Test For Success: Neuropsychological Learning Evaluations Support Optimal Living
Do you answer “yes” to any of the following questions?
- Are you curious what hidden gifts or talents you possess, but don’t use?
- Do you sense that you learn or perceive the world differently from others?
- Does it feel like you could conquer the world – if only you didn’t have so much anxiety and self-doubt?
- Do you have big wishes/goals, but feel like you’re not educated (or smart) enough to attain them?
- Ever wonder why you experience relationships and social gatherings differently from your family and friends?
- Is school or work a struggle? Boring? Simply a poor “fit”?
- Are you an entrepreneur who wants to fine-tune your role in your business?
- Are you an employee who secretly wants to be an entrepreneur?
- As a mom, do you sense that your child is not performing at their best? Or as happy as they should be?
- Is it hard for you to pay attention, remember things, organize and manage your busy life?
- Do you feel like you’re a smart, creative person who is drowning in a world of checklists, to-dos, and non-stop life maintenance?
Maybe these questions seem like an advertisement for a motivational class or success
seminar. But sometimes, they’re questions that lead individuals to seek a neuropsychological learning evaluation.
A comprehensive, high quality, neuropsychological learning evaluation can help you understand:
- How you think.
- How you learn.
- How you relate to the world.
- Your interests and talents.
- Factors that may be suppressing your performance and happiness.
The goal of this evaluation is not to “diagnose” what is “wrong” with you or your child.
But it is important to identify what issues may be keeping you from functioning your best – and being your happiest. Here’s an analogy we can all relate to:
What would you do if your car did not start in the morning? Would you “give up” – i.e., call your boss your boss and quit your job? Would you “check out” – i.e, climb into the driver’s seat, stare out the windshield, and wait for something miraculous to happen? Would you become “behavioral” – yelling and cursing, maybe hitting your car? Or, would you buckle down and work harder – i.e., push your car to work?
Everyone will respond in his or her own way, depending on temperament, motivation, how many times this has happened before, financial situation, whether a phone is available, and so on…
Of course, the ideal choice would be to call a tow truck and have your car delivered to a mechanic’s shop. There, the mechanic would begin his assessment of the problem by asking you what happened. Based on the history you give, he might continue the diagnosis process by considering your vehicle’s make/model, identifying the type of engine in the car, checking the oil, evaluating whether the engine parts are moving correctly, determining whether any parts are broken or jammed, ensuring the engine is connected to the drive rod, axle, and wheels, etc. He might even check to see if your wheels have air in them – or if the gas tank is empty!
Basically, the mechanic would take a comprehensive look at your vehicle to figure out exactly what is keeping your car from performing the way it was designed.
Similarly, a neuropsychological learning evaluation involves understanding where you are, how you got here, and where you want to go.
Like a mechanic’s shop, the diagnostic process evaluates your brain – its horsepower (IQ), output (e.g., academic achievement, behavioral symptoms, emotions), how various parts work together (e.g., attention, working memory, executive function), and if the engine connects to the rest of the car (e.g., visual, auditory, sensory processing). This is a simplistic comparison, of course, but it illustrates the value of comprehensive diagnostic assessment.
Since every human is unique, a neuropsychological evaluation is arguably much more complex than figuring out why a car won’t start… Especially when one takes into account the influences of emotional, social, and behavioral functioning, the infinite scope of interests, personality, temperament, and family dynamics – and the fact that everyone is unique!
But the overall goals of the two assessments are similar – to figure out how to optimize performance.
Unfortunately, there is a stigma about “psychological testing” that may prevent adults from pursuing a learning assessment – either for themselves, or for their kids.
Over time, this will change, of course. At some point in the future, neuropsychological learning evaluations will become mainstream. Someday, it may be as common as getting vision or hearing checked, having cavities filled, or getting blood pressure checked – just another approach to living longer, healthier, and happier lives.
Few people would disagree with the sayings, “Live life to the fullest,” or “Be the best you can be.” Wouldn’t it be nice to find out what the “fullest” or “best” really means? And then to identify and overcome any obstacles that might stand in your way?
– Dr. Katen
“Live the life you were meant to live!”
©2017 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
- Published in ADHD and Executive Function, Development, Dr. Katen's Blog, Dyslexia, Entrepreneurship and Career Planning, Gifted and Talented
What does Dyslexia feel like?
“Shame cannot survive being spoken… and met with empathy.” – Brené Brown
Individual Matters is pleased to bring the Experience Dyslexia® Workshop to Central Kentucky and beyond.
You’ve undoubtedly heard the term “dyslexia.” You probably know it refers to a type of “reading disability” that makes decoding and understanding text difficult, results in poor spelling, and is often associated with left/right confusion.
