Dr. Sharp: [00:00:00] 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.
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Okay, y’all. Hey, welcome back. Today, I’ve got part two of parent perspectives on the assessment process with Dr. Caroline Buzanko. Caroline was here last week for part one. If you didn’t listen to that episode, I highly encourage you to go check that out before you listen to this one. I do think that they can stand independently, but listening to the first episode last week will give you [00:01:00] a lot more context and I think will be a nice setup for the conversation that we have today.
You’ll notice, we jumped right into it from the get-go. Like I mentioned last week, with these multi-part episodes, it’s sometimes tough to separate the audio because we’re just on a roll, but we did our best and I think it turned out okay, but just be ready for that. Right after the music, we’re going to jump right into it, talking about ways to empower parents and adapt our assessment process to really cater to them.
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So, if you are just launching your practice or wanting to launch your practice, or you’re a solo practitioner who doesn’t really have any plans to expand but you would like to dial in your systems, be more efficient and feel less overwhelmed, these could be a good fit for you. You can go to thetestingpsychologist.com/consulting, and set up a pre-group call to figure out if it’s a good fit. I would love to have you in one of those groups. They’ve been pretty transformative for other members in the past.
All right. Without further ado, I would like to jump to part two of my conversation with Dr. Caroline Buzanko.
Dr. Caroline: There are a lot of things that parents complain about. They’ve given us a lot of insight into how to make things better for them as well. So right from the beginning, before you even get started, parents must understand that assessment process. That’s going to help reduce their anxiety. They’re still going to feel anxious. They’re going to still feel stressed, but we can reduce some of that.
So, what is it that they are going to expect? Having that conversation from the beginning, what they expect, and then educating them if there are things that, oh, actually, we don’t do that, and actually this is how long it’s going to take or whatever else it is. This is what’s being measured. This is what your kiddo is going to be doing. This is how that task is going to directly inform any decisions that are made.
So pulling all of that together so that they’re feeling… And it still might not totally make sense to them the [00:04:00] way it does for us, but at least they’re feeling like, wow, I’m a part of this process. And you’re obviously knowledgeable and you’re bringing me along with this. That alone can really help set up some positive experiences for parents. That’s what we definitely want to be focusing on.
They also want to know how to best set up their kid. So bringing snacks, doing a morning session, if you’ve got younger kiddo with attention difficulties, for example, breaking it into more than one session. How will your child function at their best? That’s what we want. We want to be able to see them at their best.
Having those conversations with parents right from the start can be really helpful. I always have a handout for an overview of what to expect from the assessment, even just things around parking. This is where you can go. You got to register your car. Even little things like that because they’re already stressed. Got to find your office. And now I can’t find parking. And now I’ve got to register. All of those little things, what can we do to just smooth the process a [00:05:00] little bit? So I do have a little handout just explaining, this is how you can explain the process to your kiddo. These are the kinds of things that help you do anything like that.
Helping them prepare for the intake meeting, that’s really important. So I do tell them, hey, I’m going to go right back to your pregnancy and delivery. So they’ll think of those stories. That way, when we’re preparing them about what we’re going to be asking, they can give us so much more information, way more details. And that’s going to be important if we’re looking at a proper diagnosis.
And depending on the type of assessment we’re doing, I often for sure, autism, I’m always getting them to find pictures of their kiddo in those preschool ages and watch videos of your kiddo. That’s going to help you jog your memory. Look through the report cards. I will want to see report cards anyway but look through those report cards. I want you to start thinking about when you were first concerned about your kiddo’s learning or whatever it is. So, I’m getting them to think about those.
I also have them collect data for me [00:06:00] right from the beginning. So I give them a datasheet, especially if there’s anxiety or behavioral disorders that we’re looking at. I want them to start taking concrete data even just to maybe see sort of sheets so that they can come in and be like, okay, this is what happened. This is how I responded. This is what I think the function of the behavior is or whatever else it is because that’s going to give us, even if it’s just doing reading, okay, we sat down, we’re going to read the assigned ebook or whatever it was, and this is what he said, or he started getting a stomach ache and this was the time of day and all the circumstances. That’s going to give us a lot of information and parents won’t be scrambling for different ideas. So that can be really helpful as well.
Getting them to bring a list of questions. I know we always say, do you have any questions on the spot? They’ll never think of it, but as soon as they leave our office, they’re going to be like, oh my gosh, I’ve got 50 million questions. So getting them to start thinking of some of those questions from the start is really good.
One thing I know we all [00:07:00] already do is get them to figure out their goals for the assessment, what they want to learn. So, they’re helping us formulate those assessment questions, but I go beyond just asking what questions they want answered to also know how will you know that this assessment process or this assessment was helpful for you? What will be different when this assessment is done in your life? Because then we’re going beyond just the referral question and we can start outlining some of the recommendations that are going to be helpful.
I’ll know that this was helpful because we can get out the door happy together in the morning. I’ll know that this is helpful that I can read for 20 minutes with my kiddo at night without a fight. So I really get at some of those kinds of things. It’s their dream, right? What will be different for them at the end of the process?
Dr. Sharp: I like that question. Can I ask a really practical question?
Dr. Caroline: Sure.
Dr. Sharp: How are you preparing them with this [00:08:00] information? Are you sending an email before their intake? Are you talking to them on the phone while you’re scheduling them? How does this happen?
Dr. Caroline: Most of the time, I try to do a call. It is just a 10-minute call to orient them just to help. Okay, we’ve got this upcoming assessment. Oftentimes, if they call in and they just want that consultation, but I do try.
And I will admit, it doesn’t always happen. There are times where I show up and I’m like, oh man, somebody just at the last minute got scheduled today. And it’s just a panic scramble for everybody. But then, I’ll take them in at the beginning and I’ll sit them down. I don’t just take the kiddo into the room. I’ll sit down with parents and say, okay, kiddo, what do you know about this process? What did mom and dad tell you? They almost always say, I don’t know. Nothing. I thought I was going to a doctor. You’re not going to give needles, right? They really have no idea.
So then I talk with the parents right at the beginning there if [00:09:00] I don’t have that chance to have that clarity call before they come into the assessment. But we do have an intake package that goes through and outlines everything. So we do have that by email, but then just that additional call before the assessment can really help them.
Dr. Sharp: Sure, that’s a great idea. I’m thinking from a business perspective, is that a video that you could record and attach to an email somehow so that you’re not doing the same talk over and over and over.
Dr. Caroline: Good idea.
Dr. Sharp: I digress, but thank you for answering that.
Dr. Caroline: I think that’s a great idea. I wonder if we could edit it, but still personalize it, but that’s a good one. I’m going to think about that myself.
Dr. Sharp: Sure.
Dr. Caroline: We’ve already talked about asking parents for their thoughts on the assessment process too, right? What do you already know about the process? What are your [00:10:00] expectations? How do you think this is all going to play out? That’s really important. And then, of course, what is it that you’re wondering about? That’s their hypothesis. So if they’re like, why can’t Johnny follow instructions? Is it because he’s defined? What’s going on?
I always get their hypotheses right from the beginning because then I can see what they’re thinking. Oh, I think he’s lazy. Oh, I think he’s got ODD. Oh, I think he’s got whatever. So we’re already thinking about how parents are perceiving their kiddo’s difficulties. And not only we’re getting information from that perspective because that’s going to be really helpful for us when we get to the feedback section to where they’re at.
