84 Transcript

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[00:00:00] Dr. Sharp: Hello, y’all. This is The Testing Psychologist podcast, episode 84. I’m Dr. Jeremy Sharp.

Today I have Dr. Stephanie Nelson, a board-certified clinical neuropsychologist and pediatric neuropsychologist, here to talk with us all about neuropsychology specifically in private practice.

Stephanie has a long list of credentials and experience. She got her Ph.D. from the University of Vermont. She did her internship and postdoc at the University of Minnesota Medical School in pediatric neuropsychology. She has worked at two group practices and now she is in independent practice. And like I said, she is board-certified.

Stephanie talks with us all about her evaluation process, things she considers, measures she uses, report style, and recommendations. We dive into how being board-certified [00:01:00] in private practice might look a little bit different than a non-boarded clinician. This is a little bit of a hot topic and there’s a lot of discussion around that in the Facebook group. So I really appreciate the way that Stephanie tackles those issues. I think there’s a lot to gain from this episode. So, I hope you enjoy it.

Before we jump to the episode, just to put it back out there, another reminder that I have partnered with At Health to offer current and past podcast episodes for CE Credit, which is awesome. I’m so excited. I think they did a great job. So if have a desire to get some CE credit for a podcast that you already listened to, check them out. Go to athealth.com, search for The Testing Psychologist, and you can use the code “TTP10” to get a discount off of any [00:02:00] CE credits that you purchase there at the website, not just Testing Psychologist episodes.

All right. I think that’s it. Onto our episode and interview with Dr. Stephanie Nelson.

Hey everybody. Welcome back to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Today, like you heard in the introduction, I am talking with Dr. Stephanie Nelson, who is a pediatric neuropsychologist, a board-certified pediatric neuropsychologist, I should say, in private practice in Seattle.

I am excited to talk to Stephanie today. We haven’t interviewed anyone who is specifically board-certified and in private practice, so I think this is an angle that will be [00:03:00] really informative and really useful for a lot of us out there.

Stephanie, welcome to the podcast.

Dr. Stephanie: Thanks so much, Jeremy. I am glad to be here. You actually may not know this about me, but I am a bit of a super fan of this podcast. I think I’ve listened to like 90% of the episodes. I think it’s such a great service that you do for the community.

Dr. Sharp: Oh, thanks. I love it. I have a super fan.

Dr. Stephanie: You do. At least I am.

Dr. Sharp: That’s great. I’ll take it. I think that’s a pretty high percentage. I don’t know how many people have been around either since the beginning or have taken the time to go back all the way to the beginning.

Dr. Stephanie: I recently moved offices and I get to walk to work and it’s about the exact same distance as half of a podcast. So I’ve been listening to back episodes.

Dr. Sharp: Oh, that’s really cool, cringe-worthy. Honestly, I’m scared to death to go back and listen to the early episodes and know what I may sound like and how [00:04:00] that probably went but I appreciate it. That’s really cool.

Thanks for coming on. I’m always grateful for the time. And like I said, I’m excited for our conversation.

Dr. Stephanie: Absolutely.

Dr. Sharp: Well, let’s start with how you got where you are. What did your training look like, your progress to private practice, and how’d you end up doing what you’re doing now?

Dr. Stephanie: Sure.  Like a lot of your guests, I did not have any idea that I wanted to be a psychologist, much less a neuropsychologist. I grew up in an environment where not very many people in my family went to college or anything like that. They didn’t really have any idea what to suggest for someone who was good in school. So everybody was like, well, you’re pretty good in school, maybe you should be a teacher. And I thought that sounded alright.

So my plan was to be an elementary school teacher. I ended [00:05:00] up going to college at Woods College in Massachusetts. I did some rotations and internships in elementary schools to explore that option. I realized I’m actually way too introverted to be an elementary school teacher, so I switched gears and thought maybe I would be a college professor.

And so I went to get my Ph.D. in Psychology specifically because I was planning to perhaps teach at the university level. I taught a lot of classes. I think I taught about 11 classes and realized, oh, I’m way too introverted even to teach at the college level.

What I discovered that I really liked about the teaching process was communicating a large amount of information in as succinct and organized way as I could. And so my next thought was that I would actually maybe write textbooks. Please keep in mind that I was young and this sounded like a good [00:06:00] idea at the time.

So that was my plan is to get my Ph.D., teach at the university level, but primarily focus on writing, especially around things like textbooks or other synthesized sources of information. And so in graduate school, that was my idea.

The graduate school that I went to was a little bit backward. They actually paid us for our clinical work and didn’t pay us for our research work, which I now understand is a little bit different than most programs. So that meant that the more clinical work I did, the more money to live on I had. So I started doing assessments as a way to supplement my income, just to basically make ends meet because all graduate students are essentially starving.

Dr. Sharp: Of course.

Dr. Stephanie: During [00:07:00] that process, I just fell in love with assessment. In a lot of ways, it’s like writing a small textbook. Every time you see a kid, you’re taking a huge amount of information about the child and trying to express it in a succinct and organized way as you can. And so it just absolutely pushed all my buttons and seemed like assessment was really the way to go.

And so I did a lot of assessments in graduate school, in a lot of different settings; in schools, at a state mental hospital, at an outpatient clinic, disability evaluations, psychosexual evaluations, just a wide range to really get experience of that. And then when I was looking at internships, I was looking at places that focused a lot on assessment, and I noticed that a lot of them were neuropsychology-focused internships.

I had taken a [00:08:00] grand total of zero courses in neuropsychology, so I knew nothing about it, but I had a lot of assessment experience, so I matched at an internship that focuses on pediatric neuropsychological evaluations and stayed there for my postdoc. And in the process of that, fell in love with pediatric neuropsychology, especially for more developmental concerns, and that’s how I ended up on this path.

Dr. Sharp: Wow. So that’s a really unorthodox path. I’ve never heard anyone say, I really wanted to write textbooks but then here I found myself in the clinical world. Come to think of it, I don’t think I’ve ever heard anyone say, I really wanted to write textbooks, period.

Dr. Stephanie: It’s not something that comes up a lot at cocktail parties, no.

Dr. Sharp: Right. Oh, that’s wild but when you frame it that way, it totally makes sense. A [00:09:00] report is a miniature textbook- that’s very accurate. Got you.

Dr. Stephanie: Yeah.

Dr. Sharp: Cool. And so now you are in private practice. How long have you been in private practice and what’s your practice look like?

Dr. Stephanie: I have been in private practice for about 4 years now. After internship and postdoctoral fellowship which was in Minnesota, I moved out to Boston for two years. That’s where my partner at the time was based and was in a few group practices there, and then got the chance to move back home to Seattle. And so I moved back home.

