193 Transcript

Dr. Jeremy Sharp Transcripts Leave a Comment

Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist Podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach. 

This episode is brought to you by PAR. The Feifer Assessment of Writing examines why students may struggle with writing. The FAW and the FAW screening form are available on PARiConect, PAR’s online assessment platform. Learn more at parinc.com\faw

All right, everyone. Welcome back to the Testing Psychologist.

Hey, today’s episode is another masterclass episode. The last one with Dr. Stephanie Nelson from a few months ago was wildly popular. And we’re back for another masterclass this time with Dr. Steve Feifer who you have likely heard of. He has done so much in our field. I’ll save the bio for just a little bit later, but if you haven’t heard of Steve, I will certainly acquaint you with his many accomplishments here in just a bit.

Steve is going to be talking with us all about reading disorders and executive functioning. The format for this masterclass is going to be a little bit different than the last one where Dr. Nelson presented her own case and I provided commentary and questions. This time we’re flipping the script a little bit such that I am bringing two cases to the episode and Steve is looking through the data and providing some commentary himself and suggestions for different considerations and how we might interpret the data on a couple of these cases. Just know that all demographic information is changed appropriately to protect client confidentiality. So everything is meant to be relatively anonymous.

We do talk fairly deeply about the scores and you can download a document that has the score report for both cases if you want to follow along and have a little bit more insight into what we’re talking about here. Or if like me, you are not a great auditory learner and you need to be looking at something to really bring it to life, then that document is downloadable from the show notes.

One cool thing about this episode that I want to mention is that Dr. Feifer and PAR are generously donating a free test kit of the Feifer Assessment of Reading. All you have to do to be entered to win that free test kit is go to thetestingpsychologist.com/far enter your information and you will automatically be entered to win a free kit of the Feifer Assessment of Reading.

Now, just in case you are not familiar with Steve and his work, let me tell you a little bit about him.

Steve is an internationally renowned speaker and author in the field of learning disabilities. He’s authored eight books on learning and emotional disorders in children. He has more than 20 years of experience as a school psychologist and is duly certified in School Neuropsychology. He’s been the recipient of numerous awards including the Maryland School Psychologist of the year in 2008 and the 2009 National School Psychologist of the year by the National Association of School Psychologists.

Dr. Feifer currently assesses kids at the Monocacy Neurodevelopmental Center in Frederick, Maryland, and remains a popular presenter at State National Conferences. He has authored three tests on diagnosing learning disabilities in kids all of which are published by PAR. And what his bio does not say is that he has also authored a recent measure just assessing trauma in kids related to the pandemic. So that is out there as well.

Steve has really done it all and he’s a great guy to boot. So I am thrilled to have him on for our masterclass today. 

Before we jump to the episode, I want to extend an invitation to any practice owners who are trying to grow their practice or take it to that next level. You might want to consider the Testing Psychologist Advanced Practice Mastermind Group. It’s going to be starting June 10th for our next cohort. And this is a group coaching experience where you’ll get some accountability and guidance and coaching around taking your practice to that next level. 

So it might be about hiring or streamlining your processes or thinking big reaching some of those big ideas that you have not been able to put into place. And we love to support you in that. You can get more information at thetestingpsychologists.com/advanced and also book a pre-group call there. 

All right, let’s jump to my conversation with Dr. Steve Feifer.

Dr. Sharp: Hey, Steve. Welcome back to the podcast. 

Dr. Feifer: Hey, Jeremy, it’s been two years. Great to be back with you.

Dr. Sharp: Yeah, I can’t believe that just came out of your mouth. It’s been two years, yeah. It seems like just yesterday but it’s been a long time. 

Dr. Feifer: And the world sure has changed since we’ve last spoken.

Dr. Sharp: What! What do you mean? Just Kidding.

Dr. Feifer: Just a little bit.

Dr. Sharp: I know. Yeah, it’s been wild. I know we were just talking about our kids finally getting back to school and getting vaccinated. Maybe there’s a light at the end of the tunnel here soon.

Dr. Feifer: I sure hope so. But I really appreciated your podcasts. I think it has helped many psychologists stay connected during this time of really feeling displaced. This is one way we’ve all been able to connect and join together. So I really appreciate your efforts, especially during this pandemic. 

Dr. Sharp: Well, thanks. That means a lot. Yeah, it’s been good for me actually. I mean, it has been isolating and it’s been really cool to have this as a touchstone and continue to connect with the audience and stay in touch with the work that we’re doing. That’s important.

Well, I am excited about our conversation here today. So this is I think what will be the 2nd Masterclass that we have done on the podcast. The intent, of course, is to do one per quarter. And I am honored that you are here. You are truly a master in many ways. I’m excited to be able to bounce some ideas off of you here. So, yeah, go ahead.

Dr. Feifer: Well, I’m looking forward to our discussion as well and an opportunity to do a deep dive into some cases that we’re going to take a look at this time for the first time and go from there. 

Dr. Sharp: Yes. And I’ll say publicly, I know I mentioned in the introduction how this is a little bit of a different format than the last Masterclass, which is more of a case presentation. This time we are doing more just kind of on the fly almost consultation. So thank you for being willing to do something like that and just wing it. But I trust that we’re going to have a great discussion. So I’m excited. 

Well, here we go. So let’s jump into case 1.

And again, before I totally get into this, I want to remind everyone there will be a download in the show notes with all of these scores. So you will have access to this material if you want to go back and check it out.

So case number one, the reason that I wanted to talk through this case and a thread for all of our cases is going to be a reading disorder/dyslexia?

That’s the theme I think for all of these cases. But the first case was interesting for me because this is an older teenage boy, 16 or 17 years old. The family came looking for Accommodations for Standardized Tests. So ACT/SAT. There is a history of a reading disorder diagnosis from early elementary school. Those records were not available, unfortunately. They were kind of spotty. So I wasn’t able to get any scores from testing in elementary school or anything like that.

But the reason this was interesting to me is that a quick glance through the results that we [00:09:00] have here would suggest that maybe there’s not a whole lot going on and it’s hard to look for or find a reading disorder here. And there were two other components that we may get into in terms of his anxiety and perfectionism. But that’s the overview for the case here. And I will let you jump in with any reflections, any thoughts, any questions from the data that you have in front of you here.