But you may be surprised to learn that you already know someone with dyslexia. In fact, you are probably surrounded by them! Research suggests that the disability is very common. As many as 15% of the population experiences some form of dyslexia, yet only 1 in 10 are ever diagnosed.
If you are an educator, these statistics may not be surprising. Perhaps you witness the struggles of dyslexia in your classroom every day. Its effects include a wide range of learning-related symptoms, as well as one or more of the following behavioral symptoms:
- Shame
- Anxiety
- Anger
- Low Self-Esteem
- Depression
- Family Problems
- Avoidance
- Frustration
But regardless how familiar you are with dyslexia, it can be hard to relate to the personal struggles of those who live with the disability. And when we don’t understand another person’s behaviors, we tend to make assumptions about the reasons for them.
When dyslexia is undiagnosed, or its effects are not well understood, those with the disability may be labeled as lazy, oppositional, immature, or dumb. Their childhoods are often characterized by continual and frequent failures, as well as by nonstop criticism from teachers and parents, and teasing from classmates. Not surprisingly, the silent shame of this burden inhibits learning, destroys self-esteem, and can lead to depression and other mental health problems that continue well into adulthood. Even when students have been identified with dyslexia, it may be difficult for parents or teachers to empathize with their struggles.
Fortunately, the International Dyslexia Association has created the Experience Dyslexia® Workshop. Now people without the disability can begin to understand what it’s like to have it.
Empathy and understanding is vital for compassionate teaching and parenting. Understanding what dyslexia feels like helps us to avoid making assumptions, recognize learning problems for what they are, refer for appropriate treatment and interventions, and help children with dyslexia and other learning problems find success. With empathy, we can begin to scaffold individuals in overcoming the challenges of dyslexia – as well as capitalizing upon its many upsides.
At Individual Matters, we are pleased to facilitate the Experience Dyslexia® Workshop – as well as others that focus on learning, teaching, and parenting. These experiences are available throughout Central Kentucky and beyond. They are appropriate for teachers, parents, or anyone else who works with dyslexic individuals and/or wants to understand impacts of living with the disability.
To learn more, or to schedule a workshop with Individual Matters, email us or call (859) 260-1914.
- Published in Dr. Katen's Blog, Dyslexia, Learning, Achievement, and Academics
Top 5 Things to Know Before Scheduling a Learning Assessment
So your school has recommended you get a “learning assessment” for your child… What does this mean?
Perhaps your child’s teacher or counselor has concerns about learning, behavioral, or attention problems. Or maybe testing is required as part of the admissions process for a certain school or program.
Your school recommends a learning assessment… What does this mean?
As a parent, you may be feeling unsure what to do next. After all, a quick internet search will tell you there are lots types of “learning assessments” available – and variety of people who provide them. But not all learning assessments are the same.
Here are 5 things you should know before scheduling your child for a learning assessment:
1. A learning assessment should be completed by a licensed psychologist.
A licensed psychologist is someone with a doctoral degree (Ph.D. or Psy.D.), legal authorization to practice, and specialized experience/training in psychological testing. Typically, schools (both K-12 and college) will only accept assessments completed by individuals with these qualifications. In most cases, only a psychologist holds the requisite credentials for diagnosing clinical disorders, such as ADHD, specific learning disorders, autism, developmental delays, and intellectual disabilities.
2. Learning assessments should include a comprehensive evaluation of IQ and academic achievement.
“IQ” (intelligence quotient) testing refers to the evaluation of intellectual and cognitive abilities (i.e., verbal and non-verbal reasoning, working memory, and processing speed). Academic achievement testing measures acquired procedural knowledge, skills, and facts related to school (i.e., reading, writing, and math). A psychologist should use “gold standard” measures to evaluate these areas. We recommend the following:
- IQ: Wechsler intelligence scales (WPPSI-IV for preschool/kindergarten, WISC-V for children and teens, or WAIS-IV for late-teen and adults).
- Academic achievement: Wechsler Individual Achievement Test, Third Edition (WIAT-III).
3. Screeners are insufficient for assessing learning problems.
Screeners are behavioral checklists and/or abbreviated versions of “gold standard” measures, and there are several reasons why they are inadequate for evaluating complex learning problems. First, they are not generally accepted by schools as evidence of diagnoses or need for classroom accommodations. Second, while they may be cost effective and a good first step towards identifying possible learning challenges, when used in isolation they do not allow conclusive or differential diagnosing (i.e., teasing out other possible causes). Third, they do not support identification of strengths. Fourth, screeners can deliver false positives/negatives for children with significant weakness, advanced abilities, or both (i.e., twice-exceptional learners). Fifth, unlike “gold standard” measures used by psychologists, screeners can and often are used by professionals with a wide variety of credentials and experience.