There were a group of other pediatric neuropsychologists and testing psychologists here in a very nearby city to Seattle called Bellevue. Each had their own individual practice that was affiliated with the group loosely. And so I [00:10:00] was involved with that for a while. And then just recently got the chance to have my own big beautiful office that I’m super excited about that I get to walk to right near my home. I moved there in October of 2018.

Dr. Sharp: Fantastic. Gosh. You can’t oversell the value of walking to work, at least as far as I’m concerned.

Dr. Stephanie: You really cannot. It’s amazing. Even in rainy Seattle where I sometimes have to have an umbrella, it’s just such a wonderful mood boost on the way to and also from work and it gives me a chance to listen to podcasts and all of that great stuff.

Dr. Sharp: Oh, that’s fantastic. Well, congratulations being out on your own. That’s a big deal. That’s pretty cool.

Dr. Stephanie: Thank you.

Dr. Sharp: I talked about in the introduction this piece of being board-certified. I am curious about this whole thing. I’ve said sometimes that if I could go back, I wish I had had the foresight to [00:11:00] take that path myself because now, at this point in my career, I think I’m past that. It’s just not feasible to take the break and do the full training sequence to get boarded riled.

There are two questions wrapped up in there. Can you briefly detail what’s entailed in getting boarded in terms of training and then how did you know that you wanted to go that route in time to actually do it?

Dr. Stephanie: Sure. That’s a great question. We should just preface this conversation by saying board certification in no way implies that people who are not board-certified are not competent or don’t have the training that they need. It was something that I did mostly for myself to make myself feel very comfortable in the confidence and training that I had, but [00:12:00] that’s not the right path for everyone.

The way that it worked for me is I’d already done the two-year postdoctoral fellowship that is required at least informally by all of the boards that are out there. You have to have done a two-year training sequence of some sort that’s at least 50% focused on neuropsychology and focus on your target population if you have doing the pediatric board.

And for some people, that’s just not going to be something that is in the cards for them. But if you’re already doing a postdoctoral fellowship and thinking about it, the process for all of the boards that are out there, but I’m board-certified with ABPP-CN and ABPdN, so I can speak to those is identical for both of them.

Essentially, you submit an application and a work sample; that has to be a case that you saw on your own that demonstrates your confidence. And then there [00:13:00] is an oral exam and a written exam. The written exam comes first for both of them, and then there is an oral exam.

Both oral exams are broken down into three parts. There’s a part that’s a case conceptualization where they give you a vignette and you answer the vignette with what you think might be going on and do your case conceptualization. There’s a part that reviews your work sample.

And then for the ABPdN board, there’s a part that’s just more of a general interview and get the sense of how you conceptualize cases as a neuropsychologist whereas for the ABPP board, it’s more about ethics and making sure that you understand the ethical guidelines associated with being a neuropsychologist, but both processes are extremely similar.

And then ABPP now has a subspecialty board for [00:14:00] pediatrics that you can do after you get boarded in general clinical neuropsychology, if that’s something that you want. By the time they introduced that, I’d already done two tests and had decided to never ever do one ever again in my life. So that wasn’t in the cart for me, but that is something that people could look into if they specifically work with pediatrics and are not sure if the clinical neuropsychology board is a good home for them. They do have actually quite a lot of people who work with use of the specialty.

Dr. Sharp: Got you. Cool. It sounds like, and correct me if I misheard, that you didn’t necessarily set out before internship necessarily to go that route. You knew you liked assessment and you found yourself in an internship that was assessment heavy and then post-doc that was assessment heavy and then it was like, oh, I can get board- [00:15:00] certified with this.

Dr. Stephanie: Right. I think what you’re hinting at is exactly how I think of it, is that my somewhat unusual path to becoming a neuropsychologist actually created a feeling in me of like, do I really have the training and experience to present myself as a neuropsychologist?

So for me, because I think of neuropsychology as being really steeped in the literature and the accumulated clinical role around the brain behavior relationships, I wanted to make sure I really knew that material because that’s what for me distinguishes coming at evaluation from a neuropsychological perspective from coming at them from a psychological perspective.

It’s really that understanding of what the brain is doing that makes the difference there. I wanted to make sure that I understood that. And so for me, [00:16:00] doing the boards was a process to check that in myself and make sure that I had that training and experience that I was representing myself as having that I’m not entirely sure my graduate program provided me with.

Dr. Sharp: Yeah, that’s fair. I think a lot of us probably go through that process in a similar fashion- the imposter syndrome.

Dr. Stephanie: Exactly.

Dr. Sharp: What tests can we take to validate our…

Dr. Stephanie: Yes. Can I take multiple ones?

Dr. Sharp: Are there more tests, please?

Dr. Stephanie: Exactly.

Dr. Sharp: Someone, yeah, I know what you mean. That’s interesting.  And I forgot to ask, did you do your internship in a hospital setting or private practice setting? Oh sorry, your postdoc.

Dr. Stephanie: I did internship and postdoc at the same place, which is the University of Minnesota Medical Center, and it is a hospital that has a pediatric neuropsychology department. My internship was halftime there and half time more of an outpatient, but part of that was also neuropsychological evaluation. And then my [00:17:00] postdoc was two years in the hospital, seeing children who were there for a pediatric neuropsychological evaluation.

Dr. Sharp: Got you. So then when you were coming out and figuring out what you were going to do, how did you decide, I feel like a lot of the neuropsychologists end up in hospitals but yet here you are in private practice. I’m curious about that decision if it was a conscious decision for you?

Dr. Stephanie: That is such a great question. I didn’t even realize that it was a question. I know mostly neuropsychologists, so when you had mentioned that a lot of neuropsychologists go into hospitals and aren’t in private practice, I was like, oh, is that even true? I actually looked it up. And for board-certified neuropsychologists, of course, I am looking at that, so for board-certified neuropsychologist, only about 18% of them are in private practice according to the most recent Suite Survey.

[00:18:00] So it’s true. They usually do go to hospital settings. The reason that I didn’t is that most of my training, most of my experience, even on internship and postdoc, and my ideal population that I wanted to work with are children with more developmental concerns as opposed to more acquired concerns.

So even in the hospital setting, most of the children that I saw, probably about 70 to 80% of them had some sort of developmental concern that had been with them since birth. I wasn’t really seeing a lot of children with new onset brain injury, disease processes, new onset seizures, things along those lines. I was mostly seeing children who had some sort of medical disorder that has been with them since birth or had some sort of developmental disorders or concerns.

And that’s the population that I really wanted to work with. And [00:19:00] that is not how most hospitals have their neuropsychological department structured. So for me, private practice was a better fit for who I was trained to see and who I wanted to continue seeing.