So if it’s congruent with what they’re talking about, it’s going to be a way easier feedback than if it’s something completely different. If they’re just sure that their kid’s defined or lazy, and we’re trying to say no, no, no. There really is going to have to be a big parenting shift here. That’s going to be helpful for how we frame our [00:11:00] feedback meeting. Or if parents are really stressed. I don’t want to hear ADHD. It’s not ADHD. Please stop telling me it’s ADHD. And then we’re like, oh my gosh, it’s ADHD. That’s going to give us a lot of information on how we’re going to frame that feedback meeting.
But we’re collaborating too, right? When we’re saying, well, what do you think? You’re the expert here. You’ve known Johnny for 10 years. What are your thoughts if you had to say what was going on? So then we’re individualizing this process and we’re really empowering parents because up until now, they might not feel empowered. Everybody else is telling them what’s going on. What’s wrong? And maybe they’ve seen it as well, but just no idea what to do, but we’re starting to make that shift. No, you really do know your kiddo here and we want to use your expertise. So, that’s going to be really important.
Also looking at the entire family. I do look at the parent’s well-being. I look at their skill set. I look at their confidence in their skills, what resources they have, how they’ve managed, especially [00:12:00] if there are behavioral difficulties, for example, how have you managed, what strategies have you used that’s applicable even for reading or writing difficulties? All of that’s really important to consider when we make our recommendations.
So if I have a parent who’s really struggling, I’m sure you’ve had the parents who’ve got every medical condition under the sun and they’re just not coping well. They’ve been on stress leave for the past 18 months. I’m not going to give them as many recommendations. I am only going to give them 1 or 2.
So, getting that understanding of what’s going on in the family context can help us frame those recommendations in the end. What’s going to be more valuable. And maybe it’s, these are now recommendations. These are in when you’re ready, when things settle down. When your health is back to normal, then maybe we can look at that. Because if we’re giving them things that they can’t even follow through on, or they’re not confident in doing, [00:13:00] that’s going to be really different. And maybe, this is going to be important. But instead of saying, you have to do this, maybe it’s educating them first. So our recommendations shift a little bit, or maybe I’m searching out more YouTube videos or some sort of resource to supplement what it is that they can do.
Dr. Sharp: Now, are you formally assessing parental stress level or confidence or personality, or are these more qualitative questions you might be asking or talking about in the intake?
Dr. Caroline: It really is more qualitative. I’m not formally assessing them. Oftentimes, they’re like, wow, I think I’ve got difficulties too. Let’s do an assessment, right? So that’s a whole different story, but it really is qualitative.
So yeah, I am looking at the best as we can within a semi-structured interview or unstructured interview, even when it comes to all these kinds of things, but we are [00:14:00] showing parents we care. We are showing parents we are looking at the big context because remember, one of their complaints is, you don’t understand my kid. You don’t understand my family and the context of this child. And so, it’s broadening that snapshot. I think that that’s really important. So, it’s more about bringing them along and them feeling empowered, heard, understood and supported at the end of the day.
Dr. Sharp: I like that.
Dr. Caroline: Yeah. I look at the siblings as well. That’s a huge piece of the puzzle as well because they’ve got their own needs and there are a huge dynamic within the family. So I also ask about how they’re doing. That gives us a lot to you. Oh my gosh, I’ve got two other kids with severe ADHD or whatever else. So that’s going to give us a lot of information on what can this family actually do when it comes to some of our recommendations.
So [00:15:00] that’s the intake piece where we’re really laying that groundwork. We’re really being supportive. We’re really giving parents that opportunity to tell their story because oftentimes they don’t. And it’s that genuine connection, which is important just from the beginning.
Once we get into the actual testing sessions, I do have a quick meeting before the assessment. So we’re going to prepare the kiddos. Even if I already had that consultation call with parents, getting kids prepared, they’re often really anxious as well, addressing any parent questions that have come up, and of course, asking how they slept. Did they eat breakfast? How eager were they coming? How did you feel about coming?
I always lighten the air. Almost every kid is just looking so apprehensive and I’m like, yeah, you’re so excited to see me this morning right away there. And even my teenagers who’ve got their baseball cap down over their eyes and their arms crossed across their chest [00:16:00] and slept down in their chair. I’m like, oh, wow, you’re so excited. It just lightens the air a little bit. But really checking in. I also ask, what are you missing that’s important today?
Dr. Sharp: Great question.
Dr. Caroline: Yeah, most of the time they say nothing, but right before the end of the school year, last year, I had a little girl, she was bawling. It was her first day of testing. I could tell she was bawling. She calmed down. And then I asked her that question. She started bawling again, and I’m like, “What’s going on?” And her mom’s like, “We didn’t realize they’re having their last day of school party.” And I’m like, “You are leaving right now. You’re going back to school.” And the little girl was like, “What?” And the mom was like, “What? I’ve waited months to see you.” I’m like, “I don’t care because if she is missing her last day, and with everything going on, with COVID, they’d already missed so much [00:17:00] school anyway, and you’re not going to see your friends, these are not going to be valid results. So you’re going to go back to school. You’re going to have your party and we’ll figure it out.” And again, this is maybe my bleeding heart that I did open up a weekend that we could get it done, but for me, I knew that the results just wouldn’t be valid
Dr. Sharp: For sure. Applause for the flexibility and being willing to meet the family where they’re at, talk about personal service. That’s pretty amazing.
Dr. Caroline: Yeah, well, they were also moving. And so we really only had one week to get it all done. I don’t always necessarily do that, but we got to watch out for our own selves as well. So I always ask, what are you missing? And it’s like, oh, I’m missing the gym or whatever it is. I think that that’s important for us to know.
On the second day of testing, I always do at least two days, [00:18:00] I will ask what were they like after the first day. Were they exhausted? Were they frustrated? Were they really apprehensive to come back? I think that that’s important information.
So, that’s kind of the debrief at the beginning, or not a debrief, but we’re taking them in just kind of chatting with how things are. But then afterwards, I save time at the end of the session to debrief with the kids and the parents. And I actually tell them what happened in the assessment.
So the feedback meeting for me is never a shock because I’m starting to think like, I am seeing some of the attention difficulties. If kids are there, I say it in friendly ways. Like, hey, remember when we were laughing because they’re like, what did you say? Totally looking around the room and had no idea what I was talking about. So, I’ll bring kids into that kind of conversation, but to also let parents know I am looking at attention.
I was talking to a kiddo the other day who really can’t read at all. And I’m like, oh man, you know [00:19:00] your sounds and you can map your letter sounds to the letters. No problem. But your memory, it’s like when you’re holding too much laundry, and your socks and your underwear falling, that’s kind of what’s happening. You know those letters and you know those sounds, dude, you’ve got a reading brain, but that memory can’t hold it all. And so that’s why when you try to sound out those words, you’ve got all the sounds. You just can’t remember the sounds to figure out what that word is.
So I’m already talking about what I’m seeing. And then I said, wow, you’ve got this amazing ability to figure out what that word was. Remember you were reading the dirt, blah, blah, blah. Oh, fly. No, it’s not dirt. It’s a bird. And I’m like, remember how you figured out those words? And then mom’s like, yeah, his tutor said he’s really good at using context to figure things out. So we’re already debriefing. And I’m already getting a little bit more information.
Mom never would have thought about saying, [00:20:00] oh, the tutor said he can use context to help them decode the words. But through this debrief, again, we’re being collaborative with parents. We’re getting more information that’s not only going to help our assessment, but it’s really helping them along that process as well. And so we’re already talking about, oh, that makes sense. That’s why I see this. For whatever reason, they can start putting puzzle pieces together about what they’re seeing in their kiddo’s situation and everyday life.