4. Insurance does not cover learning assessments.
Learning assessments are classified as “educational” rather than “medical” services. As such, health insurance policies will not pay for them. However, policies may cover testing that is provided by a psychologist or physician and results in a diagnosis for specific clinical disorder (e.g., ADHD or anxiety). The best way to find out what your policy will cover is to call the insurance company and ask. A psychologist can provide you with detailed invoices (that include clinical billing codes) that you can submit for possible reimbursement.
5. Learning assessments should evaluate strengths – and not just “problems.”
A quality learning assessment should provide insights and guidance that help scaffold a child’s overall happiness and success – not only in school, but across life. The process should include a survey of strengths, preferences, learning styles, interests, and temperament – all of which impact learning, self-concept, personal relationships, and career choices.
What is the first step you should take?
Some psychologists offer initial consultations for new assessment clients. During this meeting, they will gather history, ask about your goals for testing, review previous testing or other relevant records, describe their philosophy about assessment, outline the process, explain costs, and discuss other options. Essentially, clients should leave this session with a clear “road map” of what to do next, and what to expect along the way. The psychologist should then be able to connect with your child’s school to ensure that the testing they provide is what the school needs.
Above all else, never stop asking questions until you feel confident you’ve chosen the right path for you and your child.
– Dr. Katen
“Live the life you were meant to live!”
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
Not All Learning Assessments are Created Equal
A Look at the Different Types of Learning Evaluations
There are many different types of testing available for learning-related issues.
Where and why you seek testing for your child (or yourself) will determine who evaluates your child, which tests are administered, how results are interpreted and communicated to you, what findings and recommendations follow, and the total amount of time and costs involved in the process. Discussed below are a few different types of testing, as well as related factors parents should consider when choosing the most appropriate option for their children.
Why are you seeking an assessment?
Not All Learning Assessments are Created Equal
Answering this question is the first and most important step in the assessment process. What are your desired outcomes for testing? Are you hoping to understand your child’s gifts? Would you like to help your child understand his or her temperament? Are concerned about your child’s academic performance? Do you think your child may have a learning or attention disorder? Are you uneasy about your child’s emotional, social, or behavioral functioning? Has your school or pediatrician recommended testing?
There are all sorts of reasons that parents consider having their children tested. By outlining your goals, you will have a clearer idea about what type of testing is most appropriate for your child.
Who should conduct a learning assessment?
There is not a simple answer to this question. Many types of professionals administer “learning assessments,” but they often have dissimilar qualifications. To complicate the matter, professional credentials and licensure vary by state. For that matter, so do the ways that schools classify learning issues.
Regardless where you live, a licensed clinical psychologist (Ph.D. or Psy.D.) has the prerequisite education and licensure for conducting psychological testing and issuing clinical diagnoses. But not all psychologists specialize in testing – some only provide therapy, while others assess mental health rather than educational performance or neuropsychological functioning. Any professional – psychologist or not – who provides psychoeducational testing should have not only the minimal licensure and credentials, but also specialized training and experience in assessment.
Typically, schools and colleges will only accept diagnoses and recommendations from an evaluation provided by a doctoral-level psychologist. Furthermore, these institutions require “gold standard” instruments – standardized tests produced by reputable companies and backed by years of scientific research.
What type of learning assessment will you need?
Depending on your goals, there are a variety of assessment options:
-
Comprehensive psychoeducational assessment
This is a wide-ranging yet in-depth approach to understanding your child as a “whole person.” Comprehensive psychoeducational assessment evaluates neurological processes and cognitive functioning (IQ, attention, memory, processing speed, executive function, etc.), as well as academic achievement (skills in math, reading, and writing). Furthermore, the process will assess visual-motor integration, sensory processing, social and emotional functioning, visual and auditory processing, behavior, temperament and personality, gifts and strengths, learning styles, overexcitabilities, interests, life experience, and neurodevelopmental disorders. A skilled evaluator will be adept not only at administering the actual tests, but also at analyzing and integrating the results (including both quantitative and qualitative data). Essentially, this process should produce a manual that explains your child’s overall “operating system.” Since it evaluates multiple facets of your child – and not just learning issues – this process also supports conclusive diagnosis, generates specific recommendations, and guides the referral process.
-
Learning disability (dyslexia) testing
This type of assessment is recommended for the purpose of evaluating and diagnosing a suspected learning disability. In these cases, a qualified professional is someone who holds appropriate licensure and can issue a correct and pertinent diagnosis. The learning assessment will measure and compare a child’s IQ with his or her academic achievement – the traditional method for identifying a learning disability. If indicated, diagnosis of a specific learning disorder by a clinical psychologist qualifies a child to be considered for learning accommodations at school. While a “learning specialist” might test for dyslexia, it is important to understand that “dyslexia” is not a clinical diagnosis (per the DSM-V). By itself, identification of dyslexia may not be sufficient to qualify your child for special services at school. Furthermore, limited assessments such as these may not reveal or conclusively rule out other causes of learning problems – in fact, sometimes they produce more questions than they answer.
