264 Transcript

Dr. Jeremy Sharp Transcripts Leave a Comment

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.

This episode is brought to you by PAR. PAR has recently released the Feifer Assessment of Childhood Trauma or the FACT, the first and only comprehensive instrument measuring how stress and trauma can impact children in a school-based setting. You can learn more or purchase the FACT™ Teacher form by visiting parinc.com\fact_teacher.

Hey, y’all, I am back today with Dr. Emin Gharibian who is here to talk all about high-stakes testing accommodations for exams like the Bar, the USMLE, the MCAT, the LSAT, and other standardized tests that play a huge role in [00:01:00] professionals lives.

Emin was on the podcast maybe two years ago talking about competency evaluation. So check that out if you haven’t heard that one, but today we dive deep into high-stakes testing accommodations. We talk about how he screens people on the phone ahead of time to even figure out if it’s a good fit. We talk about the evaluation process, of course, the interview- how it’s different from a standard interview, choosing a battery, writing a report that is typically much longer than most reports that we might write, and a variety of other things. There’s a lot of information in this episode. And the hope, of course, is that you learn a little bit that you can apply to your own practice.

Let me tell you about Emin. If you did not listen to the first episode, here is the bio. He is a licensed psychologist specializing in neuropsychological and forensic evaluations. He has 10 years of education and training in clinical psychology and neuropsychology and extensive experience evaluating adults and adolescents for psychological and neuropsychological conditions.

Emin specializes in providing comprehensive neuropsychological evaluations for a variety of neurological conditions including dementia, Alzheimer’s disease, complications from a stroke, traumatic brain injury, concussions, learning disabilities, ADHD in clinical and forensic cases. If you want to learn more, there are of course links to all of Emin’s information and contact information in the show notes along with some other resources.

I hope you enjoy this one. Without further ado, let’s get to my conversation with Dr. Emin Gharibian.

Hey, Emin, welcome back.

Dr. Emin: Hi Jeremy. Thanks for having me again.

Dr. Sharp: I’m glad to have you. It’s a small club for folks who have been on the podcast more than once. So welcome to the club. Your badge is in the mail. 

Dr. Emin: With pleasure.

Dr. Sharp: I’m glad to have you back. We’re talking about a topic that I think we’ve touched on here and there in different episodes, but I’ve never dedicated a full in-depth interview to standardized testing accommodations specifically at this level, these high-level standardized tests. So I’m excited. I think there’s a lot of information to share with folks.

I always start off just to warm us up a little bit. Can you share, I know you do some different things in your practice, but why this? Why are you putting energy into this and why is it important to you right now?

Dr. Emin: Sure. Actually, it goes back to even before I was a grad student. [00:04:00] Many years ago before I started grad school, I worked as a Psychological Assistant between undergrad and graduate school for a psychologist that did these types of evaluations for the Bar, LSAT, MCAT, and all that kind of stuff.

I did most of the work actually. I didn’t do the interviews, but I did a lot of test administration and writing of the reports. In doing that, I saw him finalize the reports and I saw the accommodations that people were getting. That was my first exposure to it. I did that for about two years and I got a lot of experience and insight into it.

At least for me, I saw that you have these students that historically are good students, are hardworking people, but because of that particular disability, it was really preventing them from moving forward in their academic career.

A good MCAT score could make the difference between getting into a top-tier law school and maybe an average, sorry, not at law school, medical school compared to an average one. The same with LSAT. You’re trying to go for these top-tier law schools, try to get scholarships, and [00:05:00] stuff like that. So it can really make or break someone’s legal or medical career. And then for the students that already have gone through law school and medical school, the USMLE for medical students, and then for the Bar exam for law students, that’s your final hurdle. At that point, if you don’t pass that, you can’t practice.

So basically I saw these students struggling in those areas and I saw a big difference that accommodations made, basically, launched their careers at that point. So, it really drew me to it. And it’s a really important area for me because obviously, I’m pretty sure you can relate to it as well. We went to grad school for a very long time. So imagine if that was the last hurdle for you and because of a disability, you can’t pretty much pass the licensing exam due to whatever constraints are being placed on you and you can’t practice. That’s what drew me to it.

And then eventually when I got licensed and I was on my own, that was pretty much one of the first areas I started to practice in just because I had the experience and the knowledge and insight into it. At this point, I’ve been doing it for [00:06:00]two years. I’m still very passionate about it.

Dr. Sharp: That’s great. Like you said, it’s a pretty needed service for the folks who need it. I haven’t done a ton of this work, but there is one person who stands out over the years who was a super bright individual headed to medical school, tons of qualifications, but also just severe dyslexia. Without the testing and presumably, the accommodations, would never have gotten where that person’s gotten. So, it was crucial in some cases.

Before we dive in, I know we have a lot of practical and logistical discussions to have, I am curious about the business side just a little bit. If you could speak to how you are getting referrals for these types of evaluations if there are any particular markets you’re targeting? For folks who might want to do this kind of thing, [00:07:00] how did you build that part of your business?

Dr. Emin: Sure. Accommodations requests are not covered by insurance. It’s not considered to be “medically necessary.” So pretty much people are stuck paying out of pocket for it. I’m not on any insurance panels, so I don’t get referrals from people trying to use their insurance, to begin with. But that does sometimes come up. So I think that’s important for you to have that discussion with your clients right when they call and let them know that insurance won’t cover it. So that way, they know that they’ll be on the line for the financial aspect of it.

As far as the referral generation portion of it, it’s come through different means. In the beginning, when no one knew what I was doing, a lot of it came from my articles and online marketing, and just online presence. That was really helpful. Initially generated. And then from there, once your word gets out there and 2 students get in and they give it to their friends and to their friends, it just starts spreading from [00:08:00] there. So it starts with like a slow trickle and that builds up from there.

These evaluations happen in waves because there are always deadlines with these tests. So, you might have a period of a lot of evaluations and then nothing because everyone tries to get for that particular testing deadline and then silence. And then the next deadline comes up and everyone tries to rush to get it. So, it’s a little bit hectic at times. But just know that this is very seasonal work. Sometimes it’s not consistent just because of how testing their minds operate. 

Dr. Sharp: I know that you are pretty active on… You mentioned your articles, social media, and online presence. You’re one of the few psychologists in private practice who I’ve seen utilize blogging the way that we’re “supposed to do it.” I’ve seen you’re pretty active on LinkedIn as well. Have those been pretty successful for you in terms of building a reputation or [00:09:00] referral generation?

Dr. Emin: Yeah. I view these evaluations as legal evaluations.  I say that because you basically are doing a disability evaluation. The level of scrutiny that you’re going to face from the Bar or the MCAT or the LSAT, that’s at that level. So before people could feel comfortable hiring you, they need to make sure that you know your stuff. So being able to be present online and even doing podcasts like this or articles or whatever you might do are important things because that’s how you share your knowledge and understanding of the material and mastery of it.

If people are reluctant to hire you, they have no idea what you know about or you don’t know about. But if they feel confident in your understanding of what the criteria are and how you approach evaluations, obviously that’s going to lead to more business. And people feel confident retaining you essentially for these evaluations because that’s really what they’re doing.

