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.
Hey everyone. Welcome back. I am so happy to have a return guest on the podcast today, Dr. Liz Angoff. Liz was on about a year ago talking about her approach to giving feedback with children and her project, The Brain Building Book, which has since taken off and become quite popular in The Testing Psychologist Community.
She’s back today to talk about her newest project, which is really an evolution of that model. We’re talking today about feedback with adolescents specifically. We talk about how adolescents are different from children. We talk about the importance of shared language with [00:01:00] adolescents and getting them on board if they are resistant to evaluation. We talk about how she structures the feedback with adolescents. And we just talk about the continued development of this model- what it entails and how it’s come together over the past year. So plenty to take away. As usual, Liz is a fantastic guest, easy to talk to, and super informative.
If you don’t know who Liz is, I would encourage you to go back and listen to the podcast that she did about a year ago. You can also go to the resources in the show notes. Liz maintains a blog that is chock-full of excellent information, free information that is very valuable. It’s completely undervalued that she’s given it away for free, but those [00:02:00] links are in the show notes. And of course, you can find The Brain Building Book and anything that we discuss today on the website as well, which is in the show notes.
Here’s a little bit about Liz. She is a Licensed Educational Psychologist with a Diplomate in School Neuropsychology. She provides assessment and consultation services to kids and their families in the Bay Area in California.
Liz began her career as a family advocate and educator. She helped the Oakland Unified School District establish some of its first family resource centers. Then in 2016, she became a school psychologist, specializing in response to intervention, crisis response, and helping teachers implement Ross Greene’s Collaborative & Proactive Solutions in the classroom. She opened her private practice in 2014 where she focuses on neuropsychological testing and parents’ support.
As I mentioned, she’s the author of The Brain Building Book which is a tool to engage children in [00:03:00] understanding their learning and developmental differences as part of the assessment process.
So, stay tuned. This is a great episode and plenty of resources in the show notes. Without further ado, Dr. Liz Angoff.
Dr. Sharp: Hey, Liz. Welcome back.
Dr. Liz: Hey Jeremy, it’s awesome to be here. Thanks for having me.
Dr. Sharp: Oh yeah, definitely. I’m always excited when people want to come back. I’m like, “Oh great. I didn’t drive them away the first time. It wasn’t that bad.” So, I’m honored to have you again and just excited to share some more awesome [00:04:00] information with folks. So, if people aren’t familiar, you were on, gosh, I don’t even know, a year ago, maybe two years ago?
Dr. Liz: It’s been a year. Almost exactly.
Dr. Sharp: Oh, wow. Yeah. So you were on about a year ago talking about your approach to feedback with kids and the book that you developed. And now we’re back, there’s an adolescent version now, which I think people are probably really excited to hear about. All that as a means to say, welcome back. I’m excited about our talk.
Dr. Liz: Thanks.
Dr. Sharp: For folks who may not be familiar with your work or your previous interview here, can you just tell me a little bit about this approach that you’ve got going on and how it’s even evolved since the last time that you were here on the show?
Dr. Liz: Sure. This all came from just being asked to [00:05:00] by parents. I worked in the schools for a long time, and then when I… We don’t really have the time in schools to sit down with kids after an evaluation and go through it with them. I went into private practice and parents started asking, will you talk to my kid?
I had one amazing session with a kid where it was just transformational, and then I tried to do it again with the next kid and it just fell flat. So, I started asking around, how do you talk to kids? And it turned out nobody knew anything more than I did. And people would talk vaguely about how they approached it, but there just wasn’t a lot. And so, it went to the sideline.
The thing that really made me turn back to it is that as I started to assess more adults and listened to their stories, they come in for re-evaluation and then I would ask them, can you tell me a little bit about your history with learning and your learning disability or [00:06:00] what was hard for you, and they didn’t know. They would say, “I wasn’t really made for school or I was a dumb kid. I was really lazy. I’m not sure.” And then we would go through the evaluation and it would be a total rewrite of their life narrative.
So, we talk through. This is dyslexia. This is what this means for you. And things would start to fall into place like, oh my goodness. I’m not dumb. Wow, my teachers really missed that. Or I didn’t realize that’s why I had such difficulty with this or why it showed up in my personal life that way. And then the other side of it, like, wow, I didn’t realize dyslexia included that ability to connect with people or the way I see the big picture or some of that out-of-the-box thinking. I’m getting a lot of positive feedback at work [00:07:00] that that’s part of my learning disability too.
Watching people put all those things into place and rewrite the narrative of their entire life, and then thinking, oh my God, how many decades has this person had this negative narrative about themselves? We have to do this. And when I keep saying this, it’s not optional because kids are creating a narrative. Whether we talk to them or not, they know something’s different and they’re starting to create those narratives.
So I went back to the drawing board and started experimenting with a lot of different ways to talk to kids about these things. And just going back into some of the research that helps us to understand how to talk to kids and then how to deliver feedback. There’s not a ton of overlap between those two [00:08:00] things, but it’s there and it’s evolving.
I have a lot of training in collaborative practice solutions, which is Ross Greene’s work. The piece that I really like about it is that there’s so much respect given to kids and their experiences in their language. And so, trying to understand, what’s their perspective and how are they seeing this? That’s the way that we solve problems.
A referral question is just a problem that somebody wants to solve. Parents come in with a referral question. It’s the problem that they see that they want to solve. Teachers have a referral question. It’s their problem? So, what’s the problem that the kid wants to solve? How do we figure that out so that they can be along with us for the journey and understand?