Dr. Feifer: Sure. So taking a look at Paul and it looks like he’s 16 years old. And has a  WISC, and the first thing that sort of jumps out is I believe that 16 years is about the top of the age limit for the WISC. You’re kind of in no man’s land here. Do I go down to the WISC or do I hang in there with the WISC? Of course, one of the advantages of staying with the WISC is if this student had had that previously a triennial a few years ago, you can compare previous scores.

The first thing as we look at data, the first rule of thumb to me is, what is our conceptual orientation? Are we looking at this data through the traditional lens of a school psychologist of I need to find discrepancies, I live for discrepancies, where’re discrepancies in scores. Am I focused more on an RTI model? Well, I don’t put as much value in this data. How he responded to reading instruction and reading intervention. I mean, he’s been identified since grade school. He’s had a lot of interventions. Maybe you’re not finding anything because the interventions have worked and that’s the RTI perspective.

Dr. Sharp: Yes.

Dr. Feifer: But you and I both have a little bit of a neuro-psychology vent on our brains in how we look at data. And that’s really, for me, the only way I know how to look at data. So I’m going to take it a little bit from that brain behavioral perspective with the WISC. And to a neuropsychologist, we’re not the biggest fans of the General Ability Index (GAI).

As a school psychologist, I loved it. Why? Because I could throw away data and come to a more proper conclusion about IQ. And in this case, my goal is to get the IQ as high as possible because if I can get that IQ as high as possible by throwing away data that I don’t like, well, then there’s more chance of a discrepancy and we can continue services.

I’ve lived in that world for many years.

From the neuro-psych perspective,  the first thing I look at is there’s a big difference here between Visual Spatial, which is 102, and Fluid Reasoning, which is 85. That’s like a standard deviation difference. And a lot of people have always asked this. And so, what is the difference between Visual Spatial, is it the same thing?

But with Fluid Reasoning, there’s more of an application of knowledge from a concept. You’re applying a rule. And the visual specialist that part of the whole relationship. When we see the fluid reasoning is down in this case compared to visual-spatial almost better than a standard deviation, the first thing that jumps to mind is I wonder if there are some executive functioning issues, some difficulties with the application of a rule-bound or symbolic type of reasoning or problem-solving because there’s a difference in those two scores.

We also see the processing speed is lower. And did you mention in the intro that anxiety might be in the background a little bit?

Dr. Sharp: Yeah. So this is a kid who has a long history of, I call it anxiety but really to put a fine point, it’s more like perfectionism. So this is the kid who would let’s say, like get sick before swim practice because he would just drive himself nuts knowing that he wanted to do his best at all times, works very slowly across the board but also at the same time, very meticulous and organized. So that’s just a little bit of insight into the anxiety/perfectionism for this kiddo. 

Dr. Feifer: So maybe not a great surprise is that processing speed was probably if I can guess, sacrificing. Sacrificing speed for anxiety or something or speed for accuracy-trying to make sure he’s very accurate. Doesn’t want to make a mistake. So maybe the processing speed was indeed caused by anxiety. 

Dr. Sharp: Yep. I would agree with that. Hey, before we go forward though, could I ask you a question?

Dr. Feifer: Absolutely. 

Dr. Sharp: And this is totally in the service for my own knowledge but for the audience too, I’m guessing other people might want to know. Can you spell out that connection again, between the low fluid reasoning and executive functioning? I know the words you said, fluid reasoning is the application of these rules to a more abstract task but can you articulate how exactly that’s overlapping with executive functioning?

Dr. Feifer: Yeah, for those who have given the WISC, you know that there’s not a lot of difference between this visual-spatial and the fluid reasoning index. And if you look it up in the manual, fluid reasoning is the application of the rule. And that’s really tying in with more to me, the frontal lobes of the brain. And at 16 years old, the frontal lobes are definitely the last region of the brain to myelinate to comfortable develop. Maybe the analogy is, let’s say in a little bit of academics if I’m doing a math problem, executive functions are going to really allow me to know what to do when. So for example word problems usually the actual mathematics is really straightforward, but it’s figuring out what to do when, it’s understanding what rule to apply in a particular situation, the application of a rule.

And that’s the way I look at a little bit of a connection between fluid reasoning and in this case, executive functioning. But all we’re looking at here is page one of data so we’re just kind of throwing out some general hypotheses to be confirmed or denied as we slowly bring in more data. But that’s what’s in the back of my mind just looking at, for starters, that collection of scores, and then the connection that you made between anxiety and processing speed, and we’ll see how that plays out as well. 

Dr. Sharp: Great. I like how you phrased that. We’re just taking in data right now. We’re just seeing how it lands, maybe formulating a guess or two but we’ve got a lot more to work through. 

Dr. Feifer: We have a lot more to work through it. One of the things that I think it’s important for the psychologists listening in particular and I used to tell this with my students, especially with the younger psychologist, and tell me if you felt this way, I certainly did. When I was in my younger days starting out my career, I approached data not always from the most objective manner. I approached data thinking I have to find something wrong with this student. If I don’t find something wrong here, I’m not doing my job.

And there’s a tendency the moment we see differences in scores, I got something, I got something here because I think we’re prying to always want to find some potential disability. We don’t work because we’re so heightened that we don’t want to not do our jobs correctly. We have in our minds the way to do our jobs is always find something. And it took me a while in my career to figure out that it’s still okay to say it looks okay to me. I’m not sure I see a problem here. It takes a little confidence I think to be able to say that. I don’t know how you feel about that. 

Dr. Sharp: Yeah, I totally agree. We could go down a rabbit hole just on that concept, but yeah, to suffice to say I definitely because I feel like… this is all I’ll say about it …I feel like when we go down that path then it sort of edifies the work that we’re doing. Like, I’m doing something here. I can help this family because I found what’s wrong. And those two are related rightfully or not. 