Dr. Sharp: Sure.
Dr. Caroline: Transparency. I already talked about that. Like, if I am thinking about autism, even though you’re bringing them in for anxiety, I’m going to start sharing that hypothesis. Have you ever thought about this? Have you ever noticed this? Maybe I might not use that word, but social difficulties and conversations. And I might start asking those questions. Sometimes they’ll say, yes, somebody said he’s autistic but I was like, whatever. [00:21:00] Just helping share those hypotheses can be really helpful right from the start.
Dr. Sharp: Right. So you’re doing that during the intake?
Dr. Caroline: This is during my assessment with the kiddos. When they’re coming back to pick up their kids, I usually leave 15 minutes where we can start debriefing things that I noticed right then and there. So then by the time we meet, parents already know what I’m going to say. This little debrief, they’re already starting to think, oh man, she did notice some of that awkwardness pieces or whatever else is going on. So they’re understanding that process. They already know what directions I’m going into. Now, they can start looking out for things too.
I’ll just say, pay attention. If Sally is trying to get your attention, just ignore her. Just not say anything and see what she does. See how she repairs that. I’ll start already giving them things to [00:22:00] start looking for.
Dr. Sharp: Okay. Nice.
Dr. Caroline: When we have parents do rating scales, giving them an opportunity to talk about it. I love the ease of the online ones where we can just email them the links, but I do like the paper ones so that they can write all over it. If I do see, oh, you said this kiddo likes to harm animals, I’m going to talk about that. And I keep bringing that up because that’s been one that has come up quite a bit in the research where parents will endorse those types of items, but then be like, well, no, no, no, it’s just because they love. It’s a cuteness aggressive disorder. They’re Lenny. They’re just hugging the cat too hard.
Dr. Sharp: That’s an aggressive disorder. That’s great.
Dr. Caroline: So it’s just that. They’re loving it too much. It’s not that they’re trying to torture it, right? In their parents’ heads, they’re thinking of something completely different. So they might endorse items. So I go through any of the [00:23:00] flakes, any of those critical items that I might be worried about and actually do a bit of a qualitative interview about that as well, because it’s not about the scores, it’s about the story about what’s going on for kiddos. So that’s really important as well.
Dr. Sharp: At what point are you doing this? I know I’m asking a lot of practical questions, but I think people probably have those questions too. Like, is this post-testing, pre feedback. And is it a phone call? Is it a separate meeting? How does this actually happen in real life?
Dr. Caroline: Most of the time, it’s another phone call or video session in between before I do the final feedback meeting. I actually do things a little bit differently. I actually see the kids first for the first testing session and then I do an intake meeting. And then I do another assessment.
Dr. Sharp: What’s the rationale there?
Dr. Caroline: It’s because I have way more questions once I know the kiddo. Always so many more [00:24:00] questions. I find that our biases can really start to set in when we already know what the referral question is. We’re going to be looking at this kiddo a little bit differently and I found it really valuable for me. It doesn’t always happen, but that’s how I generally like to set it up. We do informed consent, but I don’t do any of the intake things. Then I have way more questions. I’m not persuaded by anything that teachers have said or parents have said. I really don’t look at any of the paperwork or anything.
And then it’s in that intake interview where I will now go through some of those rating scales. Hey, you said that you saw these vocal tics, for example. Let’s talk about that a little bit more. So then I can really go through, obviously the background information and all of the story pieces, but then things that they’ve already endorsed on the rating scales.
If we run out of time, then it’s usually a follow-up or they didn’t [00:25:00] get the rating scales, then it’s usually, hey, just want to chat. I have a few more questions before our feedback meeting. That’s usually how I do that.
Dr. Sharp: Got you. Can I ask another, maybe dumb question as a follow-up?
Dr. Caroline: Sure. No dumb questions.
Dr. Sharp: How do you construct a test battery even just for a half a day before you have done an intake and presumably have information that might guide the choice of test battery?
Dr. Caroline: The first day, most of the time it’s some cognitive piece. I do cognitive tests. I can’t think of anything I wouldn’t do cognitive. Is there anything? I can’t think of anything that I wouldn’t do a cognitive for.
Sometimes I do have to, all of a sudden I realized, oh man, this kiddo doesn’t have any English. There are basic things that I do already because I already have conversations with [00:26:00] preparing parents. I do have a bit of a referral question for example, but sometimes I do change things on the fly once I start working with kiddos.
So I think that there is a lot of that flexibility that I have. I just have them right there on my shelf. I’m like, okay, we are discontinuing […] we’re pulling out the Ravens or whatever it is that’s going on, or we’re adding things. But as you’ll see, I do a lot of different types of testing when we get into more of the therapeutic type of things. I’ll talk a little bit about that, but generally, it’s the cognitive stuff.
Dr. Sharp: So, those more common measures that you would likely administer during any evaluation?
Dr. Caroline: Exactly. And a lot of the time they demand, depending on agencies and things like that, they just want to see a WISC for example, right? There are some places here that say we do not take a Stanford-Binet. We do not accept a WJ. We need an FSIQ score or whatever that is. So, it’s pretty standard here in terms of that. Everything else is [00:27:00] very different, but generally speaking, that’s…
Dr. Sharp: That’s great.
Dr. Caroline: Yeah, it makes it easy. And then I also look at the why behind different things. When we’re doing… Well, even just the gentleman that I was doing an autism assessment for, I actually had him do the rating scales right there with me. He is quite complex and he’s endorsing things. And I see this even to my teen girls who are gifted and ADHD and now they’re wondering about autism, for example, because there is so much overlap. I start to ask the why.
You’re rigid. Let’s look at why you might be rigid. Is it because you’re governed by rule-bound behavior or is it that you have to have your things in this exact order because you’re totally going to forget where you put them? So there might be a different function to the behavior.
I had one kiddo, and this really hit home when I was much younger early in my practice, where he [00:28:00] had trouble with visual modulation. I didn’t even know that that was a thing, and we didn’t know about it. So, we’re trying to bust up all these rigidities that this kiddo had. And one of his biggest rigidities was he had to have on his bookshelf, his books and games in the exact same order, every single time. And he’d freak out if one wasn’t in the right place.
So we’re busting things up, we’re mixing up a shelf and we’re practicing relaxation strategies, frustration tolerance, and all this stuff but we were causing him more distress. And we found out it wasn’t a rigidity problem at all. He literally could not tell one book from another. And so he just learned, if I want that game, it’s the 5th game because he couldn’t tell. He’s the only kid since then that I had these visual modulation difficulties, but just looking at the function of Y.
One of the things we ask parents is, if you walk into a room and say [00:29:00] the kiddo’s name, will he look up at you? Will he acknowledge you? Well, just because he doesn’t, it doesn’t mean it’s autism. If it’s a kid with ADHD playing video, well,any kid playing a video game really at the end of the day, but why is that? So it’s looking at the context. We can’t just take scores of rating scales at face value. So it’s just doing a little bit more digging in. And parents now know, oh, you didn’t just base it on a rating scale. You’re actually digging deeper. So we’re bringing parents along and they’re having more faith in the work that we’re doing.
And I think it depends too at what we’re looking at, but I do know that almost all my ADHD kids score high on the autism scales. And so, it might look the same, but the reasons might be really different. Yeah, it is time-consuming when we do this. And I know that that’s probably what a lot of people are thinking, just all these extra calls and these extra questions, but we get so much more information.