I’m wanting to couch all that within the growth mindset framework. And so, really having language that was positive and [00:09:00] forward-moving that even though there are real things that are hard and the kids know that they’re hard, there are no rose-colored glasses to give to a kid. If they leave the assessment and we tell them, we found out that you have all of these strengths and there, they know something is missing. And so, how do we talk to them about the things that are challenging in a way that is positive and leaves them feeling empowered to really engage in their intervention and make changes?
Therapeutic assessment is this whole branch of assessment that is using assessment as a therapeutic tool. And so, there’s just a lot about the way that you present feedback so that somebody can hear it. And there are these different levels. When you’ve interviewed a number of people from that community, one of the big things is the [00:10:00] levels of information.
So thinking about, when I’m talking to a kid, what’s level one information for this kid? What’s consistent with the way that they think about themselves? What’s level two information for this kid? What’s something that’s just going to be a slight reframing for them? And then what’s something that’s super inconsistent with their narrative? So they’re not going to be able to hear it right now.
I think the piece that I was thinking about in developing the model that I use is if we can’t talk to them about it right now because they’re not ready, how do we prepare parents and teachers to be able to continue that conversation ongoing so that it doesn’t stop at our office or pause at our office and just wait for the re-evaluation, that there’s an ongoing conversation in parents or teachers are prepared to have that with them?
So, bringing all of these things together, the model that emerged has four pieces. [00:11:00] The first piece is that feedback starts before intake. And it’s just a way of saying that we’re starting this feedback process in the very first moment of testing. And that first moment is actually before the child comes into my office for the first time. The first moment is when their parents or teachers say, Hey, you’re going to go work with Dr. Liz.
So how do they present the assessment in a way that’s going to set the child up to engage in this collaborative, exploratory process as opposed to like, go play games with Dr. Liz, which is not going to end well because if they think they were playing games, we can have a fun time. I can give them lots of prizes and we can really jam, but if then they come back in and I’m like, let’s talk about your brain and what we learned, they’re going to feel like they got hit with a Mack truck. [00:12:00] The metaphor is not coming, but they’re just going to feel like I did a bait and switch on them. I thought I was playing games.
Dr. Sharp: Right. That’s great. So part one, it starts very early.
Dr. Liz: Yes, and it’s integrated throughout. Feedback is not a single event. It’s a journey throughout. So how do we integrate that?
The second piece of the model is actually the integration. How do we build the shared language throughout the assessment so that we’re on the same page? If you look into the literature on feedback, the main thing that comes up over and over again is using language that the patient understands. And for kids, that language might not be even developed yet.[00:13:00] I realize in the assessment process, I can actually introduce some new language to the kid as well as use different prompts and conversations to elicit their language. And now, we’re building up that language. So we have a lot to draw from, by the time we get to the feedback session, that’s all really familiar.
Dr. Sharp: Yeah. I just want to emphasize too that we’re not talking about adults but I think, you tell me if you agree or not, that a lot of us don’t even use language that adults would prefer or are familiar with. So to step it down to kids is a whole other process that we have to be extra deliberate about.
Dr. Liz: I have been just bowled over by the effect that this really dialing into what kids understand has improved my feedback sessions with parents. And it wasn’t my intention to. I [00:14:00] thought it was doing pretty good with parents. I don’t know I was doing as well as I thought because I have had so many parents that at their child’s feedback session go, oh, that’s what you meant.
I have a little handout that is now on the brainbuildingbook.com website. It’s very simple. It’s just four boxes.
And it says highways, which are your strengths; construction zones, which are the things you’re building, not weaknesses, but things you’re building; special words, which is just how we’re explaining the diagnosis to the kid and then the tools that you’re going to use to build. So that’s your recommendation.
I started using it just to plan my feedback session so I had that kid language, but parents started asking for copies of it. And so now it’s a document that I [00:15:00] produce formally and I use it during zoom IEP meetings because that’s all we have anymore. And so, instead of putting the report up on the screen, which is ridiculous, just put this four-part thing which is a lot easier for people to see, and that’s the document that everybody wants. Nobody actually cares about my report it turns out. They just want these four things. And it’s helping it to make sense to parents and teachers in a way that’s just like oh, here’s the elevator speech on my kid. And this, I can wrap my head around. It’s not to say the rest of it isn’t important. I’m being a little flippant, but it really brings things home in a way that was unexpected to me.
Dr. Sharp: I hear that. I have the benefit of hindsight, of course, and like the big picture view, but that totally makes sense. People want simple and digestible [00:16:00] and what’s the easy way to take this in. Anyway, we could go down the rabbit hole as far as to report effectiveness and how we write reports and all that, but we’re not going to do that. We’re going to stick with the feedback session and just acknowledge simple is better.
Dr. Liz: Right. So that shared language. The key part of this model is really spending the time to get the kid’s language and to introduce different concepts throughout the assessment.
I do a lot of trying things on for size with kids. Like today I had a kid in my office who’s talking about how he loves to write but he has a hard time with punctuation and things like that. A middle-school [00:17:00] kid. I said, “Okay, so the things you’ve been talking about, it seems like you really like the big ideas but like little details can escape you. Does that feel right?” And he says, “Well, no, not really.” And then he corrects me and he’s like, “I can’t catch my own errors, but I can catch it. If I have to correct my friends’ paper, I’m all over it. I can find every little detail.”