Dr. Feifer: Exactly. We had a term for this way back in my day called compassionate coding. Our hearts are in the right place. We’re trying because we have equated our minds if we find something wrong, we can get the student’s help. I’m a helper. That’s why I’m a psychologist. I want to help kids. And it takes a while I think to get to a confidence level. To realize that not all tests are perfect. They all have their strengths and weaknesses. Don’t take everything at face value. There is something called the standard error of measurement for a reason. And as we flip the page and take in more data, we’ll see where that takes us. 

Dr. Sharp: Great. Well, as we move along just for the listeners who may not have the material in front of them. So like Steve said, VSI was at 102, the fluid reasoning 85, processing speed was at 75 and the other two were in the average range. So come out to a full-scale of 85 and a GAI of 89, if that’s interesting to anyone. So let’s continue. 

Dr. Feifer: Well again, if you look at the achievement data, if you are a person who’s coming at this from a slow discrepancy standpoint, you look at the achievement data and the total reading composite score was 95.

Dr. Sharp: Right.

Dr. Feifer:  How could that be? The IQ is 85. How could you be stronger than your IQ? You are exceeding your potential and that right is an error [00:19:00] speaks to a bit of the ridiculousness of that discrepancy model and thinking that IQ represents some form of potential. The reading is 95 and most of the reading scores look pretty solid. And not knowing much on the history other than you had mentioned, he got the services since elementary school. It looks like everything is really within that average range if I’m not missing anything. Here’s one thing that’s below average. We have a score of 89. Oh my goodness. At 89, that was an oral reading fluency that we’ve already established.

Now, oral reading, I asked you, is there anything more anxiety-provoking in school than oral reading? Reading out loud in front of everybody else, especially in this case, coming to your office and reading to a stranger out loud. Not that this is a dreadful score but that’s the only thing unless I’m missing something here that I saw slip into the low average range and it was only an 89. 

Dr. Sharp: Nope. I think you are right on.

And just for context, everybody, we did the WIAT-III. So that’s what we’re looking at. But yeah, all those reading scores are in the average range except for 89.

So let me ask you, actually. Now, this is the beauty of a discussion like this. We can go in all sorts of directions. I’m sure people are asking out there, well, what about this IQ thing? How do you make sense of that from your training and experience? So IQ is an 85 but yet most of the academic scores are way higher than that. What does that mean to you?

Dr. Feifer: Well, a number of things. First of all, I don’t think we should look at IQ representing attention. I think that’s a misnomer. I talk quite a bit about the opposite also happens quite a bit with reading as well. For anyone who’s worked with an autistic population, you might see kids with what I call the opposite of dyslexia and that’s hyperlexia.

In other words, IQ is incredibly low 45, 50, 55 yet they’re reading. Well, how was that possible? Their reading is a 90 but their IQ is so low is hyperlexia being opposite dyslexia? And what this suggests is it’s not a perfect one to correspondence between IQ and reading.

In fact, when you look at the phonological interpreting only, the ability to just code, the ability to crush the words. If you go back to a lot of Wechsler research, you could go 30 years to research. You’re not going to see from a neuropsychological standpoint, a whole lot of correlation between the coding and ability. This is one of the reasons in my estimation we should not be using IQ scores have to be in the average range in order to determine disabilities with kids. It’s not that hot and dry. But I think here’s a perfect case where IQ 85. What brought this student perhaps down on the IQ to get an 85, those particular abilities have absolutely nothing to do with reading.

So I think it just shows that in this case, what are you supposed to say? Oh, they’re exceeding their potential. That doesn’t even make sense when you say something like that. 

Dr. Sharp: Fair enough.  I like this.

Dr. Feifer: I’ve sort of talked around the question a little bit without getting too technical. But basically, from a neuropsychological standpoint, a lot of reading and decoding is in the temporal lobes of the brain. Where is IQ in the brain, we’re not even sure, probably inferior parietal lobes. But it represents other areas than what we’re looking at here with reading. It’s not a one-to-one correspondence. 

Dr. Sharp: Got it. Thanks for indulging that question. Okay, so we have these largely average academic scores, especially in reading.

Dr. Feifer:  And math is not bad at all overall, but when we dive into the math a little bit, for those who can’t see the math composite was 89, but you dive into the scores you should see that the numeric operations, the straight problem solving 86, not that great but the math problem solving was 95. Normally that suggests a decent conceptual understanding of math but execution may be a little shaky there. 

And I’m wondering, we could certainly make the case if this is a student who had reading intervention in the past, maybe hasn’t had a whole lot of math intervention. I don’t know why the numeric operations weren’t specifically was tripping the student up. Was it with fractions or decimals or just division that might’ve brought that score down a little bit?

Dr. Sharp: That’s a good question. Yeah, I don’t have that right at my fingertips. I would have to go back and look at why that was so low or lower than the math problem-solving score. The interesting thing about this kid is they would say that math is a strength. I think that a story within the family is that reading is the weakness, math is the strength but yet from the scores, it was the opposite. 

Dr. Feifer: Yeah. The scores are all over the map. As I look further with math in that you have addition and subtraction pretty low and multiplications are higher. And one of the things that I get, I think your indulgence to interject our FAM test is a diagnostic processing test of mathematics. And what are the things we do with addition, subtraction, multiplication division with them is we have a straight speed test. You have one minute ready, set, go, answer as many problems as you can.

And then back towards the latter portions of the test, we have addition, subtraction, multiplication, division knowledge, where the answers are already provided for you and you have to determine, fill in the blank. If 7 + _ = 12, fill in the blank. And the reason we do that is to try to tease out. A lot of kids try to memorize their way through math. And they might do really well on fluency tests but when you get into the knowledge or conceptual understanding, they just fall apart.

Or vice versa, a lot of our language-based learning disabled kids conceptually get math. Like this student conceptually gets math, but the numeric operations were all over the math. And sometimes that reflects just well retrieval or anxiety or something else getting in the way. It allows us to tease that out in perhaps the way that WIAT not quite can do. It’s a pretty much straight math test but there’s a lot of inconsistency there. We’re not quite sure why but we do know that there’s underlying anxiety here. And there is something about math that brings out anxiety in all of us. And that could have been a factor that led to some of the inconsistency for maths.

