Understanding Psychological Evaluations
Introduction:
Welcome to our enlightening episode, where we delve into the world of psychological evaluations with Dr. Diana Naddeo, a seasoned Licensed Clinical Psychologist. Known for her comprehensive approach to pediatric psychological assessments, Dr. Naddeo integrates emotions, personality, learning, and behavior to offer a holistic understanding of her patients. Her expertise spans psychiatric diagnosis, educational assessment, and a myriad of treatment approaches aimed at crafting effective plans for patients and their families.
Guest: Dr. Diana Naddeo – Licensed Clinical Psychologist, Owner of the Center for Assessment and Psychotherapy (https://newtowncap.com/contact/)
Host: Dana Jonson
Discussion Highlights:
The Importance of Private Educational Evaluations: Dr. Naddeo explains how these evaluations offer insights beyond standard school assessments, focusing on cognitive, academic, social-emotional, and behavioral aspects.
Components of Psychological Assessments: An exploration into the various components of a thorough psychological evaluation and how they contribute to understanding a student’s needs.
Collaborative Planning: Insights into how Dr. Naddeo collaborates with families and schools to create individualized educational plans that leverage each student’s strengths.
Culturally Sensitive Approaches: Dr. Naddeo’s commitment to understanding her patients within their cultural contexts ensures assessments are both meaningful and respectful.
Memorable Quotes:
“We’re not just assessing; we’re understanding the whole child within their world.” – Dr. Diana Naddeo
“Every child’s learning journey is unique, and psychological evaluations are key to unlocking their full potential.” – Dr. Diana Naddeo
“Collaboration with families and schools is not just beneficial; it’s essential for creating plans that truly support the child.” – Dr. Diana Naddeo
Call to Action:
Listeners are encouraged to learn more about Dr. Naddeo’s work and the transformative power of psychological evaluations by visiting the Center for Assessment and Psychotherapy’s website at Newtown Center for Assessment and Psychotherapy. Discover resources, insights, and how to schedule a consultation to support your child’s educational journey.
Note:
This episode provides a deep dive into the significance of psychological evaluations, offering invaluable perspectives for parents, educators, and professionals in the field. Join us as Dr. Naddeo shares her expertise, shedding light on these evaluations’ critical role in supporting students with disabilities.
TRANSCRIPT (not proofread)
SUMMARY KEYWORDS
test, child, evaluation, evaluator, scores, testing, adhd, school, average, parents, problem, school district, cognitive, kids, neuro psych, assessment, reading, find, skills, high
SPEAKERS
Dana Jonson, Diana Naddeo, Psy.D.
Dana Jonson 00:09
Welcome back to Special Ed on special ed. I am your host, Dana Jonson. And today I’m really excited because our guest is Diane and the Daio, who is a licensed clinical psychologist, and she’s going to talk to us about evaluations. But I can’t do anything without my disclaimer. So let’s hear that first. Information and this podcast is provided for general informational and entertainment purposes only, and may not reflect the current law in your jurisdiction at the time you’re listening. Nothing in this episode creates an attorney client relationship, nor is it legal advice. Do not act or refrain from acting on the basis of any information included in or accessible through this episode without seeking appropriate legal or other professional advice on particular facts and circumstances at issue from a lawyer or service provider licensed in your state country or other appropriate licensing jurisdiction. Before we get started, though, I want to give you a little background on Diana, back during the day is a licensed clinical psychologist. She’s also the owner of the Center for assessment and psychotherapy in Newtown, Connecticut, which is a private practice focusing on work with children, adolescents and young adults. She is dedicated to seeing the whole child and specializes in pediatric psychological assessments that focus on emotions, personality, learning and behavior. Dr. Today is also well versed in psychiatric diagnosis, educational assessments, and a wide range of treatment approaches using this information to create a useful and effective plan for patients and their families. She also values the relationships between herself and her patients and strives to create a warm, accepting and easygoing atmosphere while also emphasizing the need to undo old patterns of behavior that are barriers to healthy functioning. Dr. Annandale is also an assistant professor in the education and educational psychology department at Western Connecticut State University, where she instructs and trains graduate students entering the field of Clinical Mental Health Counseling and School Counseling. That is a lot. Hi, Diana, thank you so much for joining me.
Diana Naddeo, Psy.D. 02:03
Hi. Thank you so much for having me. I’m excited to be here today.
Dana Jonson 02:06
Yes, I’ve had the great fortune of having you in some of my IEP meetings, because you do a lot of evaluations for schools as well as for parents and give great educational recommendations. I particularly like your PowerPoints that your to do does a PowerPoint presentation after her her evaluations for a lot of students for school districts, and I think it makes it really accessible and understandable. I like the visuals. I just like how you present them, I think you have an understanding of how much we don’t understand if that’s the right way. And
Diana Naddeo, Psy.D. 02:38
that will there’s not there’s no point in writing 15 pages of jargon isn’t helpful for anyone. But there is a standard right that a report be written in that way doesn’t mean you communicate there was often that way. So even I will pick up a report sometimes and have to sit there with a dictionary right to decipher decode what is actually being said. So I think that’s like the one I hope to bring to the table here today. And then also in the meetings.