If you think about it, they’re hiring you for a service, you’re providing that service to them [00:10:00] similar to how an attorney might. So demonstrating your knowledge and mastery of the material is really important. And if you view it in that regard and approach your marketing from that perspective, that it’s really helpful. 

Dr. Sharp: That’s fair. I like that framework. Well, I appreciate you indulging the business side of things here for a bit, but I know we have a lot of clinical stuff to dive into too, so maybe we could just start with the, and this might be basic, but I think it’s important context. So, generally speaking, why are people asking for accommodations on these exams? Why is this even important work to do?

Dr. Emin: The simple answer is they are really hard exams, you know what I mean. The California Bar, for example, I think that’s the hardest Bar exam in the country. And then I think New York is probably second. So they’re really high-stakes exams. The Bar used to be three days in California. Now it’s two days. It’s two full days. People rent hotel rooms and spend the night there because they have to wake up the next morning and start testing again.

So for these [00:11:00] tests, there’s a lot on the line. Obviously, for the Bar, it’s what makes you be able to practice. For the USMLE is the medical licensing exam. There are multiple steps. You can’t proceed through the steps without passing them obviously and scoring well on them. Step one for USMLE, I think that decides your initial scores and your residency is dependent on that first score. So again, your entire career is dependent on one, not one test necessarily, but it plays a big role in essentially what you’re doing.

So, they’re already hard tests, to begin with. And imagine if you have a disability, whether it be a psychiatric condition like depression, anxiety, panic attacks, PTSD, ADHD, or dyslexia, it could really profoundly impact your ability to take the test and compete with other people. 

And if you have to think about the populations, the people that you’re up against or being evaluated against, they’re pretty high functioning, very intelligent people. People are not able to get into law school or even make it to the law [00:12:00] school or medical school without being reasonably bright and hard working. So, it’s definitely an uphill battle just given the type of test that you’re supposed to take.

Dr. Sharp: Sure. That makes sense. And for a lot of folks, anxiety has ramped up during high-stakes testing situations. Micky said a lot on the line. I know that there’s a component here that is probably important again, just for context, but the legal aspect of this is I think important to understand, and the different laws that operate around testing accommodations.

We touched on this a bit, Gosh, I don’t know, maybe a month, I’m not sure how long ago in a past episode given the release dates here, but we touched on it a bit, but I would love to hear your perspective on that and lay it out, what laws are we working with here? What do we mean when we say [00:13:00] accommodations on these tests? What’s happening here?

Dr. Emin: I think before you start doing this work, you really have to understand the framework to operate within. So it really comes down to the Americans with disabilities act or the ADA for short. Basically, you can read about it online if you just Google it.

As a quick overview, pretty much individuals are entitled to reasonable academic accommodations if they have a mental or physical disability. So disability can be physical or mental. Most of the time, people don’t understand that. They always assume disability in anything physical. They don’t understand that mental health conditions could also be a disability under the ADA.

So anything that impacts, it could be seeing, hearing, learning, reading, concentrating with thinking can be accommodated under the ADA. And if you think about most psychiatric conditions or mental health conditions, they impact those domains. ADHD obviously could be concentrating and thinking and reading; dyslexia is obviously reading; people with severe depression and anxiety can have [00:14:00] impairments, all three of those domains.

For the ADA, that’s a substantial limit. That’s the legal language that they use. So it doesn’t mean necessarily that you can’t do it, it just has to limit your ability to do it. And then the accommodations have to be reasonable, meaning that, for example, time and a half might be a reasonable accommodation, unlimited time is not a reasonable accommodation. They’re not going to give you that. So, based off-of those, that framework we operate within.

And that’s important to know too, because, in my reports, I actually quote the ADA and say this is the law, this is what it means, here are the accommodations and this is why they’re reasonable. That way, no one could really question the legality of what you’re trying to do.

I hate to say this, but the Bar in some of these MCAT, LSAT, they’ve all been sued at one point because they violated the ADA. If you go on the MCAT website, I’m not sure if they still have it up, but for a [00:15:00] while, they actually had mentioned that they had violated the ADA and they were trying to rectify it. And they had redone their entire website. It’s a lot more informative to know exactly what they’re looking for, exactly what you need to include. And that’s because they’ve been sued a lot because they were not reasonably accommodating the request for students.

Dr. Sharp: Yeah. I remember the big deal over the LSAT, I forget when it was, maybe 10 years ago or 8 years ago or something, but like you said, they’ve all probably run into trouble because it’s hard to cramp accommodation sometimes.

Dr. Emin: Yeah. And there are attorneys that specialize in this too. I’ve worked with attorneys before where they were representing clients that have been denied or the client because they are scared of being denied, they retained an attorney to review their paperwork, to review the report, to make sure that everything’s up to par just to prevent headaches later on down the road.

Dr. Sharp: Yeah, all this is important. All this background is important. [00:16:00] I would love to dive into the practicalities here. Everything that we’re going to be talking about.

So, let’s start at the beginning. You, in our pre podcast chat, mentioned something that I think is super important that I’d love to talk about, which is this process of screening people on the phone ahead of time when they call you for the evaluation. Can you share more about what that screening process looks like?

Dr. Emin: Yes, absolutely. I think it’s really important because like I said, since insurance doesn’t cover these, people are on the financial line for covering the expenses. So, I do a screen for one or two reasons. One, I want to make sure that they’re a good candidate for accommodations. I mean, they’re not just trying to get accommodations just because. And then two, that they understand pretty much what they’re getting themselves into, that this is not going to be a very simple, straightforward process. And sometimes it can be an uphill battle.

When the accommodations request comes in, typically, I’ll always call them always on [00:17:00] the phone. Emails don’t work too well for this just cause there’s too much back and forth. I always call them on the phone and ask them, what’s coming? A little bit about what’s going on. And then there’ll be like, well, I need accommodations on the Bar exam for ADHD, for example. And I’ll say, okay, have you ever had accommodations before? And then the conversation can veer off depending on how they answer.

If they have a long history of accommodations, it’s a much easier conversation to have. It tends to be shorter and more straightforward, but if they don’t report it, I’ll usually ask them, what have you been struggling with? What have your difficulties have been just to get a general idea of what their difficulties are?

And I’ll tell them right away when I always compare it to the bar exam, just because the bar is usually the strictest, I’ll tell them, you have to have evidence of impairment before age 12 and one or more domains that it has to be causing functional impairments. Be honest. Is that something that you’ve struggled with? And if you haven’t, pretty much you’re not going to get it because that’s what they look for.

And [00:18:00] sometimes I’ve had I people say, well, my problems only started when I was studying for the Bar.

I’m like, well, that’s not ADHD. So at that point, we could end the conversation. So, it helps save me time and it also helps save them time. 

Dr. Sharp: Are there other “red flags” that you’re looking for during that conversation? It sounds like a lack of evidence of accommodation or impairment is a big one. Are there other things people might say or deny that would point you in that path of, Hey, this is not going to be helpful?