Dr. Sharp: Sure. Okay. So as we continue moving through the data.

Dr. Feifer:  Well, looks like you gave a CTOPP. I’m going to guess maybe is 16 years old pretty much the top of the age range for the CTOPP?

Dr. Sharp:  Let’s see. I think the CTOPP may go to, is it 24? I’ll have to look it up. I think it is a little bit higher though. 

Dr. Feifer: Well, not that high. We have a very good performance on the CTOPP with the exception of some of the Rapid Symbol Naming. Again, processing speed once down on the [00:27:00] WISC, anxiety- a student who consistently is sacrificing speed for accuracy so might be a low score here on Rapid Symbol Naming but could have gotten them all right. He just worked at a very slow pace. And that seems to be a little bit part of what we’re seeing. 

Dr. Sharp: Yeah, I think that’s true. He was very accurate but slow. 

Dr. Feifer: And your final education tests? One of my favorites, the KTEA-3 for Written Expression. Wow! 123. I’m knocking that one out of the ballpark. I like it. And for those who have been given the KTEA-3 with writing, I’m sure you’ve used a number of writing tests. I like how they go through the little story booklet. I think it’s really clever that they work all the way through that.

Dr. Sharp: We definitely prefer the KTEA-3 to the WIAT writing. That’s for sure. 

Dr. Feifer: So you just love scoring the essay on WIAT, huh?   

Dr. Sharp: So hard to give that up. No.

Dr. Feifer: Yes. So writing looks really good. And it’s funny, this is really set up as these scores are being laid out as really a bit of a neuro-psych assessment. In other words, it wasn’t just IQ and achievement. You’ve got data on executive functioning coming up and then 8-year social-emotional. I know a lot of people were asking, well, what is the difference between a psychological assessment and a neuropsychological assessment then?

I remember Cecil Reynolds talking about that once and I loved his answer. And he basically said, the person interpreting the data. That’s the difference. Not necessarily the specific test that you’re given. I thought that was good. It is in this case, executive functioning, at least on the  Conners Continuous Performance Test which more attention, more focus, those elements that executive function as opposed to perhaps high-level decision-making, symbolic reasoning aspects of executive functioning. At least of the Conners, everything looks great.

Delis-Kaplan, the D-KEFS which we taught that for years, that test is getting a little age on it. I’m hearing that they might be reissuing that this year. Have you heard about that? 

Dr. Sharp: Yeah, are you talking about the D-KEFS 2.0? 

Dr. Feifer: Yeah. Is that the one that’s going to be on the iPad version, right?

Dr. Sharp: Yeah. I’m excited for it. I think this is one of the first tests that I know of that truly was standardized over digital administration. I’m curious to see what that looks like. 

Dr. Feifer: Yeah. I want to say the D-KEFS norm was, let’s say 2007 off the top of my head. I’m sure people are chiming in their house, no, it was 2009. But here we are in 2021, it’s got a little bit of age on it but still the scores on the color, word, interference test, it’s more of a response in that Inhibition type of test, not bad. Your lowest score was 7. I guess for me, I’m not really too worked up over that. The BRIEF-2, an excellent instrument looking at a host of executive functioning. Can I ask on the BRIEF-2 who completed this? Was this a teacher or parent? Do you recall? 

Dr. Sharp: This was a parent.

Dr. Feifer:  Interesting because two things stand out. The Emotional Regulation Index is kind of high. So the parent completing that and basically suggesting, I don’t know what the behavior. We’re about to get to the school behavior, but perhaps the student keeps it pretty buttoned up all day at school and comes home and lets mom and dad have it which is not terribly unusual for anxious kids who don’t want to make a scene in school but that Emotional Regulation Index was kind of higher.

Dr. Sharp:  True. Now a lot of that came from the Shift scale, right? So kind of that cognitive flexibility component. So for me, that is really tapping into, okay, this is someone who is a little bit rigid, a little bit inflexible, in my mind at least, it kind of dovetails with the meticulousness and perfectionism. That might be a reach but that’s one thing I’m picking up from that high score on the Shift scale. I don’t know what you think about that? 

Dr. Feifer: I think you’re spot on because as we look between the numbers, that is a good point. Emotional control was high but that shift was super duper high. So maybe getting stuck with separating and shift, a bit stressed out the low […]. I’m with you. Also, mom and dad have some issues with the organizational component, a little bit of planning and organizing at home. And then I believe the last scale… was the last scale BASC-3?  

Dr. Sharp: Yes, that’s right.  And just to say, sorry, before we jumped to the BASC, you tell me what you think but when I see that elevation on the plan-organized scale of the BRIEF-2 that calls back to the difficulties with fluid reasoning a little bit. It’s like laying out appropriate steps, getting from point A to point B, being able to devise a path, and then follow that path. So I don’t know if that’s in the same ballpark as you were saying, like applying rules or figuring out how to make sense of some of that abstract chaos on fluid reasoning. 

Dr. Feifer: Sure. I mean, at the end of the day, it’s kind of maybe some inefficiency there. 

Dr. Sharp: Sure. That’s a good way to put it.

Dr. Feifer:  Quick scale of the scores on the BASC-3 and nothing really jumping out. A whole lot on the internalizing art. Look at page two here and obviously, what really stands out on the BASC-3 is the anxiety. And I’m sorry, Jeremy, was this the teacher who filled this one out? 

Dr. Sharp: No, sorry, this was parents as well. So this was an eval that happened over the summer. So we do not have teacher data available.

Dr. Feifer: Where is the date? It’s nice coming through. Do you know if this is a student perhaps getting any counseling or any either accommodations interventions or seeing someone?

Dr. Sharp: He is not. At least from a psychotherapy perspective, at school, he’s had an IEP 0504 since elementary school that provides extra time. So he’s been accommodated in the school environment.

Dr. Feifer:  Got it. So if we were to sum up the data for case 1 here, to be honest, this is a reevaluation. My mindset personally is a little different from a reevaluation and an initial eval. One of the things really look at and put a lot of emphasis on the re-evaluation is basically how are they doing academically irrespective of whatever IQ score we have out there. Somebody down the line had previously established reading disorder with the student, they’ve had interventions, how are they doing? How have they responded? This is a student who is asked for accommodations as par of this evaluations for SAT.

