PsychoEducational Evaluations: What are they, exactly?

As discussed in this post, it’s important to consider scheduling a psychoeducational evaluation if a parent or a teacher believes that something is impeding a child’s learning. In spite of how often all of us search on Google, it’s not enough to type into a browser, “How to tell if my child has a learning disorder.”

DIY diagnosis, as this article clearly spells out, is not appropriate for complex issues such as those that impact learning.

The suspicion and diagnosis of a learning disorder means several things. First of all, “learning disorder” is a very wide umbrella, as these disabilities can be academic or non-academic. Psychoeducational evaluations are designed not to point out flaws, but to gather facts about your child, identify learning strengths and weaknesses, and create a strategy to help them grow into their best selves.

Learning disorders are more common than you might think. Oscar winner Octavia Spencer recently noted in an interview that she deals with dyslexia, and pointed out how it’s been a factor in her transition from film to television. Like many others, she is successful despite this challenge.

Testing may be recommended to determine the appropriate teaching environment, level of performance, and need for accommodations. The testing is a process used to confirm or rule out specific cognitive or learning disabilities or a developmental delay, as well as ADD or ADHD, language and communication difficulties, phonological (auditory), processing and visual-perceptual difficulties, and other underlying factors contributing to behavioral and emotional concerns.

Children as early as kindergarten and first grade frequently demonstrate the early markers of learning struggles. Therefore, it’s important to evaluate early in order to identify and remediate issues before the child experiences significant problems in school and frustration, anxiety or feelings of failure.

What happens during psycho-educational testing? Rest assured that tests are conducted by a well-trained psychologist with hundreds of hours of training and studies that lead to proper diagnosis and treatment.

A psychoeducational evaluation can be difficult to visualize. The evaluation process begins with an in-depth interview with the parent or guardian to identify concerns, discuss the history of the problem and what has been tried, and review academic performance, test scores, etc. The actual testing process takes 4 to 8 hours, which are usually broken up into several sessions.

It’s impossible to say exactly what the testing will consist of here, because it all depends on the child in question. The results of the first round of tests may indicate which resources are used in the subsequent sessions. Although each is tailored to the specific needs and concerns of your child, the testing will likely entail some combination of the following elements:
Standardized tests, which include measures of:

  • Cognitive and intellectual functioning;
  • Academic achievement;
  • Visual-motor skills;
  • Memory and learning tasks;
  • Emotional and behavioral inventories, and
  • Personality measures.

A psychologist may also utilize:

  • Rating scales;
  • Self-report scales;
  • Observations in familiar settings, and
  • Interviews.

After the process is complete, the psychologist will review the report with the parents, who can, in turn, discuss it with teachers, coaches and others who interact with the child. It will include an explanation of the testing procedure and background information, as well as a summary of the results and their interpretation. Finally, it will contain some recommendations about special services and actions that might be appropriate and which teaching methods will be best.

In this process, there is no such thing as a dumb question. The intent is to identify priorities for intervention and a strategy as well as a partnership whose only goal is to figure out the best path to success for a child.

Psychological Evaluations: What You Don’t Learn on Criminal Minds

Viewers regularly see characters on television getting something called ‘a psych eval,’ including investigators on shows like Criminal Minds and Bones. They never quite explain what it is, though.

Emily Prentiss, the star of Criminal Minds, twists the truth when answering questions from an unseen department psychologist after seeing her friend killed, her mental health assured by the fact that she is seeing a new man, Sergio (which is actually the name of her cat).
But did she pass or did she fail?

The term ‘psych eval’ (as presented in popular culture) is a very openly defined sort of test that characters have to pass. Setting aside plot, it’s not clear why these evaluations are even occurring. Where’s the sign that says ‘evaluation needed?’

In reality, when kids are having trouble in school, teachers and guidance counselors also suggest a psychological evaluation to the parents. The detection and treatment of learning issues requires a good deal of advanced knowledge, and it’s critical to seek a professional.

As many as 1 in 5 people in the United States may have a learning disorder. These can first be recognized clinically around 7 or 8 years of age, but there is no one sign that indicates a learning disability. A psychoeducational evaluation is designed to recognize them.
Here are some general red flags:

  • If a teacher suspects the child has a learning issue;
  • A child that isn’t performing to their academic potential, or keeping up with their peers;
  • A child who continues to struggle despite additional help or alternative learning strategies, and
  • “Acting out” or misbehavior, which often stems from frustration.

One example comes to mind. This young man was from a loving, extended family of high-achieving individuals, yet he was the black sheep who struggled in spite of natural intelligence. Neither of the two medical professionals in the family circle picked up on the reason for the maladjustment. It was a tutor, brought in during 10th grade to help ensure admission to a good college, who suspected his under-performance was related to a learning issue.