Dr. Emin: Usually, actually people are pretty honest on the phone and I tell them the length of the evaluation and the report and the process. And once they hear what it is, they realize that I shouldn’t just waste my time and spend all this money if I’m not going to get the accommodations or a reasonable chance of getting the accommodations.

Usually, red flags for me or people that call about anxiety. And it’s always in the context of testing. Test-taking anxiety is not a disability. You’re not going to be able to get accommodations for test-taking anxiety. [00:19:00] So if you tell me that the only time you’re ever anxious is when you’re taking a test and no other history of anxiety at home at work and in multiple settings, I usually tell them, I’m sorry, I can’t do this evaluation for you. And I’ve yet to have somebody decide to go forward with it just because usually when the “expert” tells you that you shouldn’t move forward with it. So that’s usually a red flag for me.

People that report depressive symptoms but it’s been very mild and intermittent and they’ve never had treatment before. Sometimes there are explanations for it to why they didn’t get treatment and you’re able to work with that, but those are always red flags for me. People that claim to have had a disability or struggles but they’ve been a 4.0 valedictorian student their entire academic careers and now they’re trying to take the Bar exam and they want accommodations. That’s a little bit of a red flag.

So, I try to get some basic background and history on the phone over a [00:20:00] 15-20 minute conversation with them. I’ll give them my 2 cents. I’ll tell them, these are the strong points in your case, these are the weak points in your case, and then based on that they can make an informed decision if they want to move forward. Flat out, I’ve told people, hey, this is not a good case for accommodations. I don’t think you have one. This seems like it’s more situational anxiety or, Hey, this just seems like poor attention just because of stress. I wouldn’t recommend that you do the evaluation at this point. 

Dr. Sharp: Got you. And is this call complimentary or a business?

Dr. Emin: Yeah, I always do it for free. Basically, it’s an opportunity for you to vet the lead, and then also it’s an opportunity for the person to feel comfortable with your understanding and knowledge. And I’ve had a lot of students thank me because they just realize that, hey, I have to study harder. I have to find another path around this. I’ve had students that were calling multiple psychologists and they’ve commented that I was the only one that spent the time actually explaining things to them.

[00:21:00] So, it’s me answering the phone, it’s me returning the phone calls. I don’t have anybody else do it for that reason, just because I think you need someone with a legal eval. When my attorney calls me for a legal evaluation, I’m the one that calls them and we spend 20-30 minutes on the phone talking about the case and then we move forward from there, or we don’t depending on the outcome. 

Dr. Sharp: Right. I know I talk so much about having an assistant not answering your phone and that sort of thing, but I do think there are certain situations where that could be really helpful. Building a relationship and building trust is huge.

Dr. Emin: Yeah, exactly, especially for legal evals. I keep going back to that because that’s what it is. You have to view that mindset of, I’m basically doing a medical-legal type of evaluation. When attorneys come to me for other cases, when they can interact with me and answer questions right away versus an assistant, it just builds their confidence in my abilities and it helps me figure out whether or not I even want to do this. Sometimes I just turn people down because I don’t think that [00:22:00] I’m a good fit or I can help them. 

Dr. Sharp: Right. You’ve used that term two times, “medical-legal evaluation.” Just real quick, can you define for people? How is that different from a clinical eval? In your mind, why are you using that term versus a general evaluation?

Dr. Emin: I use that term because my assumption when I write these reports is that somebody else on the other side is going to try to tear it up. So I view with the mindset of, if I was a consultant or the person from the MCAT or the LSAT, or the Bar reviewing this, what are all the criticisms I would have about my report? What are all the ways that I could disprove the points? What are some alternate explanations that maybe I’ve forgotten or ignored? And that’s important because that’s what happens in medical-legal evaluation.

There’s always an opposing expert for the most part or an attorney that’s going to go through and try to discredit the things that you’ve written. So you want to make sure that the work that you do is at that level.[00:23:00] I’ll give you a common example that I’ve done appeals for others. I’ve done appeals for students that got rejected when they did an evaluation on another psychologist, the most common issue that comes up is ADHD- People who are diagnosed with ADHD with no child had symptoms.

So everything you talked about was when the person was 18, 19 years old, where are the childhood symptoms? That’s what the diagnosis requires. So, you need to address that in the report. And if you don’t address that, I can promise you the consultant that reviews it is going to tear apart your report and say, this is not ADHD. This seems like just poor attention. Accommodations denied. And then you have to explain to a client why that happened and that’s a hard conversation to have sometimes.

Dr. Sharp: Sure. I like that framework that these evaluations are going to be under more scrutiny than maybe a typical clinical eval that goes to a school or a parent or something like that.

Dr. Emin: Yeah, exactly.

Dr. Sharp: I don’t know, I would hope that most of us[00:24:00] have the rationale for our diagnoses, at least living in our minds somewhere, but whether we spell it out on paper as clearly as we need to for these standardized testing evaluations is a different story. It seems like that’s really the difference.

Dr. Emin: Yeah. I always tell people that ask me questions about these evaluations, if you didn’t write it, it didn’t happen. It doesn’t matter what you think. It doesn’t matter what your conceptualization was. If you didn’t explain in an articulate way, expressing all the facts in an easy understanding hyper manner, it doesn’t matter what you thought because you didn’t write it.

The consultant is not going to call you and ask you a question. They’re just going to go off of what you wrote. Similar to a court report. The judge is not going to give you a call and say, hey I have a question about this. What you wrote is what you wrote. So you have one shot at it. So you got to view it from that perspective. 

Dr. Sharp: That’s a great point. Well, I think that’s a [00:25:00] good segue into what this work actually looks like. I know that we had mentioned using this framework of looking through the lens of the Bar and the USMLE because they’re the hardest ones. They got the highest standards. So, where do we start? Is there a way to just talk about general principles when you’re doing these evaluations or the mindset that you want to have when you go into these evaluations?

Dr. Emin: Yeah. All these testing companies require obviously an interview and then the administration of certain tests. Different conditions require different tests. So you got to figure out what you want to give to people. For example, dyslexia is going to look different on testing when it comes to test selection versus maybe ADHD or depression, or anxiety This is an issue that often comes up.

For example, it makes sense why you would [00:26:00] give somebody that is asking for dyslexia accommodations a WAIS or any electrical screener or academic tests like a Woodcock-Johnson or a WIAT, and then maybe a Nelson-Denny, right? You want to rule out any low cognitive functioning, and borderline intellectual functioning, and then also look at difficulties with phonetics and pronunciation and spelling and all those kinds of things that are consistent with dyslexia. So that battery makes sense for that test.

But a lot of these testing companies will also ask for a Woodcock, a WAIS, and Nelson-Denny for depression. Why do they ask for that? That’s not diagnostic by any means. There are ideas that they want to sit there and have an objective measure of someone’s cognitive functioning and in their minds have decided that giving those tests, somebody with depression or major depressive disorder, maybe panic attacks or PTSD will have some sort of impairment on these tests. Oftentimes they don’t.

Dr. Sharp: That is challenging.