The overall academic scores to me look fairly solid on the client. You have two that might dip into the below-average range. However, it’s hard to say there is a learning disability jumping off-page as much as if you begin to connect the dots, you have an underlying current of anxiety. It seems to lead to a few consistencies of learning, some slowness in learning. And according to the parent at home, they’re certainly seeing anxiety. And this shift you had brought up is getting stuck or separated. If this were an initial evaluation I think it’d be a tall order and say where’s the learning disability?

Dr. Sharp: I agree.

 Dr. Feifer: Let’s say that we can put some accommodations in place but it seems like maybe they’re… I’m sensing more social-emotional accommodations might be more beneficial than a specific academic intervention. 

Dr. Sharp: Yeah, I’m with you. I think it was a tough cell, especially in the consideration of accommodations on the ACT. It was a really tough cell to go down the path of a learning disorder or learning disability. And I ended up pinning this on the anxiety and trying to build a case around that for the accommodations. 

Dr. Feifer: Great minds think alike. Yes, that sounds very appropriate.  Moving forward, just the other thought that comes to mind, a lot of times when you’re trying to come up with accommodations for ACTs, that kind of thing. What is the accommodation that every single student wants? Wartime.

The dominos fall like this; being under the gun, not being able to manage time which is an executive functioning issue in my opinion but it’s also influenced by anxiety. Not being able to manage a time that in and of itself, it’s the sanction. So, I mean, you look up at the clock and you’ve got five minutes to go and you’ve got 30 more questions and you hit the panic button. The more anxious we become the more that impacts our competence of managing working memory, anxiety, and working memory never go hand in hand nor does anxiety and executive functioning, or maybe a better way, a better term, I always thought the term executive functioning is rather vague and nebulous. It leads to indecisive decision-making. That’s a multiple-choice test. Should I go with B or C? Oh gosh, I can’t decide. Just very indecisive in the approach.

What I find is that a lot of times with the ACT board, if we’re going this route of what time, they want to see more fluency-based measures. A reading fluency measure, a writing fluency measure, a math fluency measure. And what I liked about this evaluation is I think you’re able to capture a lot of that with the WIAT as well as what I really liked is you built processing in here and you gave a CTOPP. You looked at some elements of processing.

I think the biggest issue facing all psychologists and diagnosticians at this point in time is the referrals that you are getting right now. You’re going to have students who might be a little bit below grade level, right? You’ve got a big decision to make. Are they below grade level because of a budding learning disability or in this case, maybe a bit of anxiety or a social initial issue? Is this a COVID casualty. Is this a result of the last year: I’ve been displaced from school, I don’t have a great internet connection. My teachers aren’t really… they’re still learning how to give remote instruction.

There’s a lot of factors that have interrupted the continuity of learning over the last year. And that is a huge question we all have to face and deal with. A nd just taking lower achievement at face value and saying must be a learning disability is a huge leap. The way to answer that question is to me, you have to demonstrate some psychological processing issue is getting in the way of learning. 

What do I mean by processing way reading? Is it a phonics issue? An orthographic issue,? Is it a retrieval issue? Is it a working memory issue? Is it a language? We have to have some element of processing giving the way to lead us into that learning disability direction. Otherwise just looking at that sheet that’s in between 85 and 90. Wow, isn’t everybody going to be impacted in this pandemic world by just straight achievement tests with no processing?

And I think for me, that’s the approach I’ve taken to try to read that out. I don’t know, in your clinic I’m sure that’s a discussion you’ve had with much of your staff is how do we make that difference? 

Dr. Sharp: Let’s take a quick break to hear from our featured partner.

Feifer Assessment of Writing™ or FAW is a comprehensive test of written expression that examines why students may struggle with writing. It joins the FAR and the FAM to complete the Feifer Family of diagnostic achievement test batteries, all of which examine subtypes of learning disabilities using a brain–behavior perspective.  The FAW can identify the possibility of dysgraphia as well well as the specific subtype. Also available is the FAW screening forms which can be completed in 20 minutes or less. Both the FAW and the FAW screening form are available on PARiConnect, PAR’s online assessment platform allowing you to get results even faster. Learn more at parinc.com\faw

All right, let’s get back to the podcast.

Dr. Sharp: Yeah, that’s a really good point. Gosh, I feel like we talked about this quite a bit. I have also found though that with the ACT and other standardized MCAT, whatever, they really want that nuanced data. It’s not enough to just say the score is low or even there’s a history of this area being low. You really have to get in and demonstrate it. So I like that you are making that distinction and say like, Hey, especially in these cases where there are accommodations at stake on a standardized test, you have to fill out your battery a little bit and make sure to explain exactly what’s underlying these difficulties. So I’m right with you.

Now, looking back, is there anything that you would have added or done differently in this battery to get more information, of course, acknowledging that you have an entire suite of academic tests that are amazing, right? So there’s that. Are there other measures that you would administer instead to get at different aspects of functioning here?

Dr. Feifer:  Yeah, so not a lot. Normally if I’m doing KTEA or […]  like you, I’m seeing pretty average scores here. I can’t really justify them giving a FAR. FAR is a diagnostic reading assessment looking at subtypes of dyslexia. We’re getting into all the neurocognitive processes that support reading. But if the net result of reading is pretty average, and I’m seeing that by your scores here, I don’t see a real need to jump in that direction.

Our newest test to father the writing test was just released, great timing releasing a test during a pandemic, but just released. It looks into three subtypes of writing, whether it’s a network issue or more of a cognitive linguistic issue. I just can’t formulate my thoughts up here and put them down on the paper here or is the issue more the third subtype- I can say, look, you’re really dyslexic. And if you look at the definition of dyslexia, especially by The International Dyslexia Association, guess what? It doesn’t just impact reading. It impacts spelling and writing as well. In other words, is it just a spillover of your dyslexia? That’s what we’re trying to determine.