-
ADHD assessment
Attention-Deficity/Hyperactive Disorder (ADHD) is a complex neurodevelopmental disorder (not a learning disorder). Who can diagnose ADHD? Generally speaking, only a medical doctor (M.D.), psychiatrist (M.D.), or psychologist (Ph.D. or Psy.D.). In most cases, diagnosis is based solely upon results of behavioral checklists and interview with the child and parents. However, there are many reasons for a more in-depth evaluation. As a result, some psychologists assess ADHD using not just checklists and interviews – but also neuropsychological measures of IQ, attention, memory, and executive function. Unfortunately, there is no single, decisive test for identifying ADHD.
What are the costs of a learning assessment?
Just as the types and scopes of testing vary, so do the costs. Some learning professionals and tutors provide “learning assessments” for as little as $300 or $400. These can be completed in a few hours and may (or may not) utilize standardized tests of IQ or achievement, result in diagnoses, or provide individualized recommendations. Unless completed by a doctoral-level clinical psychologist, these evaluations may not qualify a student for accommodations at school.
Evaluations conducted by schools may be more extensive, but schools do not diagnose learning disorders or ADHD. Schools may assess for learning “issues” like dyslexia and make recommendations for special education services, but only psychologists and doctors diagnose clinical or medical disorders. Furthermore, school evaluations are not intended to assess your child as a “whole person” – only whether he or she has a condition that affects functioning in the classroom. Since educational classifications and resultant accommodations are based upon your child’s current grade-level and classroom functioning, they may not be pertinent a year from now.
Finally, comprehensive psychoeducational assessments are conducted by doctoral-level clinical psychologists. Prices typically range from $1500 to $5000. The entire process involves 8-15 hours of testing, twenty or more hours of scoring and analysis, an extensive and detailed written report (15-25 pages), a feedback session with parents, and school consultation. Clinical diagnosis of a learning disorder by a psychologist who utilizes “gold standard” test instruments is often required by schools before they will consider a student for school-based learning services and supports. Furthermore, a high quality assessment will accurately capture your child’s gifts, strengths, personality, and underlying areas of challenge (the “whole person”) – and stay relevant for years to come.
Want more information?
As a parent, you justifiably want to ensure that whoever evaluates your child can deliver outcomes that support your specific goals for testing. How do you do this?
One way to find out is simply to call their offices and inquire. Some will provide basic information over the phone.
Another option is to schedule an initial consultation. During this meeting, you can ask the assessment professional about his or her background and scope of expertise. Also, find out what specific tests they use, whether they issue clinical diagnoses (as contained in the DSM-V), and if their findings can and will be accepted by your child’s school. You might also inquire about their overall philosophy towards assessment, learning, and ADHD – in other words, how they approach testing, and why. While psychologists are unlikely to share client testimonials (due to patient privacy policies), they might offer generic samples of past reports. Furthermore, consultation with an experienced assessment psychologist sometimes results in immediate referrals that save you time and money. In any case, this initial step will give you solid information – a “road map” for action – that helps you to be more informed about, and comfortable with, the testing process.
– Dr. Katen
“Live the life you were meant to live!”
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
10 Myths About ADHD
Perspectives of a Clinical Psychologist
Although Attention-Deficit/Hyperactive Disorder (ADHD) is a household word, there are a lot of misunderstandings and misconceptions about the disorder.
Below are 10 myths about ADHD that I frequently encounter in the media and when working with families.
1. ADHD is a straightforward diagnosis.
This may seem true based upon the prevalence of ADHD in the U.S.. Indeed, one might be tempted to assume the diagnosis is uncomplicated, simple, or quick. In fact, the opposite is true. ADHD is a complex disorder and diagnosis should only be made following a careful evaluation by a licensed clinical psychologist or other qualified professional. The abundance of ADHD diagnoses has led some to ask whether the disorder is being been handed out too lightly, while others suggest that ADHD may also be “under-diagnosed” in many cases. Both arguments undoubtedly have their merits. In the absence of a comprehensive assessment by a qualified professional, the risk of ADHD misdiagnosis is a legitimate concern.
2. ADHD is a behavioral disorder.
In fact, ADHD is a neurodevelopmental disorder. While ADHD is well known for its behavioral symptoms, the underlying cause and mechanisms of the disorder are neurological. As such, the diagnostic process should take into account not only an individual’s behaviors, but his or her overall neurodevelopmental profile. While behavioral checklists are a good first step, results to not ensure accurate diagnosis. Checklists should be supported by clinical interview and neuropsychological assessment by a psychologist or other professional with expertise in diagnosing ADHD.