After testing and identification of the issue, Barry’s educational team began to tailor study sessions and introduce note-taking skills to address his issue. Barry, whose name has been changed to protect his privacy, went on to near straight-As in his last two years of high school, and he gained admission to his college of choice.

Many issues can require a psycho-educational evaluation, and many issues that occur in a classroom can be attributed to a learning disorder. It takes a skilled professional to accurately diagnose the issue and create a treatment strategy. Similarly, it’s taken years and years of research to form the evaluations used by psychologists today.

The good news is the opportunity and information necessary to address these problems are now available to parents.

I encourage every parent to arm themselves with as much knowledge as possible – and with a carefully chosen treatment team – in order to help their learner get to the brightest possible future.

What Graham Moore, Academy Award-Winning Writer, Got Right about Depression

One of the most compelling speeches at the Oscars this year was delivered by Graham Moore, winner of Best Adapted Screenplay for the film The Imitation Game. You may already have seen or read his words, which can be found here. In front of a worldwide audience of millions, he brought up the important issue of depression, which anywhere from 2%-8% of young people experience. He said:

In this brief time here, I want to say this: “When I was 16 years old, I tried to kill myself because I felt weird and I felt different and I felt like I did not belong. And now I am standing here, and I would like this moment to be for that kid out there who feels like she’s weird or she’s different or she doesn’t fit in anywhere. Yes, you do. I promise you do.”

Bravo, Mr. Moore, for speaking for so many who suffer with depression and giving hope to a worldwide audience that it can get better.

Being a kid is hard. Mr. Moore’s experience is not unusual, but, as he points out, it doesn’t always feel that way. Certain combinations of genetics and temperament combined with environmental factors put children at risk for depression. For example, the risk increases 2-4 fold for girls after puberty. Many adolescents even have subclinical depression, meaning that while they would not be officially diagnosed, they still experience significant or persistent symptoms.

The disorder involves at least two weeks of persistent depressed/irritable mood and loss of interest, as well as a change in appetite and sleep, decreased energy and motivation, increased guilt feelings, decreased concentration, and suicidal thoughts. Children in particular may exhibit irritability and anger or tantrums as well as physical symptoms.

Depression can be deadly. For instance, Major Depressive Disorder has a high recurrence rate, and 60% of children who suffer from it experience suicidal thoughts. Many have attempted suicide.

One of the more astute reactions to Robin Williams’ death last summer came from those who did not share the news by saying he died of suicide. They said, rather, that he died of depression. This is not a spin doctor’s take; in fact, it is a far more truthful explanation.

What Mr. Moore and many of us who treat people with depression want is to bring this issue to light, and to be honest to each other about how prevalent depression is. Fortunately, there are also effective treatments.

First, however, we as parents or adults need to recognize the red flags and act on them. These include:

  • Sadness, agitation, restlessness, anger or severe mood changes; especially when they persist more than 6 months;
  • Weight loss or gain;
  • Fatigue and loss of energy;
  • Sleep problems;
  • Withdrawal and loss of interest;
  • Drop in grades and academic performance, and
  • Legal problems.

Talking to children about depression can be difficult and effective treatment often takes some time. However, it is of the utmost importance that we do so. One key step is letting go of any stigma attached to this problem and consciously choosing to help our children learn strategies to cope with depression. If we do so, we may be giving them the most important gift of all.

Want to Change Your Child’s Life? Give Them Music Lessons

Clap along if you feel like a room without a roof,
Because I’m happy. –
Pharrell

At last month’s Grammy’s, Pharrell Williams’ “Happy” won Best Pop Solo and Best Video, and his live performance galvanized the audience. It’s easy to see why his snappy, motivational tune has been so successful.

Yet, it was his CBS Sunday Morning interview that made the comments fly on Facebook. Why?

Because on CBS, Pharrell credited his high school music teachers for his success, right along with his grandmother, who originally suggested he take drum lessons at age 15.

Yes, the man that Billboard magazine called “the top music producer of the past decade” named his high school band teachers (all of them) as the principle reasons for his success.

WHO BENEFITS FROM MUSIC LESSONS

It’s not just explosive talents like Pharrell who benefit from music lessons. Even when the horn playing is less than perfect, musical training helps children in numerous ways, according to a study in theJournal of the American Academy of Child & Adolescent Psychiatry.

The study, one of the largest to investigate the effects of playing an instrument on brain development, confirms that playing instruments helps develop fine motor skills right along with emotional and behavioral maturation. To reach these conclusions, the researchers analyzed data including MRI scans of 232 healthy children between the age of six and 18 who play a musical instrument.