But going by your scores, believe it or not. I don’t think I would have followed up. I don’t think there would have been a need. I think that would have been over-testing. So one test that comes to mind, we could have used maybe the FAM if you want to really get at the mathematics test to get at some of the why of you have a lot of inconsistencies in the math performance even if your overall score was very respectful, 89. I mean, that’s not quite shattering. Maybe the FAM. But the one test that I really liked for students to this age, when I have more of a social-emotional question is, I really like the PAI which is the…

Dr. Sharp: Is it Personality Assessment Inventory?

Dr. Feifer: ersonality Assessment Inventory, yes. We got it. I really liked the PAI a lot. It would drill into the anxiety component as well as other social-emotional components but it would really delve into the anxiety component and look at the different subtypes of anxiety. Is it more affective? Is it more physiological- shaking, flushing, that kind of thing? More behavioral?

I really liked the PAI, of course ,the lawn is great too. It’s really the dealer’s choice. I think all of these are phenomenal tests. So what I find myself doing similar rating scales as you, and if the BASC is coming up a little significant anxiety or depression or something, and I want to do a little deeper dive perhaps have a PAI to go more in that direction. But from a cognitive battery, looking pretty solid here. 

Dr. Sharp: Okay. 

Dr. Feifer: We can certainly suggest other tests but I think we have to be mindful. I’m just very cautious about over-testing just for the sake of testing. 

Dr. Sharp: That’s fair. Well, I’m glad you brought that up. We did do a PAI. I didn’t send that data. And the only thing that emerged from that, the only elevation was the obsessive-compulsive dimension of that anxiety scale. So it’s not anxiety, it’s ARD.

Dr. Feifer:  Anxiety-Related Disorder?

Dr. Sharp:  There you go. Yeah. So that was the only elevation across all of the sub-scales. So to me, it was just more evidence pushing in this perfectionism/anxiety/rigidity direction.

Dr. Feifer: This is a student who’s going to get the acco… It seems to be, it might be a bit of a stretch to get accommodation. 

Dr. Sharp: It is a stretch.  Yeah. You’re asking all the right questions. So we submitted the application. The initial was denied and then had to appeal it. And I think we’re still waiting to hear back from the appeal. So there you go. You nailed it. 

Dr. Feifer: Here we go. Okay. I don’t think I added anything that you were not already one step ahead of me on that. 

Dr. Sharp: Hey, this is great though. Of course, it’s validating, right? But the way you got there though is different, honestly. Like the way you were thinking through it, it was very valuable to hear what was running through your mind as compared to mine.

Dr. Feifer: Well, I like your battery. I know that there’s a lot of different approaches hence the name of our podcast here, The Testing Psychologists, the different theoretical approaches for testing, and there’s many out there who probably follow a rigid kind of CHC approach and want to tap fluid reasoning and crystallized knowledge and long-term memory and short-term memory and processing speed and short-term and hit all of these domains.

For me, it’s whatever path gets you to the proper destination. That’s the path I want you to take. It doesn’t have to be my path. But hopefully, it gets you to the right destination which was the conclusion you made and the recommendations you have. Me personally, I shy a little bit away from that CHC approach. Not that we don’t want to look at underlying processes, that is the main thing. We have to be mindful of time. We have to be mindful of expense. We have to be mindful let’s just look at the main attributes of this referral question. And as we began to look at those main attributes, it actually put us more in a social-emotional direction which CHC doesn’t necessarily go there. So the fact that we didn’t do it, we stopped where we did and then jumped over into that social-emotional piece, I thought that was very appropriate. I would follow in the same footsteps.

Dr. Sharp: I appreciate that. Okay. Well, let’s see if we can squeeze in a second case here before we wrap up.

Dr. Feifer: Sure.

Dr. Sharp: So just to set the stage a little bit. This case is a 7 or 8-year-old girl, self-referred, nothing significant from say medical history or family background, anything like that. But parents were concerned about a learning disorder and, or inattention disorder. So that is just a brief summary of the background. Similar battery. For listeners, we’re going to run through a WISC, a WIAT, KTEA, a CTOPP. And then with her, we actually did a little bit more a CDLT and a little bit more of the D-KEFS. So we will walk our way through this and see what pops out. 

Dr. Feifer: Well, starting with the WISC, nothing could be more solid. For those of you who don’t have access to the data right now, it’s a full-scale 99, that’s it. And all of the impact scores right in the average range with a bit of a strength for this particular case in the fluid reasoning. In our first case, that was a bit of a weakness.  But again, I could go on hours about IQ testing, which I’m not going to do, but when I look at it, this is an initial evaluation. And when I look at IQ, I’m looking at two things. Does the student have to meets a certain threshold? They have a certain threshold of intelligence in terms to handle the day-to-day pacing that the curriculum or those. I don’t care if their IQ is 85 and it’s 99, that doesn’t really concern me.

Now you got me. Oh, what if their IQ 73? You got me there. You need a minimum threshold. It’s going to be really hard to keep pace. If the IQ testing can give us some good insight about the strengths and the weaknesses as a problem solver? Absolutely. And in this case, everything was average clearly meets that threshold. Yes, she was referred because we’re getting into some hiccups with learning. So, we will take a look and focus a little bit on the learning issue. And it looks like the WIAT was given. And in this case, we have reading composites of each.

So I know what everyone is saying right now. Okay. We’re done here. IQ 99, reading composite 82. I can get a two-digit subtraction here. I can figure out there’s a 17 point difference. Must have a learning disorder, okay? And in all respects your probably right, however, not necessarily. Again, as I mentioned before and I’m going to give it a cheap in test and if I see readings low, I’m going to follow it up in this case with the FAR. Not just because I’m the test author. Well, yes, because of the test author. No, because it is important to be a 2021 psychologist. To not stop our evaluation as at the point of looks like they’re going to qualify. You got a 17 point discrepancy here. It looks like you’re qualified.

To be a 2021 psychologist, we need to go to the finish line. And that finish line is not necessarily stopping until they qualify but it’s taking that next step further and saying, what exactly is the issue? More importantly, the finish line is interventions. How does our data lead to better interventions?