Dr. Emin: That is challenging. So the testing is [00:27:00] one part of it, but I want to go back and really emphasize the interview for this reason. So I went a little bit backward.

In those cases, somebody with depression or anxiety or PTSD might do perfectly fine on all those tests, right? Somebody with depression might have slow processing speeds on the WAIS, maybe impairments in working memory, maybe their fluency measures are slow because of cognitive slowing that happens with depression, but oftentimes, I’ve had people with severe depression do perfectly find out everything because those tests were really designed to measure learning disabilities and maybe cognitive functioning in neuropsychological contexts.

So, sometimes you have these tests or situations where you have a student that has all of the signs of major depressive disorder. They’re in treatment. They’re meeting with a psychiatrist. They have a long history of therapy and everything, and all the functional impairments, but all the testing is fine.

I bring that up because the interview really is the most important piece to it because you’re going to be able to capture the functional impairments in their real-world through the interview. The testing is just a snapshot in time in that moment when they’re in the room with you. [00:28:00] So having a thorough interview that starts from the beginning and works until the present day, and when I say beginning, I mean when the problem started.

So if you have someone that’s reporting a history of major depressive disorder since they were a teenager and now they’re in their mid-twenties, you want to be able to explain how this started and how it progressed and the different areas they’ve had impairments with along the years. So I’ll go through middle school. I’ll go through high school. I will do college. I’ll go through other tests that they’ve taken standardized tests like the SATs, or maybe the LSAT. You want to know how they’ve struggled.

So the interview, I would say is probably more important, if not just as important at least than the test that you’re going to give, because what happens if you do a week interview where you don’t capture that information, and then on top of it, you have testing where everything is average. How do you justify accommodations at that point?

Dr. Sharp: Great question.

Dr. Emin: Exactly. It’s hard to [00:29:00] explain. Whenever you have the interview, you’re able to capture that information. For example, someone might have PTSD or depression, or major depressive disorder, and along the years, they always struggled on tests because their mind’s clouded, they can’t focus, they can’t concentrate, their cognition slow. You’re able to capture that through their day-to-day struggles, right?

So maybe they have to get a lot of tutoring. Maybe they approached their teachers when they were younger and said, Hey, can I get a little more time on these tests? Maybe they didn’t have an IEP, but the teachers just gave them extra time as a favor. I’ve seen that happen plenty of times.

So in the interview, you’re able to capture that information and make sense of their functional impairments. I keep going back to that because that’s really what you want to emphasize. Functional impairments either at school, work, or in their personal life. Most of the time it’s going to be in school because realistically you’re trying to get them accommodations.

So through the interview, you’re able to capture that information pretty much tell this person’s story and the [00:30:00] history of their impairment. Usually in my reports, before I get to the relevant history section, the first paragraph I have his history of presenting problems and current symptoms. So that’s literally what it is. I have a history of how this started, the difficulties they’ve had in different areas of functioning, and where they are now.

And interviews take a while. I had interviews take me two hours before. And oftentimes when they leave, when I’m organizing stuff, I’ll realize that I miss things. I didn’t really explain the diagnosis well enough, or I didn’t get enough information about symptoms. So I’ll call them and just do a full interview and fill in the missing pieces. And that way you be able to explain to this person that’s evaluating your requests pretty much what the struggles have been for this person.

Dr. Sharp: Yeah. You anticipated my question, which is how long your interviews. It seems like, if you’re digging into this much detail, you have to have the time to do so. I could not imagine trying to do something like this on [00:31:00] an hour. And just to clarify, maybe just reinforce, it seems like we can’t get by with just asking about symptoms. We can’t just list symptoms. You really need specific examples. You need to dig in pretty deep to understand how the supposed disability has impacted someone.

Dr. Emin: Yeah, exactly. I use the open-ended question format when it comes to asking these questions. I’ll ask them, for example, you said that you have a hard time struggling with attention when you were a kid. Tell me a little more about that. In elementary school, what were you having difficulty with? What was it like being in class? What was it like having to take a test? What was it like being at home and having to study? Just think about those multiple areas a student would have to function. Usually, it’s at home or at school, and ask them to explain it.

And this is a good way to know whether or not someone’s legitimate or not. People with legit struggles have no [00:32:00] problem explaining their struggles. People that are trying to do this for secondary gain might have a lot more difficulty trying to explain their struggles because they never had it.

So that’s a good way to also filter at that point to see, Hey, should I continue with this evaluation? Or after the interview, hey, this does not seem legitimate at all. Maybe at that point, you can decide to stop it. That’s another way to look at it too.

Dr. Sharp: Yeah. Have you terminated evaluations after the interview before?

Dr. Emin: So far, no. Luckily, in the screening process, I’ve been able to catch the ones that didn’t seem legitimate and I just didn’t proceed. But obviously, if I’m interviewing somebody and they’re claiming ADHD and I’m going through their history and they’ve never had any impairments and that they’re just trying to list off symptoms because they could obviously read that online, it’s not that hard to figure out what the symptoms of ADHD are, then that should be a point that you should consider maybe, hey, this is not an appropriate evaluation or appropriate accommodations request. 

Dr. Sharp: Right. [00:33:00] That makes sense. What role does collateral information play in these evaluations or interviews with parents, siblings, et cetera?

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

Kids are experiencing trauma like never before, but how can you figure out whether they’ve been affected and how it impacts their behavior and performance at school?

The Feiffer Assessment of Childhood Trauma or the FACT is the first and only comprehensive instrument measuring how stress and trauma can impact children in a school-based setting. The FACT teacher form solicits the teacher’s perspective on the performance and behavior of children ages 4 to 18 years. It takes just 15 seconds to administer, and the available e-manual gives you detailed administration and scoring instructions. You can learn more or purchase the fact teacher form by visiting parinc.com\fact_teacher.

[00:34:00] All right, let’s get back to the podcast.

Dr. Emin: They can’t play an important role. I’ll tell you for the California Bar exam, for example, when you fill out the form for ADHD specifically asked, do you have third-party info? How did you get that third-party information?

So, typically I’ll use a Conners’ or a Barkley’s checklist, but sometimes collateral sources aren’t available. And I’ll give you an example from my practice. I’m Armenian. All the clients I evaluate are Armenian. As far as parents are concerned in Armenian culture, there is no ADHD. There’s no dyslexia. You’re just not a good student. Just work harder. I’m serious. It’s a real issue.

Dr. Sharp: I believe you. Yeah, I’m just laughing.

Dr. Emin: A lot of the students that I’ve evaluated that are Armenian have had this issue of difficulty, have this history of impairment, and they always say, my parents would be called into school because I was disruptive and I wasn’t paying attention. I was too talkative. My parents were up to parent-teacher [00:35:00] conferences because I couldn’t keep up with the reading and I just didn’t understand what was going on. They would tell them to get me evaluated, and they’ll have sometimes at the beginning of report cards or progress notes that say these things.

I’m like, “Why didn’t your parents ever do that?” They’re like, “Well, they just told me to work harder. Get a tutor and work harder.” So it’s a bit of a catch 22. Sometimes you’re not able to get a collateral source and I’ve had situations where I’ve given forms to parents and they send it back and everything’s a zero mark and they’re like, there’s no problem.