Dana Jonson 03:03
Yeah,
Diana Naddeo, Psy.D. 03:04
for all of us to get it right. Like we need to understand it. It’s not about
Dana Jonson 03:07
I mean, I find I’ve been reading these reports for years, and I still find myself pulling out my like whisk book or like whatever it is to be like, how does this work again? Or what does that mean again, so I find it really helpful. And I love the way you connect the results to the child as to how they are and what they need and why. So it’s not just hear my numbers, and here’s what the child needs and do it. There’s like a whole explanation behind it. So I find that really helpful. And the reason I wanted to have you on here today was because I also had the privilege of seeing you present not that long ago on evaluations and explaining them and understanding why they’re necessary and why people like you do exactly what you do and why it is so important. So I do want to start with why does one need an evaluation your you don’t work for school districts, school districts are obligated to provide evaluations. So what is it? Why would a parent becoming or a school district be calling you and saying we need you to evaluate this kid? What is different between you and the school psychologist or whoever they have on staff?
Diana Naddeo, Psy.D. 04:12
So I think there’s a few things that really is that kind of an outside evaluation apart from a school type of evaluation. And the main one that stands out is the the breadth of testing that can be done in a private setting. Right. So I know that the schools are coming from a place of, you know, needing to meet a lot of needs, and not always having the resources to spend hours and hours doing testing. Therefore it’s like appropriate although not always done, right in this way. Let’s just refer out well, we need to go deeper. And we need to dig a little bit more to figure out what is going on what is the problem area because what we’re doing now isn’t working. So I have tried to approach testing whether it’s a family wanting to I can opinion, because the school testing wasn’t sufficient or they don’t agree with it, or it’s this school. And usually it’s a school and family right in the form of a independent eval coming together and needing a third person to mediate, perhaps them, like kind of just got them seeds of conflict between the school and family. Either scenario, my job and how I view testing is to really tell the story of the child. And I don’t want just the Table of Contents, which is often what kind of more kind of straightforward testing in school testing entails, I want to tell the story of at least three to four chapters. And I read about 15 pages, which turned into you know, 45, and that can be done. But really, to what degree is it helpful to know every single thing about the child when you can only start with what’s most disruptive? What’s most of interference? So my approach is to get as much information as I can in a reasonable that’s reasonable and timely, and really hone in on those three key features of the child’s functioning, whether that includes how they respond to difficult emotions, what they do when they can’t read something, or understand it, or why can’t they do math facts quickly? Right? You want to unpack that? Because things aren’t unique dimensional. Everything is multiplied, determined. And so by that, I mean, what’s the recipe? What are the ingredients in the recipe that make up this problem area?
Dana Jonson 06:39
I love that. The other piece I wanted to ask you specifically it was when we when the school district does an evaluation, they refer to it as a psycho educational. And that means the cognitive component as well as the educational component. And that often includes an achievement component, meaning, you know, what can they do and what do they know? Do you do neuro psychological evaluations or are they also psycho Ed’s? Does that make sense?
Diana Naddeo, Psy.D. 07:03
Yep, I do. So I’d say a straightforward neuro cycle neuropsychological evaluation is I think the word is used more loosely than intended to describe testing of different mental capacities. So it’s a good question. Formal neuro psych testing usually implies that there’s some medical condition that has caused the disruption in inorganic brain functioning. So if I have a child who got into an accident, car accident, and suffered post traumatic brain injury as a result of that accident, when neuro psychological assessment in this way would be really helpful, because it includes things like brain scans, MRIs, to look at the brain and really see what may have been altered, and then to test to see if there’s accuracy between like the frontal lobe being harmed in some way. And we know that when the frontal lobe is disrupted, we can have things like a lack of inhibition or problems self regulating in general. We also know that kids presents, right with all sorts of issues that can look like we our brain is responsible for regulating and modulating all the different experiences we have. So while neuro psych tests are super important to include in a battery assessment, I don’t think that I think that formal neuropsychological testing, has a time in place. Instead of answer your question, I would most of my assessments include psycho educational and neuro psychological all in one, I tend to view them more as comprehensive evaluations, I guess, taking a wish, you know, that include neuro cognitive, academic, social, emotional, and personality, we need to have those four features there. And what you call it, I guess, fits into both categories. And that’s because I think that the unfortunate kind of trend is that neuro psychological testing is what it’s called. Right? So people are out in the world asking for that, but it’s not always necessarily necessarily what they need.
Dana Jonson 09:14
Yes. And I have clients who will say, Oh, I’m getting a neuro psych insurance is paying for it. And I know that’s even more different because insurance can’t pay for educational component. Correct?