Dr. Sharp: Yeah. Let me go off on maybe a small tangent but are you aware of anything that really drove you toward working with that population? Was there anything that pulled you in that direction specifically?

Dr. Stephanie: Well, because the graduate program that I was at did not have any neuropsychology, I didn’t see any kids in graduate school except for the accidentally who maybe had some sort of brain injury or acquired conditions. So I had a lot of years of training that didn’t include that kind of population.

And during that time, I was seeing children with developmental conditions or adults with developmental [00:20:00] conditions. And so that was more of my particular interest even before I went to internship and postdoc.

I think the reason they took me on the internship and postdoc even though I didn’t have that experience was because I was a good match for their patient population, even though I didn’t have the neuropsychology part of the training. I remember maybe like my first week of internships being like, what is this magical thing called executive functions? I’ve never heard of this. I was not exactly where my fellow interns were at.

Dr. Sharp: Oh gosh. 

Dr. Stephanie: I think it was more just that’s always the population that I’ve been drawn to. I have a particular interest in significant mental health issues, which is what I specialize in now and something that I’ve always been interested in.

And that comes from, my mother has schizoaffective disorder so I’ve been particularly interested in [00:21:00] that particular population and in helping children and young adults with psychosis or significant emerging mental illness that may have psychotic experiences as part of their disorder. But that’s not a huge part of anyone’s practice really, probably. And it’s not a incredibly large part of my practice but it did probably influence my decisions to do some of the assessment work that I did in graduate school and that I do now.

Dr. Sharp: Yeah, of course. I think a lot of us have stories like that where there’s some personal piece which I’m always interested in.

Dr. Stephanie: Yeah.

Dr. Sharp: So when you talk about, I’m going to back up just a little bit, just to spell it out a little bit, when you talk about developmental concerns versus acquired concerns, can you give examples of each of those?

Dr. Stephanie: Sure. So for developmental concerns, I am thinking of things that arise at some point [00:22:00] during development. Generally, that would be things that most testing psychologists see quite a lot of, like ADHD or a learning disability but also emotional disorders like anxiety, depression, social communication disorders like autism.

I also include in that category common genetic disorders that kids have really been dealing with basically since birth and that have significant impact on cognitive, social, emotional functioning that we see a lot of like Fragile X or 22q11.2 deletion syndrome or things along those miles or lines.

When I think of acquired injuries, I’m thinking of things like concussion or seizure disorder that emerged at some point after the child had had a period of relatively normal development or a demyelinating condition [00:23:00] or something along those lines that there was a period of normal development that got disrupted by the acquired injury or disease.

I don’t know if other people tend to divide pediatric neuropsychology like that, but that’s how I think of it and explain which population is my major area of specialty and my clinical home.

Dr. Sharp: Yeah. No, that totally makes sense. I just wanted to make that a little more clear for anyone who might be asking that same question.

Dr. Stephanie: Sure.

Dr. Sharp: So when we think about those developmental concerns, I’m particularly interested generally in this question of how does your practice look different than my practice?

So you’re a neuropsychologist, I’m a “regular psychologist”, Maybe that question is more like, how does your brain work differently than my brain? How are you thinking things differently than I am?

[00:24:00] I think there’s a lot to talk about in there but I’ll lead with maybe an easy question, which is, for those of us who may not be thinking along those lines as specifically, what sort of less common things might we be looking out for that might come through our door, I’m thinking like genetic disorders, like seizure kind of stuff, like birth trauma. What are those red flags that we might need to pay a little bit more attention to that are fairly common in a private practice setting?

Dr. Stephanie: Oh, you went in a different direction. You started that question in one direction and then went in a different direction.

Dr. Sharp: I am just keeping you on your toes.

Dr. Stephanie: Yeah, you are. Just to start out with how you started that question of how my practice might be different than your [00:25:00] practice, the truth of it is that it may not be that different.

I think a lot of psychologists who don’t necessarily identify as neuropsychologists and are not board-certified think of themselves as someone who does neuropsychological testing as part of their evaluation, where they’re really trying to think about what are the brain-based relationships between what this child is doing or the struggles that they’re having in their everyday life and what’s actually going on in their brain.

I think of all of my cases from that perspective, which may or may not be true for other psychologists but I don’t necessarily think that in my day-to-day practice, it necessarily means that I’m doing things that much differently than you are doing. But again, I don’t really know what other neuropsychologists or psychologists are doing.

What I can talk about that I could speak to a [00:26:00] little bit more authentically is how being a neuropsychologist changed what I do now versus when I identified more as just a psychologist. It changes in my thinking and how that helped me and why I felt like I do something different now than I did before.

And the first thing that I think of is that there are domains that I assess now that were not on my radar before. I think of some of the early evaluations that I did in a school and I realized there were lots of areas of children functioning that I just didn’t even really know to assess.

One case really stands out in particular where I was assessing a girl who they were concerned about depression, they were concerned about school failure, they were concerned about oppositional behavior. They were concerned about maybe low IQ, maybe a reading disorder. [00:27:00] I looked at all of those things but in interacting with her, I felt like, wow, she doesn’t really understand anything that I’m saying. And although her vocabulary is age appropriate, I have to work really hard to understand what she’s saying to me.

And the idea of assessing language was not on my radar then. It was not part of the evaluation. It was not something that I had a lot of training or experience with, and so I probably did a disservice to that young woman and wasn’t able to link together all of the different pieces of what was going on with her to say that’s probably a language disorder that’s impacting her in a wide variety of ways.

So the first thing that it helps me with is just working at different domains. I think the perspective also really helps me put those puzzle pieces together. That example I think really shows that I am constantly thinking about how does this behavior [00:28:00] over here in the child’s social life or in the cognitive testing or in their family functioning, how do those all link together?

Is there a way to look at this a little bit more parsimoniously to identify what the main underlying problem or maybe two or three problems, concerns are as opposed to perhaps more of a list of multiple problems that may seem more unrelated or mysterious to, at least it did to be when I was first doing evaluations without my neuropsychological training.

I think it also helped me communicate that better to parents in a way that matches my love of textbooks, a little bit more concise, a little bit more organized, where I can try to explain to parents why this underlying concern is happening and why it looks like this in this domain in a way that helps them hold onto a model or a blueprint of their [00:29:00] child.

I always tell parents my goal is to help you be able to, I want to be able to explain in 1-3 sentences how your child works, what makes her/him really tick so that you have a great blueprint for what’s going on, because I may have specific recommendations to help you but if you have that model, you’ll be able to think of way more things than I ever could to help your child in a variety of settings if you instantly have this intuitive understanding of what situations are going to be hard for her or what situations are going to be more a better fit for his profile.