So just understand that sometimes you’re not going to have that collateral source depending on the person you’re evaluating and their cultural background and what ADHD or learning disabilities are viewed as in that culture.

Dr. Sharp: I assume you have to explain that in the report somehow, and I’m curious how you conceptualize that, how you might do that basically saying, I don’t believe these parents, [00:36:00] these parents are wrong. 

Dr. Emin: I just explain it. I say, from a cultural perspective, this is a common issue. I don’t view this to be a reliable source directly. It’s either the parent is lying or the kid is lying. Someone’s not being honest with it. You have to use your clinical judgment at that point and decide which one I’m I going to put more weight to?

You run into the same problem with forensic evaluations too. When you interview multiple sources, sometimes one source is more credible or more reliable than the other. So at that point, it comes down to clinical judgment. And you have to make a call and just explain the report.

At these last 2, 3 evaluations that I did with ADHD, one of the people one of the students had a history of ADHD going back to childhood. And then along the way, came depression due to family issues around adolescents and teachers were telling her, Hey, get her evaluated for ADHD. You have her on medications. Mom strictly [00:37:00] did not want to do it. It wasn’t until the person turned 18 that they are able to go to a psychiatrist on their own and get medications for their ADHD and their performance in school changed dramatically. So that’s why history is important because you’re able to explain that information and put it into context.

Dr. Sharp: Right. When you go through your interviews, do you have a standard form? Is it something you’ve developed? Is it something you got somewhere else? How do you make sure to ask the questions that you want to ask?

Dr. Emin: I don’t have a form necessarily. I think at this point I’ve done enough. I’ve seen enough, not rejections, but whenever someone applies for the bar and they’re turned down or they give them partial accommodations, they usually will get an email back explaining why, and it’s could be a couple of pages long. I’ve done appeals for people that have gone to another psychologist in the past. I’ve seen enough of them at this point that I know what to look for.

This is one of those [00:38:00] things that are hard because if you’ve never done one of these and you’re trying to do for the Bar exam and you don’t understand what they’re looking for, you could inadvertently miss things that you otherwise wouldn’t have. So maybe a report that you wrote for school or for a medical doctor for ADHD, a diagnostic clarification, maybe that would be fine for them but if you don’t ask the specific questions that they might critique on some of these tests, it might become a problem. 

I wish there was an easier way to explain it. It just comes with experience. I’ve done enough of them at this point that I know what to ask. Well, I can give you a general overview of how I start.

Dr. Sharp: Yeah, I think that’d be helpful just to hear the structure.

Dr. Emin: Sure. So usually again, ADHD childhood diagnosis, right? So start from the beginning. I usually ask them, when is the first memories they have of having difficulties in school? And I’ll just go from there and go through the different areas they could have had difficulties in. So in class, while they’re taking tests. In class, while they’re taking notes. At recess or on the playground [00:39:00] that they have behavioral issues where they’re getting suspended or expelled? At home, how was it like taking tests? How was it like studying? Did you have a tutor?

Sometimes I’ve had students that academically have done really well in school, but as soon as they went home, they had a tutor or a parent that would sit with them and make them do everything with them. So maybe they’re getting good grades, but they have a lot of support with them to allow them to get those good grades.

So those are the questions I’ll ask. And I’ll basically repeat the same questions from elementary school to middle school to high school. Usually in high school, before they go to college, there’s an SAT or PSAT they took, so ask them, how was it like studying for that test? How’d you do on that test? Did you run out of time? What was going on? And then the same thing with college or community college if they were at a community college first.

And then if they took, let’s say they’re a law student they’re taking a Bar, they should have taken an LSAT at a certain point, right? So you’re going to ask about the LSAT. How was this studying for that? What kind of support did you have? What kind of struggles did you have? [00:40:00] And then the same thing you have for a law school.

So it becomes a little repetitive because you asked the same thing, but you want to capture the difficulties from the beginning to where they are right now. That’s how you explain the functional impairments. That’s how you explain the course of their struggles and ultimately why they need it now. So it doesn’t matter that you had accommodations back then, it matters why you need them right now in the present day. So that helps explain it for them.

Dr. Sharp:  Yeah. And it just makes me think again, of how you need the time. Do you ever run into folks who are trying to get accommodations for two different things like someone who might be depressed and have ADHD or ADHD and learning disorder?

Dr. Emin:  Yeah, those are a nightmare. 

Dr. Sharp: I was going to say that’s a lot of time.

Dr. Emin:  Those are the hardest evaluations to do because the most difficult for me are the ones with co-occurring ADHD and a psychiatric illness. So co-occurring [00:41:00] ADHD with depression and panic attacks or generalized anxiety, co-occurring ADHD with PTSD, I’ve seen that before.

It really comes to teasing out the symptoms. Sometimes you get lucky and the psychiatric issues started after the development of the ADHD-like symptoms. So maybe they had no mental health issues with depression or anxiety or trauma when they were a kid, and then the problem started and when they were an adult or late teenager, and that’s usually easier.

In some cases, they both started. So imagine someone has ADHD symptoms at a young age and then they were a victim of a trauma, I’ve had that before. Then you have them both happening at the same time. So how do you know which is causing it, right? It’s tough. It gets a little bit tricky when it comes to that.

In those situations, I’ve seen, as an example, the person had ADHD, and then they had a traumatic thing happen to them. And then as they went through treatment, the trauma went into remission, but they continued to have problems with ADHD. So it becomes a little [00:42:00] easier to explain that. But when you have them on both occurring, you just have to explain that I can differentiate between the two of them. Maybe one of them is a primary one, the other one’s provisional.

But the diagnosis is only a part of it if you think about it, right? At the end of the day, whether it’s ADHD causing impairments and attention and focus and concentration, or really bad anxiety or depression, ultimately it’s still impairments in attention and concentration you really want to focus on at that point. The symptoms and impairment are more important, I think than the label.

You’re sometimes going to be splitting hairs between differentiating the two of them because it’s tough. Sometimes you have them both happening at the same time. So, how can you separate them out sometimes?

So it becomes difficult. That’s probably the most challenging case you could have is when you have those two things happening at the same time. 

Dr. Sharp: Right. I wonder if we might talk about the battery selection. I know you mentioned two pieces, but anything else to add in terms of selecting a battery for these evaluations?

Dr. Emin: Yeah. [00:43:00] So for the most part, I have a standard battery they’ll go through. I always give a WAIS. You want an academic measure like a WIAT or Woodcock. I like the Woodcock. I was trained on and it’s what I’ve always used.

And then usually I’ll give the tests that are relevant to what they’re going to be taking it for. So if they’re going to be taking the Bar exam, for example, I’m not going to give him the math class. It’s pointless. I’ll just give them the reading and writing tests. With a family history of difficulties with dyslexia, I won’t give them spelling. So you can pick and choose which one was you might want to give depending on the impairments that they’re having but definitely give all the fluency measures. That’s really important. The reading comprehension measures.