Diana Naddeo, Psy.D. 09:25
Right. So insurance companies specifically state in all their guidelines that any form of psychological or neuropsychological testing is a covered service that it’s done for medical necessity, and it’s something I’m very sensitive to and cautious in terms of testing the limits in any capacity. Because the second we bring in education, academics, the parents technically could be at risk of getting a very big bill at the end of the day, and that That’s because it’s up to the insurance companies to dictate what is quote to educational. Right? You know, for myself, I’m not just for the the insurance, customer service rep who’s authorizing. They’re doing their job, they have protocol to follow they no way, shape or form have a expertise that allows them to dictate these rules on a clinical level, but they do on an administrative level that
Dana Jonson 10:25
when kids are this is just a random question popped in my head. But what about children? Who are they’re not children anymore? Like adults, like I know, some people when they maybe go to graduate school or something need to get evaluated, or want to get evaluated to see but they’re no longer under the purview of their education system? Would that change at all the outcome of neuro psych for that person? Or no,
Diana Naddeo, Psy.D. 10:48
in terms of the coverage? Or in terms of the Yeah, no, it’s it’s it’s educational purposes. So it cannot and that’s I can just so the way I think about it, and why it’s such a ridiculous kind of concept is that even at the college level, or graduate school level, rather, I want to see if I have a learning disability that will make schoolwork more stressful for me, and therefore make might make me vulnerable to develop an anxiety disorder. So in a preventative model of healthcare, we would test at the beginning stage of starting this new endeavor, so we can limit the possibility or reduce the likelihood that I could develop some mental health issues by putting a plan in place ahead of time, but we live in a very reactive system. Yeah. And waits for the House to catch on fire doesn’t put the stovetop fire out first.
Dana Jonson 11:36
Got it? Okay. Yeah, I know that I know that a lot of parents hit that area when children are going to college or even graduate school or something along those lines and need that information. And they’re not cheap evaluations. I’m very, I mean, I can talk a little bit about the public schools obligations. And I think we know that schools are obligated to evaluate children when they’re referred for special education, that they are obligated to evaluate them every three years if they are qualified for special education. And I think you typically come in, as you said, when either the child is so complicated that both the parents and the school district are looking for something a little deeper. Or perhaps the parents have asked for an independent or sometimes the school asks for an independent, I’ve had that happen as well, understanding that your type of evaluation, I don’t mean you just specifically but outside evaluators really can dig in a little deeper, they can assess more of the process than the school can correct the grades round to us.
Diana Naddeo, Psy.D. 12:35
Yes. Right. Not getting just like not focusing on the content. So the content would be the test scores,
Dana Jonson 12:41
exactly
Diana Naddeo, Psy.D. 12:42
right processes. What does that mean in relation to the child’s life?
Dana Jonson 12:47
Right, exactly? How did they come to those test scores? And how should we be looking at them? And are they valid or not? So I think that’s, that’s important information for parents to have. What are? And I don’t know, if you covered this little bit, I did say about the cognitive and achievement, but what are the different tests that you would incorporate into that neuro psych or psycho ed that you would do as a private evaluator? Do you have more tools than like the public school would have or different?
Diana Naddeo, Psy.D. 13:18
I think, yeah, I think that you get more creative than have to look into what else is out there to be able to still meet the needs of the role of being an outside evaluator, because they can, it’s likely had the standard battery that we all use when we someone comes into my office. And they’re simply just wanting to get testing done very simply. But Myaree is not for the purpose of the school, maybe they want to understand school and academic functioning, but it’s not in a relationship to an IEP or eligibility for special ed. And in that fall at the toolbox that contains like the basics, the basics that you need, in the cognitive, academic and social emotional realm. For a child, he’s had an IEE, where Sue’s having an evaluation done where the school has done testing in the near past and past that, they are likely to have had that initial set of the standard types of assessments. So yeah, I think that for the cognitive, right, I’ll go pack maybe I’m gonna go through each one and in my mind, tell you what the standard is and what they likely paired and then what I might use in response or in replacement for that. Just as a side note, just familiarize, everyone you can repeat, especially cognitive and academic achievement tests are very sensitive to the practice effect. So that when a child is given any assessment of things like working memory processing speed, reading abilities, math calculation skills, when they’ve already done it once, they’re likely to do better the second time you give it the
Dana Jonson 14:58
protocols It’s been
Diana Naddeo, Psy.D. 15:02
