you want to make sure actionable, you want to make sure that you feel um, you know, you really trust yourself to be a good advocate. Find a provider you think is going to jive well for your child. just because someone else, you know, recommends a provider may maybe it's not the best fit for you. You should feel really comfortable asking them questions and feel like they're going to work well with your child. You know, afterwards, you want to make sure if they're recommending specific therapies that you answer, get all your questions asked about that and that you feel kind of supported in that process, too. And that also, you know, that what is and isn't realistic for your child. So that way, you can kind of streamline some of those decisions. Um, I know I talk a lot. I talk fast in terms of, you know, 2E. I'm sure I also have ADHD as well. Um, but I want to see I do want to pause because I feel like there's so many questions that people could potentially have. There's other things I can talk about, but I definitely want to see if there's any questions that I can read them pull them out for you because there's been a lot of other stuff because people are um introducing themselves.

11:53

Um, some we did an evaluation last year with psychologists who admitted they don't usually see such uneven profiles like our child, two ends of a spectrum. Should we just wait for a couple years to do re-evaluation? Now, eight, ADHD, very gifted in one domain, which explains the exceptional ability and engineering and robotics kind of pursuits. Interesting. So, here's a I always, you know, in terms of like doing an a re-evaluation, I think it depends. And so if you feel like there's unanswered questions, like I just don't feel like they like fully saw the picture or that I don't really understand that something is actionable. You can always get a re-evaluation at any point in time. Some parents though feel like, okay, this is good enough kind of information to get started with and then wait until like a new question comes up and then yes, like closer to middle school entrance or something like that, have a re-evaluation. There are also some middle options. I don't know if other people provide this and I'm not just trying to like talk about my services or anything, but like one thing I do is I have like an evaluation navigator service is what I call it where I literally like review other reports and then talk you through it. And so I think there are probably other providers who do that. So it's kind of like a second opinion to see like, hey, do you have any other thoughts? Does this make sense? You know, are there any other recommendations you would have right now? Does a reevaluation make sense or should I wait? and can always look kind of more in depth at the profile with a different set of eyes. Um, but yeah, some people I will see kind of get a reevaluation kind of quickly because they're like, "Hey, I feel like a piece is missing." And other people wait like, "Okay, it's good enough to get started and then when they feel like they need more information, we'll seek that out." We ended up redoing it at the time where I needed it, you know, for the next phase of life. Like you need it for your SAT, need it for Yeah. college or um someone is also asking about insurance coverage.

13:54

Oh, great question. So, yes. So, insurance, in terms of insurance, if you're like talking about medical or actually most insuranceances, there's basically you need to go to like one of the major hospitals. It's like UCSF, you know, Stanford or PAM. So, one of the things to consider is often times they can serve a good purpose for diagnosing. Sometimes they are more streamlined evaluation, so it may not be a comprehensive evaluation, but you may be able to get your question answered. Um, they do have longer weights. I am not aware of other people outside of with very few exception of other people outside of the major medical facilities that take any insurance. Um so that makes it really hard. I do like on my website I have a guide and it doesn't really work as well for medical of like questions you can call your insurance and ask like one thing you can do and I don't know if this would work for medical but there's something called a network deficiency request and this is where I love AI for this kind of thing and so basically the reason why you're supposed to be in network with your insurance is because they're supposed to provide you with providers in network if you have like United Insurance you're not going to find in network providers who are not from one of the major facilities. What you can do is try to get them to cover an outof network evaluator at an in network rate. And this is called like a network deficiency. And basically making an argument with insurance, which is always fun as most of you know. Um but saying like you have a deficient network. I can't stand network. I want you to cover Jessica at an in network rate for an out of network exemption. And the nice thing is I do I've know specifically with Etna several times it's been granted and what they do is they don't it doesn't change like the fee that I receive like the parent pays me but then when they get reimbured via super bill from their insurance they get reimbured like that person is in network. So it's always worth trying for some of these kind of things. There are some things where it's not diagnostic because schools don't diagnose, but you can if you feel like your school did an evaluation that isn't really meeting the child's needs, you can try to get an IE or an independent educational evaluation, which can be tricky, but that is something where then you can go to a private provider and the school pays for it. But there has to be like an educational need not being met. Um, but there are some things like that that you can definitely try with insurance.