The Bar specifically asks if you’ve ruled out a learning disability. Usually, by the interview, you have figured it out whether or not it’s dyslexia depending on what they’re reporting but always give fanatic measures just to help rule that out.

And then [00:44:00] Nelson-Denny is a common one I’ll always give. The Nelson-Denny, it’s not the greatest test, but unfortunately, there are no other tests that I know of. And if someone else knows, by all means, let me know, that has a 20-minute version and then an extended time version. So that’s the only one. It goes up to college age. There’s nothing past college age. And so you’re stuck giving that. But they ask for a lot of these tests. I’ll say, give it like a timed or untimed or regular time- extended time reading measure. And Nelson-Denny is usually the one that I’ll give.

Dr. Sharp: Sure. Yeah, go ahead.

Dr. Emin: The other ones, for ADHD, definitely the Connors or the Barkley are helpful because they have an observer and self-reports. The  Barkley has observer childhood reports as well- checklists. The TOVA, I’ll give, I know the TOVA is not diagnostic for ADHD, but I’ve seen them ask for it before and they want a measure of sustained attention. Sometimes I have people that have all the symptoms of ADHD perfectly fine [00:45:00] on the TOVA. So don’t be cautious about how much weight you give to that.

If you have co-occurring mental health issues, obviously an MMPI or a PAI, a BASC, depending on what age range they fall into. Those are really critical. You want to measure effort, so, you could have embedded measures, but obviously, you could give TOMM or any other measure of performance validity. Honestly, all these years I’ve been doing, I’ve yet to have anybody try to even fake it.

Dr. Sharp: That’s surprising, actually.

Dr. Emin: Again, it comes with a screening of them. If you’re able to explain the cost and the time and the effort and the probability of getting accommodations, at that point, if they’re still trying to fake it, then I don’t know what to say. I have yet to have anybody try to exaggerate their symptomology or at least their performance on some of the tests.

Dr. Sharp: Okay. That’s [00:46:00] encouraging, even if it’s surprising, but yeah, I guess it just goes back to that screening process and making sure people know what they’re getting into.

Dr. Emin: When I start my evaluations, I always tell people two things. One, please don’t lie to me, be honest about everything. It’s not only me that’s going to be reviewing this. I always tell them, somebody else is going to be reviewing this. If something seems fishy, it could be a potential hindrance in you getting this. So be honest about everything.

And two, try your hardest on every single test. If you’re feeling tired, if you’re feeling fatigued, if you’re not up for it, let me know. We’ll reschedule it. Don’t try to do it just to finish it in one day. And that goes even outside of this. I think that’s a caveat or a statement you should tell everybody so that way they know that you should be trying your hardest in all of these tests and that if you don’t, then it might be an issue.

Dr. Sharp: Right. I like that. I think that’s good for probably all of our clients as well. Let’s see. What about the [00:47:00] report? That seems to be maybe the most important part of this process.

Dr. Emin: Yeah. So I’m always been a proponent of short, concise, straightforward reports. These reports are not short. They end up being very long. I’ll give you a ballpark. Anywhere from 15 to 25 pages sometimes. I don’t do write a lot because I want to write a lot. Honestly, I prefer to write less because ultimately someone has to read this. I don’t want them to have to sift through so much information, but if you have somebody with a long history of complex issues, it’s going to take a while for you to explain when it started and where they are now.

I’ll give you an example. I had a student that had ADHD that then developed into, had an eating disorder at an older age and then had hospitalizations. So going through all that information is going to take a while. So your report ends up being long. 

Dr. Sharp: Let’s do a little context because I have seen a lot of the stuff you’ve written in the Facebook group about short reports. [00:48:00] When you say these are 15 to 20 pages, what’s a standard report for you?

Dr. Emin: It depends on the question. Sometimes I’ll do mental health diversion, or competency evaluations where they’re three pages long and four pages long, and those are legal evaluations. But those are more specific in the sense that you’re answering a legal question. Is this person competent? Do they meet these four criteria for diversion?

For this one, you’re trying to explain someone’s history of impairment, how they’re impaired right now and why they need accommodations. Sometimes you’re able to explain in a very easy-to-understand way or a very short way depending on their presenting problem and what they’re going through. Other times when they have complex diagnoses and complex histories, especially if they have multiple inpatient hospitalizations and have seen multiple psychiatrists and therapists and all sorts of stuff, it gets complicated and it just takes time to explain it.

And usually, when I’ve seen people get rejected when I’ve reviewed other people’s reports, it’s because they didn’t take the time to explain this [00:49:00] person’s course of treatment and of course of impairment throughout the academic career.

And so ADHD, that’s obviously very important because it has to be present throughout the lifespan. For, depression and anxiety can be important too, depending on when it manifested. And maybe it was at a young age, so you’re going to have to start from the beginning. Maybe it was at an older age and a little bit shorter. So that’s why it ends up taking a long time to just explain and write everything.

Most of my report is the narrative of the interview. The testing results section is pretty straightforward to explain, but most of it ends up being dedicated to the history. 

Dr. Sharp: You’re doing a great job of reading my mind with this interview. I was going to ask you, how does your report break down? So of those 15 to 20 pages, most of it, it sounds like is history interview.

Dr. Emin: Most of it is. Yeah.

Dr. Sharp: What is the interpretation or summary look like in a report like this?

Dr. Emin: I’ll break it down from the beginning. The first part of the report is obviously the [00:50:00] referral question and the test you give. In the second part, I’ll say of history of presenting problem and current symptoms. So that’s the narrative portion.

And then I’ll jump into the relevant history. It includes family history, developmental history, education, psychiatric. That section usually is a little bit shorter because I’ve already discussed the symptomology before. So this one is more factual information like they saw a therapist from this date to this date. They were employed from this date to this date. They went to this school from this date to this date. It’s a shorter way just to get an idea of their history. It’s always the relevant history remember.

Sometimes people spend way too much time talking about psychosocial history when it’s not relevant to the presenting problems. If there’s trauma involving family, then yeah, talk about family, but if the person’s applying for dyslexia, why you need to spend so much time talking about their family history is kind of irrelevant unless that’s an issue that is impacting the current presenting problem.

So after that, I’ll jump into just behavior observation that [00:51:00] I might see with the mental status exam.

And then after that, I have my testing results section. I use tables. So I’ll have a table for each test that I give. So like the Woodcock, the WAIS, the Barkley, the Connors. I’ve made tables of all these tests so that way all that data is there for people to review.

I’ve talked about this in the Facebook group. I have an Excel spreadsheet that I use that does the score conversions automatically. So when I answer the standard score or the scale score, it’ll give me the descriptor and the percentile rank. So that part flies by really quickly. I just think of the printout from the WAIS and I just enter it into my spreadsheet and I cut and paste those tables in.

And then for the summary and conclusions, usually I will go through and explain the most relevant tests and how it’s impacting them. So I want to explain every single test result. That is [00:52:00] going to be on a case-by-case basis depending on how people are scoring and what they’re doing. And I summarize the most relevant, salient things and how it relates to what they’re applying for.