Yes, there are the tasks. If I were to Jessie repeat the, you know, the whisk, for example. So the cognitive component, or cognitive and intellectual functioning is usually measured by the first kids, the whisk, which is the Wechsler Intelligence Scale for children. And then once they hit 16, it’s the Wechsler Adult Intelligence Scale. So the Wechsler system is the most popular mine kind of highly large norm group standardized over decades, and constantly kind of evolving and updating in its additions to be up with the kept up to date with the times and findings in the literature on the fields. So that would be the standard. And if someone were to have done that John was did that at school. I’m all for though testing in September, if I repeated it, even four to six months later, which I think we in our minds feels like a large gap of time, I am vulnerable to the child presenting as though they’re functioning better than they are. Because they might do better on each of those tests, simply by nature of the fact that they’ve seen this stuff before. That doesn’t mean they remember, I mean, part of it is yes, just a memory thing. I remember that question. And the answer that they’re not getting feedback. So that’s usually what people think. But it’s not, it’s the anxiety and the level of unknown. That is what is kind of one of the foundational components of why this testing is effective. I’m trying to grasp the snapshot, I’m trying to get a snapshot of you at this point in time, without any studying or without any preparation. So on the unknown component is really important. And that is why would we give it again, that familiarity and greater or standard a little bit of comfort with it, we’ll call it could cause someone to do better as a result, by my replace that with like the Riis, the Reynolds intellectual Reynolds,
Dana Jonson 17:03
to clarify with the IEE because, you know, I think that term is thrown around. Sometimes an independent educational evaluation is technically any evaluation not done by the school district. But I think we’re using it in the in the term of a lot of times in Connecticut, or at least I refer to IE as an evaluation that the parent has requested after the school district does their own evaluation. So there’s a component in the ID EA, which is a law that governs special education that says that once the school district does their evaluations, then the parent if they disagree with them, if that evaluation doesn’t look like your child, or if it looks like them, but maybe not the same highs and lows, you know, if there’s anything about it that you disagree with, then you can disagree and request an independent educational evaluation. And if your school district agrees with you, then you pick the evaluator and they pay for it. They they’re obligated to give you a list of evaluators but you don’t have to use their evaluators, I personally always find, if you can come to a mutually agreed upon person, I always find it a little easier than to get those recommendations implemented. So I find that to be a good strategy. But it doesn’t have to be and you still have the right to get it and the school district is still obligated to consider it. But technically independent evaluations are anyone not in the school district and the school can ask for one. But that doesn’t meet the parents ie rights if the school district asked for it, because if they choose the evaluator, and they ask for it, then it’s still their evaluation. So I just wanted to clarify that you were saying about the raise? Oh, that was the other thing I was gonna say is that a lot of times what I’ll hear from school districts is they’re just going to use the same test we did. And my response is typically Well, outside evaluators tend to have access to a variety of different tests. And I do know that some tests have alternate sheets, like type A, or A Part A or Part B. So they some tests can be done the exact same test, it’s just a different protocol. So they’re not actually doing the same work. Right?
Diana Naddeo, Psy.D. 19:02
Yeah. 100%. Right. So it’s a different form different items, just the same didn’t test developer, it’s under the same name. So you just you know, you want to find an evaluator who has a complimentary version, an alternative version of the ultimate version of the test that was done by the school. So the the rise to the Reynolds and intellectual assessment scales do near a lot of the tests that are on the west, they’re sustained Bourbonnais amongst others that are available out there. What as it relates to academics, Woodcock Johnson or the Wechsler, there’s that name, again, achievement tests are often used, so I will use one of the two that the school didn’t, and then really I go, I think that the there’s at least two broad main kind of attractions standouts rather, within each category, and then From there, I tried to replicate, right? Do the one that wasn’t done, but then hone in on what do we need to know more about? Because if this kid is doing really well, verbally, yes, I want to repeat the verbal comprehension tests of the broad measure. But I don’t need to spend more time doing another battery, telling me how if it’s consistent, it’s consistent, right? The scores are high average high average, I need to focus on these other features that might be consistently low average for the problem area, kind of sticking point, usually, the child is just on the cusp of average. So the school testing, they’re just at that 25th percentile. So as a side note, when we say Apple, the term average, my opinion means nothing. Shanghai average does, and the term low average does explain why how average represents kids who are in the 25th percentile, all the way to the 75th percentile. So percentiles are basically I did
Dana Jonson 21:01
that’s a really broad range.
Diana Naddeo, Psy.D. 21:04
So and percentile is not like a test score, like 75% is like a C. Now, it’s percentiles are the degree to which you’ve done as well or better than the other people in your age group on that particular test or construct. So I have someone reading at the 25th percentile, that’s right at the cusp of average and low average, which is very different than someone who’s reading at the 74th percentile, which is on the cusp of high average, 75th percentile, high average and average. And therefore, that though, that would be an area, I’d want to dig into a little bit more. So it’s not that the strength is not important. But once I’ve maintained, established can consistency, it’s time to move on to kind of other other mechanisms. So I tend to try and find sub tests, right, from different batteries that can be useful to kind of meet that need.