And so now, things have gotten interesting because now I’ve tried a general theory out on a kid, and now he’s had a chance to take my language and then correct it back. Now we have something that’s getting more complex, which I don’t know where this evaluation is going yet. I know the referral question, but I don’t know where we’re going to end up, but I do know that we’ve just started to have a really in-depth conversation about how his brain works and the fact that sometimes his attention can be turned [00:18:00] totally on for details and sometimes it’s totally for details. And I can’t help but think that that’s going to be really helpful on the other end to talk about some of the things that are challenging without saying this is all challenging all the time. We’ve already started to unpack that.
Dr. Sharp: Yeah, that’s great. I like that illustration as well. I know we’re going to dive more into each of these areas or some of them at least, but I’m curious, can you give us steps three and four to wrap up the overview, and then we’ll dive deeper?
Dr. Liz: Step three is no surprises. I think that every time a feedback session has not gone well, I can trace it back to missing this step. And it’s really trying to make sure that whatever I am presenting at the feedback session is not a surprise. It’s not brand new information. We’re building off of things we’ve already been talking about. [00:19:00] Again, it’s true for parents too.
If I am looking at the feedback session and I’m now seeing something that I wasn’t expecting, I get a call with the parents to plant the seeds for that first so that I’m not throwing them a curveball at the feedback session because there’s no way to process those things.
And so for kids, that’s really important because as we’re building that shared language and I’m hearing from them how they’re understanding things and the questions that they’re asking, which is a big thing, like how do you get a kid to ask their own questions? Whatever we’ve talked about, I know that we can continue that conversation.
If it hasn’t come up at all, or if they flat out rejected it, as we talk about adolescents, a lot of times I’ll say, your parents say that sometimes you seem anxious and they’re like, no, I don’t get anxious.[00:20:00] Not at all. And it’s like, okay, so let’s put that to the side and we’re going to figure out something else. There’s no way I’m going to convince a kid that they have anxiety if that’s not how they’re thinking about it.
This no surprises helps me in preparing for the feedback session. I think about, what have we talked about? What’s the child’s current narrative and then what have we already introduced so we can shift that a little bit? And then, what’s off the table because we haven’t gotten there yet and help parents to understand that too, that we’re just not here yet.
The fourth piece is for kids especially, setting up the adults to be able to continue the conversation because it’s overwhelming for adults to hear all of this. For a child, they can nod their head and be in agreement and even tell me I get it in the feedback session, but that doesn’t mean they’re going to be able to generalize to the next time they hit a [00:21:00] roadblock. The next time something hard, it’s like, oh, I’m so dumb. I can’t get that. The frustration takes over or they’re not making the connection. So, I want to make sure that the adults are really set up to be able to keep this conversation going and really help the kid make the next step.
Dr. Sharp: That’s so important. We talked at other times about the follow-up for evaluations and what that might look like. Well, we don’t talk a whole lot about setting parents up to continue the conversation, right? I think a lot of us assume that we have to be a part of that process- a part of the continuation of their support, but in the vast majority of cases, that’s not happening. People don’t return to our office necessarily. So I love [00:22:00] that fourth point that that’s a pretty important part of this.
Thanks for talking through the overview. I know folks probably have a million questions from getting the teaser for each of those parts of the model. And so, I would love to go a little deeper with a few of them. I’m generally curious, I’m not sure actually where this fits into the model that you described, but I’m generally curious, how you are finding this process is different with adolescents compared to kids. Can you speak to that a little bit?
Dr. Liz: Yeah. I think the thing that strikes me over and over with adolescents is that they, especially adolescents seem to have a very different conceptualization of what’s going on than their parents. And so, really understanding their language is really [00:23:00] important because when you have a kid who’s in the stage of their life where their biological imperative is to define themselves independent of their family, even if they come back to the same conceptualization that their parents have, they’re driven to see it differently.
And so, just validating that the way that they understand their experience is going to be different and giving them the space to articulate that, it comes back to really having a space to really show the kid, I respect your opinion. I’m going to weigh it with all this other input that I’m getting because we can observe you, but you’re the expert on your experience.
And it’s a huge piece that comes up all over the collaborative assessment literature. We are experts in assessments, we’re experts in psychology, [00:24:00] we’re experts in education, we’re experts in all the things we’re experts in, but the patient is an expert in the patient’s experience. And this is true for kids also.
And so I think, especially in adolescents because they are in a process of defining themselves and figuring out their identity in this way, that we actually have the opportunity to use the assessment as a way for them to explore that a little bit. So helping them come up with their language and really hearing how they’re describing their experiences.
A really simple one that happened recently is, I have a child who’s super anxious. His final diagnosis is anxiety, but the way he describes it is really around stress and overwhelm. The word anxiety is loaded for him in such another way [00:25:00] that the wording becomes really important. And the specificity of what we’re talking about becomes really important so that we can, like I mentioned before, figure out what his problem is that he wants to solve so we can help him solve that problem.
We’re actually working on the bigger issues that we might be able to see as adults by helping him to address that problem. I mean, obviously working on stress management and the executive skills involved in homework, that’s going to help the bigger picture, but that’s where he’s at right now. And putting weight there means that he’s going to be more involved in the intervention as well because he gets it. It’s solving a problem for him.
I found that younger kids, sometimes they’re going to see a piece, but they might be more willing to go with the flow. You’re going to go work with Mr. Smith to help you with school.[00:26:00] We can get away with those things. I get away with the wrong framing, but I think there’s a little more trust in like, we’re going to set this up for you and it’s going to help. But with adolescents, it just feels like I’m doing a little more work and making sure there’s a real connection between the thing that they’re interested in making better and the thing that we’re going to do to help.