So what the FAR is going to do is it’s not a traditional achievement test. That’s what a WIAT or KTEA. It’s going to be more diagnostic. And I really want to put a shout-out to both the CTOPP which you used and I think it’s a wonderful test. That’s just supported the test. And also the PAL-II, which is Virginia test. I think those two really opened the door for me, and they really were the first to try to get into that diagnostic aspect of academic learning, and hence allowed us to develop and walk through that door and develop a diagnostic achievement test where the goal is not to say so much where you are on the curriculum, but try to explain why you’re there. And if we can explain why you’re there, I think it puts us in a much better position to take it to the finish line and offer interventions.

So what’s the FAR, in this case, going to do? Is the reading low because of a phonics issue or decoding issue? We look at four aspects of reading. Well, is it is low or because of the literacy and pacing issue, is it low because of a combination of both- we call that our mixed dyslexia index, or is the actual mechanical side of reading just fine? The problem is you can’t answer the 10 questions in the back of the chapter as more of a comprehension issue.

At least at this age, I like the fact that a CTOPP was given because a CTOPP is going to answer one of those questions. And that is, is the problem with reading all of that phonics issue or it more of a speed issue? I’m fast-forwarding, just a drop but as I look at your… we’ll back and look at the other academics. But as I look at the CTOPP scores from Nemic awareness was 88.

All right. We’re getting there, but the Elision score of academic awareness was very low. Elision again, Hey, Bobby say the word snack, snack. Say it again without the month.

What do you have? So Elision is a high-level Phonemic Awareness Subtest where you have to strategically manipulate sounds within a word and reconfigure them to come up with a new word. That’s a little different than a boat. What is a boat start with? That’s more of a lower-level phonemic skill. So phonemic awareness is coming, but we’re not there yet.

Processing and we don’t do this on the FAR, only the CTOPP does this. It gives you a chronological memory score that’s so insightful. You yield that but what stands out on the CTOPP is Rapid Naming was at 60. And what we know about dyslexia especially in the language is, we’re screening dyslexia, we’re looking at not just lower scores and phonemic scores, but also that rapid naming- how quickly can you look at a visual stimulus and define a verbal tag to that? For the neuropsych, this is out there. You know what we’re talking about- the ventral stream with the brain, looking at an object and assigning a tag. This was really low. I’m going to ask the question. Did she have anxiety issues like the first case we had that could have tripped up the speed here? 

Dr. Sharp: No, certainly not to the same degree. I don’t remember her having really significant anxiety at all.

Dr. Feifer:  It certainly didn’t look that way on the WISC. The WISC process speed was super solid.

Dr. Sharp:  uh-hum. That’s right? Yeah. She’s a little more easygoing, actually. A lot more easygoing. 

Dr. Feifer: Yeah, so 60 on a rapid symbolic naming, not good. 

Dr. Sharp: It’s notable. Yeah. 

Dr. Feifer: So that that’s a big red flag in that we have some phonics issues and we have that rapid. So we’re really, I think building a bit of a case here for dyslexia. And some might say, look, this is all overkill. Why are you dieting down to this level? You already know there’s a 17 point discrepancy between IQ. And the answer is, as a psychologist, where do you put your finish line? And if your finish line is I could qualify them, then yes, you’re done. But if your finish line is, what are we going to do about this? Because you and I know one of the habits our schools get into is running the same intervention for every student. The reading issue. I always say specificity with assessment will lead to the specificity with intervention. And if we’re going that IEP direction, I think that’s what that I is supposed to stand for. Individualized. Yeah, that’s it.

Another way is specificity. And that’s why if Jeremy’s taking this to the next level, what exactly, where exactly is the reading breakdown. I think this CTOPP is really yielding quite a bit of information. That authenticity aspect, as well as some of the higher-level Phonological Awareness skills, that the Elision subtest is pretty low.

Dr. Sharp: Great. So let me, Steve, I’m going to jump in just real quick. And just being mindful of time, I wonder ..and maybe it’s a spoiler that the rest of the data I think is largely unremarkable, say for some elevated scores on the BRIEF and some trouble on the continuous performance test. So we have some indications of executive functioning concerns. 

Dr. Feifer: I may be tempted to take that attention was an issue. Was that a referral question? 

Dr. Sharp: It was, yes. 

Dr. Feifer: Yeah, and as I am jumping ahead to work, with inattention, if I can throw out a test or two that really light, most of us when we get into attention in a non-pandemic time, I think the best measure is to go into the classroom and do an observation. Where we are now is […] a lot on rating scales. Well, it’s hard to do a teacher rating scale when you’ve only worked with the student on zoom for the last year. I don’t know how relevant that is and how you guys get around that. 

Dr. Sharp: No, it’s really challenging. We’ve had very few teachers who have really been willing to fill out rating scales. They just don’t know the answer. They don’t know the student well enough to complete all of those questions like that. So, yeah, we’ve been doing a lot more just teacher interviews. A little brief. Like, what’s your impression of the student? How are they doing online? But even that there’s an asterisk I think besides every evaluation where we’re doing in this context, just because we don’t know. It’s like to be determined, you know.

Dr. Feifer:  Yeah. And it’s like trying to do an evaluation with one hand tied behind your back. You just don’t have that information. So what are we left with? Well, we can certainly do a parent rating scale. We actually use a test called the teach. Teach is the test that everyday attention for children, which is a little different from a checklist. The checklist we are looking at more behavioral aspects of attention. The teach is really an innovative test. That’s where to look at the cognitive aspects, your ability to sustain your attention, select attention, shifted attention.

It’s a hybrid test. Half of it is really on a computer and the other half is more paper pencil. It’s put out by Pearson. I know what everybody is saying and you’re exactly right. It was normed in the UK. I’d take that up with Pearson. They tell you attention is attention. It doesn’t matter. But I can tell you from an innovative and just a creative test it teaches a lot of fun to give and students seem to enjoy that very much.

And I think we’re going to have to… whether it’s that Cecil Reynolds has a new test called the RIT that looks at response inhibition. There are sub-tests on the NAPSI to look at ambition as well as the D-KEFS, but she’s probably a little young for the D-KEFS. I think what this calls for during these times we find ourselves in is we’re going to have to be a little more aggressive and trying to directly measure attention because we just cannot elaborate its scores.