Dana Jonson 21:59
And that was actually that that leads right into my next question, which was going to be how do we understand these test scores? And I do know that that’s hard to explain without visuals. I’m a visual person. So I love that that curve, the bow, but can you articulate? You know, how do parents interpret these because sometimes, like you said, they’ll say, Well, they’re in the average range, and I’m looking at it and like, they’re in the average range at the 26th percentile, that’s completely different, as you just said, as the 75th percentile average range. I’ve also noticed sometimes schools don’t offer all of the different numbers. So like, there’s a standard scale, there’s a percentile. And then sometimes there’s a grade equivalency. And I’ve even seen within the school district, you’ll get one year you’ll get one of those, and the next year, you’ll get a different one of those. And so what can parents do to better understand these scores once they actually see them other than hearing while they’re average?
Diana Naddeo, Psy.D. 22:51
Well, so there will always be tables, and it should be in the back of a testing report that lists all the scores and scales.
Dana Jonson 22:59
I would start there, if you don’t have a table of all the scoress, make app requests all the
Diana Naddeo, Psy.D. 23:04
evaluator Yes. For school testing, not always for medical, but for school testing. That’s a necessity. So why that stands out here is that the tables are going to contain all the scores that make up anyone like like an umbrella term, an umbrella caught construct, we’re measuring, processing speed, anxiety, attention, right. So that’s just the umbrella term, I’m going to get a score from the umbrella, that’s an average, it’s an average of a bunch of different tests that were done that are like, this is what you are overall in your attentional capacity, how much you can how long you can maintain, essentially, we’ll just say, it doesn’t take into account what that doesn’t tell you. Because we know right, within any average, lower scores are going to offset higher scores. And so when you’re looking at a classroom average, how well does this entire class know the material from the tests, maybe we can take into account the variability for all the different students and what they’re bringing to the table. Here, we only have one, we have one child, we need to know. So in the, in the case of the average for the classroom, on the test scores, that we just want to make sure that most people right are falling into a certain range. And let the combination of scores are here, we’re going to assume that the overall score is representative of all those little test scores just for the child, that one child, so you need to go back to the tables and look at the sub scales. Look at what’s called the scaled score, not so much the standard score, the standard scores, the umbrella, the scaled score, or the scaled scores are what make up all the sub areas that resulted in a average umbrella term. I’m sorry, umbrella score.
Dana Jonson 24:56
Yeah, I cannot think sometimes within those sub sets, they’ll be you know, like a huge discrepancy, sometimes between the umbrella scores to, you know, from one area to another, there might be a huge discrepancy. And there was a time that we required that to find a learning disability, which we no longer require just that, but it is still an indicator of a learning disability. So huge differences across the board, because I guess technically someone should be somewhat consistent, right? That, right? If I ever bring I used to be in another?
Diana Naddeo, Psy.D. 25:27
Yep. So that’s why I say you’re looking at the subscale scores first, to see, are these clustering together, or are they separate. So if you have a child who’s subscale scores, who’s up who’s whose umbrella score, the overall score is in the 50th percentile. And then all the five things that make up that average are between the 40th percentile and the 60. Year, they’re kind of they’re in the same range that they’re commingling together, if you think of it on a graph, like data points, so they’re all kind of in the same area, when you have a scaled score, or one of those things under the umbrella is very high, and another is very low, or a few are really high. And two things are really low, we have what’s called a scatter. And scattered scores automatically represent some type of problem area, because we really should cluster together with the things we’re better at being a little bit higher than the things we’re not so good at that they should generally be in the same range. Yeah, so back then gives an indication when there is the scatter, something is going on. One points high on the graph, one points low, something is interfering, to make that line a diagonal and not linear.
Dana Jonson 26:46
I love the visual too, if you look at when sometimes they talked about just full scale, like full scale their average here, and I think, you know, you could have a full scale of 110 here and a full scale of 110 here. But if you graphed out those specific points underneath those two children may not look at all, not at all be the same, just because that one large overarching score that is similar. So it does drive me nuts when I hear that, but overall, they’re like hi, right? No, that’s not that’s not how this works. Like, we got to look at everything individually and break it up.