Those are some of the ways that I’m different as a psychologist with my neuropsychological training than I was before I did that training.

Dr. Sharp: That makes a lot of sense to me. When I pursued more neuropsychological [00:30:00] supervision a while back, I’ve talked about this on the podcast a little bit, those were two of the things that changed pretty quickly. I’m paraphrasing and interrupt me if I totally missed this but one part was going from a report that’s broken down by test to a report that’s broken down by domain.

Dr. Stephanie: Yes, exactly.

Dr. Sharp: That was a major shift. And then the other piece, like you said, is the finding the most parsimonious explanation rather than simply matching symptoms to diagnoses and like boom, boom, boom, here are the diagnoses. Okay, now what? Now we go forward from there. So that makes a lot of sense.

Dr. Stephanie: I think both perspectives are certainly valid and that both perspectives have benefit to treating children. There’s definitely a benefit to just taking a symptom approach and not really worrying too much about the underlying [00:31:00] diagnoses or processes that are going on.

You just had Ross Greene on your podcast. He talked about how he is really just looking at what are the lagging skills and let’s address those. I think that is a perfectly wonderful way to look at kids if that works for you and if that works for the family. It’s not naturally how my brain works, so it wasn’t a great fit for me.

I’m always interested in what’s the deeper explanation so that I don’t feel like I have to be chasing symptoms. I have a good underlying model that’ll help me be able to better predict and more proactively address some of those symptoms. But both approaches are really good.

What I actually think of myself as the second line of treatment. I actually do not prefer to see kids who, it’s just a question of do they have ADHD or [00:32:00] it’s just a question of do they have dyslexia? I don’t think those kids necessarily need a neuropsychological evaluation. I think their research is pretty clear that they don’t.

But I don’t think they necessarily do if they have thoughtful, wonderful people in their lives who are helping them address those concerns. Where I want them to come see me is if they’ve been identified as having ADHD or dyslexia and they’re trying the standard treatment and it isn’t working and there might be something else going on.

And that’s when I think you should, when putting on your neuropsychological hat, if you’re someone who does both types of testing or if you’re someone who refers to neuropsychologist, that would be the perfect time to refer to a neuropsychologist is to say, we thought this could be ADHD, we did all the standard things. That’s not working. What else might that be?

One of the other ways that being a neuropsychologist helped me is increasing my [00:33:00] awareness of all those other things that might be going on. So before, when I did evaluations, parents would say, we think this child has attention problems. And I would say, okay, I’ll rule in or out ADHD.

And now parents say, we think this child has attention problems. And I say, great. I’ve got 20 ideas in mind of what that could possibly be. And so if most of the time it’s ADHD, great, go ahead and treat that without necessarily needing a neuropsychological evaluation but if that treatment doesn’t work, come see me and we’ll see if it’s one of those other 19 possible concerns.

Dr. Sharp: Yeah. Well, so now I’m curious, what are some of those 19 other possible concerns in your mind?

Dr. Stephanie: Not necessarily 19. Well, so sleep difficulties would be one of the most common ones. And I know a lot of psychologists routinely look at that. Trauma history, of course, would be one. Language disorders would [00:34:00] definitely be expected to affect attention. General cognitive delays would be expected to affect attention. Something that’s more of right parietal or right frontal like what we sometimes call NVLD would definitely be something that would be expected to affect attention. A mismatch between the child and the environment.

A seizure disorder that someone hasn’t picked up yet. A giftedness certainly could look like ADHD in the wrong setting. So there’s just so many concerns that I’m thinking about. There’s also some less common things like that that could possibly be a concern, like something that’s more subcortical like a basal ganglia or cerebellar involvement where there’s a [00:35:00] dysmetria that would be expected to affect attention.

Dr. Sharp: What was that word you used?

Dr. Stephanie: Dysmetria. The cerebellum does the timing and intensity of your movements. And so dysmetria is when kids have movements that are not smoothly or effectively timed. There’s some research on social dysmetria, for example, where kids have all the right social skills but they’re just not able to weave them into a flexible real-time dance. And we think that that might implicate cerebellar involvement in their social behavior.

Dr. Sharp: Nice. That’s pretty good. So how do you then get at some of those things. Let’s take this ADHD case that could be any number of other things. Then do you [00:36:00] have a fixed battery approach or do you adjust and throw things in on the fly? How do you approach that?

Dr. Stephanie: I’m definitely a flexible battery person, but I also try and use the research to guide my evaluations as much as I can. In recent years, what I’ve basically done is, Kevin Youngstrom and colleagues have this empirically based assessment model.

And they’ve actually published, I think it was in 2014, a guide to empirically based assessment, a clinical guide, I think that actually might be the title. And what I did is I looked at what they were doing because it’s very well supported by the research and I modified it to my practice.

So I actually go through a series of steps for each of my evaluation that I’m doing. I start with just considering they do demographics [00:37:00] and local base rates and the referral source to just be thinking off the top of my head, how likely is this to be ADHD? Because I see a lot of second opinion and complex differential diagnosis work that actually lowered my likelihood that it’s going to be ADHD because if it was, that would probably already have been identified.

I’m thinking of those types of things, just to start out with, just to have a good rough estimate. I think base rates are incredibly important and underappreciated especially for some of those more complex or what we call serious mental illness. For example, constantly, I feel like reminding people that the base rate for psychosis or psychotic-like experiences is actually a lot higher than most psychologists think.

For adults, it’s about 3% of individuals [00:38:00] have schizophrenia or a mood disorder with psychosis as part of it. In adolescents, it gets pretty close to that level. That’s twice the rate of even the most generous estimates of autism.

I see people making an autism diagnosis a lot even in adolescents who didn’t have that diagnosis as a child but psychosis is still treated as if it’s incredibly rare and uncommon in that population when it actually isn’t. But I’d like to start with base rates.

Dr. Sharp: Yeah. Can I dig into that a little bit because I’m somewhat familiar with their approach but certainly I don’t know that I could articulate it very well at all? So can you bridge that gap a little bit? When you’re saying base rates, I know what that is but how are you considering that in the assessment process? Can you spell that out?

Dr. Stephanie: Absolutely. [00:39:00] They actually have a very specific mathematical model that they use to do, which is why I said I adapt this for my practice. They get a sense of national and then also local base rates.

In their clinic, they look at historical records and actually get a sense of what their base rate is in their own population, and then they graph it on a chart and then they look at in, I think it’s step two, they look at other risks and moderating features that might raise or lower that base rate. And then they graph it mathematically. Their article shows an example of that, that you can work through.