16:20

And one other question, someone saying um they have a seventh grade girl, ADHD, doesn't want to ask questions, doesn't want help, is super smart, passing math, not passing math and science because doesn't want to try and work hard. And the her question is, I'm not sure what to have an evaluator test for. Yeah, good question. And so I think so like if you're looking at that and sometimes they will have questions and even people coming in with some diagnosis but I think like the question is or kind of the feeling you're getting at is like she's struggling and there's something getting in the way of her doing well like and I very much believe as humans like we do well when we can and so whenever I see someone not doing well then it's like well what is getting in the way and so sometimes times it can be the ADHD because with ADHD boring tasks are like can be very very painful very very very painful and so it could be related to that it could be the executive functioning you know kind of required to carry out the task it could be anxiety because they feel that they're going to be overwhelmed and don't know how to plan it out there could be some learning challenges even though maybe they have a very high IQ or maybe they're processing more slowly there's all of these different things that can come in that is why like for example that I do compre comprehensive evaluations and kind of put everything on the table because usually there there is some sort of explanation as to what is going on. And you know that can be very frustrating for the child too because it's probably feeling like okay either one I don't want to try right now because it just feels so overwhelming and nothing I'm doing is working. Um or like people don't think I'm trying so why am I going to bother? It can be all of these things and then that can help to really identify services. So for example, if it's really truly like executive function, there are some great executive function coaches who can help like okay you feel very overwhelmed by science. How do you break this down? What can you do to get support in your own way? If it's more subject matter, someone else could help with that. If it's more like ADHD, then there's other kind of treatment options, too. So I do feel like that can be helpful.

18:35

Great. You're caught up with questions. I see a question about the ACT. That's a really good question. And I actually, and I can put a link to this one specifically, and it's something to think about. It's not just for ACT or SAT. It's also for things like IB or AP. Um, I did write up something about where you can go and this is my website, but it talks about I wrote up about like SAT, ACT, AB, and IB accommodations and college because they do have very like the college board or anything for AP or IB classes have very strict deadlines like of when the valuation had to have happened, how many years ago, when you have to submit it by and I will get parents who unfortunately didn't know understandably that they could get these accommodations or it's kind of like last minute or maybe the kid doesn't do as well on the AP test and like oh my gosh they could have had accommodations. So it is really important to kind of pay attention um to those deadlines and just be aware of those too.

19:46

Yeah, great question. How accurate assessments are as kids since they learn to mask or go out of some habits? Yes, but might have been noted in radio school when the kid was younger. Yes, absolutely. Good question. This is why developmental history is so important. And so this could even be like I will my my specialty is kids. I have worked with adults before and I will sometimes test parents or you know an autism diagnosis is given and as they're learning about they're like huh this explains my life and are looking for a diagnosis and most of the times they have learned very effective masking skills. But there are also not just the rating scales but like interview questions about like they get at like masking and kind of what they may be doing even unconsciously. And it also looks at like developmental history from their perspective and also can always talk to like if there's parents still around that people feel comfortable or spouses or whoever was important in their life to really kind of get at those things because I will see people who I would probably not even notice a lot of the characteristics with what they're describing from their childhood now heavily masking and like the diagnosis maybe of autism or ADHD or something that like really explains um a lot for them.

21:04

Assess for self- advocacy. So the question is, is there a way to assess for self- advocacy? How can you support her solution? Yeah, for a child who doesn't self- advocate, there's not really like a measure for self- advocacy. There are things that get at like, you know, is it related to anxiety? Is it related to like language where they don't feel confident? Is it related to like self-esteem? And sometimes, honestly, it can be personality. You know, as a mom of four who is raising kids, I have 75% who are really, really good advocates for themselves. 100% are good advocates in the home and one will never advocate for themselves outside of the home. Even though we practice, we do all of the things. Um, and so it can be really tricky, but I do think if you know your kid and kind of can get at like why they don't feel comfortable with it, then sometimes, you know, therapeutic support can be helpful even just to role play, practice a self- advocacy. Sometimes it's freezing and not knowing what to say. And so the more you can like roleplay and practice it, they may or may not do it, but at least kind of they're building up the skills and the language to be able to do it, too.

22:14

And I have a question. How do you know if you are dealing with a neurodiversity affirming clinician? How do you know if it's the right fit for you? That's a really good question. I would ask that question specifically. Some of it can be from reviews, too. So, you can ask like how do you take a like how do you incorporate someone's strengths into like the testing and in terms of the recommendations? because we were kind of chatting about this earlier, but I've I've read reports and I even had a report for one of my own kids where I was like, "Wow, even a lot of this is accurate, but it sounds very negative, very, very, very negative and just not very affirming at all." And that's not good. That's not what we would want for ourselves. That's not what we want down on paper about our kids. Your kids may read it. They will definitely read it if they're older. And you can ask like their perspective on like neurodiversity affirming evaluations. How do they make sure their evaluations are affirming? Do they have experience with 2E kids? I just got an email today about how do I feel, you know, do I have do I have a what's my comfort level in working with disabled parents? What's my comfort what's my comfort level with like gender diversity or non-binary? Like ask the questions directly. Anyone who would be working with your child, you can ask all of the questions. Like it's very important. If they don't want to answer them, that also tells you something. Um, and I also think from talking to them and kind of getting the an getting those questions answered, you can tell. Um, you might not be able to, but you can ask them specifically with that. And then also recommendations can really really help with that, too.

