The Benefits of a Neuropsychological Evaluation

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Tonight, we’re welcoming Christiana Sperrazza to our webinar family of presenters. Doctor Sperrazzais a early career pediatric neuropsychologist with experience in neurodevelopmental disorders particularly autism, ADHD, and specific learning disorders as well as common comorbidities such as anxiety, depression. 2:16 And disruptive behaviors, doctor Sperrazza also provides executive function coaching. She has worked in research and clinical settings across New York City, New Jersey, and Pennsylvania. DoctorSperrazza’s’s experience has emphasized the importance of inter disciplinary collaborative team approach to effectively help families. Welcome doctor Sperrazza, we look forward to your presentation. 2:46 Thank you much for it and thank you very much, Kelley for that introduction. I’m going to start showing my screen now. so hopefully this is in you. 2:56 Oh, Is that all good? 3:00 Needs to be in presentation mode, but yes, go. 3:05 Oh, good to go. 3:06 Good to go. 3:07 Wonderful, awesome. So again, thank you for that introduction, Kelly. As mentioned, my name is doctor Christina … and I am a clinical neuropsychologist currently working at … Healthcare. I’m currently at the wall Township location and we also have locations in Vorhies New Jersey as well as King of Prussia PA. Today I’m going to be speaking to everyone about what the benefits of a neuropsychological evaluation evaluation may be And as Kelly mentioned, a lot of my work is primarily with the pediatric population. This ranges from toddlers all the way through college students. So oftentimes, throughout my talk, I’ll be referring to kids to patients, their families, parents, and schools. That’s not to say, though, that these benefits can also apply to older adults, and I’ll make some references as appropriate throughout. As Kelly mentioned, feel free to use the chat, and I’m happy to answer as many questions as possible towards the end. 4:06 So for tonight, we’re going to talk a little bit about what is neuropsychology, how our evaluations differ from school evaluations, who also can benefit from neuropsychological evaluations, what the process entails? 4:21 What the actual benefits or outcomes of a neuropsychological evaluation may be, and I’ll also be providing some resources and these handouts are provided to you with links and other access as well. 4:35 So, I wanted to start off first, you’re going to also hear me probably throw a lot of acronyms around at you and abbreviations. And I just wanted to put in here for reference throughout some of the abbreviations that aren’t explicitly spelled out, but you’ll hear me say things such as ABA therapy. This is a common form of therapy for, particularly kids with autism or individuals who have weak adaptive skills. You may also hear me make references to CBT or DVT. These are types of outpatient therapies like cognitive behavioral therapy or a dialectical behavior therapy, to help treat, mood, or behavior disorders. CST, an IEP go together in terms of a school setting. 5:15 So, for example, the Child Study team at a school consists of academic staff who helped to implement an individualized education program for students who need that, and this is really kind of a document that outlines any accommodations or special education services a child may be eligible for and should be receiving. 5:37 You may also hear me talk about or referring to what we call the DSM five and this is as a psychologist, as a neuropsychologist, a diagnostic and statistical manual that we use. So basically it’s this big book that has all these criterias and features of certain disorders, and this is what we’re using to help guide our diagnoses to help decide if a diagnosis is warranted or not. And, lastly, to other types of therapy, you may hear me refer to our parent child interaction therapy, or parent management training. Also, different types of behavior therapy, more based on parents, learning some new tools and tips and techniques to help support children who may have some disruptive behaviors. 6:21 So let’s first start off by talking about what is neuropsychology? 6:26 Neuropsychology is considered to be a science that looks at analyzing brain behavior relationships by utilizing standardized test measures. So our goal with these tests is to see how individuals approach tasks, how they’re thinking, how their problem solving. 6:44 That gives us into insight into how they’re using certain parts of their brain functions, and then through their behaviors, their responses were able to effectively collect some data on that in a standardized way. 6:58 Neuropsychology is used for various reasons across the lifespan, It can be used to evaluate an individual’s neurocognitive capacity. So what are their abilities? What are their strengths? What are the areas they’re struggling in? 7:12 It’s also used for diagnostic purposes. It helps us to identify if there is something going on that may be causing some dysfunction or interruption in somebody’s functioning. It’s used to to help to increase the validity of diagnostic impressions. 