Dr. Sharp: Yeah. Can you give some examples of how you do that? How do you make that connection?
Dr. Liz: Sure. Where do I start? There are two different ways that I go about trying to help the kid ask their own referral question, their own assessment question. I [00:27:00] use The Brain Building Book. The new book for adolescents is called Brain Building 101. The prompts in there are designed to set us up for asking questions.
So, I start with just introducing the brain similar to how I do it with the younger kids but I use more sophisticated vocabulary. We talk about the different lobes and take something that they just like doing. Today, I had a kid who really likes rapping. And so, we talked about what it takes to design his rap lyrics. Often a sport is one of the things that kids really like. We’ll talk about how their brain is involved in helping them to do that sport.
And it just gets us talking about how the brain works together and these different systems go. And it’s just designed to get them curious about the science behind what we’re doing because it’s fascinating. The brain is just [00:28:00] interesting and it’s not you. Let’s evaluate you as a person. We’re going to see how your brain works. It takes it one step removed. So it’s a little easier to talk about. And it just takes down that emotional wall a step, because it’s easier to ask just a question about the brain than it is like, oh, let me tell you about my most vulnerable, deepest, darkest, secret, wondering within the first five minutes of meeting you. So, just getting them curious about the process.
And then after we’ve gotten into our groove and we’re at another interview break, I don’t know how everybody does it, but I integrate my clinical interview throughout the process at different breakpoints. So we talk about what are some things that you feel come easily to you? I do a lot of educational evaluation, so like things around school or [00:29:00] things extra, like things that you do outside of school, things you feel talented at, or sports, art, some other robotics club you might be part of, what are the things that you really enjoy doing?
And then what are some of your construction projects? So these might be things that you are working on that are just new. It’s the next frontier. It could be something that’s trickier for you or something you just don’t like. I don’t like history class. And so, we can put that under like, okay, that’s something that’s not flowing as easily as your math class, which is one of your highways.
Once we have this, we start making comparisons. I might model something like, you said that you really like math but you don’t like history. What’s that about? Can you tell me a little bit more? And a lot of times that compare and contrast can help us come [00:30:00] up with a question.
And I’ve told kids at the beginning that we’re here to ask questions. I want to find some questions that are interesting to you. So to model that I might say, I wonder if it’s interesting to figure out why you’re always bored by history, but you seem to like your math classes. Does that feel like a question that’s worth asking? And so, that’s another way to start to generate the kinds of questions that you might ask.
Oh, I love this club I do after school because I have so many friends there. And then you find out that it’s harder for them to make friends at school or they don’t like group work. I’m like, I wonder why it’s so easy for you to work in groups in your afterschool program but not during your English class. What’s going on there?
Being able to set up the comparison [00:31:00] contrast, I’m able to see what’s interesting to them. I’m also able to test the waters on some things. There’s a social question in the parents’ referral questions. I can start asking about these things to see if that’s a question that the kid might want to answer too.
There are so many ways to do this when we do some more of the social, emotional questions, things that you wish were different, things that you’d like to change. How do I change that? How do I make that difference becomes a really great question?
And then for some kids who are more resistant, thinking about the next construction project can be really helpful, even if it seems unrelated to their “academic” problems or their “social-emotional” issues or problems that are coming up.
I have an example. Recently, a kid who was really hesitant to talk about anything, I’m fine. I’m fine. [00:32:00] But when we did this, what are you working on next? She really likes photography. And I was like, where’s it going to take you next? And she’s like, “Actually, I want to really get good at art.” Okay, well, what’s that going to take? She’s like, well, I don’t know, because in the class I want to take, you have to display your work at the end. And I just don’t like showing my work at all. I don’t want to do that. And so I was like, okay, well, let’s figure out how we’re going to help you get better at drawing.
And through that, we were able to tackle the anxiety piece which is a big part of her profile. Part of why she was so resistant to talking, but we could talk about like, okay, if you want to get better at this thing, it’s going to involve getting your work evaluated, let’s stay within here. And it was a really great way to attack the anxiety in a way that was safe for her and solved a problem for her [00:33:00] that was still in line and really respecting where she was coming from. And then she wasn’t ready to talk about what we think we see as adults quite yet.
Am I answering your question? I feel like I might be rambling a little bit.
Dr. Sharp: You’re doing great. Yeah, this is good. I’m thinking through this lens or looking through this lens of shared language, right? So we started in this place of how is this different with adolescents compared to kids, but I like how it’s evolved into this component of language. Adolescents have a lot more awareness of themselves. They have presumably a bigger vocabulary and different ways to describe what’s going on for them. They’re typically resistant. So we’re touching on all these components.
Dr. Liz: Yeah. And I think being able to write those things down and do the comparison has been really helpful for me. I don’t do well on the fly. I definitely need a process. [00:34:00] Having those steps has been just really helpful for me. The book’s really helpful because it’s right there. It’s like the next page, like, oh, oh yeah. Okay. Let’s talk about things you like to do, the things that you feel like you’re good at. And then we can really concretely look at like, okay, you said this on this page and this on this page, let’s talk about how those two things go together.
If you’ve heard me talk about the way I end up defining a diagnosis at the end, it’s often putting those things together. Your brain is built in a way that gives you this highway and makes this hard. And that pattern is what we see in a lot of people who are dyslexic or a lot of people with ADHD or a lot of autistic people. These are the patterns that we see these strengths and challenges that go together and just the way that your brain happens to be built.