23:48

Is it typical for a clin clinician to do interviews if the rating spells does not indicate a strong correlation to autism? So, I would say yes. It should. And so like for example, when I'm working with a family and I do an intake, I am asking questions about everything. And so you may not reporting, I'm going to say autism, for example. You may not be reporting any characteristics of autism in your referral question, but I'm still going to ask about sensory. I'm going to ask about transitions. I'm going to ask about deep dives. I'm going to ask about, you know, routines they have to follow. I'm going ask about friendships and, you know, b social boundaries and conversation. And so I want to know all of those things that might kind of hang with autism even if that's not what you're reporting. And most clinicians should be at least at the intake like you would have a conversation and you know kind of go through all the things asking through like I go through criteria for ADHD because again a lot of parents may not see it in their child but then you start talking about like making these simple mistakes or forgetting things or can't track their belongings or whatever else they're like oh yeah that really does sound like my kid. And so I do think it's important to ask those specific questions. I think with a comprehensive evaluation, you're usually going to get that. Um, if they have experience with autism, which is always kind of a question there, too. I do think for more narrow evaluations, if you're going to someone you're like, I only want the question answered of ADHD, they're not going to be asking the other questions. That's why I personally don't do those types of AVLs. I only do comprehensive AVLs. But I do think those eval serve a purpose. like my second kiddo straight up classic ADHD Vanderbilt from school, Vanderbilt from home, diagnosis, good enough. Um, and it had already we already knew he was gifted. Like that's what we could um so that that like really helped and there. So like he didn't need a comprehensive evaluation. Not everyone does, but I do think that asking the questions can be helpful.

25:45

A lot of traits. Yes. How do you make sure you're not biased towards overdiagnosing autism or ADHD? So everything everything exists with all people and that is a question that you get and I love the book if you haven't readly read it uniquely human which specifically talks about autism and you know kind of use the argument of like people say like this does or does not equate autism and they talk about hand flapping and they're like no hand flapping occurs like look at people when they win the lottery or people win you know whatever they win a prize like oftentimes you will still see people like jumping and flapping their hands may not be autistic And so all of these traits exist in everyone to some extent, but it's looking that's kind of where the art comes in about looking as a whole and putting everything together for that person. Um, and you know, there can be people like I actually am now seeing more underdiagnosis of autism. Um, maybe overdiagnosis of ADHD, but still under diagnosis depending on if they're 2 or not. And so I do think but I also think it's important like for example when someone's going over like impressions or diagnoses with you to make sure you're getting your questions um answered and if it doesn't jive with how you're thinking about things as a parent like be very direct like ask those questions like hey that hasn't been my experience or like you know this has been my experience how does that relate to autism or ADHD or how does it not if they're not getting the diagnosis too.

27:16

Um, yes, criteria for the evaluation or questions for the evaluation. Yes, the parents guide that they just put on has a lot of questions and I think it's good to go through there and kind of feel like what is the most relevant for your child. I agree like I also will forget to ask things. Um, and so that can be helpful. Again, feel free to ask all the questions. I do have parents often, and I will just say this, ask me for a list of tests I'm going to give. I don't think that that is the most maybe useful thing because unless you're a psychologist, like I actually one of my kids is being tested right now and I didn't even ask a psychologist what test giving. I just made sure things were covered. But you do want to ask like about domains that are being covered. Like there's specific things like that. And again, the questions that are going to be answered. The one thing that is also included in the evaluation guide is even just about giftedness. Like once you hit the age of six for the whisk, we have extended norms. I often have to recalculate people's IQs who come in to see me if they were done elsewhere or done, you know, where they're not using extended norms and the IQ's significantly higher, which can make a difference for things like if we're looking for the Davidson program or something like that that have a pretty high IQ cutoff. So, there are questions like that included in the guide that you can definitely feel free to ask anyone who would be working with your child.

28:38

Thank you so much, Jessica. Um, I know we I'm sure people have more questions. I'm going to stop the recording.