3. ADHD is an attention deficit problem.
Actually, ADHD is an attention regulation problem. In fact, many individuals with ADHD can “hyperfocus” on a topic of interest for long periods of time. Their problem is not that they cannot sustain attention to a task; it is that they cannot regulate (i.e., moderate or switch) their attention. Sometimes their attention is fleeting, while other times it’s laser-focused. The possibility of ADHD should not be discounted in individuals who demonstrate the ability to work on a project of interest or play video games for hours at a time.
4. ADHD only affects attention.
Unfortunately, this is not true. If undiagnosed or ignored, ADHD can lead to other problems like anxiety and depression. The consequences can be enormously damaging across an individual’s social, academic, and professional lives. Having ADHD is like walking across a minefield every day of your life. It’s not a matter of whether you will step on a mine; it’s simply a matter of when. Years of living with fear of making mistakes, forgetting, and “screwing up” is not only frustrating and confusing, it’s possibly traumatic. It’s little surprise that the disorder has been correlated with low self-esteem, anxiety, and depression in both kids and adults.
5. Behavioral symptoms are sufficient for diagnosing ADHD.
This is a common misconception. Just because an individual exhibits the symptoms of ADHD does not mean he or she actually has the disorder. After all, ADHD shares many behavioral symptoms with other problems like anxiety, depression, stress, impaired executive function, auditory processing disorder, visual processing weaknesses, and other neurological pathologies/abnormalities. An evaluation that takes into account an individual’s overall neurodevelopmental profile – and not just his or her behavioral symptoms – will improve the probability of accurate diagnosis.
6. ADHD looks the same in everyone.
Fact: ADHD looks different in everyone.
Again, not true. We are each unique in our circumstances, temperaments, interests, abilities, skills, strengths and weaknesses. Not surprisingly, ADHD affects everyone differently. Inattention, hyperactivity, and impulsivity can manifest in different ways and at different times for different people. For example, extroverts with impulsivity may display more obvious symptoms than an introvert who works to hide these symptoms. Some kids can appear hyperactive, while others seem quiet and reserved. Certain students struggle more with ADHD when they are overstimulated, while others are more challenged when under-stimulated. Alternatively, visual-spatial learners can look inattentive for reasons that have nothing to do with ADHD. And whenever environmental and learning environments are a “poor fit,” ADHD-like symptoms typically worsen.
7. There is a single test for diagnosing ADHD.
Unfortunately, this is not true. Because ADHD is so complex – and it affects everyone differently – the ADHD diagnostic process should incorporate not only behavioral checklists and patient history, but also neuropsychological assessments. ADHD “profiles” can be gleaned from a battery of tests that measures IQ, attention, memory, and executive function. Developing a comprehensive profile of the “whole person” helps confirm (or rule out) the presence of ADHD, even if behavioral symptoms are not obvious. Comprehensive assessment also supports differential diagnosis – in other words, “teasing out” other factors that may be causing ADHD-like behavioral problems.
8. A diagnosis of ADHD guarantees a prescription for medication.
This is not just a myth, but a harmful one. In some cases, parents who suspect an attention issue (and know in their heart that their child is struggling) avoid seeking diagnostic help out of fear that their child will be medicated. The truth is that medication is a highly individualized choice, and it’s not for everyone who has ADHD. Depending on personal preference and circumstances, medication may not be desirable or even effective. Furthermore, there are other ways to support, treat, and embrace ADHD – for example, behavioral interventions, lifestyle changes, family supports, and skills-building approaches. Don’t be afraid of an ADHD diagnosis simply because you think it means you’ll have to take medication.
9. ADHD is all bad.
Actually, there may be many upsides to ADHD. One of the greatest is creativity. The ability to jump from idea to idea, to synthesize seemingly unrelated topics, and to wander inside a world of imaginative creativity has probably contributed to the success of some of history’s great entrepreneurs, artists, inventors, scientists, writers, and teachers.
10. ADHD is an excuse for unruly behavior.
No one chooses to “have ADHD.” But while having the disorder is not anyone’s fault, managing ADHD is ultimately the individual’s responsibility. Successful living is rooted in self-awareness and self-understanding, both of which can be supported by an accurate and clear diagnosis of ADHD. Next, coaching and skill-building can scaffold ownership of ADHD symptoms by helping an individual understand the disorder and how it affects him or her. By developing strategies for circumventing limitations and designing a lifestyle that capitalizes upon advantages, ADHD becomes just another part of life. And like life, ADHD is simply what you make of it.
— Dr. Katen
“Live the life you were meant to live!”
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
Is it ADHD, sensory processing, anxiety, or something else?
Behavioral Checklists Are Just the First Step Towards Accurate Diagnosis
Attention-Deficit/Hyperactive Disorder (ADHD) is an incredibly complex neurodevelopmental disorder. While behavioral checklists serve as useful starting points for identifying the possible presence of ADHD, they may be inadequate when used in isolation.