And then, the diagnosis section I’ll put right afterward. The diagnosis section is really important. I’ve seen sometimes people, they just put a label, they’ll say major depressive disorder and they just leave it at that. You need to explain why that diagnosis exists and why you ruled out other things.

I literally will open up the DSM and put it next to me. And I make sure that if I’m diagnosing the major depressive disorder, I’m to a T hitting all the important points. For ADHD, for example, I explain why it’s ADHD, why it’s not something else, other Rulloff’s that I was considering, but it’s not those things.

So you want to really explicitly explain your diagnosis and your rationale. And this becomes more of an issue with ADHD because oftentimes other things can mimic it. But if you don’t do a good job [00:53:00] explaining the rationale, then what happens is when the combination requests get reviewed, at least for the bar exam, the person reviewing it will just say, well, this diagnosis is not valid. We don’t believe this is ADHD. So we reject the whole thing. And that aspect of it, it’s really important for you to get the rationale down and clearly explain why you’re giving this person a diagnosis. 

Dr. Sharp: So in that section, are you going almost symptom by symptom and then giving examples? Is it that detailed or are you just listing the symptom and saying this was present based on the history? How’s that?

Dr. Emin: I usually write it in a shorter format because remember the history of presenting problems section is already super detailed. There’s no need to be super repetitive either. So, I’ll list out the diagnosis and the symptom, as I’ll usually put in parentheses, please refer to the history of presenting problem section for more detailed information, and they can go back and read the details of it.

But over here, it’s more of like a listing format. For ADHD, I think it’s five symptoms before age [00:54:00] 12. And then I’ll say, refer to the Conners’ printout or to the Conners’ table or to the Barkley’s table for additional details. And you can see the checklists there. There’s no need to be super to be that repetitive. And I think it becomes a little bit cumbersome for the reader at that point.

Dr. Sharp: Sure. Yeah, brevity is still important even when you have to provide detail.

Dr. Emin: Yeah.

Dr. Sharp: Yes. Let’s see. We talked a little bit about what kind of information to include in the report. You mentioned folks with a trauma history. I imagine there might be other types of sensitive information. Do you have any thoughts on how to balance demonstrating symptoms or need or relevant history versus protecting privacy in some of these cases?

Dr. Emin: This comes up in forensic reports too. The trauma one is obviously the most difficult, especially when people have a history of like sexual assaults or molestation when they were kids. [00:55:00] These are not easy things that they want to talk about with you, especially if you think about it, they’re just meeting with you maybe once or twice. So you don’t want to open up Pandora’s box.

Usually, they’re already in treatment, for the most part. Most of the people have been evaluated. So I keep it very short and sweet. I’ll just say this person was the victim of childhood sexual trauma and just leave it at that. I won’t really include the details. Even want to interview them, I’m like, I don’t need to know the details of what happened. Just give me a broad basic overview of what you experienced and how long did it go on for? And then I just leave it at that. I always respect people’s privacy.

And I tell them that too. I’m like, I’m not that I don’t want to talk about this with you, but just understand that a third party will be reading this. So I want to be respectful about how much information you feel comfortable sharing. And I always let them see. They’re obviously they’re going to see the report before we submit it, but I always tell them too. I’m like, hey, read the report. If there’s too much information or you don’t feel comfortable with sharing this level of detail, let me know, and let’s have a conversation about that.

[00:56:00] Sometimes we’ll take out things sometimes we’ll add things. But I think it’s an important conversation for you to have with people that have a history of trauma or even severe depression, that’s been very debilitating. That’s maybe it resulted in suicide attempts or hospitalizations. Those are important discussions to have. 

Dr. Sharp: Yeah, it’s such a good point. Thinking as well about information in the report, I wanted to circle back to this idea of documenting or justifying impairment in the face of average test scores or good grades, or where the quantitative data doesn’t necessarily support the request, but you still think that they need accommodations.

Can you talk through that a little bit?

Dr. Emin: Those are hard. Fortunately, that hasn’t happened to me too many times. I can think of one instance where that might’ve happened. And I told them, Hey, you’re probably going to get [00:57:00] denied. Let’s try anyway. I’m like, where am I fine. And sure enough, they got denied.

So usually in the report, I explain why it might be average. So an example would be, dyslexia, you’re not going to get an average score. They’re going to have some sort of impairment in reading. I’ve yet to see somebody with dyslexia have average scores. And if they all have average scores, then they probably don’t have dyslexia.

I guess figure with ADHD, for example, or PTSD or major depressive disorder, you end up having people that are perfectly fine. So I think it’s important for you to really understand or really explain to the reviewer why they might be perfectly fine on these tests, but they might have a real-world impairment.

Typically, the processing speed tests become an issue for some people with ADHD or maybe severe depression, but they’re only two minutes. They’re not very long. That’s where the interview comes in that’s handy because you’re able to figure out on a test that’s maybe 30 minutes or [00:58:00] 40 minutes what happens.

More often than not, people will explain, I noticed that I’m much slower as time passes and everyone’s beating me. I’m always the last one in the classroom. I have had a hard time focusing lately after the first 15 to 20 minutes. So that’s how I usually will explain it saying like, Hey, this test, they did fine, but it’s only two minutes long. Some of the reading fluency tasks on the Woodcock-Johnson are anywhere from 3 to 5 minutes long. And they’re relatively basic if you think about that compared to someone on the Bar exam, being complex answering complex legal questions or answering essay portion, they have to put together a legal argument.

So, it’s a different construct. And that’s the part I’ve always struggled with. And it gets me frustrated sometimes as an evaluator because I’ve seen these reports come back and they’ll deny and say, well, all the scores are average, and this is why I suspect that it’s not a psychologist reviewing and maybe more of a medical doctor or an untrained person, because it sometimes doesn’t make sense.

[00:59:00] Like you you’re putting way too much weight on a basic sentence or reading fluency task. This person’s in law school or medical school. They’re probably going to do fine on a two-minute test. The test that you’re making them take is two days. So, you have to explain it as best as you can. And sometimes I’ve seen it get criticized anyway, even though I provide a really good explanation and that’s when you usually can appeal it and explain it again more thoroughly. And sometimes it ends up, actually not sometimes, every single time I’ve done an appeal, it’s worked out pretty much for the most part, except one instance.

So you might have a second crack at it, but you just have to explain it as best as you can. Ultimately, there’s only so much you could do because somebody else has to review that and decide how much weight do I want to put on it. But the more you could explain it, the more articulate you are with your explanation, and the more thorough I think that might be easier for them to make a decision based off that.

[01:00:00] Dr. Sharp:  Right. I wanted to ask you about recommendations here as we start to wrap up. Thoughts on recommendations. Are you, for example, recommending specific accommodations? That might seem like a dumb question, but are you getting as granular as to say like, time and a half or a time and a quarter or double time or whatever it might be versus like a quiet room with this. How specific are you getting with the recommendations?