Diana Naddeo, Psy.D. 27:24
Yep. And so then second to your point, then next, you want to look at all of the umbrella term scores that are out there. So that then leads to what is now considered a dated model, but one I use as part of my decision making that discrepancy or the difference between the umbrellas scores for cognitive and intellectual functioning, and those for academic achievement. So we expect our cognitive abilities, working memory processing, non verbal reasoning, verbal comprehension, vocabulary level, all of those things are the skills that underpin learning and subject areas, we teach our children in the public school system reading, writing, and math essentially. So because we need solid vocabulary, like we would need a strong score on the vocabulary test cognitive assessments to predict reading level, right, you’d see those two things as being as being interrelated, right? Because we know that when you have a stronger command over your vocabulary reading is easier, right? And so that makes someone want to read more, which increases their vocabulary, it’s a nice kind of cycle that facilitates that that skill set. So therefore, the test scores will look very similar between those two, we want to see them be linear, where that meet by that extended, we don’t have a visual representation, music, my hands a lot here. And I know that that’s not very helpful. If you think about brass, we are plotting the data points that just little circles, and we would want them on the same level of the graph, when we see the verbal skills and the cognitive be at the low end, or not at the high end. And let’s say in the reading comprehension and reading decoding skills on the low end, those are not linear, those are a Diag, their line is a diagonal. And that diagonal represents some type of interference, that is likely a problem. It’s not the only methods, interpret results, but it definitely for me, the issue is and why they have left kind of taking it off the table as a criteria is because of the unpredictable factors that could contribute to the person’s test. This is just one example that could contribute to the person’s approach to the test or you know, explaining it’s not explanatory enough, right? And in the schools mind, so but it certainly makes a lot of sense when it is explanatory. I think that it, that’s why someone on
Dana Jonson 30:02
that’s a red flag right? Like I agree with you, I also look at that and say there’s something going on here that we need to reinvestigate, like maybe there is some unpredictable component. But you know, if you’re telling me that this evaluation is an accurate representation of the child because they were compliant, and because they gave it their all and all of this stuff, and then you’re going to tell me that this is unpredictable. That doesn’t fly with me either. And I think when you see those that kind of scatter and those differences, sometimes I’ll hear someone say, Well, you know, the over the umbrella score is good. And the only reason this one’s a little lower is because of the sub tests. Well, that’s what I want to look at why? Why are they doing well, and for the sub tests, and one of them, they just bombed it, I’m not looking at that, like, oh, well, these other four skills are going to take over and make it better, I want to look at the skill that isn’t working, because it’s clearly impacting something. And then also looking to your point at the cognitive component, versus the achievement component, I think is a huge piece. Because if we have a child who is scoring, say super high cognitively and their average to low average achievement wise, that’s telling me something, too. Why is that? You know, why are they not performing at their ability level. Or the other way, I’ve also had, I did once have a case where the child’s cognitive component was way lower than their achievement. And it was either something’s going on with them taking the test, or this kid is ridiculously motivated enough to think I do,
Diana Naddeo, Psy.D. 31:32
I can write those are the factors that you have to really take into consideration like behavioral observation. That’s the section of the report where the evaluator will describe how the child approached the test. Well, there can ranging from how they held their pencil to whether they persisted when things get hard becomes so just as important as the test scores.
Dana Jonson 31:54
Right? When administering the test too, right? Because a lot of them, you can’t explain things, you can’t reword the questions. So you have to and if you don’t know if, if a teacher did read word, the question or did get, you know what I’m saying? Like, there’s just there’s some level of consistency within the test administration to that needs to happen. And, you know, sometimes I had children say, well, they tested me in the library and the reading class was bothering me, well, that shouldn’t have happened. i Oh, my gosh, I was in a meeting once where they said, Well, we administered it in a small group. And I’m like, I’m sorry, what? And and they said, well, they had so many kids, they needed to test it, they administered some of the sub tests in small groups. And then that just that, I don’t know, does that nullify the schoolwork, or I don’t know what discounts it somehow, like, that’s not how you’re supposed to administer the test. So adds a critical component as well. And admittedly, sometimes kids do do better one on one in a quiet environment. But that’s what that’s what the test is for. Right? You know,
Diana Naddeo, Psy.D. 32:58
what is the child’s performance? Like, when they’re kind of an optimal environment for performance? Right, you know, like quiet, no distractions, no confounding factors like, hey, he handed in his test first before me, what does that mean? Oh, my gosh, am I not doing Am I going fast enough to write all the just needing the distraction of like other kids in the room not being disruptive, but just what their approach to the test is? Or the task is right. So that I mean, you’re not giving tests like we do for an evaluation in a classroom setting. But there might be an element of, well, they perform well, or they perform, they perform very well on my reading, assessment, assessing their comprehension. But when they took the test last Friday, in the classroom setting for ELA, they bombed it. Right. And so like, we have to take those factors into consideration, too.
Dana Jonson 33:49
Right. And so I yeah, I always focus on the administration, too, because you never know. And sometimes they don’t say anything. But if you ask, like, what was the environment? What who was around you? You know what, why? Ask questions. That’s what I always say to parents. If this doesn’t look like your child, ask questions, you know, ask as many questions as you need. And
Diana Naddeo, Psy.D. 34:07
I would really hone in on the what was different, you’re not being thought about the right approaching it being curious. Right? There always is going to be a difference in I don’t mean for like, it’s like to come together right to think about why what other factors may have been present that weren’t kind of like you couldn’t control for, like, oh, well, the whiskey tests that I gave requires the child to think off the top of their head, where that same skill was measured in class that they had paper and pencil, kind of to do it, which lays a very different thought about how much of their their vocabulary is being assessed. Well, they did great on the vocab and definition test we did in class on Friday. They did terrible on the vocab test in my office. Well, that’s because my vocab test requires them to just define words off the top of their head. Your tasks had a visual component that may have prompted them, which is good information. Why? So that’s like getting a ticket a step further, again, being curious, what what does that mean? What is that that was a difference in the format? Or
Dana Jonson 35:10
were they aware of the words in advance? When something they mean? Yeah, absolutely. That would make a difference to what are the areas that you see that you most often say, you know, we need to do additional testing. And like, I’m gonna guess that executive functioning comes up a lot. During that a lot. Yeah. So what are some areas where you would look at and be like, this kid needs additional, we need more information than maybe either you have to do more testing, or you have to say they need to go somewhere else for more testing? Because like, Does that happen a lot?