What is ADHD?
ADHD is classified as a neurodevelopmental disorder whose essential feature is “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (DSM-V). The disorder begins in childhood and lasts into adulthood, often causing a lifetime of personal, academic, and professional struggles.
What causes ADHD?
Unraveling the neurodevelopmental causes of ADHD is still at the frontier of neuropsychological research. Numerous theoretical models have been proposed for understanding what causes the disorder, how it impacts daily functioning, and how it correlates with other issues. In recent decades, ADHD has had an assortment of other labels, including “minimal brain dysfunction”, “hyperkinetic reaction of childhood”, “executive function disorder”, and “attention deficit disorder (ADD).” Some experts simply refer to ADHD as a “symptom complex” – that is, a cluster of behavioral symptoms whose neurological cause is not well understood. Other experts regard ADHD a “context disorder” – a group of behaviors that stem from a mismatch between an individual and his/her environment.
How is ADHD diagnosed?
Overlapping Symptoms of ADHD and Other Psychiatric Disorders. From A.D.D. Resource Center.
In most cases, ADHD is assessed in a medical setting and the diagnosis based upon an individual’s behavioral symptoms. Since no genetic or blood test exist for ADHD, the diagnostic process often relies upon behavioral checklists completed by (and dependent upon the observations of) parents and teachers. Checklists ask parents and teachers to rate the severity of a child’s conduct at home and in the classroom.
Why might checklists be insufficient?
ADHD is not a behavioral disorder—it is a neurodevelopmental disorder. Behavioral checklists, as the name suggests, measure the presence of specific behaviors. These behaviors may be symptomatic of a neurodevelopmental disorder like ADHD, or they might be due to something else. The most informative way to assess the neurodevelopmental workings of a child’s brain is to use objective neuropsychological testing.
Since checklists only emphasize behaviors, relying solely upon them to make an ADHD diagnosis invites the risk of misdiagnosis. The behaviors listed on ADHD checklists can be caused by a variety of other factors, including anxiety, auditory and visual processing issues, temperament, fine motor delays, learning styles, learning disabilities, sensory processing difficulties, poor environmental fit, physical health problems, and/or other neurological pathologies/abnormalities. In other words, just because a child displays a large number of behaviors that are typically associated with ADHD, this is not confirmation of the presence of ADHD.
Why does accurate diagnosis of ADHD matter?
Accurate diagnosis is essential for effective intervention. For example, a child with sensory issues may display behaviors that are nearly identical to symptoms of ADHD. Based upon a checklist, this child might be diagnosed with ADHD. Interventions for ADHD can include behavioral strategies, skills-building, environmental modifications and, in some cases, medication. While a child with a sensory processing may benefit from behavioral strategies and environmental modifications, medication would not be appropriate. Furthermore, a child with sensory issues needs occupational therapy. If diagnosed with ADHD, he may be less likely to be assessed and treated by a sensory processing expert.
In addition to the possibility of over-diagnosing ADHD, behavioral checklists can also lead to under-diagnosing. Some children do not display obvious symptoms of ADHD and, therefore, will not score highly enough on a behavioral checklist completed by their parents or teachers. This is particularly true for children who have only an inattentive type of ADHD, as well as introverts, highly compliant children (aka “pleasers”), and the intellectually gifted. Under-diagnosis is also common among girls who suffer from the inattentive form of ADHD. As a result, girls often develop social anxiety and depression, for which they may seek help. In these cases, intervention usually focuses on their anxiety and mood symptoms, while the underlying ADHD goes undetected.
Takeaway
In short, if you have met one child with ADHD, you have met one child with ADHD. It is not a behavioral disorder, but a neurodevelopmental one – and it is exceptionally complex. ADHD affects everyone differently, and not everyone who displays ADHD-like symptoms truly has the disorder. While behavioral checklists are a good first step, individuals suspected of having ADHD should be referred to a psychologist or other professional who specializes in this disorder and provides objective neuropsychological assessments.
– Dr. Katen
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
Insurance vs. Private-Pay?
How to Pay for Learning Assessments?
To use insurance or to private-pay? That is the question, right? Perhaps you’ve already decided to go forward with a psychoeducational (or learning) assessment for your child or yourself. Or maybe you’re still busy comparing services, costs, and trying to determine whether and how to pay for the assessment. No doubt you’ve spent a lot of time researching options. You understandably want to find the best possible assessment service – but also at the most reasonable cost!
Somewhere during your research, you’ve probably wondered whether to pay for the psychoeducational assessment with insurance or private-pay (i.e., paying with cash, check, or credit card). What are the advantages of each payment option? And which is right for you and your family?
