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Dr. Karen Begun, Clinical Psychologist
Specializing in Children, Adolescents and Young Adults
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Common Questions

When should you consider an evaluation?


Parents decide to have their children tested for a variety of reasons. In some cases, a school counselor or teacher has suggested it. In other cases, parents themselves suspect that their child needs to be evaluated. Parents often report that they “just know” that their child is brighter than their schoolwork demonstrates or that something “just doesn’t add up.” Often times parents and/or teachers have determined that something is affecting the child’s ability to perform in school, and that the challenge is not simply due to a lack of effort on the child’s part. Similarly, there may be a suspicion that “acting out” behavior stems from frustration that the student is experiencing. Typically, learning issues do not appear suddenly and they do not impact just one area. Over time, children with some type of learning challenge frequently come to believe that they are “dumb” or that they “just can’t learn.” This can impact self-esteem, coping behaviors, and relationships with friends and family. Parents who have watched and worried over a child where something doesn’t seem “quite right” take an important step when they decide to have an evaluation. The evaluation report details a great deal about a child’s strengths, weaknesses, and neurological development. The psychologist can explain to your child that “the testing shows us that you are very smart, but that you just have some difficulties with your working memory.” After so much frustration, possible self-blame, or self-loathing, it is very powerful for a child to hear a specialist reinforce that they are smart and capable, and back it up with evidence. There may actually be a neurological basis for challenges that are mistakenly construed as “lack of motivation” or “laziness.”

 

How to decide between school testing and an independent evaluation?


1. The intent of an evaluation within a school is usually to determine whether or not a child is eligible to receive special services within the school system. For a child to be eligible for school services, he/she usually must have a learning disability, defined through the school system as a “severe discrepancy between the child’s cognitive ability and their academic achievement.” Additionally, children tested through the school need to be more than one year below grade level in one of the broad areas of academic functioning in order to be provided with services. However, not all children with learning problems qualify to receive special services within a school. A school-based evaluation may miss subtle learning problems and attentional issues, particularly in bright children or younger children.

2. The intent of a private evaluation is to find out WHY there is a problem. Often, parents and teachers suspect a student may have a learning issue, but only an evaluation conducted by a professional, such as a psychologist or neuropsychologist, can result in a clear diagnosis and explain in a thorough way all the factors, including cognitive and psychological issues, that could be affecting a child in school. With an exact diagnosis, the psychologist is then able to create a treatment plan tailored to the exact and specific needs of the child.

3. Time can be a key concern when opting for school-based evaluations. Despite the best of intentions, the school-based evaluation takes longer than an independent evaluation. Of course, an independent evaluation is typically more costly and insurance may not cover the expense.

 

What is the process of a neurocognitive evaluation?


A neurocognitive evaluation of a school-aged child depends on the referral question or the areas of concern reported by both parents and teachers. Dr. Begun will first interview the parents to obtain a detailed developmental history to determine what tests need to be administered. Some abilities may be measured in more detail than others, depending on the child’s needs. During this interview session, parents will be given behavioral and emotional rating forms, along with forms for teachers, to assist with the evaluation. A testing schedule will be arranged for the following sessions. After the assessment is complete, Dr. Begun will review all of the records, score and interpret the data, write the report and provide feedback to professionals with parental request. A feedback session will be scheduled with the parents to discuss the test results. A brief feedback session with older children is encouraged to discuss the child’s strengths with them and to answer any questions about the testing process. The most sensitive indicators of head injury and learning disabilities are often weaknesses in subtle and complex cognitive and behavioral functions. It is these functions among others that are assessed in the educational neuropsychological evaluation, which measures these areas in depth using standardized, objective tests. By comparing your child’s test scores to scores of children of similar ages, as well as comparing his or her own profile of scores, Dr. Begun can create a profile of your child’s strengths and weaknesses across broad ranges of functioning, identify the appropriate diagnosis, and determine reasonable and evidence-based interventions and school accommodations.

The specific neurocognitive processes assessed in an educational neurocognitive evaluation can include:

  • General Intellect
  • Achievement skills, such as reading, writing and math
  • Executive functions, such as organization, planning, problem solving and flexibility
  • Attentional and concentration skills
  • Learning and Memory
  • Speed and efficiency of processing
  • Visual-spatial skills
  • Fine motor skills
  • Behavioral, emotional, and personality functioning
  • Social skills

 

Who refers for an assessment and why?


Children can be referred for a neurocognitive evaluation by parents, pediatricians, teachers, neurologists, psychiatrists, school psychologists, educational therapists, psychologists or other professionals because of one or more problems, such as:

  • Difficulty in learning, attention, behavior, socialization or emotional control
  • A disease or inborn developmental problem that affects the brain
  • A brain injury from an accident, birth trauma, or other physical stress

The neurocognitive test results help those involved in your child’s care in a number of ways:

1. Testing can explain why your child is having school problems. For example, a child may have difficulty reading because of an attentional problem, a language disorder, an auditory processing problem or a reading disability. Testing also guides the psychologist’s design of school interventions and strategies to draw upon the child’s strengths. The results identify what skills to work on, as well as which strategies to use to help your child

2. Testing can help detect the effects of developmental, neurological and medical problems, such as epilepsy, autism, ADHD, dyslexia or a genetic disorder. Testing may be done to obtain a baseline against which to measure the outcome of treatment or the child’s development over time.

3. Different childhood disorders result in specific patterns of strengths and weaknesses. These profiles of abilities can help identify a child’s disorder and the brain areas involved. For example, testing can help differentiate between an attention deficit and depression or determine whether a language delay is due to a problem in producing speech, understanding or expressing language, social shyness, autism or cognitive delay.

4. Most importantly, testing provides a better understanding of the child’s behavior and learning in school, at home and in the community. The evaluation can guide teachers, therapists and you to better help your child achieve to his or her potential.

5. An neurocognitive assessment may also be required for high-stakes exams such as the SAT/ACT/MCAT/LSAT/GMAT. The testing procedure is seen as necessary in order to determine current functioning, with specific diagnosis, and appropriate accommodations based on the diagnosis and disability.
 

What should I tell my child about the evaluation?


What you tell your child depends on his/her age and how much he/she can understand. It is usually best to be simple and brief and relate your explanation to a problem that your child knows about such as “trouble with math,” “problems following directions,” or “feeling upset.” Tell your child that you are trying to understand how they learn and that all children learn differently. This process will help them understand how to make things better. Reassure a worried young child that testing does not involve “shots.” You may also tell the child that “nobody gets every question right,” and that the important thing is to “try your best.” Your child will probably find the evaluation interesting as many of the measures are colorful and fun! You can also tell them that they can take breaks and bring snacks.

 

What should I do if I have more questions about the assessment process?


Please feel free to contact Dr. Begun at 805-368-8077 if you have any clinical or administrative questions.