At the [00:30:00] end of the day, if we’ve got happy parents, from a business perspective, we’re going to get more referrals too. And so, we can look at it that way, but really it’s about, we do this work because we want to help the families. We are going to most help these kids that we work with or the individuals that we work with when the parents are feeling confident in the work that we did, and that we did a comprehensive job.
Oftentimes, right then and there, I will just do extended inquiries. So that’s why I like having them in the moment do rating scales with me just because right then and there, I can start asking them questions. I’ve already talked a little bit about that, but I think that that’s important that we’re doing this to get good information and parents are seeing that we’re being comprehensive. We’re not just focusing on test scores. We’re really trying to understand their child.
If there’s an opportunity for [00:31:00] parents to observe, that can be really helpful too. They can take this role of co-assessor where they’re providing observations. They can provide interpretations of what’s going on especially in some of the more social, emotional types of assessments. I just did an ADOS the other day, actually not my favorite.
Dr. Sharp: I know the conversation.
Dr. Caroline: I was just kidding. Yeah, I know the conversation. But I was doing an ADOS just because that’s what the pediatrician wanted me to do, but it was interesting. The dad at the end was like, “Wow, that was so incredible to see. I didn’t realize how deficited my kid was” because he has his older kiddo, an adolescent functioning fantastically, but we see how much we compensate for him.
I left things hanging. I left things so awkward. The dad was shifting in his seat. It was so awkward. And I had debriefed him at the beginning. Do not say anything. I’m going to look like I’m mean. I’m going to [00:32:00] ignore him. I’m going to be doing these things. But it was so awkward. And so, then it can be really helpful, but that opportunity for parents to see what’s going on can give us a lot of information and it helps them understand the child.
I used to have, when I did more early intervention stuff and did just assessments for funding for kiddos with autism, I’d have aides sit in the room, especially if there were huge behaviors or I didn’t really know the kid. And I always checked in with them afterward. So how do you think the kiddo did? They’re like, well, if you had phrased it this way, for example, they probably would have understood it. So just understanding. So it can give us more information that way.
I do a lot of that, anyway. That was in my early years where I just found it so valuable when you had people who knew these kids. Oh, they per separate on Thomas the train. And you mentioned Thomas and now that’s all they can think about. So [00:33:00] every question was something around Thomas the Train or whatever it is. It just gives us a lot of information.
So giving them that space to share their story, to share their experiences, making that time throughout the assessment can go such a long way. And it doesn’t have to, I know in our minds it’s like, oh my gosh, it’s such a long process. Just give them an extra five minutes. It doesn’t have to be a long time. They’re just feeling like they’re part of that.
So we’re just moving beyond that standard battery. We’re engaging the child. We’re or engaging the family so we can understand that child as best as we can in different contexts, maybe get a better understanding of them. There’s lots of different things that we could be doing.
So that brings me to dynamic testing. I do lots of things within the testing itself with kids. I’m always asking them what their experience was like especially if I [00:34:00] start to see them shifting or losing focus or getting frustrated, what was easy? What was hard? What didn’t you like about that? What didn’t you like? Having them really reflect on their responses.
Just the other day I was doing the CBLT and the kiddo who I was working with, the third trial of the verbal learning and they’re like, ah! And their hands go up and they’re just like, ah. I just continued on and then afterwards I’m like, okay, around the third trial, you went ah, what was that about? Because is it boring? Is it their brains getting tired? What is it? And they’re like, “Yeah, man, I’ve already heard it three times. Why do I have to hear it again?” That’s going to be really helpful.
And then there was a little bit of anger. So this is a kiddo. Now, I’m wondering, are there autism spectrum things going on because I hate it when people repeat themselves. There was also a little bit of anger there. So it’s really interesting. Whereas other kids you can see they’re just getting tired. They can’t hold all that information. So just getting their [00:35:00] experiences.
If there is a kid with ADHD, how has your attention on this? Or what kind of tasks was it easier to focus on? What was harder and how does that compare to in the classroom or at your hockey lesson or whatever it is. So I’m asking them what their experiences are like. So that can give us a lot of information too.
Of course, we all know about limit testing. I do a lot of dynamic testing and trying out different interventions, dynamic interviews. So when I’m working with kiddos, if writing’s really hard and they’re getting defeated, they’ll have a little bit of an interview. Who’s a good writer? Who do you know that’s a good writer in your class? What makes them a good writer? What is it that you think that they do and how do you know that they’re a good writer? So looking at all of those kinds of things can be really helpful.
And then just doing, if I’m looking at, I might redo a subtest and then I might [00:36:00] give some prompting. I might repeat instructions. I might rephrase instructions. Does that all help? Figure weights is a great example of one where I’ll go through standardized testing. That’s the score I’m going to report, but then I’ll go back and be like, hey, remember, and color and shape matters, dude. And especially when you’ve got kiddos, I keep going to ADHD, but maybe they can’t pay attention to too many details or they’re using the wrong information to solve problems.
We know that kids with ADHD lack frameworks. So what if we give them that framework? What if we help them figure out what’s the information I need to figure out to be able to problem solve effectively? And then we can say once we gave them this framework, or once we gave them that clarification or directed their attention to what it was they needed to pay attention to in the first place, because half the time that’s the problem, they had no problem. [00:37:00] And then maybe I will report that when we gave the framework, look at how much more of their score improved. So now that’s feeding into our interventions as well and our recommendations, right?
So we can start integrating these intervention breaks into the standardized tests that we’re doing so we can see what is actually helpful. Is it just a rephrase? Is that all it is that they need or is it helpful for them to remember? There are two things you need to look at here. Matrix reasoning is another one. It might just be color, but it might be color and direction, right? So there are two pieces of information you need to look at.
So looking at what supports or prompts or feedback or questions, all of those things, then we know for sure, that’s actually going to help this kiddo if they’re really nervous, right? They’re really nervous. You can tell. Block design. It’s one of the first things that we do. Their heads are trembling. Let’s do it. Let’s get our score. Now we’re going to go do [00:38:00] some shake off the stress, or we’re going to do some reframing or relaxation. And now we’re going to come back and test the limits and see what happens. So those are going to directly inform some of our recommendations.
Dr. Sharp: This is great.
Dr. Caroline: Yeah, hopefully. Just jump in. I know I talk a lot.
One thing too that I tell kids, I always say that we’re detectives. I know Loki is super big. Not all kids know Loki, but I often introduce Loki. I talk about how our Loki brain likes to cause problems and might like us to think things are too hard or it’s too boring or whatever.
So we’re going to play detectives and we’re going to figure out Loki and his henchmen. And then I’ll talk about different henchmen that get in the way of our learning. So there could be the attention robbers. There could be brain eaters. There could be the letter mixer, upper, or whatever name. You figure out what’s going on for the kiddo and you can kind of come up with all these [00:39:00] henchmen. So then in the testing, they can be like, oh my gosh, the brain eater just showed up.
And I do that with my teenagers too. They kind of get a kick out of it. And we’ll talk about time robbers when they’re studying. TikTok is a huge time robber for me, for example, or whatever. But then they can start sharing their experiences and not get frustrated. They’re not beating themselves up. They can start actually articulating. That was really hard. My brain started to shut off. And if they can’t come up with it in the moment, they can start looking for it, and this is why I like having it over more than one session too.
It’s okay. Through the next week, before I see you again, look for when those henchmen show up. And then they come back and report on it. They don’t always, but they can start reflecting on some of their experiences. And those are experiences we might not get to just based on our standardized scores. I think that that’s really important. So just looking at that.