I’m not that specific about it but what I do try and think about is when a kid gets referred to me, I’m trying to use the referral source and some of the demographic information. I usually also get the intake [00:40:00] questionnaire beforehand and to look at, based on some of the things they’re reporting and awareness of how common these things are or are not in the population, what I need to be thinking about and looking at. I do it a little bit more informally than they do.

Dr. Sharp: Sure. So then on an applied basis, does that just mean that in your mind you are either, I guess it could go either way, you’re more open to certain diagnostic possibilities or less?

Dr. Stephanie: Yes. Using psychosis as an example, if I hear about auditory hallucinations and the patient is 16, 17, or 18, then I’m immediately concerned about the possibility of psychosis. But the base rates of childhood schizophrenia, which is onset of symptoms before age 12, is actually 1 in 10,000. So it’s [00:41:00] extremely low. So if I hear auditory hallucinations and she’s 8, I’m immediately lowering my threshold for being concerned about psychosis based on the child’s age and demographic issues.

Dr. Sharp: Got you. Cool. Okay, so you start with that process and then you said you do have a flexible battery.

Dr. Stephanie: Exactly. So then based on the interview that I’ve done, I’m doing an interview to look for those risks and moderators of the base rates, and then just trying to get information about contextual factors and look at things like sleep and family functioning and trauma history. And so then based on the interview, I’m sure just like most psychologists who do testing and then planning a test battery.

What I always explain to parents is that I am going to screen everything. I’m going to spend some [00:42:00] specific time really digging deep into two areas. And so what I’ve done through the interview process and through consideration of intake interview is narrowed down which ones I’m just going to screen and which ones I’m going to dig into more comprehensively.

Usually, I tell parents about that at the end of our intake meeting because I say, here there are 2 or 3 areas that I really want to look into based on what we’ve talked about today. But then I’m also screening just about every other area, so even if I don’t think there’s a memory concern, I’m going to be screening memory. If I don’t think there’s a language concern, I’m going to be screening language. If I don’t suspect effort is a problem, I’m going to just be more screening effort. So things like that.

And then I picked my areas that I’m going to dive into more deeply. Usually, by then I have a good idea of what tests I’m going to give and I give. I’m sure a lot of the same [00:43:00] tests that everybody does but that screening process is when my battery is more flexible.

Say I am just screening language and I’m just doing, gosh, I don’t know, I could be screening it with anything; the language tests, some tests of one of the achievement measures or a PPVT or something like that, just to screen it, and I don’t like the way that the child answered the question because it really stood out based on how I’ve seen other kids answer questions or the score is unexpectedly low or they just seemed very distressed during that part of the testing, something like that, then that’s when I’m going to change my battery right then and add in more language testing immediately.

Dr. Sharp: So what would be your go-to dig in language measures?

Dr. Stephanie: Oh, they’re all terrible, aren’t they? I’m not really in love with [00:44:00] any of the language measures but mostly what I’m trying to do with the test is get a sample of the child’s behavior that I can use, their test scores, any sort of error analysis and behavior observations to have a good sense of what’s going on.

Language was maybe not a great example because I think we pretend that language is normally distributed like IQ and I think it’s actually not. I think it’s more distributed like walking; either the process works okay or else it doesn’t even if the score is in that 85 range. But generally, I’m using something like the […]or something like that. It depends on what I think might best capture what it is I’m concerned about.

Dr. Sharp: Yeah, that makes sense. So, all the other domains that you are screening?

[00:45:00] Dr. Stephanie: For sure. I can just rattle this off the top of my head because this is how my test results are talked about in my report, which is by domain. I’m generally looking at cognitive functioning, attention and executive functioning, language-based learning, and things like phonics and rapid naming.

Memory, I usually look at temperament or what I call learning style because one of the questionnaires I use has learning style in the domain. Temperaments like introversion or extroversion things along those lines. Sensory, motor, social, adaptive, if I’m concerned about adaptive functioning. Otherwise, I’m just screening that with maybe adaptive functioning questionnaires on questions on the BASC. Emotional functioning, academic functioning, and effort.

Dr. Sharp: What was that last one, effort?

Dr. Stephanie: Effort, yes.

Dr. Sharp: Got you. What are you pulling for the sensory-motor domain [00:46:00] in particular?

Dr. Stephanie: I do the group PEGS and something for visuospatial which might be something like the Hooper Visual Organization Test; it’s just a click screen, or the JLO in older kids or young adults or something, the Woodcock–Johnson Cognitive has two of good visual subtests that you can use.

And then I usually do the BMI and then I try and at least look at auditory processing a little bit. I used to use the series of tests of the WJ, three that were really good for that and now I use things like the Developmental Tests of Auditory Perception.

Dr. Sharp: Got you. So as you talk through this, it sounds like you have a pretty large battery or a pretty large selection of tests.

Dr. Stephanie: I do have a lot of tests. I’m [00:47:00] constantly looking for good ones, which means you end up with a lot of tests just in general. I do actually have a lot of tests.

Dr. Sharp: Which I think gives you a lot, well, obviously gives you a lot of choice. I’m just thinking like the economics of being in practice and how you…

Dr. Stephanie: That part is not good but what it also does that saves my sanity, if I had to give the exact same test, [..] so part of it might also just be like I may sometimes, okay maybe occasionally be selecting a language measure based on which one I haven’t given three other times that week.

Dr. Sharp: Oh, I see.

Dr. Stephanie: There’s also that component of it.

Dr. Sharp: I hear you. Cool. So let me circle back to that long and windy question that I asked a long time ago and tie it back to our current case. So the second part of that question was, what are some of the things that [00:48:00] you might have your radar tuned to that others of us may not, let’s just say like a classic presentation of ADHD, other things you mentioned; trauma, sleep.

Other like medical concerns, genetic issues, the seizure thing, I feel like that’s like one of those things that’s always out there but I don’t necessarily know how to ask about it or screen for it. I don’t know. There are other things that are kind of running through your mind. I’m thinking specifically from a medical perspective that we need to be cautious or vetting for.

Dr. Stephanie: I think the most common concern for seizures, and I am in no way a specialist in epilepsy, so you may want to get one of those on, but I always ask parents if there is any seizure history or if there’s anything that’s maybe looked like a seizure. [00:49:00] I also am watching the child for seizures during testing. I think the one you would be most concerned about would be absence seizures, and I have definitely seen two kids in my time in practice where I’m almost certain that that’s what was going on and then referred to a neurologist as appropriate.

I think the best way to look at those is actually you can google them on YouTube and see some actual absence seizures, so you know what they look like. And then once you have that kind of background see what that might look like in testing. But generally what I’m thinking about if I’m going to do something like refer to a neurologist is, is there something about this child’s attention profile that just looks different from all those other kids that you have seen with ADHD?