And so building up all that language over time, that we can then really concretely come back to and say, look what you wrote. I think this is the pattern I’m looking at, and this is what that means. [00:35:00] This is what we call it.
Dr. Sharp: Yeah, I think it just goes back to what you said. I think it was the third piece, no surprises, right? You’re building this shared experience throughout the assessment using their language. It all ties together. It’s like it’s a coherent model or something.
Dr. Liz: If it were, it surprised me when it formed that way. Here we are.
Dr. Sharp: Right. Let me see. I want to focus on the language component a little bit more particularly around how you are doing this during the assessment process because it’s not built into our standardization to talk with kids about how they’re doing during the process, right? That’s not in the manual, but yet I know that you consider that to be pretty important in [00:36:00] building the shared experience. So how do you approach that?
Dr. Liz: Yeah, I will pose it that is definitely a paradigm shift to think about talking to kids about their results at all, never mind thinking about how you integrate that into the whole process, but there is precedent for it. There’s a lot. And so, thinking about different approaches, I know that for me, I’m not going to be able to cite them all, but for me, the Boston process approach does a little bit of this breaking a task down and individualizing the different pieces within the assessment process.
In some of the things that I’ve been reading, even tracing back to Lauria, he had a model of presenting feedback in a way that checked in with the patient, like, [00:37:00] is this making sense? Do we have examples of this? Can we connect it back? And then, the therapeutic assessment does a lot of this too. Let’s look at what we did here, and let’s look at your response.
There’s a tiny bit of literature on collaborative neuropsychological assessment and asking patients, how do you think you did on that? And then getting their response and then comparing that to what actually happened and having this back and forth. So, there’s a lot of precedent for this. And with a kid, they’re not going to remember. So integrating it within becomes actually really important. So the experience is fresh because it’s hard to take them back.
And so, what I’ve been doing is, the first thing that I do is in that whole introductory process of showing them their brain and [00:38:00] and orienting them to, this is a discovery process format to the assessment, as opposed to, let’s see why things are hard for you. It’s like, no, we’re going to discover how your brain works. I’m setting it up and I’m telling them, I want you to let me know. If something is particularly fun for your brain, let me know. If something is particularly challenging, let me know that too because I’m not always going to be able to see it or know. So, if we get to the end of something and you’re like, oh my God, I am so exhausted after that, tell me. I want to know.
So before we even start, I invite them to let me know about their experience. And then a lot of times after I’ve completed a section, so after the WISC or after we’ve completed a memory battery, after the WRAML, after these big sections, I’ll ask a general question like, what did you enjoy the most? What was hardest for [00:39:00] you? Can you just tell me a little bit? And a lot of times they’re sharing.
One kid recently he’s like, I love digits. He said, “I love the numbers thing. I love digit span.” And I was like, really, that was fascinating?
Dr. Sharp: Said no one ever.
Dr. Liz: But it became really important because I ended up diagnosing him with ADHD, with a working memory score that’s off the charts and it’s because he loves numbers and actually got a kick out of trying to memorize these things. He was so into it, but his functional working memory on a day-to-day basis was really challenged.
So it was actually really important information to know that he got such a kick out of that task and he felt like it was such a challenge because it made it make more sense, right? Just asking for simple things like that.
I love asking about the WRAML because, and I’m not [00:40:00] trying to push any tests, but any memory battery is actually awesome to ask about because you’re looking at visual memory, auditory memory, story memory, all these different, you’re kind of breaking it down. I get a ton of information just by asking, what was easier, what was harder, what did you like, what didn’t you like, about how they’re approaching different tasks, and what they’re doing in that.
If I see that a kid had a really negative reaction, and this happens a lot with writing for whatever reason, it’s just like, oh, or sometimes tears, I mean sometimes head on the desk and tears. It’s not uncommon. And when I see those big reactions, I will stop and do a little Collaborative & Proactive Solutions style emergency plan B intervention, like, wow, [00:41:00] I am noticing you’re having a really hard time. What’s up? And we break it down. And those kinds of conversations have been so critical to analysis because you really get insight into what’s going on with the kid in that moment.
Dr. Sharp: Yeah. I love that. This is so validating. You’re describing a lot of things that I like to do, but never really put it all together necessarily. I love that. I love asking kids, what was really fun for you during the process? What was hard? How does that map on to your life? All that kind of stuff.
Dr. Liz: Yeah. How does it map on to your life? Do you have an example of where that shows up, is a good one too because sometimes it’s immediate? They’re like, oh yeah. And a lot of times I get, oh yeah, I think, and with adolescents, this is cool because they’re old enough to start making these connections on their own.
And a lot of times asking about a memory battery, they’d be like, [00:42:00] do you think that’s why I hate history so much? Because she just talks on and on. I didn’t like the stories and those were so long. Do you think that might be something? I’m like, “We should put that as one of your questions. Why is it hard to remember a lot of talking? That’s a great question.
I’ve had that experience a lot that can start to make those connections, or I can prompt it, like, do you think this has anything to do with what you told me earlier about not liking this class or why you really like this teacher? Is that a connection? And they can start to make those and they become really important insights.
And then I get to tell parents, your child had this amazing insight, which is just like really, really cool to shift the parents’ narrative of like, oh, my kid really understands themselves and bring them in.