I also will go back. Hey, [00:40:00] on this one, how come you answered that the way you did? How did you figure that one out? And I don’t tell them if they’re right or wrong. I just want to know how you figured it out. So it can be really… like on picture concepts, it might look like they’re really concrete in their thinking, but are they? And oftentimes you can go back.
My gifted kids, man, they’ll do terrible. They’ll have a scale score of 5, but then when you go back and get their reasoning, it’s like, wow, that was phenomenal. I wouldn’t have never thought of those relationships between those things. So it can be really interesting to go back or it really is because they were all yellow or whatever else.
Sometimes I’ll use tests and novel ways too. These are some of those intervention breaks. Therapeutic assessment can look really daunting when you look at the literature and they’re 3 to 6 months long. It’s not the same kind of testing that we do, but we can do little breaks and we can do things in [00:41:00] novel ways. So maybe it’s, now that you’ve done this task, I want you to explain it to me like you’re a teacher and I want you to talk through it to me. Or like I said, giving them those different frameworks.
If there are behavioral concerns, I’ll bring parents in, and maybe we’ll do some activities together. This is again, after all the standardized testing is done, but see how they interact. So are there things in my recommendations that I can give to parents? Hey, I noticed this.
Actually, I had one kiddo who has accidents still quite a bit during the day. He’s older. He’s 10. And it’s quite embarrassing, but some of the research talks about kiddos who lack this internal sense, their awareness of their body when they’re not feeling heard. And so there’s a correlation between that. And so I had parents come in because that was one of the pieces. They were [00:42:00] wondering about ADHD. They were wondering about learning disabilities, but that was a piece too. And so I had them come in and I had them look at a picture and they had to problem solve through this picture. What was going on and how they could… like what just happened right before, and then what happened as the picture was taken and what can they do to resolve the information?
And the kiddo started giving his story and the dad’s like, “Really? That’s what you think is happening here?” And the kid’s like, “Yeah.” And then the dad was great after that. He was like, okay, let’s see. What do you think? Oh yeah, that’s a great idea. And then he was super engaged with the kiddo, but that first really that’s what you think. And so then afterwards, I asked the kiddo, and I was praising dad for everything that he did right.
And then I say, just at the beginning there, I noticed you tried to correct him. He’s like, “What? I didn’t correct him.” I’m like, no, but you questioned his interpretation of the picture. So then I turned to the kiddo and I’m like, does [00:43:00] dad correct you a lot? And he’s like, “Yeah, all the time.” And the dad’s like what? And he is. And I joked with that a few times because he is mean-looking. He’s law enforcement and so he just comes across rough and gruff and he’s like, I had no idea.
And so just that awareness of, wow, I really had no idea. And I know it’s not therapy that we’re doing, but these little pieces can make all the difference in the world just by shifting their awareness. So, it’s just looking at how can we bring in the whole family here? What’s the bigger picture really at the end of the day? And then dad left feeling like, “Wow.” It’s just one little thing. It took three minutes from beginning to end. It didn’t take any extra time, but dad was feeling almost refreshed, rejuvenated. He had a lot of energy after that.[00:44:00] Dr. Sharp: Let’s take a quick break to hear from our featured partner.
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All right, let’s get back to the podcast.
Dr. Caroline: Diagnosis. So before I talk about it, this is a [00:45:00] life-altering event for a lot of parents. Of course, there’s context and information that we need to think about. So there are considerations like having a face-to-face conversation, not doing it over the telephone, being in a private location because some of the stories were about in a hallway or in a classroom with just a divider and the sheep on the other side could hear. So just being aware of those little contextual pieces can be really helpful.
How we communicate the results though is really important. And there are a few key pieces here. So the first thing to consider is our way of being, and I talked a little bit about that. So our way of being a professional. Are we helping parents feel supported? Are they feeling respected and heard and informed, or are they still feeling confused or angry, or stressed out? So making sure we have that compassion, that sensitivity. Putting ourselves in their shoes, especially at this point in the assessment when they’re learning about their kiddos [00:46:00] difficulties. Even if they already are aware, it’s still hard to hear it in actuality.
So addressing any worries parents might have before jumping into the results, that can really help minimize. Like I said, I always say, what do you want to hear? What don’t you want to hear? What are you worried about hearing? All sorts of things. So right away, it already lightens the mood. They laugh at that, but it really is addressing that I get that this is really anxiety-provoking for you.
Dr. Sharp: You’re seeing them. You’re validating it without them having to ask for it.
Dr. Caroline: Yeah, exactly. Which is so important. And just by doing that, they’re going to be able to attend better. They’re going to be able to understand and accept the results better.
We still want to be hopeful. I know we talked about the strengths-based approach before and we don’t want to go overboard where it’s like, yeah, yeah. But okay, just give it to me. But we still want to maintain [00:47:00] that hopeful side of things.
I always say, congratulations when I’m talking about autism or ADHD, but even if I’m not saying, congratulations, your kid has got dyslexia. I’m still being hopeful because we do know lots of successful people, right? It’s not an end-all be-all. And I think most parents take these diagnoses as a death sentence. And so, just the language that we share with them is going to really affect how they perceive what’s going on for their kiddo.
I had to have one feedback via video while I was at my cabin. And usually, I make sure my kids are gone, but they happen to come in for a second right before I was giving the diagnosis to a family. And unfortunately, it’s just all open so they could hear. And afterward, they immediately left, but there was a moment they [00:48:00] heard the mom crying and they’re like, was that mom crying? I heard you say ADHD, and then the mom was crying. And they’re like, why. ADHD is awesome.
We have a family with ADHD. I always talk about how it’s awesome and they just couldn’t get their head wrapped around it. So, how we think of it greatly affects our kids. Obviously, I talk about ADHD being a superpower at my house. So my kids see it as that. They don’t see it as a disability.
And so, the words we use are really influential. Even just in the report, I would say, kiddo had tremendous difficulty with something. That tremendous is going to be really hard for parents. And it doesn’t matter how empathetic we are. So we got to look at the language that we’re using. But again, it’s that balance because we do need to be direct, especially when we’re talking about the areas of challenge and what the implications of all of that kind of stuff are. So, I think that [00:49:00] it’s finding that balance between.
Dr. Sharp: So in a case like that, would you just drop the tremendous and say something like, this task was really hard or so-and-so struggled?
Dr. Caroline: Yeah, I do. I’ve stopped using those big words anymore even though it might be true. I still use it though, because parents still laugh at this. With the Digit Span, for example, I’ll use his performance plummeted. Digit Span is a good example where I still might use a word like that.
So great when they take it in and simply have to repeat it back. They can do that. Johnny go do X, Y, Z. But as soon as they have to do anything with that information, they turn to go do X, Y, and Z, it’s gone. They can’t remember it. Then parents see that and they can see it in their everyday life. And then it’s just a moment of lightness. So I’ll say, it’s how I say the word plummeted, [00:50:00] and then we can have a little laugh at that. So it’s just understanding the family and things like that. But yeah, I just say that was hard.
Dr. Sharp: Sure.
Dr. Caroline: One of the things that I often do too, is I ask them about their worries, of course, but I get them to start answering their assessment questions themselves because then they’re getting out of their worrying brain in that anticipation of what I’m going to say, and we’re getting into their thinking brains. So now we’re going to get them engaged. So they can answer those questions or even if I’m going to look at something like reading, I’m giving the feedback on reading, I’ll tell them, say, Hey, I look to these three areas of reading and I’ll explain each three areas and then I’ll ask them, how do you think they did? What do you think out of those three areas was easier or harder for them? And then I can really gauge the conversation based on how they respond.