[00:50:00] So that’s where I think sometimes the knowledge of brain-behavior relationships can really be helpful. So if you think of ADHD as a problem in the frontal-subcortical circuitry like I do, then you are looking for problems with those five frontal-subcortical loops. You’re looking for problems in the dorsolateral prefrontal cortex loop, which is going to be your pool of executive functioning skills.

You’re looking for problems in that orbitofrontal loop, which would be your hot executive functioning skills, but you’re also looking for problems in the motor loop, which is going to affect handwriting or other motor planning skills. You’re also looking for his or her eyes jumping around all over the page because there is an optimal motor frontal-subcortical loop. And then there’s also [00:51:00] the anterior cingulate cortex which does motivation, persistence, and error monitoring type of things.

So I’m looking for concerns in all of those areas and if the child’s having attention problems but it’s not fitting neatly into those areas of functioning or I’m not seeing concerns in those areas or I’m seeing concerns but just really in just one of those areas, then that looks a little bit different than the typical kid that I see with ADHD. And so I’m thinking maybe this is a zebra when most of the kids are horses. And that’s the time when I might refer for a medical evaluation if I’m seeing something that doesn’t fit into that box, that framework I should say.

Dr. Sharp: Sure. That makes sense. Can we backtrack just a touch and can you briefly elaborate on cool and how executive [00:52:00] functions for folks who might not be familiar with that terminology?

Dr. Stephanie: Sure. Probably most of your listeners are familiar with the BRIEF, so you can just think of the first four scales on the BRIEF as being more of those high executive functions and the rest is being more of your cool executive functions. But the idea of cool executive functions is those things that a child is usually doing when they’re not emotionally invested in the task. And that would be most of the things that kids are doing in my office. We actually don’t have a lot tests for hot executive functioning.

So tests of working memory, processing speed, efficiency, organization, planning, things that the child’s doing as they’re may be working through homework but not emotionally compromised in any way will be your cool executive functions. And then your hot ones are going to be things that have to do with planning and organizing your feelings and your behaviors in order to reach your goal. So it’s going to be things like impulse [00:53:00] control, emotion regulation, shifting gears and self-management.

Dr. Sharp: Yeah. Got you. And so you say once you consider all those areas and it seems like the kid, if the profile just looks off, if it’s not fitting, then you think about other aetiologies.

Dr. Stephanie: Exactly.

Dr. Sharp: Are there any, again, I know I’m pressing you for examples, but anything in particular that might jump to mind or cases you can think of where a kid looks like they look “ADHD” but it turned out to be something else that you found through medical referral.

Dr. Stephanie: I was doing an evaluation of a child who it looked very classically ADHD and we were halfway through the evaluation and had done IQ testing and some other things like that, and then the parents took him to lunch and they reported that [00:54:00] he, he was about 14 or 15 and they reported that he fell asleep in the car on the way to lunch.

And I was like, that’s a little odd. And then they said, oh yeah, he does that all the time. He actually fell asleep in the car on the way back from lunch. I immediately looked into sleep and it turns out that he had sleep apnea and was having 90 obstructive incidents an hour. So we didn’t have ADHD, we had a sleep disorder. And so that would be a really dramatic example that immediately jumped to mind and an answer to that question.

Dr. Sharp: Got you. That’s got me thinking about a kid that I recently evaluated as well, who can seemingly not get enough sleep ever and too old to have that.

Dr. Stephanie: That’s right, it is just really not getting that restful sleep and perhaps you’re [00:55:00] seeing some of the emotional consequences of sleep not doing its job clearing out some of those icky emotions from the previous day. I recommend kids for sleep studies in that kind of case. And I find that that’s easier for parents to try and obtain a sleep study, which is not always easy to do, if you have a clear thing of why I’m recommending it and what you would tell the doctors that I’m concerned about.

Dr. Sharp: Sure. I think we’ve talked a fair bit about conceptualization and how you design your battery. What are your reports looking like?

Dr. Stephanie: That’s such a fun question. I am obsessed with reports right now. I see about three kids a week, and so writing a little textbook about three kids a week was a recipe for burnout. And so I [00:56:00] am on this crazy mission to streamline my reports and make them more reader friendly and more comprehensive while easier to write.

Another thing that was a catalyst to that is a colleague and one of her students and I did a research project looking at neuropsychological evaluation report that we presented this at a poster at one of the AACN, I think. And we looked at just the readability of pediatric neuropsychological reports and we had people submit a de-identified report and we looked at just the reading level of them.

We looked at what most people in the United States, what level they can read at, which is about 7th or 8th grade. We looked at what the medical community says we should be writing information for the public ad which is about the 5th or 6th grade level. And then we look at what pediatric neuropsychological reports look like, which was a little bit above [00:57:00] the 12th grade level.

Dr. Sharp: Oh my gosh.

Dr. Stephanie: Exactly.

Dr. Sharp: I don’t know why I’m shocked, but I am. Okay. That’s good to know.

Dr. Stephanie: Most people in the United States cannot read our reports, and we are giving these reports to parents of children who have ADHD or learning difficulties or emotional difficulties. So their parents probably may also have some of those concerns and we’re handing them something that the average college freshman would have a little bit of challenge getting through. And we’re taking hours, days, months to write them as well.

Dr. Sharp: That’s the worst part. We’re laboring over something that nobody can understand.

Dr. Stephanie: No One Reads. A friend and I joke that we’re writing papers all the time for the Journal of Things No One Reads.

And that just isn’t a very [00:58:00] sustainable model. I don’t think it’s good for testing psychologists in general. I don’t think it’s great for the kids we serve. It’s not a great recipe for life balance either.

So what I have done for myself is looked at what’s out there in terms of improving reports and using some of that, like looking at Dean B and his colleagues, he’s going to be presenting at AACN in June on what their group is doing. And hopefully they’ll have some great stuff to share. But they use an inverted pyramid model, and so I just immediately went to that.

So what that means is I start my reports with the summary and the recommendations. I say there’s a little bit of a reason for why the kid was here, and then I just list in bullet points the diagnosis and then I do the summary. I do a more strength based perspective.

So I say, here are our strengths, here are their [00:59:00] vulnerabilities. Here’s how that impacts them in the classroom. Here’s how we can help. And then the specific recommendation. I try and keep that to two pages for the summary and two pages for the recommendations.

And then I do the history and current information and behavior observations. Those each get one page. And I do them in bullet point form, actually have columns. So it’s not quite bullet point, but it looks very similar to that. So it’s just family history on one side and then in the next column, I write it out.