7:28 So in the big book that I referenced, the DSM five, it has all these features, Behavior, symptoms, essentially, of different disorders that we’re looking for. And neuropsychological testing is not required in order to make a diagnosis, so nowhere in that book will you say that someone must have a neuro psych evaluation. Rather, though, neuropsychology can give us a lot of insight into an individual’s strengths and weaknesses from a cognitive perspective. It also gives us a lot of great information behaviorally. 8:01 So our evaluation can help to increase the validity of diagnostic impressions that parents may already have Some kind of concerns about, or other providers on the child’s team may have these concerns or provided initial diagnoses and just want some more insight into their functioning. 8:20 Neuropsychological evaluations can also be used throughout the course of treatment monitoring outcomes. This could be, for example, in medical settings, perhaps individuals who are receiving cancer treatment. This could be for kids all the way up through adults, and we want to monitor their functioning over time, post treatment, to see if there’s any changes in their cognitive functioning. 8:43 Neuro psych evaluations can also be used as decisions for surgeries, for example, such as bariatric surgeries. 8:50 They often have to go see a neuropsychologist first and pass a series of tests to see if they’re cognitively appropriate and mentally appropriate for such a drastic surgery. 9:03 You’ll also will hear a lot of different terms, which do overlap quite a bit, but they’re also pretty distinct in the area of neuropsychology, so when we’re talking about testing, this is just exclusively administering the test, so we have a bunch of tools and measures and tests in our office. Some of them involve blocks, pictures, puzzles, iPads, computer games, paper and pencil tasks, Word games. This is all what testing is. We’re administering a standardized tool, and our goal is to get some standardized data out of it. 9:36 Next is assessment. This refers to a broader process. So this includes any data acquisition that we get over different sources. So, for example, getting the intake information with the perron, talking to a teacher, and having them complete a questionnaire. Things like that to help supplement the direct testing done in the office. And, lastly, there’s the evaluation, and this consists of everything from the start to the end of the process. So, evaluation starts with the clinical intake the first time we make contact with the family. And, it goes all throughout until the very end, when we’re giving feedback and providing recommendations for future treatment as needed. 10:17 So, neuropsychological evaluations do differ from school evaluations in many ways, and I want to preface this by saying I’m highlighting these differences, because one evaluation is not necessarily better than the other, It all depends on the needs of the child or the needs of the student, As well as the referral question, and what families are hoping to get out of it. 10:39 So that being said, a school evaluation is commonly referred to as a psycho educational evaluation. And these are determined, these are used, and these are done by the school, usually by a school counselor, school, psychologist, or social worker, other academic staff. 10:56 And it’s used to determine if services are warranted for a student. So, does the student need special education? Do they need speech, occupational, or physical therapy? So they help to determine how appropriate a service is for a student. 11:13 On the other side with neuropsychological evaluations, most families come to us saying, Does my child have ADHD? 11:22 Does my child have autism? So it’s very diagnostic focused. We also are able to provide a pretty comprehensive understanding of their overall functioning. So if families don’t have a specific question in mind, like, does my child have autism, they may come to us saying, why is my child struggling with making friends and getting along with other people? Is it inattention? Is it anxiety? Is it Autism? So, they might not have those specific questions, but rather, they may come to us with a broader question. And there are comprehensive evaluations, we can provide them with some insights. 12:00 So, because our evaluations are quite comprehensive, we can assess more domains than a school often can. So, some of the areas certainly do overlap. So, for example, across both evaluations, we look at overall intelligence, or essentially, their IQ, We look at a range of academic skills, and we also look at behavioral or emotional functioning. This may not always be part of a student’s school evaluation, they tend to kind of include these more. So as needed, again, depending on the needs of the child. 