Diana Naddeo, Psy.D. 35:44
Yes, I think that in the area of attention and executive functioning, and then social emotional functioning. So that it’s unfortunately the case that sometimes things are couched in, we’ll just say an ADHD. So in a child with a suspected attentional issues, the message that I do hear from parents that’s sent to them often at times at the school level, when it relates to testing is, go treat it yourself. This is more of an outside issue, we know that there is some attentional issues present, but that’s probably because they have ADHD. So Right. Like the idea is like that the diagnosis is explanatory. And it’s not. And it’s just a category we’ve kind of used to help communicate with each other about what the child is struggling with, what about their attention is disruptive, or interfering. And even if it’s not a disruption to the teacher or the classroom, if the child’s not performing to their potential, it could be a factor involved within themselves, right that we had to like be in school needs to understand more to really
Dana Jonson 36:59
feel like being attentive piece versus the physical, acting out kind of thing.
Diana Naddeo, Psy.D. 37:05
Right? Right. So that but also like executives to tie in executive function. So attention, retention problems and executive functioning problems go go hand in hand, and involve more than just daydreaming, I’ll take an inattention going around extended time on tests is the kind of go to recommendation as though it’s like a just fix it strategy for all the problems that a child with ADHD suffers and struggles with. So we don’t do two things, we need to both like qualitatively look at it, like what are parents what the rating scales that everyone completes the parents, the teachers, the sometimes the student, those are kind of checklists for what symptoms you observe, or do you experience and that’s really helpful. But we also need to get actual numbers attached to those skills, because they are brain based. They’re not just out in the world, right how in behavior and how they operate, they’re affected by problems in certain areas of brain functioning, the executive functions are in the frontal lobe, right. So we want to also get like a direct measure. And that’s this is where I do think, an area that for the schools fall short, there’s not a lot of direct measuring, of the attention skills. And that’s important if we’re actually going to plan for the child’s because to say, Oh, they just have ADHD, to step and who has just ADHD, right, it’s in the way they learn in our public school system, at least in this part of the country is not geared towards a learning style that gets off task that doesn’t involve that involves on sitting and working. And remember my own kids coming home from first grade, first grade, oh, my gosh, the transition from kindergarten to first grade. Simply being all we do is we do packets, all we do is pack it on, never forget, it was still representative and that was the year that they learned what law school is. And you know, there’s a level of like acceptance like this is for them. This is what they have to adapt you right, because that’s the school they’re going to for now. It really was like a eye opening in terms of how demanding school is for kids at an earlier and earlier age every year. And that that demandingness isn’t a one size fits all kind of method. It is something that works for some kids. And work doesn’t work for a whole lot of
Dana Jonson 39:34
kids. I think we learned during the pandemic that however children are learning is not promoting independent work. Because anyone else in the world and my kids come home and work from home, whatever we called it. I know mine are not independent. And I had a variety of ages. I got five kids. So I got a bunch of ages in my house during the pandemic. And you know, no one was independent that that was a huge component of it. So I don’t know was keeping them you know, in the in the public schools in the in that zone but coming home it was a whole different ballgame. So, you know, that can definitely impacted as well and isn’t ADHD? Doesn’t that impact some of these tests in their scores? If a child does have ADHD doesn’t? Don’t you expect that some of these scores will be a little bit skewed?
Diana Naddeo, Psy.D. 40:22
Yes. So we there’s, there are ADHD profiles. So things that run the research, we know kids with ADHD tend to do have weaker skills in or do poor and processing speed and working memory are the two kind of most common ones. So when we talked about that scatterplot before someone with ADHD might have average to high average problem solving verbal nonverbal problem solving skills, visual spatial skills, vocab skills, whatnot, blend their working memory, and their processing, speed, assess, those tend to be lower. So we have a scatter there, it supports it doesn’t tell us the child has ADHD. But if we have a suspicion that it’s present, that would be an example of a way we’re measuring it directly. With that said, I’ve had plenty of children who have eventually level have like, eventually come to have an ADHD diagnosis that saw in the superior range, and every single cognitive test, they get them. And that goes back to unpacking and understanding what’s under the umbrella. What makes up attentional problems that is specific to this child’s because for the tests that we give, whether it’s a school or my setting, they’re all more or less the same, there are tests that are of short duration. And even if they’re a little bit longer, they’re not representative of like, a class that runs for 90 minutes, or a project that one has to work on. That takes them in, you know, in class the full hours time, right there, they’re at most 13 minutes for the test that’s looking at sustained attention in the child was a very boring task on the computer for 30 minutes straight. I can, if I did that, for all the tests like we wouldn’t have kids would not be able to come in and just like the natural kind of boringness of that one on one would would confound the data. So that’s one piece is that the child that might be able to negotiate the test in our office because they don’t have a problem with selective attention, like honing in on and narrowing in on the tasks that they need to do getting it over with and moving on, they might struggle with persisting as task demands increase or sustaining their attention for a long period of time, right? So that persistence, and attentional stamina there tank my empty quickly. And we don’t really know that from a four to five minute tests, which is usually like the average of what they are. Right? So we have to look beyond that. Great.