From a strategy that I got from listening to one of your podcasts, I use TextExpander to help me write a lot of those. So I have written the standard medical history, for example, and then I have dropdown menus, which I can do in TextExpander that I can choose. And that’s made a huge difference.

And then I do the test results and I [01:00:00] actually have a model where my tables contain the test name, the test score, the percentile and then a description right in the table of how the child did on the testing. And again, I use TextExpander to write a lot of those.

So I’ve created these little dropdown menus that say things like Donny’s processing speed is in the dropdown menu in para range or high average range, something like that. This means that he can quickly and efficiently complete tasks or whatever the appropriate thing might be so that I can write that section really fast.

That’s what my reports look like now. It’s made a huge difference in my quality of life, and I would encourage anyone who wants to look at maybe doing that to get in touch with me if they want to see a sample, if there’s ideas that they want to, feel happy to share.

I don’t really believe [01:01:00] that there’s any need to keep my work product secret or anything like that. So if anybody wants to see what that looks like and see if there’s anything they feel for their own practice and their own peace of mind, I’m happy to share that with them.

Dr. Sharp: That’s very kind and generous. I for one, would love to see a copy. That sounds super interesting to me.

Dr. Stephanie: I should hook you up.

Dr. Sharp: Yeah, thanks. I’m curious about that section you said the summary basically. So you do strengths, you call them vulnerabilities, which I like. I use the term challenges but challenges different.

Dr. Stephanie: You have to get out your persona so you’re not using the same word over and over again. 

Dr. Sharp: I know.

Dr. Stephanie: Schedules, challenges, vulnerabilities, weaknesses, areas that are hard for him. Exactly.

Dr. Sharp: Nice. And then you go into an explanation of how those vulnerabilities [01:02:00] impact day-to-day functioning, you said at school. Does it also encompass home?

Dr. Stephanie: Absolutely.

Dr. Sharp: Okay. So kind of like here’s the real world impact and what you might see.

Dr. Stephanie: Right.

Dr. Sharp: This is getting back to the parsimony/diagnosis question. Do you articulate the diagnosis at any point in there? Where does diagnosis come into the picture in your summary?

Dr. Stephanie: It depends. There’s already a bullet list at the top of the diagnosis and then somewhere in that section I may include more information or a little bit of psychoeducation about that particular diagnosis. I have moved a little bit more to putting those in appendices at the end where

Dr. Sharp: The diagnosis?

Dr. Stephanie: The explanation of the diagnosis and from what battery [01:03:00] is and how that affects functioning. So, I have templates written on like what ADHD looks like and how it affects kids and some basic recommendations and resources and one on anxiety and one on language disorders, and one on the most common type of dyslexia, things like that to save myself a little bit of time.

And so in the actual summary, I will often say, based on his vulnerabilities, he meets criteria for this disorder. Here’s a brief explanation of what that is. And then I’ll direct them to the appendix in the back for more information. And then I go into real world impact.

Dr. Sharp: Got you. The reason I’m asking this question is I find and others might as well, that the more that I move to that model of parsimony, [01:04:00] it seems to become more and more divorced from diagnosis.

Dr. Stephanie: It does, isn’t it?

Dr. Sharp: Well, it seems to.

Dr. Stephanie: Yeah.

Dr. Sharp: That’s actually validating to hear you say the same thing that I might be talking about executive functioning, which can look any number of different ways and map onto any number of different diagnoses, just for an example. And so I’ll talk through that. I’m just kind of wrestling currently too with like how to then tie that core explanation or challenge or whatever to a diagnosis in a meaningful way.

Dr. Stephanie: Yeah, I would call that neuropsychological wrestling. We’re wrestling with the fact that the DSM does not really very well map onto what we know about how the brain works and what we know about brain systems and brain networks. And so trying to make a diagnosis in a lot of cases is almost academic [01:05:00] exercise that really doesn’t impact the child that much one way or the other.

And so trying to decide, for example, between whether it’s ADHD or whether it’s something that looks more like a disruptive mood dysregulation disorder or something when you’re talking about hot executive function systems being involved is tricky for everyone. And I’m sure I bounce around in the diagnosis categories just depending on probably just whether I had lunch that day or not to be honest.

It’s really an academic exercise that doesn’t really impact the child’s day-to-day functioning. What the parents need to know is what are these hot executive functions that the child is struggling with? And once we know that, how can we predict what situations he’s going to be having trouble with and proactively address them so that we can accommodate him so that he’s challenged to gain new skills without [01:06:00] overwhelming him and directly train those skills.

That’s more useful as I think you’ve discovered, I think, than trying to decide which exact disorder it is, especially for ones that research shows, like for example, anxiety and depression don’t really separate out in kids. 90% of kids with anxiety also meet criteria for depression. So why are we trying to separate them?

So once you move to that parsimony method, it does mess with your interest in the DSM. You did have a podcast on the RDoC criteria that I think people should go and listen to as another way of looking at things that’s a little bit more transdiagnostic, and I hope we’re going to be moving more in that direction in the future.

Dr. Sharp: Yeah, it’s funny we’re talking about this. I just or maybe I was [01:07:00] primed, who knows? I just earlier today emailed an expert in the field of nosology of psychiatric disorders, the study of the classification basically of mental health disorders. I just got my fingers crossed that he’ll see.

Dr. Stephanie: Yeah, that would be so interesting.

Dr. Sharp: We can really dig into it. Gosh, let’s see. I know our time is getting close but I wanted to at least touch on recommendations a little bit. You mentioned that your recommendations are typically about two pages, all total.

Dr. Stephanie: Yes.

Dr. Sharp: How do those break out? Do those correspond to diagnosis or is it to setting or is it a combination of both or something else?

Dr. Stephanie: I actually go through a list of domains that I’m thinking about in terms of recommendations. So I get this question a lot in the intake where parents are saying, are you going to make specific recommendations and what will that look like? And so I’ve actually just made my recommendation section [01:08:00] really structured.

The first thing that I look at is anything medical that we need to do to support the child. And that could be anything from referring for medical workups to referring for a medication evaluation to lifestyle factors that we know support healthy children’s development.

So I started including in my reports things like get an hour of play a day for kids with ADHD because we know research shows that that is almost as effective as the medications. So things along those lines where I’m just thinking how can we support this child physically? If there’s a situation where he is in pain, how do we eliminate that? If I’m concerned about a hearing problem, how do I get that tested for her? So that’s what I think of first is medical.

And then I think educational because that’s where they spend a huge amount of their time. So even if it’s not a learning disorder, which is usually not for me, I’m thinking how do we best support him in the educational setting?

And then I think of any [01:09:00] outside therapies that the child might need. So individual therapy, occupational therapies, speech language, those types of things that I’m thinking specifically of what services does the child need. If he’s already getting services, is there any way I can tweak the intensity or frequency or focus of those and if there’s anything that he’s not getting that he might need?