Dr. Sharp: Yeah. That’s wonderful to be able to share that information for the love of doing that. [00:43:00] Before we transition to the actual feedback session, I’m curious about what you do with kids or teens if you see these teens who are just super reticent. My parents dragged me in here. I don’t care. I don’t have any questions. I’m working on getting better at this video game or whatever. Do those cases ever pop up for you? And do you have any…
Dr. Liz: I am not special in that way. The first thing is that I think that this approach in really thinking about what’s the problem the kid wants to solve has been a big help with those cases because it really shifts us away from, I think most often it shifts us away from diagnostic categories and [00:44:00] into just like what’s the kids’ daily experience.
Instead of focusing so much on them, is it like, what are the hardest parts of the day for you? What’s going well? What’s not going well? Because often there’s some point of conflict or something that like, my teachers are against me or my parents are against me or they just give me too much homework or I’ve got it. And so, starting from those places where there’s something there that could get better.
And a lot of times, for those kids, I’m not writing things down. I might not be using the feedback workbook at that moment, but more trying to figure out what’s going to move the needle just a degree here to really help them start to [00:45:00] engage? I think it’s really important to recognize where a kid is at, and describe that accurately to a family. This is what this child is working on right now.
A lot of times with adolescents, there’s such a strong desire to be normal, whatever that means, and to be part of the group that any recognition that anything is hard is like, I’m opening myself up to Pandora’s box of you’re going to tell me there’s something wrong with me and I need special help, and I need all these things. And so, it’s really important to recognize when kids are in that place and to see what one degree of moving we can make.
For a kid who is on my mind right now who really came in with that, the only question we can come up with was why are my parents making me do this? Which is actually not an invalid question. One of the things I [00:46:00] say a lot is, I don’t care what question. Ask me any questions because we can do something with it.
One of the conversations we had with the school team for him is, how do we normalize the struggles of adolescents? Let’s just start there. That adolescence is hard. You don’t have to be special in any way to have a hard time between 12 and 16. So, let’s figure out how we can start normalizing these things and intervening on some of the common things. And this is going to help move the needle just a bit to open this child up to help moving things.
And I think for where that kid is at, and then having stuff documented so parents can help move him those steps without having to wait until their next appointment with me or their next evaluation becomes really important so that we have some movement that makes sense for the child.[00:47:00] Dr. Sharp: I like that. And just validating that if a teenager has the question of why do I have to do this? That is a question. Or why are my parents making me do this?
Dr. Liz: I feel like then you can come back and be like, well, your parents are concerned about your Ds.
That’s why you’re here. Like, why are my parents making me do this? I have an answer to that. And I like to check in with the parents. Can I share your referral questions? Can I share this referral question? To be honest, your parents are concerned about the Ds. Let’s talk about them.
I’m going to really validate that respect for the child. You’re telling me nothing is wrong. Help me understand the Ds in the perspective of nothing is wrong. Actually, that can often help shift parents away from I’m so scared for my child’s future to, oh, this is a hard time. And we can [00:48:00] move them to the middle.
I don’t want to go too far off, but I can think of a number of times that parents who are just looking at how much trouble their kids are having at school at this adolescent age, and wanting them to be in either a specialized program for learning or behavioral challenges or a smaller school depending either within a district or moving them to private school because the learning needs are so high.
And what we find out from the child is actually my biggest problem is the social piece. I feel in one child in my head, we did this CPS- the Ross Greene intervention with him, and just learning, geez, it happened today too. This happens a lot. Learning at this age, how important the social support piece [00:49:00] is, and hearing out the child. The kid’s fear is that you put me in a school and I’m going to be so isolated. My life is going to be awful. It doesn’t matter if I’m getting all the support that I need.
So helping parents figure out how to weigh, this stage of his life or the stage of her life is as much about building those social connections as it is about the learning piece. How do we come to the middle to find that balance? And I found a lot that when we start to validate that, the kids start to soften.
I’ve had very few cases, I have a lot of cases that start with, I don’t need to be here and end with, okay, if we can just make this one thing better, that would be good. Or if you can make sure that my parents don’t send me to that school, we will be on a good page. And that just opens up the conversation for let’s figure out what [00:50:00] everybody’s needs are here, and then we can come to a solution that’s going to work for everybody and validate the child.
Dr. Sharp: I love that. Well, let’s talk about the actual feedback session. How do you structure feedback with adolescents?
Dr. Liz: So with young kids, it’s a family affair. I’ll come in, I’ll talk together. It’s great for parents to be able to hear all that language. For older kids, I see them alone first.
With the kids that I work with, we’ve been using the feedback workbook to document all this stuff. So when they come in for the first half just on their own and we recap what we’ve done and what we’ve already learned and seen what’s happened since that. If they’ve had any other experiences, any other thoughts about things.
I often start just with a [00:51:00] game. If we’ve played cards or something, we’ll play that again and just catch up on what’s been going on and remind ourselves of what we did and what we’re discovering. And then we start to bring these things together. So we look at the highways that we found and sometimes I’ll add one or two more if there’s something that when I brought all the data together, I learned.
When I’m sharing things, people often ask, “Well, do you share test scores with kids?” I’m never sharing test scores and very infrequently will share you did “well or poorly” on something. Obviously, if a kid refused to do something or wrote two words for an essay, you might say like, gee, what’s going on? They already know. I’m not sharing those things. And if I’m not sure that I’m seeing a pattern, if I’m not sure [00:52:00] of something, I’m also not going to share it at the moment with the kid.
And so a lot of times at the feedback, I’m like, I looked at everything that we did and it’s like, wow, whenever I gave you something that had a story behind it, your brain really turned on. And these are the things that you actually did better than most kids your age on. So I want to add those to your highways.