Dr. Emin: So if you go on the testing websites for these different companies, there are forms that you have to fill out in addition to your report for the most part. And they’ll list on there to types of accommodations that they usually provide. And it covers a wide gamut of them, anywhere from time and a half to, even more, the start and stop breaks, to extend the 15-minute breaks or 10-minute breaks, to a private room to a semi-private room. People with dyslexia could get a reader or maybe a laptop. So it was a wide variety of accommodations that you get, and it depends on the conditions that you’re trying to get [01:01:00] accommodations for.

Dyslexia of common things is time and a half usually. And I use the time and a half metric because the Nelson- Denny operates off of time and a half. So, that’s what I use. And I’ve seen this sometimes come back and say, no, we’re not going to give time and a half. I will give time in a quarter. I don’t know how they decide that, but it is what it is.

What else? The screen reader is common for people with dyslexia. I’ve seen them get granted laptops sometimes. Sometimes a private room that doesn’t have distractions. For ADHD usually, for the most part, it’s either a time-and-a-half or private room to minimize distractions.

For psychiatric conditions, panic attacks, or PTSD, I’ve seen the tip a little bit for time and a half and a private room, starting stop breaks or extra 15 minute breaks are a big deal. People that panic attacks or feel the panic coming on, usually, at that point, for most of the people evaluated how those compensatory strap strategies what are they’ll use deep [01:02:00] breathing or progressive muscle relaxation.

So that’s the rationale that you use to explain why someone needs to stop the clock when the why that they should get an extra 10 minutes to use that technique so that they way they calm down before they go to the next portion of the test.

So whatever accommodation that you write, you have to rationalize and justify and explain why you’re giving it. So that’s really important. It doesn’t matter that if you say, I think this person should get this. Well, why? 

Dr. Sharp: What does that rationalization look like? Can you give me an example? Let’s just say for time and a half, how would you recommend that?

Dr. Emin: Sure. So at the end of the report, I’ll usually have a section that says functional impairments and recommendations. I’ll quote the ADA again. I have the legal framework that I have pulled from the websites and stuff. And I’ll say, these are the accommodations I request based on the ADA’s explanation of reasonable accommodations and stuff. [01:03:00] I recommend this person has time and a half, and this is based on, and I’ll go through and provide a summary.

Usually, if they have a history of it, I’ll say, in the past, this is how they were before accommodations. This is how they got it, and this is how they’ve been. They continue to have difficulties with sustained focus or reading fluency or whatever impairments they’re having difficulties with. And then I’ll say, based on these, this is why I recommend them time and a half.

So, imagine you were to summarize your entire report into two sentences. How would you summarize it? That’s how I view it for rationalization. It’s much easier when they’ve had it in the past, because you could explain like, hey, this person’s had it in the past. They’ve done well on it. They struggled before they got on it, and this is how they are now. It becomes obviously more challenging when they’ve never had it before. And usually, on those, I’ll provide a little more explanation as to why they need now. I’ll basically go through each one and explain it.

For a private testing room, usually, it’s, they [01:04:00] get distracted by the surroundings. There’s too much extraneous noise, their mind wanders when they hear people shuffling their feet or typing on the keyboards.

For starting stop breaks usually, when they have panic attacks or they have periods of intense anxiety, they usually use these strategies. This takes up too much time for them. By allowing them to stop the clock, they’ll have sufficient time to use the technique and also not run out of time.

So you have to think, how am I going to explain this to the average layperson and why this person needs it and just view it from that perspective and really be very concrete and definite with your explanation.

Dr. Sharp: Yes. I like that. Let’s see. We’ve covered a lot. I feel like we hit people with a lot of information. You’ve hit people with a lot of information. For folks who… well, actually, before I start to really wrap us up, are there any other key points that you think are important to mention that we haven’t touched on?

[01:05:00] Dr. Emin: I think the most important thing is whatever tests you’re trying to get accommodations for, on their websites, they have all the guidelines, all the information. So before you even start doing this work, go on the websites of these different testing companies and become familiar with what they’re looking for them.

MCAT has a fantastic website that explains it for each type of condition, what they look for, what tests they want, what their expectations are. You really should know and understand that before you even do the interview, because it will help guide you through the process.

If you’ve never done one of these and somebody calls you for like a bar exam one, it’s going to be really hard. I’m not saying that you won’t be able to do it, but it’s going to be hard because they expect a lot. And if you’ve got no idea what to look for, it might hit you out of left field when you submit this request. And then two months later, your client gets a dial letter denial letter, and you have to explain why.

So, it’s definitely challenging. I would say, familiarize [01:06:00] yourself with the ADA and definitely each specific testing company’s requirements. So that way, you know exactly how to approach the evaluation. And all their websites have this info. It’s not a secret. It’s clearly spelled out there for each condition. Each condition has a separate form and separate requirements. So you got to familiarize yourself with that. 

Dr. Sharp: Yes. That’s good advice. Any resources? For folks who are trying to get into this realm, any places to learn, any other sources of information you might recommend?

Dr. Emin: I think for anyone who does learning disability evaluations or ADHD evaluations, I don’t think this is out of your wheelhouse. I think you just have to become familiar with the ADA and with what the testing companies want and start viewing your reports as a legal document. So like a forensic report writing course would be really helpful because you learn and figure out how [01:07:00] somebody else might tear apart your report, how someone might criticize it.

I think report writing really big because you might be the best psychologist ever, but if you can’t explain it in a very articulate concise way, it doesn’t matter because if you didn’t write it down, it didn’t happen. So I would say that’s a pretty good start. If you worked on some forensic report writing courses just to understand how medical-legal reports might operate.

Dr. Sharp: That’s a great suggestion. Well, I can’t say enough thanks for coming on again and sharing more knowledge with us. The thing that I really appreciate and admire about you is that I know, anything that you are doing, you have researched it very thoroughly and you’ve done probably a ton of training that you haven’t mentioned that backs up the work that you’re doing. I know whenever you’re speaking about something, it’s because you’ve done your homework. So I really appreciate you coming on and talking with us about another topic.

[01:08:00] Dr. Emin: You’re very welcome. And honestly, if anybody who has been listening to this has questions, I think you’re going to include my information in the show notes hopefully. If people have questions, just reach out to me. I’ve had people contact me in the past and ask questions and I’m more than happy to give you some feedback and some tips because when I started out, the person that was supervising me gave me all my tips. So I’m happy to share knowledge. 

Dr. Sharp: That sounds great. Well, again, thanks. Hopefully, we’ll talk again soon.

Dr. Emin: Thank you. Have a good one.

Dr. Sharp: All right, y’all, thanks so much for listening as always. I really appreciate you. Hope you had a great holiday season and heading into the spring with a positive mindset. As always, if you are interested in group coaching at whatever level you might be at, you can go to thetestingpsychologist.com/consulting and schedule a pre-group call to figure out which one might be a good fit.

A new feature, Spotify [01:09:00] within the last month or so has released the ability to rate podcasts. I know I have a lot of Spotify followers out there. If you get a minute, you can go into Spotify and rate the podcast. I’d be very appreciative.

Okay. That’s it for today. I will be back next time with a business episode. Take care.

The information contained in this podcast and on The Testing Psychologist 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 [01:10:00] 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.