Predictions are [00:51:00] really important. And that’s why I do this. We know that making predictions, and this is entrenched in the research, keeps us engaged because we want to know if our prediction is right. Our brain is motivated when we’re right because then we’re like, yes, I got it. Nailed it. And then we can praise parents. Wow, you’ve got really good intuition. You really know your child. So now we’re empowering parents because yeah, you got it. You’re bang on.
But then if they’re wrong, we want to learn more about why we’re wrong. Oh, I totally thought it was decoding that was wrong. Now I want to hear more because if it’s not decoding, let me know. Now they’re engaged and they’re not worried about a label that we might give them. So that’s one way I kind of get around that. And especially when it’s an important topic like this, we’re just kind of engaging their brain.
So I think that that’s really important because, at the end of the day, the most important goal for our feedback meeting is to empower [00:52:00] parents. That’s what we want to do. That’s our goal. So yes, understanding their kids is important; knowing exactly what’s going on and everything else.
So to really empower parents, the information they receive, everything that we’ve talked about in all of our training and every professional training development, we always know that all the information has to be memorable, has to be understandable, and useful, of course. So we can arrange our sessions in response to parents’ questions. We’re getting them to answer those questions. Hopefully, they’re already involved throughout the process, so they can actually answer those questions pretty bang on because we’ve already talked about it.
Now we’re just digging deeper and now we can talk about it. Yeah, you are right. They really do have these reading difficulties. So let’s talk about the implications of that. So the feedback meeting isn’t really a feedback meeting so much as we’re going to dig deeper here and we’re going to talk about, we can spend more time on what we’re going to [00:53:00] do about it. So I think that that can be really helpful.
The results section when we’re doing the feedback meeting should really just be about how we initiate this dialogue about how the scores actually contribute to their everyday situations. So now, we’re doing this in-depth co-investigation of what’s happening.
It’s not me saying he was 50 percentile on this, and he was 25th percentile on this, but only 5th percentile on this, and therefore, he’s got dyslexia. It’s not about that. It’s together. We’re looking at, this is what I noticed was hard. What do you notice at home? How does that fit with what you know? Does that fit with your hypothesis? So then they can start reflecting on what we have to say. Does that fit with what’s going on for their child? Because that’s going to be really important.
Now, I know you asked before about the whole [00:54:00] average, do parents really want to know that or not? We can educate parents about what normal expectations are for our kiddo’s development and where their kiddo fits, but they really don’t care about that normative data at the end of the day. And it’s not just anecdotal. We do see that in the research. They want to see how it connects with everyday life. That’s what they want to see.
Dr. Sharp: Right. Like, how do these numbers explain what I’m seeing with my kid?
Dr. Caroline: Yeah. So how does it fit their child? We also want to respect their expertise too. That’s why we’re reflecting on the results and how they can connect it to real-life examples, because then that’s giving us, oh, you’re really struggling here. I’m going to make sure my recommendations talk around that area that you’re struggling with. So that’s helpful.
I had a little girl. Oh, it was so heartbreaking. She’s just beautiful; [00:55:00] blonde hair, blue eyes. Her FSIQ was in the 50s and her parents don’t see that. I had to talk about compared to other kids her age where that fits into, but what was most helpful was talking about the future and the vulnerability.
One of the examples that I often give parents is, I had worked with a teenager, talking to him I would have had no idea had I not done the cognitive testing. I really wouldn’t have had any idea how low he was cognitively because he seemed like a normal teenager. But his decisions, he had gone to a party the weekend before I saw him and he got picked up for DUI and he’s like, “Caroline, I don’t get it because, after every beer, I drank a glass of water.” So he thought he was neutralizing the alcohol with every glass of water.
And so I shared that example and they’re like, oh my gosh, Caroline, our little [00:56:00] girl, she knows she’s not supposed to go past the yellow house. But one day dad went for a walk with the dog and was like six blocks away and saw her riding her bike with a little boy who’s like, just follow me. It’s a vulnerability piece. And that’s where the pieces all came together because even teachers were questioning, no, no, it can’t be a cognitive disability. She’s so sweet. And that’s the problem. She’s so sweet. And she’s so beautiful. And she’s so funny and so engaging, but you’ve got a kiddo who’s 9 or 10 years old who will come and sit in your lap without having ever met you before and give you hugs and say she loves you.
I think that vulnerability piece for them connects to a real-life example of, oh my gosh. They didn’t think of it as a big deal, but they started to realize the implications going into the future. So that’s [00:57:00] really what we need to do is how it applies to their kiddo, their family situation, their everyday routines, and then we can look at those recommendations.
So a huge recommendation for me really was about your circle of intimacy. We’re going to focus on that circle of intimacy. That’s our focus. I don’t care about reading. I know you do, but then parents really in the bigger picture, they didn’t care so much about, she’s still reading not even kindergarten level books, it’s man, what are the bigger implications?
So we’re giving them very specific information about what’s going on positively as well, right? How is your kiddo thriving? Where do they do their best? And then going into some of those difficulties and can we use some of their interests and strengths in these other areas? That’s going to be important. Really clear, relevant information about those difficulties. And that was just a great example of how they understood the diagnosis of the cognitive disability, the day-to-day functioning, and what the future could look like for them. [00:58:00] That’s a huge piece for parents.
Are they going to outgrow it? Will they always need medications? Will they be able to go to college? We don’t always know what that’s going to look like. For this little girl, well, I had another teenage girl similar profile, and she’s going to college near us. It was like a wilderness adventure kind of thing. So no, she’s not going to med school. So I give examples. We really don’t know.
When I did early intervention with kiddos with autism, you really don’t know what they’re going to look like as adults. We do know we need to start working on daily life skills a lot earlier for them. They’re going to be doing things at a much younger age because they need that repetition or whatever, but that’s a big stressor for parents too. They just want to know about the future.
Dr. Sharp: I know. Those are the hardest questions to answer sometimes. It’s hard to disappoint parents or at least leave them hanging in my experience.[00:59:00] I interviewed Karen Postal a long time ago around her Feedback that Sticks book. And I think she was the one that said she’ll do a best-case and a worst-case scenario. And then say, it’s probably going to end up somewhere in the middle, but it’ll at least give you the extreme so you can start to wrap your mind around this.
Dr. Caroline: Right. And I hate to be the Debbie Downer Because we actually have…
I know a woman who was the chair of her department with a Ph.D. who was identified back then it was mental retardation and she was in special Ed classes, pretty much all of elementary. And she was reassessed in middle school and they were like, no, actually she’s quite bright. It’s so scary. And so there are those stories too where it’s just like, what happened? I actually see that all the time where you’ve got a kid with severe ADHD and ESL and [01:00:00] they’re misdiagnosed. But I didn’t tell those stories about this little girl because it really was a different kind of story, but there’s always those comparisons. It’s scary.
So always thinking, what am I telling them about their kiddo? What is their kiddo going through? What are their kiddo’s experiences? What are your experiences as a parent? Why might your child be behaving this way? They aren’t brats. They aren’t lazy. What’s going on for them?
I do a few exercises and I like to show this picture. I don’t know. Do you want me to show it to you and I can send you the link or should I just talk about it?
Dr. Sharp: Yeah, let’s see. I’d love to see it. Let’s do that.
Dr. Caroline: Okay, I’ll see if I can share my screen.
Dr. Sharp: Got it.
Dr. Caroline: So what’s in this [01:01:00] picture? Have you seen this picture before?
Dr. Sharp: No.
Dr. Caroline: Okay. Oh, I guess I can. Okay, you can now see. What’s in this picture?