And then we look at the construction projects that we had come up with and I might add one thing. If it’s something we haven’t already reviewed, then that’s going with those levels of information. I don’t want to add on like, and then we found these five things that you can’t do.
So, we’ve already talked about some of the things and I might say, I found more evidence that this thing… I have more examples of this thing that you pointed out that you’re working on is showing up. I [00:53:00] think we can connect that to different things, but I’m not going to introduce something new, maybe one new thing.
So really careful about introducing new information. The thing that I say is, this pattern is common and you’re not alone. We have a way of describing this. One example would be this pattern is called ADHD. And for you, it means your brain finds it easy to come up with big ideas and even quick creative ideas, but it can be challenging to pay attention to little details unless it’s your friend’s paper, whatever comes in. But we have that information. We’re looking for patterns. This is the pattern we found. And when we bring your highways and your construction zones together, we have a name for it.
And that name can be an official diagnosis, or sometimes it’s not for whatever reason. Either [00:54:00] we don’t want to share it with a child for some reason, or we’re not sure because sometimes we’re not sure what’s going on. For a child who’s in this stage of life where everything’s in flux, there can be a number of reasons why we may not share a specific technical term, but we can always show things like, we call the kinds of construction projects you have going on executive functioning skills. And so, those are the things we’re going to work on. Or the patterns that we see, these are big feelings and those big feelings give you those big passionate ideas and they also can give you that anger that you’re feeling, that frustration that you’re feeling when your mom is telling you, you have to do more work when you just spend an hour or whatever the situation is.
We can come up with other terms to tie it together that’s like, this is a pattern that’s familiar.[00:55:00] And then we write that definition down and that’s documented so that it’s on our office, but then that’s there for parents to use and for teachers to use moving on to build on. So we all have that common language to talk about.
A lot of times I’ll ask the kid, how would you describe it? And they’ll come up with new things. There’s one example I use that I told a kid when you talked about that sometimes people don’t understand your jokes or you might feel like you have the wrong timing on when you comment on something, we call that difficulty with pragmatics. And this is a kid who was on the border. We were considering autism as a possible diagnosis. We didn’t have enough of this during COVID. We didn’t have enough data. And so it’s something we talked about as a family, but we wanted to do some [00:56:00] intervention with this kid.
We needed to help him understand the pragmatic piece, and he had talked about I laughed at all his jokes but nobody else did. And you mentioned that I was like, oh, that’s an interesting question. And he goes, oh, I get it. My jokes take off, but they don’t always land. I was like, great, that’s a great way to understand pragmatic. So we wrote that down and that was his definition. And we went to his IEP meeting and he attended and he’s little for attending, but he attended and he’s like, I was like, oh, do you want to share what you learned? And that’s what he shared. It was pretty cool to get his little take on how he would do it.
And then the last thing, I invite the parents in and we share what we discussed. So it gives the kid another time to process. And we only share what they give me permission to share. Some of our conversations with adolescents sometimes are just between us. But we [00:57:00] talk about what we want to write down in the book and what we want to share out. And then they have a chance to teach their parent about their brain which is just a whole different experience and you get their language and then I help them out. I tell them, it’s not a quiz, I’ll help you. And I fill in the blanks.
And then we usually watch a video or a comic or look at a bio of a famous person who might have a similar profile if that’s available. And we do that as a family because a lot of times when we watch these videos, families will be like, that’s totally you, or I noticed that about you or do you think… So that can lead to a lot of great conversation. It is an awesome way to end altogether.
Dr. Sharp: Yeah. This is very granular, but how long would these typically last, and do you ever do separate feedback just with parents?
Dr. Liz: I always do a separate feedback just with parents.
Dr. Sharp: Okay. Good to know.
Dr. Liz: The first feedback [00:58:00] is with parents only, and that’s important because it gives them time to process. I want to make sure that they’ve had time to process and I want to make sure that I let them know that this is the piece I want to share with your child for them to be okay with that, and sometimes parents aren’t. And so then we have to… And really having respect for the parents processing whatever we’ve done is a really important piece of this. And so that feels like a whole nother area to go into that could take a while, but yeah, I want to make sure the parents and I are on the same page about what we’re going to share with the child.
And they know from the beginning that the intent is to share with the child something. We want the child to leave with an understanding of how their brain works, whether that’s a formal diagnostic term or just a way of explaining, [00:59:00] it’s important to me that kids are getting something out of this, that they feel like they, I mean, they’re the ones putting in all the effort to do all of this. If they leave with something that feels like, okay, I learned something here, I got something out of this, I think that that’s really important.
Dr. Sharp: How do you evaluate what the kid is taking away?
Dr. Liz: I ask the kid if somebody is like, “Hey, what’d you do a Dr. Liz, what would you say?” Or if somebody said, “Dyslexia, what is that? What would you say?” And often at that point, parents are there, so they can hear what the kid got and what they didn’t.
And that’s part of the reason for the workbooks honestly, is that it’s all written down because sometimes kids are there with me, [01:00:00] but to rely on a one hour, with a kid it’s an hour at most, and to rely on that one hour to be this magical moment where the kid suddenly understands everything that we did is ridiculous. It is an unreasonable expectation. It relies on so many factors including how the kid shows up and how I show up that day. If we’re resonating, it’s a lot.
And so, being able to write it down and have a way to document that is the piece that makes sure that they do leave with an understanding of how their brain works, because that can then be communicated to a parent, a teacher, whatever intervention they’re going to, so that it’s like, you know what, they came in, I started to explain and they just shut down. I tripped over something that shut them down, but this is where we got [01:01:00] to, and now I’m going to pass this physically onto you, therapist, or on to you resource specialists to continue that conversation. And here’s how we started it so that it’s not dependent on one magical moment every time because some kids, it’s just a very hard thing to come. It’s scary to come in for a kid even when we do everything to build it up. It’s a tough session.