Both options – insurance and private-pay – have their advantages:
Insurance vs. Private-Pay
Insurance
- Can reduce the cost burden. Depending on your insurance plan, as well as the type of assessments and diagnosis, insurance companies may pay for some or all of the costs of testing for “medical” conditions (usually these refer to mental health or neuropsychological issues that are deemed “medically necessary”).
- Discounts are typically available for going through “in-network” providers.
- Other discounts may be available when you use “out-of-network” providers.
Private-Pay
- Insurance does not pay for “learning” or “educational” assessments. Insurance policies do not typically cover “learning” or “educational” assessments such as testing for learning disabilities. In general, insurance does not pay for psychoeducational assessments of academic achievement, cognitive (IQ) testing, or personality and temperament inventories. However, as discussed above, your health insurance might cover assessments of certain “medical” conditions. For example, depending on your insurance policy, you might be reimbursed for assessment of mental health issues or, in some cases, ADHD. Your policy might also pay for certain types of neuropsychological testing that your physician believes to be a “medical necessity.”
- In order for insurance to pay, you must be diagnosed. This is important to consider before you decide to utilize insurance. Since health insurance is part of the medical model, you (or your child) must be diagnosed with a mental health condition if you utilize insurance. This stipulation is important to understand up front, since any subsequent diagnosis will become part of your permanent medical record – possibly affecting your future insurance coverage, school options, employment, etc.
- Your privacy is protected. When you pay privately, you share an agreement with your psychologist – and no one else. With the exception of special cases (e.g., issuance of a court order, or in situations where someone’s life or safety is threatened), your records will never be released without your written authorization. Cash sessions are entirely confidential. Conversely, insurance companies can and do audit psychologists – meaning your (or your child’s) records must be made available to the insurance company and, quite possibly, various other “third party entities” (such as government agencies). Even if your psychologist is not audited, he/she is still required to submit certain information about you to your insurance company (see below).
- Only you and your psychologist determine scope of care. When you pay privately, your psychologist will work with you to formulate goals and intervention based upon your unique circumstances. These plans can be modified, continued, or concluded based on the decisions you make together – in confidence. On the other hand, insurance companies require psychologists to submit client treatment plans – which their claims departments will then decide to approve or deny. When you choose to utilize insurance, the type of assessment, results and diagnoses, and recommended treatment must be submitted to your insurance company. Their claims department will then determine whether the outcomes and recommendations of your sessions fit the insurance company’s decision-making matrix.
- You have more options. When you pay privately for an assessment, your psychologist can utilize any assessment tools that he/she believes will be most helpful and appropriate for yielding a clear and comprehensive profile. He/she is not constrained by what your insurance company will or will not pay for.
- No hidden costs. Private-pay typically involves “flat fee” rates. For example, if an assessment is advertised as $800, then that’s the final cost. All agreed upon services will be provided for that price. There are no “extra” or “hidden” costs. You will not receive any “surprise” follow-up bills.
- Often less expensive than insurance. In the long run, the cost of a psychoeducational assessment may end up being less when you private-pay. One reason is “deductibles.” Insurance companies typically require you to pay a certain amount before they will cover additional costs. If this amount (i.e., your deductible) is greater than the cost of the evaluation, your insurance policy will not pay. Keep in mind that, just because you have received an initial quote for reimbursement, this does guarantee you will actually be reimbursed (as mentioned above, claims may still be denied). Furthermore, since insurance companies direct scope of care, they may agree to cover only a limited-scope assessment. And in all cases, the insurance company will require a diagnosis. But what if no diagnosis is warranted? And what if further testing is appropriate? When all is said and done, you may be left with more questions than answers, and the total cost of the assessment process will increase substantially.
- You pick your provider. Perhaps most importantly, when you pay privately you are able to choose your provider based on “best fit” for you (and your child).
What should you do?
There is no single, best, “right” way to pay for a psychoeducational assessment. Both insurance and private-pay have their advantages. Here are a few final suggestions to consider:
- If you have insurance coverage, check your particular plan by calling the customer service number on your card. Ask the representative about the benefits of using in-network and out-of-network providers, as well as to explain exactly what is (and is not) covered by your plan.
- If you have a Health Savings Plan, you may be able to use these funds to pay for psychoeducational assessment. Check with your HSA provider.
- If you can afford to do so, use cash or check to pay for psychoeducational assessment. This ensures the highest levels of privacy and comprehensive service options.
- If you need to use insurance, get a quote from your company, pay privately first, and then seek reimbursement. Your psychologist can issue you a detailed invoice with insurance billing codes. However, keep in mind that, if you do utilize insurance, your psychologist will still be required to issue a diagnosis (and then submit it to the insurance company). But with this option, you can at least have greater freedom in your choice of psychologists.
- If you still have questions or are uncertain about the options, call and ask your psychologist. They love helping individuals and families – and they will be more than happy to provide information or answer any questions you have!