Dr. Sharp: That’s interesting. Okay. So you’re falling back on more of these in-office measures and maybe just a good interview, but really the in-office measures compared to the behavior checklist?

Dr. Feifer: Combination of both. And I like the fact that you still try to get some information from the teacher through an informal interview. I think that’s smart as opposed to just discounting that teacher completely. Look, I know we’re psychologists, but I like to use the term we’re cognitive detectives and we have to just go to the source and gather as much data and clues as we can. It was a crime that’s been committed. That crime is student underachievement and we are trying to solve that mystery.

And we gather as much data as we can. I just think in this case, if possible, take those rating scales for what they’re worth at this point in time and even your own observations, I think it’s okay Jeremy that sometimes school psychologists are afraid. If you can’t put a number to it, then I can’t use it. I think your clinical instincts and observations, they’re pretty sharp. Don’t be afraid to use those as well. 

Dr. Sharp: I like that. So let me go back before we wrap up here. And first of all, I’ll just say thank you for jumping in and winging it with unfamiliar data and almost zero background information and so forth. This was great.

You mentioned this whole idea of tailoring the reading intervention to the specific concerns, right? So how do you present that to schools? Like, say we’ve identified, okay, she has these weaknesses with rapid naming and higher-level phonemic awareness skills. What are you saying to the school from that point?

Dr. Feifer:  Yeah, I’m quite an aggressive report writer. First of all, I’m not going to say this student needs READ 180. READ 180 is a program that costs over $30,000. I’m not putting schools on the hook or doing anything like that. But what I am going to do is try to drill down and that’s why we develop the FAR is to be able to drill down and say, we have a reading issue. Here’s what kind it is. It’s more of a problem with phonics or more or a little bit of both or whatever.

Then when we get into the recommendations, I might phrase it like, Billy would benefit from an explicit and systematic phonics instructional program. And then I’ll put in parentheses. And I always make sure to the best of my ability that these are programs a lot of our schools already have, okay? Gillingham language foundations program which we use quite a bit for dyslexia. I will give examples of programs, but I will not dictate. That is the school to decide. But these are the types of programs.

But right under that, this student also might have an issue with fluency. So I might talk about programs such as Great Leaps or something along those lines in my second recommendation that Billy could also benefit from building on speed. And I always put it in parentheses list of a few for some that are going too far and I’m fine. You don’t even want to go there. But for me, I stop at a point. I’m not going to tell a school what to do but I’m going to give examples. You decide. And I always try to make sure these are things, believe it or not, a lot of schools already have. They’re sitting on a shelf somewhere that they would benefit from these types of interventions.

And what I’m trying to go for is not the one size all fits approach, but there are multiple aspects of reading here that the student is struggling with. Therefore it’s not unreasonable to think we might need multiple types of interventions and then try to give some choices. 

Dr. Sharp: That sounds great. I think we can definitely get locked into it, especially if we’re using templates or whatever to just say reading intervention, but not drilling down and specifying. But you need the data to be able to do that in the first place. 

Dr. Feifer: And you have a nice battery. And I think when you give this kind of battery where it’s not just a cognitive and academic, but you take it, you’re looking at the California Verbal Learning Test that is a masterful Dean Delis creation here in neuro-psychology. One of my favorite tests. Looking at the memory, and we haven’t even gotten to this, but we had a lot of issues with memory. And what this test really gets at is how you store information, whether it’s just literally word for word as you hear it, or can you store it by more semantic? Meaning it’s an ingenious test. And it’s so ingenious that I slightly, I’m not going to say rip off. I was inspired by it to develop our Word Recall Subtest on the FAR, trying to look at the same thing because that’s really explained it’s reading comprehension for students who are trying to remember stories literally word by word and not see the connection. Good luck on a more detailed story, trying to remember all that.

But a lot of that goes to being Dean Delis. And a lot of help with verbal learning tests has to be a lot of what you’ve given. It’s not a neuropsychological evaluation. This is psychological, this is a group of tests. That’s a psychological eval with strong neuroscience layered to it because I can tell it’s really drilling down and trying to get underneath problems. And I think that’s important. And I think we owe that to our students in order to generate interventions. 

Dr. Sharp: I think that is a fantastic note to close on. That is picture-perfect last word. Thanks again. This was really fun to hear how you talk through these cases or think through these cases. It feels good. I’m not going to lie to get a little bit of praise for our battery and some of the conceptualization. So thanks for that as well. It was a nice little shot in the arm for me. But no, this was great. I am so grateful for your time and your knowledge and just the willingness to engage in this experiment and see where we ended up. So, thanks. 

Dr. Feifer: Well, thanks for having me back. And you laid this out in a way that it wasn’t just the three test scores. Hey, what do you think is going on? But we’d had a litany of things to look at, and it was fun to talk through them with you. And again, keep up your great work. I think you are an important voice in our field and I’ve greatly enjoyed listening throughout the pandemic.

Dr. Sharp: Thank you. That means a lot. Take care of Steve. 

Dr. Feifer: Okay. We’ll talk soon. Take care. 

Dr. Sharp: Okay, y’all, thanks so much for tuning in to this masterclass. Like you noticed a little different format than the last one. I would love some feedback. I would love to know if you prefer this format where I bring cases and the expert talks through the data, or if you liked the case presentation format from before. I will continue to schedule these masterclass episodes hoping for one per quarter. So your feedback is really important.

And like I mentioned at the beginning, if you’re interested in winning a free test kit for the Feifer Assessment of Reading, just go to thetestingpsychologists.com/far and enter your information to be considered for a random drawing, basically just to win a free test kit and we’ll send it to you. And I’ll be doing that drawing within two weeks of the podcast. So I will notify whoever wins the test kit immediately. 

Okay, thanks as always for listening y’all. I appreciate any feedback. I love those ratings. And I really appreciate you sharing the podcast with anyone, any friends, colleagues that you think might like to hear this info. Hope everyone’s doing well enjoying some growing springtime weather and we’ll catch you next time. Take care.

The information contained in this podcast and on The Testing Psychologists website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

Click here to listen instead!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.