And then I think of what the child needs at home or in the community. So a lot of parents want to know, what do we do at home with this particular concern? So that’s creeping through there. Or what else can we provide in the community that may not be a formal service like tutoring, but that may be something that could be really helpful for the child. So a gifted child who has never had to learn study skills, maybe we can find him at a cool college student who he wants to spend some time with who can teach him some of those things informally or something like that.

And then I think of any resources, so any websites or books or things like that that I can refer them [01:10:00] to. And then I put in a recommendation if any follow up or monitoring is needed.

Dr. Sharp: Got you. That’s great. That was very well laid out. It’s like you’ve done this a thousand times.

Dr. Stephanie: It is. I do this for a living, isn’t it?

Dr. Sharp: eah. Very cool. Well, let’s see. I want to be respectful of your time of course. And just thinking about anything to wrap up. Any resources you’d recommend for clinicians out there to dig more into, maybe a neuropsychological perspective or even just general resources that have been helpful for you?

Dr. Stephanie: Sure. I offer consultation and supervision if anybody is interested in that. We’ll just start there. But in terms of other areas to go to, I would definitely, if they’re not already subscribed to your Facebook group, they should absolutely get in touch with you about that.

If they’re interested in pediatric neuropsychology in general, [01:11:00] even if they’re just a student, I would recommend the Pediatric Neuropsychological Listserv which is a little bit more rigorous and not as warm and friendly, but you get some really great content there if you really want research and evidence based things.

And I have also started to write, I spend a lot of time writing in comments from the listeners in the Facebook group, which is like a hobby, which is like a weird hobby, but I have weird hobby. So I’ve started keeping them in a blog. If anybody is interested in that, I can give you the details about that if you’re interested.

Dr. Sharp: Yeah, absolutely. We’ll put all that in the show notes.

Dr. Stephanie: Yeah. Perfect.

Dr. Sharp: Yeah, that sounds fantastic. I’m trying to think of anything else. If anyone wants to reach out and get ahold of you for one [01:12:00] reason or another, what is the best way to do that?

Dr. Stephanie: My website for my general practice is Skylight Neuropsychology. So www.skylightneuropsychology.com. I’m at snelson@skylightneuropsychology if they want to email me directly. And then my blog where I would have samples and some of my random posts and things like that, it’s just starting, so it’s a mess right now but if people are interested in taking a look at it, it’s thepeerconsult.com.

Dr. Sharp: thepeerconsult.com?

Dr. Stephanie: Exactly, thepeerconsult.com.

Dr. Sharp: That’s good.

Dr. Stephanie: Oh, thanks.

Dr. Sharp: Nice. I’m going to go there immediately after this.

Dr. Stephanie: It’s a mess.

Dr. Sharp: Hey, that’s all right.

Dr. Stephanie: Exactly. I’m just starting it. It’s mostly just because I, one of the things that you had mentioned when we talked [01:13:00] just briefly beforehand is things that people do to stay sharp or to stay current in the field. And what I often do is I use the material that I come across that either my consultees or supervisees bring me, or that cases bring me, or that I see in the Facebook group or that I see on the Listserv or that I hear in a podcast and I think, what do I actually know about that subject?

So if somebody says, what are the differential treatment responses of different subtypes to different medications and I think, what do I actually know about that? And I look through the research that I already have and that I’ve looked at, and I remind myself of anything that I’ve already looked at or put together about that. And then I dive into the research usually during my lunch hour and write it down for myself as a way to keep current.

I often want to refer back to these. [01:14:00] So the blog started as a way for me to just have a place for those but other people may also want to take a look at them and take advantage of the legwork that I’ve already put in. And they’re welcome to do that.

Dr. Sharp: Absolutely. Well, and the way you articulate that process, I think is, what would I call it? I don’t know. I can’t think of a good word.

Dr. Stephanie: Weird?

Dr. Sharp: No, it’s not weird. I think it’s what a lot of us aspire to. That’s what I aspire to, honestly. I think about that probably 20 times a week where something comes up and I’m like oh, I need to dig in. And I’ll make a note on a Post-it, and then something happens and I don’t know.

Dr. Stephanie: Or I’ll scribble it down somewhere and then misplace it, or I come across notebooks that have random stuff in them that I wrote [01:15:00] five years ago and have completely forgotten. And I thought if I put it online, it will all be in the same place and I can refer back to it and it will give some direction and impetus to that, that I thought might help me stay current and help me remember work I’ve already done so I don’t have to redo it.

Dr. Sharp: Absolutely. Well, and I have to say, I think this is a good point to wrap up and we’re coming full circle where this is a major reason that I wanted to have you on because through our interactions in various forms over the last several months, I’ve come to learn that you are very meticulous and conscientious in diving into research and making sure you’re going about things in the right way.

I know that everything that you’re doing is well informed and well-intentioned. And so I just think it’s nice that we can close on that and that you’re willing to offer some of that [01:16:00] knowledge and energy to the rest of our field because I know it will be quality. So thank you.

Dr. Stephanie: Thank you very much. I really appreciate that. And just for your listeners, see imposter syndrome really can have good side effects. Struggling with that.

Dr. Sharp: Nice.

Dr. Stephanie: Positive, optimistic message.

Dr. Sharp: You can turn it around and use it as motivation.

Dr. Stephanie: Exactly.

Dr. Sharp: Great. Well, Stephanie, thanks again. I think this was great and I hope that it’s been informative for everyone. Thanks for your time and I’ll look forward to talking to you again in some form or fashion, hopefully soon.

Dr. Stephanie: Great. Thanks.

Dr. Sharp: All right, y’all. Thank you so much as always for listening to this interview with Dr. Stephanie Nelson. I hope that you took away some gems. I know that I did. The show notes for this one are pretty extensive. I link to many of the resources that she mentioned.

I also want to give another shout out to the fact that Stephanie [01:17:00] does do consultation and her website, thepeerconsult is fantastic. So definitely check those out.

What else? CE credits, just to put that out there. Again, I’m so excited. You can get CE credits for The Testing Psychologist podcast at athealth.com. Use code “TTP10” to get a discount off your entire purchase.

All right, y’all take care. This was a good one. I have more good interviews coming up that I’m really excited about, and I hope that you’ll stay tuned. If you haven’t subscribed to the podcast, take a few seconds to do that. It’s usually pretty easy in iTunes or iPodcast, the podcast app on your iPhone. There’s a subscribe button. Super easy and it should be pretty obvious in other podcast apps as well.

Thanks again, y’all. Take care. Talk to you next time.

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