"What we found was the more a child trained on an instrument, it accelerated cortical organization in attention skill, anxiety management and emotional control,” said James Hudziak, M.D., a psychiatrist and the lead researcher, in this Washington Post article.

We’ve known for some time that the cortex, or outer layer of brain, changes in thickness a­s a child develops. As neuroscience advances, we’ll know more about the exact pathways that make practicing an instrument such a beneficial activity, especially for kids with ADHD.

This underscores one of the arguments for keeping music in the elementary school curriculum i.e. that making music involves whole brain processing, which ultimately trains the brain.

In fact, both music training and music therapy help those with ADHD in areas of working memory, executive functioning and other high level skills that become significant as we humans mature.

For now, I strongly recommend that my patients and their families select an instrument and follow Pharrell’s lead. You don’t need to hire Pharrell’s teachers, whose names were Mrs. Warren, Mr. Warren, Mr. Edwards, Mr. Sharps and Mr. Copley.

Find your neighborhood music teacher and have your child select an instrument whose sound piques their interest.

Parents may also need to get a great set of noise-proof ear phones for those early days of practice!

FIDGETY PHIL AND THE ESSENTIALS OF ADHD: PART 1

"Let me see if Philip can – Be a little gentleman;
Let me see if he is able – To sit still for once at table"

Thus begins “Fidgety Phil,” Dr. Heinrich Hoffman’s early 19th Century ode to children with attention problems. The tale is sadly familiar to frustrated parents today, more than 170 years later.

ADHD remains one of the most misunderstood and challenging issues for both adults and children although today there is hope for treatment and much better understanding. We know that kids won’t just outgrow ADHD but the good news is that ADHD can be treated.

HOW DO YOU DIAGNOSE ADHD?

Most people know that ADHD is the acronym for Attention Deficit Hyperactivity Disorder. Attention is the ability to focus or filter information. Psychologists are uniquely qualified to diagnose ADHD using standardized tests in addition to observation and parent or teacher reports. Too often, ADHD is inaccurately diagnosed based exclusively on symptoms.

Using neuroimaging studies, we know that children with ADHD have physical brain differences in numerous areas. The outcome of this new knowledge is an understanding that children with ADHD typically lag 2-3 years behind neurotypical children in the development of the brain’s prefrontal cortex, the area associated with higher-level skills of planning and impulse control.

For instance, it is not until adolescence that the prefrontal cortex becomes more active. Individuals with ADHD lag behind their typical peers in this process and therefore are more likely to exhibit difficulty with problem-solving, anticipating consequences, inhibiting responses, and impulse control

The prefrontal cortex is associated with executive functioning, which is the ability to plan out strategies make a goal, and anticipate outcomes/consequences. The prefrontal cortex plays a role in the ability to differentiate between conflicting thoughts and emotions i.e. decision-making.

It’s rare that someone only has ADHD; this much-maligned illness is often accompanied by a learning disability or a mood disorder. Adding to the difficulty, there is a significant overlap between the symptoms of ADHD and other disorders, known in psychology as ‘comorbidities’.

Family dysfunction, parenting issues and low self-esteem are frequent co-conspirators in ADHD. Any of these issues may lead to depression, a frequent co-occurring condition. So, clearly, ADHD has a serious impact on kids, families, and schools.

WHO IS AFFECTED?

ADHD is known to affect more boys than girls, and although the prevalence rate is thought to be no more than 10%, roughly 50% of children referred to mental health clinics have ADHD-related problems. The societal cost of ADHD is estimated to be between $12,005 — $17,458 annually per individual, or a whopping $36 – 52 billion in total.

The worst impact of ADHD is in school, where the kids typically show:

  • High rates of disruptive behavior;
  • Low rates of engagement with academic instruction and materials;
  • Inconsistent completion and accuracy on schoolwork;
  • Poor performance on homework, tests, and long-term assignments, and
  • Difficult getting along with peers and teachers.

Socially, there is also an impact. ADHD can impact peer relationships; while eager to make friends, kids with ADHD often have difficulty keeping them. In fact, some might feel ignored but other kids insightfully know they are actively being rejected. They may sense that they are deficient in the mechanics of friendship, what we in the clinical world call appropriate social behavior.

Even team sports may be challenging, as the kid with ADHD may become too easily frustrated and show poor emotional regulation. Their friends may find them annoying or impatient, inflexible or bossy, none of which bodes in school or at play.

CAN ADHD BE TREATED?

It’s clear that children with ADHD confront significant issues at a young age. How can we expect a ten year old with ADHD and the brain development of an eight year old (or younger) to behave beyond his capability? As parents, we want to help our children build character and self-discipline and to lay cornerstones in executive functioning.
Therapy can help our children develop these necessary skills for success. Stay tuned for details in my next post!