– Dr. Katen
Dr. Katen to Discuss Learning Differences at The Lexington School
We are very excited by the upcoming “Saturday Series” at The Lexington School: November 5, 2016.
Dr. Katen will present: “Students with Learning Differences: Navigating the Challenges.” Topics include:
- Different ways that students think and learn
- What learning differences are and how they impact learning
- Social and emotional challenges experienced by children with learning differences
- How to support your child’s unique temperament and learning style
This is a unique opportunity to:
- Gain valuable insights
- Learn helpful strategies
- Participate in hands-on activities
- Collaborate with other parents and professionals.
Parents and professionals from all schools welcome. To register, visit www.thelexingtonschool.org/Page/Saturday-Series
The Lexington School will award attendees with certificates for Continuing Education/Professional Development Credits.
- Published in Dr. Katen's Blog, Learning, Achievement, and Academics, Parenting
What is Executive Functioning and How Does it Affect Learning?
Is your child struggling in school? “Refusing” to complete chores at home? Is homework an epic battle every night? Does your child complete the homework but forget to turn it in? Does your child’s desk, bag, and room look like they were hit by a tornado? Are their emotions intense and unpredictable? Do you find yourself referring to them as “lazy”? Perhaps the reason is a weakness in executive functioning.
If a child were an airplane, executive functions (EFs) would be the pilot. While many parts and processes of a plane may be in good working order, only the pilot can set a destination, take off, steer the plane where it needs to go, address any issues along the way, and land safely. Without a skilled pilot, the plane is nothing more than a complex assembly of hi-tech parts and equipment sitting idly in a hangar.
Executive Function is the Brains Pilot
Similarly, our brains are powerful and complex mechanisms. But without efficient EFs, individuals may find it difficult to achieve even the simplest goals. From fixing a lunch, to cleaning a room, to learning math, to organizing a school project… EFs are needed to set and reach objectives of all dimensions. Without strong EF skills, a child is essentially a plane without a pilot.
Though the term EF is often described as a singular brain function, it is in fact comprised of multiple, interconnected, complex skills and abilities—so much so that even the experts cannot not agree on a single EF model.
Dr. Thomas Brown’s model offers parents and teachers a clear and straightforward way to categorize skills, understand strengths and weaknesses, develop interventions, and scaffold success. Brown divides EF into 6 “clusters”:
- Activation (getting started, organizing, prioritizing)
- Focus (sustaining and shifting attention)
- Effort (regulating attention, sustaining effort, processing speed)
- Emotion (moderating frustration, excitement, anger)
- Memory (juggling and recalling information)
- Action (controlling pace of action and impulsivity)
The key to any successful intervention is to correctly identify the specific area of struggle. Dr. Brown’s model provides a framework for identifying and understanding which area(s) of EF your child might be struggling with so that intervention may be tailored accordingly.
Children do not wake up in the morning and choose to “fail” at life or in school. So why, then, is life so challenging at times? If you answered “yes” to any of the questions at the beginning of this post, it is possible that the culprit is a weakness in executive functioning. – Dr. Katen
©2016 Katrina Katen. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
- Published in ADHD and Executive Function, Dr. Katen's Blog
Creativity: The Upside of ADHD
Creativity and ADHD
– Frank Coppola, MA, ODC, ACG
Creativity: The Upside of ADHD (Attention-Deficit/Hyperactivity Disorder)
When many people think of Attention-Deficit/Hyperactivity Disorder, or ADHD (formerly called ADD), they tend to picture a hyper and oppositional kid who is bouncing off walls. Or maybe they envision a day dreamer who never listens. Or they think of a disorganized and habitually late adult, whose desk is a mess, and who can never remember where he put his phone. While attention regulation – and sometimes hyperactivity and impulsivity – are certainly part of this “disorder,” there are also many advantages to having ADHD.
One of the greatest gifts of the ADHD mind is creativity. The abilities to jump from idea to idea, to connect seemingly unrelated topics, and to wander (apparently without aim) inside a world of imaginative thought is a double-edged sword. In some situations, these traits can be disabling. But when understood and effectively channeled, these same handicaps become the seeds for ingenuity and discovery. “Impulsivity” can spark spontaneous and brilliant solutions. “Hyperactivity” can fuel the creative process. A “lack of focus” is an advantage when it frees a person from preconceived notions or strategies that aren’t working – and if it results in heightened concentration on more important activities and goals. Indeed, the creative juices of ADHD often produce novel and ingenious solutions, theories, and inventions.
Albert Szent-Gyorgyi, a Hungarian physiologist who won the Nobel Prize in Physiology or Medicine in 1937 and discovered vitamin C, said,
– Albert Szent-Gyorgyi, Physiologist
– Dr. Katen
- Published in ADHD and Executive Function, Dr. Katen's Blog
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