Dr. Sharp: Okay. This is interesting. I’m just going to describe it for the listeners. It’s a black and white picture with what looks like ink or sand on it strewn around it. I don’t see anything discernible here. Maybe it’s a map. I don’t know. It looks like a map of parts of Europe or something.
Dr. Caroline: Come on, Jeremy, you’re not trying hard enough. Come on.
Dr. Sharp: I don’t like being put on the spot. Yeah, I really don’t know this. That’s the best I can do. Maybe it’s a microscopic view of something.
Dr. Caroline: So maybe you’re not lazy. Maybe you’re not motivated enough. I’ll give you $100. Tell me what’s in this picture.
Dr. Sharp: Let’s see. It’s a rabbit leaping over a dandelion.
Dr. Caroline: Okay. Now, you’re just being a class clown. Go to the [01:02:00] principal’s office. I’ll show you. Where’s my draw? Okay. I can’t go on my drawer, but it’s a, it’s a cow. And I can send this so that people can actually see what it is. Here’s the top of its head. Here’s one ear. Here’s its face. There’s a size. And then the body is out over here. Normally, I would draw it out for you.
Dr. Sharp: Sure.
Dr. Caroline: So I will often give that to parents, and do that. And I’ll actually be really neat. Like, come on, come on. You’re not like, come on, look at it. You’re not trying. Why are you being so defiant? But the problem is with that, they can’t perceive it. The kiddos can’t perceive it. They can see it and we can motivate them, but they can’t bring meaning to it just like you couldn’t bring meaning to it. Kids need a teacher. We need to give them [01:03:00] direct instruction. We can’t just leave them on their own to themselves to figure it out, and then they’re going to feel defeated. Why can’t I do this? I’m the only one who can’t get it.
So, in the feedback meetings, depending on what’s going on for kiddos, I’ll give them different exercises or I’ll give them pictures like that. I have another one where from a distance, it looks like a skull and I’ll have parents to give me a title of this story. And there’s something about a skull and then I’ll yell at them. How dare you talk about a skull. I’m trying to show you this beautiful Victorian picture. And then you see it up close and it’s a woman in a mirror putting on her makeup.
And so it’s just helping parents understand what’s going on for their kiddo and what their kid is experiencing. So if there is pushback every time they’re doing writing or there’s this defiance or anything, how can I as a parent respond in helpful ways? How can I create the right environment?
And so I do experiential things like that with them right in the feedback [01:04:00] session as it pertains to their kiddos. I’ll give them a mirror and I’ll have them. So all they can see, they have to use their non-dominant hand looking at the mirror, trying to write their name or something like that. Look at how effortful that was for you. Now you’ve got a kiddo with severe fine motor difficulties who has to actually think about just how to form their letter, forget about spelling, forget about everything else.
So it’s just that aha, where parents are like, wow, I didn’t even realize. I just always thought the fight, the fight, the fight, whenever we were doing this. So doing those experiential things can be really valuable for parents and checking in. And sometimes I won’t even explain it. I’ll be like, why do you think I showed you that picture? Sometimes they’ll think about it. I mean, some things are very obvious and then they can start reflecting back right on what that means for their own kiddo.
So it’s really going beyond just [01:05:00] sharing the results. It’s sharing it in a way that makes sense that they’re getting to hear it. They’re going to take it in and take it to heart. And we’re really inviting them to be co-meaning makers of this information and what that means for them and for their kiddo too.
So it’s looking at now, they understand their child’s needs and how much of a struggle it is. They’re going to feel empowered and that’s our goal, to make sure that they’re feeling empowered. So what it is they can do to just respond differently. That can be really helpful. Advocating for parents, that’s another big one where they’re feeling at the end. I don’t know what to do. How can we advocate for them? How can we connect them to appropriate resources? Ultimately we want to coach them on how to be good advocates themselves, right? How you can go advocate to the school and with the teacher, with these learning supports or whatever it is.
So looking at, what do we need to do to help parents be successful? And if we did that little [01:06:00] bit of qualitative information gathering at the beginning, we now have a bit of an understanding of what their dashboard for success looks like. Maybe they do need a little bit more holding and we will help them through that process. Or it says, here you go. Here’s the checklist. And off you go, right. Or what could be getting in the way of their success? That’s what we need to do.
A few more things. Are you still good to hear a little bit more?
Dr. Sharp: Yeah, I think we’re good. I’m particularly curious about this process after the feedback session and how we support parents and not just leave them hanging. You mentioned that a while back. I wonder if we could chat about that if that fits in your…
Dr. Caroline: For sure. So again, they’re not coming for labels. That’s a good segue. I like to think of the assessment as a comma. It’s not a period, right? It’s the beginning of a new journey for them.
The reason they came was for a [01:07:00] roadmap. So we are creating that game plan and the next step. So a huge piece of it really is in that feedback meeting. Well, ideally you want a second feedback meeting. And that’s where we’re going to deep dive. And together, we’re going to go through some of those recommendations.
Is this feasible? We are checking in with them. And so helping them along the way. And where do I come in? And do you want me to talk to the school and give that feedback or the IPP? So we are doing that together. I think that that’s really important in terms of how do we translate this into something that’s going to be helpful for you and just going through what’s not important necessarily, or what do you need to learn? Ideally, I would love for you to be doing this, but what is it that you need to do to learn or to support this?
So it’s a second feedback meeting where we can really go into making sure that those interventions and the next steps make sense and that they’re doable, and the parents are actually feeling motivated and confident that they could do it because there is some grief here and we don’t want [01:08:00] them to feel stuck in that grief and then feeling that they’re abandoned because that’s not going to be helpful.
So having that follow-up feedback session is really helpful. That’s where we dig deep into the recommendations and maybe clarify any questions they had because now they’ve had a chance to read the report. I also ask, what did you learn from this assessment about your kiddo? So looking at all of those things can be really important.
But then after that, every family is going to be a little bit different. Not to say that we have to have 50 million different pathways for every family, but you’re creating a library of resources. So you got a diagnosis of Mixed Dyslexia. Here’s a packet. Start here. It talks about what Mixed Dyslexia is. It talks about some of the things that you could be doing. These are some local resources, national resources, or whatever it is that you could start looking at.
So we curate a lot of those. [01:09:00] So just a little resource package. Maybe there are other people. This is the kind of intervention program that’s going to be really helpful for your kiddo. Here are people in the city who do that kind of intervention, for example. So if we can give them really easy, next steps, that’s so valuable.
Maybe you have a clinician in your office who could then take on some of that. Maybe there’s anxiety and you’ve got someone who does counseling around anxiety. Maybe you have an executive functioning coach that kiddo can develop some strategies around that. So maybe there are things in-house that you can do, but if not, where things that they can do or go to and what resources they can have afterward, that’s huge.
At the end of the day, that’s about what we can do. We do need to be careful about dual roles. Being assessor and then interventionist and all of those [01:10:00] kinds of things, but it’s really laying out those next steps. And I often tell parents too, I think even just the reassurance of knowing, in a few weeks, once you’ve had it, let me know if you’ve got questions. But you know what, you can let me know next year when you’re creating the IPP or next year when your kid has got an exam, you’re like, ah, Caroline, we didn’t even think about this, but we have no study strategies, help. You can call me and let me know because these recommendations are based on this assessment right now. But next year or in two years, well, they might be needing a reassessment anyway, you can call me back and we can look at those strategies.
And I think that alone can make all the difference in the world for parents because they’re not feeling like they’re abandoned. They can’t call you back.