Dr. Sharp: Sure. Well, and there’s research right around just messaging and how many times it takes to have a message sink in and have it stick with someone, things like that, just from a general information presentation standpoint that, something’s going to stick, there are probably going to be some flashbulb moments or whatever, but some won’t. It takes all well.
Dr. Liz: Yeah. I have many more magical moments now. [01:02:00] The more I think about feedback as a process that’s integrated throughout the entirety of assessment, the more magical moments there are because even if it doesn’t happen at the feedback session, it’s already happened or we’re building on something. Those things are there and we’re on a trajectory. And so it definitely helps.
I think one of your guests a little while ago said something like parents hear five minutes of what you’ve said. So make that five minutes count. It’s like, well, okay, I bet a kid here is one minute of this whole session. And so, we got to make that minute count.
And I think my answer to that is, I can’t rely on being magical for that to show up at that minute exactly the way the kid needs me every single 100% of the time. So, I need lots of minutes. I don’t know. I’m a person who needs a lot of do-overs in life. And so, I figured might as well work those into everything that I do.
And so having lots of [01:03:00] moments with this kid to try things out and what are we discovering, and that’s a cool thing and light like, hey, this was just a testing session, but we just discovered that you really learn in groups better than on your own. That feels really important. Let’s share that with your parent is just like something that we learned today and we’ll figure out what that means later. We just discovered something, so why wait until this one session to share everything instead of making it this whole process with a kid that could be really exciting and get them really engaged?
Dr. Sharp: Yeah. Gosh, I feel like we could talk for a long time. It always goes by fast. The part we didn’t really get to is the supporting parents after the evaluation and how to send them away successfully and continue that conversation. So maybe since you’re willing to come back a second time, maybe there’s a third time. Maybe I haven’t driven you away after the second [01:04:00] time. We’ll see. I want to make sure I know.
Dr. Liz: It’ll be amazing.
Dr. Sharp: Yeah, I would love for you to talk about the project you got going on though. That’s a huge deal. So, what’s happening and is related to how the audience can actually access some of this material.
Dr. Liz: Last year I was on talking about The Brain Building Book, which is a book for elementary students. It was amazing. It was just a cool tool I wanted to share and it caught fire. So many people are using it now. I’m sure people are using it in ways that I never even imagined because I’m just getting a lot of feedback that it’s being used in the hospitals and therapy practices and different types of assessment in schools. I think people didn’t have a way to talk about these things. And so, any [01:05:00] way to involve the kid, I think it’s something that a lot of people really want to do.
Now we have an adolescent version. So this version is called Brain Building 101. It follows a super similar format to The Brain Building Book but the language is a lot more sophisticated. The drawings are comic book like as opposed to The Brain Building Book junior is very colorful and playful and the older book just has a different style of drawings and much more space for kids to contribute and for kids to write, or for me to write to document what we’re discovering.
And that is up on Kickstarter right now. I used Kickstarter to launch the other book and use this book because it just gives me a sense of whether this is [01:06:00] important to the community, whether it’s something that would be helpful for older kids. I’m super stoked to say that we met the goal. We met it, so that means that the book will be printed, but you can still pre-order books through Kickstarter and get some of the Kickstarter discounts until February, 18th- just a few more days. And then the book will not be available for a little bit while I get the final copy printed and work out all of the details.
It’s been really fun to use the prototypes in my office. I really like this book. It’s just really helped to bring out for those resistant adolescents or really bring all that out, and have a process for doing it. So, it’s been really cool. And I hope other people also like it and it brings that same thing to their work.
Dr. Sharp: Yeah, absolutely.
Dr. Liz: And you can find it on [01:07:00] brainbuildingbook.com. You should probably know where to go.
Dr. Sharp: That was a great pitch. Here it is. And we’ll have a link to that in the show notes, of course. I’ve seen, I guess, an advanced copy of that. That sounds very official. I feel important. And it’s great. The first one was great. It’s not like it’s unexpected, but it’s super cool to see this continue to evolve. And I know that folks really appreciate it and they found that super helpful.
Dr. Liz: And then I’m going to send you a discount code for the younger version too. It’s available just available for purchase on the brainbuildingbook.com website. So, I’ll throw that out to you for the show notes.
Dr. Sharp: Well, thanks, Liz. Thanks for coming back. It’s always a pleasure. This was really fun and informative at the same time, which is a good interview in my book.
Dr. Liz: Aww, thanks, Jeremy. It’s really fun to be on here and talk to you.[01:08:00] Dr. Sharp: All right. Take care until next time.
Dr. Liz: Okay. Bye.
Dr. Sharp: Okay y’all, thank you for checking out this episode. I hope that you found it helpful. Like I said, there are plenty of resources in the show notes, both free and for purchase that will aid you in your assessment and feedback process. If you didn’t check out the first episode with Liz, it is great as well. So you can run back and check that out.
All right. I think that is it for today. As usual, if you were at any stage of your practice, beginner, intermediate, or advanced, and would love some group support and coaching and accountability, I have rolling admission for mastermind groups, The Testing Psychologist Mastermind groups, and you can get more information and schedule a group call at thetestingpsychologist.com/consulting.
All right, y’all, take care. I will catch you next time.
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 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. [01:10:00] Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.