Dana Jonson 43:00
I think we’ve covered just about everything on these evaluations. I don’t know if there’s anything else that you wanted to incorporate. I did want to ask you my last question, which is when a parent is looking for an evaluator when they are going out to find somebody, and they get a million names from different people, and they say, well, this person was great for us. So this person was great for somebody else, what should the what questions should they be asking an evaluator? If they’re going to get an educational assessment of their child, whether they’re paying for it or somebody else? That doesn’t matter? What sort of questions should they be asking the evaluator to make sure they’re getting the recommendations that they’re looking for? Mm
Diana Naddeo, Psy.D. 43:35
hmm. I would be asking if I had to choose one, because I think that you can do on paper, right? Every usually most people who do evaluations in this nature, are trained and well versed and doing them so I want to will i wouldn’t gravitate towards asking like what types of tests they do, or how long it will take for them to do it. Unless, of course, it’s time sensitive and now becomes an issue. What I will be focusing more on is, how do they interpret the results? What’s your style for interpreting the scores, and the key word you want to listen for is integrative. I integrate the result, school testing, and this is not a knock on school. This is their approach based on what the training model dictates. They do report the scores as is, with little to no integration, time in place for that which is usually an outside the bow. For my training as a clinical psychologist with the specialization and assessment. The bulk of the extra coursework was in writing the results in a way where we will reasonably well I mean, the integrated is how does one affect the other? So how does my child’s moderate level of anxiety that came up on the bass three that the teachers and the parents filled out on their behalf? How does that then interpret You’re with their attention level. So we often think of when we’re anxious, we have thoughts that distract us. So if I’m already distracted based on an organic issue, the PhD, and I’m also now anxious because I see everyone in my class finishing first, or I don’t know how to approach this because I don’t have those executive functions to break things down into smaller steps, or doesn’t come naturally to me. How does that then cause a perfect storm, where I now have a failing grade and reading, because I couldn’t master the task. It’s not that I have dyslexia reading disability. It’s not just because I have ADHD. It is often like the combination of all these factors that then leads to a big problem. By itself, we don’t look at those transactions, and the way they interact, we are usually only treating one part of the problem.
Dana Jonson 45:55
That’s a great explanation. I love that integrative as a lawyer, I have different questions. My questions are usually will you present this at the PPT or the IEP meeting? Or is that separate or separate cost? Because I’m aware that sometimes, you know, when either parents pay for it or school districts, if it comes time for the meeting, and the evaluators nowhere to be seen, or they won’t do that? I also asked, Would you testify to this in a hearing? Would you testify to your to your results in a hearing because I know that there are some people who won’t do that they don’t want to get involved in the dispute and knowing that it would be really important, even if you don’t anticipate a dispute, I find that if somebody is unwilling to get involved in one they may not be willing to write strong recommendations to so you never know where you’re gonna go. So those are kind of my main question, but I think yours is better. But thank you, this has been really great. I know this is a ton of information in one small place. So if somebody’s listening to this, and they’re like, Oh my God, I’ve got to get doctor today. Oh, to evaluate my child. How can they find you? How can they reach you?
Diana Naddeo, Psy.D. 47:01
So our website, New Town cap.com has contact information to get in touch with our office manager who can start the process of setting up the parent consults, where I meet with the parent or parents to get a lay of the land and figure out what, what’s needed, what’s wanted, what kind of the best practice would be based on kind of like understanding the bigger picture inside the full story. So consults is the parent club sold will be the first step. And from there we discuss the different options for testing. Great. What’s the next?
Dana Jonson 47:39
Excellent, well, I’ll have that in the show notes. So if anyone’s listening to this, and they are driving and not sure where to look, definitely go back and look at the show notes. And thank you so much for Diana for really helpful and I know this is gonna be really helpful for parents. So thank you so much. Thank you so much for joining me today. Please don’t forget to follow this podcast so you don’t miss any new episodes and leave a review when you have a chance. If there’s anything you want to hear about or comment on, please go to my Facebook page special ed on special ed and find me there. I’ll see you next time here on special ed on special ed. Have a fabulous day. The views expressed in this episode are those of the speaker’s at the time of the recording and do not necessarily reflect the official policy or position of any other agency, organization, employer or company or even that individual today.