Dr. Sharp: Yes. That’s so crucial. I always try to impress that upon parents. I am available anytime. It could be six years from now. It could be six months from now. It could be six days from now.
Dr. Caroline: Exactly. [01:11:00] Our relationship is one of the strongest variables to their experiences with the assessment process. And it’s directly correlated with their involvement with their kiddo’s intervention in the future. So whether they take up treatment or intervention or tutoring or whatever else, our relationship directly affects that. So when we have a strong relationship, that’s really…
Everything that I’ve talked about is about building that relationship. Yes, it’s about getting more detailed information, which is also helpful and all of those kinds of things, but we’re promoting that relationship. And parents will say, and this is in the research, they’ll say, just talk to me like a person. Talk to me like a friend who’s genuinely interested. You really want to know about me. You really want to know about my kiddo. You’re not just some stuffy clinician.
And so that approachability, that openness, easygoing-ness, that’s all really important. And even little things like eye contact. Are you stuck on your clipboard madly taking notes or are you actually looking and engaging with families because [01:12:00] that is a piece? They pick up on that.
Dr. Sharp: Sure. That’s huge.
Dr. Caroline: Yeah, so just looking at those little things like what can we do to enhance their experiences and really validate where they’re going with everything. And of course, looking at their expertise because that’s going to help with the empowerment piece. That’s going to help build the relationships.
So if we can engage in collaborative problem solving just like we would do with a kiddo if we’ve got behavioral problems or whatever, let’s come up with as many ideas for difficulties. So what are some of the things that you’re really struggling with? And so those were some of those questions at the beginning that I asked, remember.
How will you know this assessment was helpful? Oh, well, I will know because of these situations. Okay, let’s go back to those situations. What are the things you’ve tried, haven’t tried, let’s look at all of our ideas. Let’s do some problem, solving here. Let’s make a plan and then go put it into practice, evaluate it, come back and let’s [01:13:00] let me know how it goes. And then we can update from there. So now we’re teaching them skills that we want them to do anyway. So it’s just looking at that piece.
Right from the start, there’s that collaboration. And from all of the research that I had done, I did develop this parent input form. It’s tricky because it’s another form. It’s one more thing for us to do, but just helps gather some of that information that we know is most important to parents. And I’ve got a link for that for you if people want to look at it, then you can modify it however you think, but those are the most important pieces that are identified in the research that are important for parents. It’s just looking at all of these little pieces.
The only other thing, I know we talk about the reports a lot. We don’t necessarily need to go too much into this, but the recommendations for the report, it’s still important to bring up again because I think us hearing the same messages over and over is really [01:14:00] helpful. So, of course, readability is important. Short sentences, no jargon, simplifying vocabulary, only short paragraphs, plain language, all of those things can be really important.
I break it down into concrete examples of everyday functioning. I don’t say visual, spatial processing, blah, blah. I’m like, this skill is going to be important for your kid to pack a suitcase or to read a map. That’s how I break it down in the report. That’s how I talk about it.
I really don’t like bullets. I do see reports with bullets, but if you do have parents who maybe their language or their literacy skills are limited, then a simplified bulleted summary can be helpful. I do pictorials, especially if I think parents might be low cognitive. I actually use pictures and talk about things in that way.
Definitely, next steps, we already talked about that and specific behavior [01:15:00] management strategies. Where do you need follow-up support, what kind of support, funding. Here in Canada, we’ve got disability tax credits, I don’t know what you guys have, but do we think that they can qualify? You know what, we can do those forms for you? This is what that looks like. So we’re really giving those next steps.
The only last thing I really wanted to talk about was thinking about our values and our purpose. And I know that that’s a big piece in the counseling psychology world. We’re always thinking about our values, but it really applies here too, even in our report writing. My value and mission in the work that I do is to inspire and empower families. And really at the end of the day, it’s to promote the resilience and growth of kiddos. That’s also therefore the purpose of my reports.
And so if I always remember, that’s my mission in all of the work even my reports, how do I empower family? So it has to make sense. It has to help them understand [01:16:00] their kiddo. They have to know exactly what they need to do next. They need to be hopeful and inspired.
It’s one thing to know what’s going on for my kiddo and what I need to do next, but if there’s no hope for the future, that’s going to be pretty defeating for them as well. So when we look at the report, how do you do whatever is important for you and how you want to be most helpful is going to be really important because this really should be a manual for their kiddo.
We get a manual for everything in life. And the most complex things in our life are our kids, and we have nothing. Even dogs, I’ve got 2 dogs. You’ve probably heard them shift here, but they […] too, right? Like it’s really easy for, it’s not quite the same, but there are trainers and there are black and white steps. This is what you need to do if you’ve got this problem. Kids are a whole other game. So this is the beginning manual. And we don’t want it to go in the garbage or the shredder.
Dr. Sharp: [01:17:00] Yes, such a good point. I like what you just said about living the values of your practice through the report and the other parts of the assessment process. I talk about values a lot in the context of business and employees and things like that, but it is equally applicable on the clinical side. You’ve got to bring those values to life in the work that you do as well.
Dr. Caroline: Yeah, exactly. And it’s just bringing it down. I often talk about myself as this big blonde baboon, because I was just on a panel with a bunch of other professionals for experts around COVID the other day. And I was the one who was like, oh, blah, blah, blah. I use layman language. I don’t talk about orthographic processing and all of these different things that nobody can make sense of. I break it down for people to make sense of it, and that for me is what’s really important.
But man, that was a lot of information. Like I said, I think it’s just focusing on [01:18:00] one thing. What’s one thing that stands out for you that you could start doing in your practice and then you can build from there once that’s entrenched, but starting small and just building from there.
Dr. Sharp: Yeah. I love that. You shared so much information with us and so many actionable ideas which I love. I think we all want to take that sort of information away from a podcast like this, but there is a lot. I think ending on this note of, hey, this is a lot of info and just pick one thing that you can work on this week or this month and the rest of the list will be there. You don’t have to do everything but think about one thing that you could do to change things for the better.
Dr. Caroline: And I shared with you a link to just basic parent recommendations too, just so people who are like, [01:19:00] what was that all again? I can’t remember it at all. There are a few recommendations there that they can get started with.
Dr. Sharp: That’s fantastic. Thank you so much. All the resources will be put in the show notes, everything we mentioned, everything that you sent me. Gosh, I took so many notes during this episode and got the wheels turning about ways that we can do things differently here. So personally and professionally, I’m so grateful for the time that you’ve spent with me here.
Dr. Caroline: Good, I’m glad it was helpful. Thank you.
Dr. Sharp: Absolutely. Well, I hope our paths cross again sometime soon. In the meantime, take care and do good work.
Dr. Caroline: Thanks. You too. Take care.
Dr. Sharp: Thank you as always for listening. I really appreciate it. I hope that you were taking notes. I know I was. I had to review those here as I was putting the podcast together so that I can implement some of those things in our own practice. Just so many good [01:20:00] pieces of information.
Like I said at the beginning, if you are attracted to the idea of an accountability group where you can work with other psychologists to grow your testing practice, I would love to chat with you and see if it would be a good fit. I’ve got space in the intermediate group and the beginner group. You can get more information and schedule a pre-group call at thetestingpsychologist.com/consulting.
Okay, y’all, that is it for today. I will be back on Thursday with a business episode and the following Monday with a clinical episode. I believe I’ve got Dr. Michael (Mike) Posner coming on to talk about attention and his research in that area and just his perspectives from being in the field for so long. He was one of the most prolific researchers in our field. It’s a good conversation. So stay tuned and don’t miss it.
All right. Y’all 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.
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