12:30 From a neuropsychological perspective, we can also look at language skills. We can look at motor abilities. We can also look dive deep pretty into attention and executive functioning and how this may impact other areas, such as a child’s academic skills, or their learning and memory abilities as well. 12:48 And we can also, again, look into social functioning. 12:53 With regards to outcomes, they’re also a little bit different. 12:56 So, with a school evaluation, no diagnosis is given. Rather, they do provide classifications for an IEP. 13:04 If an IEP is warranted, these classifications can be something like other health impaired, Autism, a specific learning disability. There’s a whole range of them. And these criteria that they’re using to determine eligibility are based on state or federal guidelines. 13:22 What the school is essentially doing is to see, does the student need services because their education or their academic performance is adversely, impacted, or affected. So they’re looking at it from a very specific lens by looking at education impact. 13:41 In contrast, on our side, we’re looking at it from a clinical lens. So we are able to provide diagnoses if warranted and ours is based on clinical criteria. 13:51 So again, the DSM five, we’re able to recommend intervention, so if we do diagnose, let’s say, a learning disability, we’re able to recommend that a student should get an IEP, or that they should be provided with related services, or supports, or academic interventions. 14:10 However, the school is the one that ultimately has the final say, in these decisions. They have to just, at the end of the day, consider our report. They do not have to implement everything that we’re recommending. 14:23 On our end, also, we’re looking more for clinical impact or clinical distress, and this could be across more settings than just school. So, for example, if we see any impact or impairment at home, if we’re seeing it in social settings, So we can look above and beyond just the academic or the educational impact and look at other areas as well. 14:49 So, who can benefit from a neuropsychological evaluation? 14:53 And the answer is, absolutely, anyone can. 14:56 As young as pediatrics, we see toddlers’ often, a lot of times it’s related to language, delays, other developmental concerns, questions of autism, all the way up to young adults who are in college. 15:08 There’s also a fair amount of adults who sometimes come through as well or at other practices and also individuals in the geriatric population. 15:17 For, I would say, older adults, a lot of times questions may be related to, there’s their subjective changes of cognition, and they want to see if there’s something going on. 15:26 So, for example, in a geriatric population, questions may be related to, do I have dementia, Alzheimer’s, I had cancer treatment. What is my cognitive functioning? Like now, they may be more medically based. 15:41 Another reason why it would be helpful for a lot of individuals to obtain neuropsychological testing at some point in their life, is because it can help establish a baseline of cognitive functioning should there be any significant changes down the line. So for example, a common one that we see in individuals who play perhaps like sports in high school. For example, football. They may have concussions. 16:05 A lot of times it’s really helpful to try to get an image of what their kind of functioning is like. 16:10 Obviously, we can’t tell if or when they’re going to have a concussion but early on as possible. And then following concussions over time, we can kind of monitor what their cognitive functioning is like. If there’s any significant changes, if there’s any impairments, similarly, we can also assessed for this, again, if kids have any medical treatments that are epilepsy or seizures. And we want to monitor their functioning over time. So, there’s a great range. It’s a really, really great tool to help establish a baseline and monitor changes in the years to come. 16:44 A lot of common referrals, again, kind of focusing more on the pediatric population, relate to low academic achievement. So, does my child have a learning disability? This is one of the biggest concerns that we see, and we’re able to answer for parents. They also may want to know, you know, what else is going on? Why can’t my team focus? 17:04 Kind of one of those broader questions, like I mentioned before, Are they inattentive, do they have anxiety? Do they have a learning disorder that’s getting in the way? 17:13 And with our evaluation, we often really, really want to collect as much collateral information as we can. This helps to kind of give us an image of what this individual is like across settings. So, for example, we want to get reports from the teachers, How are they viewing them in the classroom? If a therapist refer them, getting information from them about their relationship with the patient, What are they seeing? What is the patient reporting to them? 17:39 We also may have concerns about cognitive abilities. Does my child have an intellectual disability? Are there concerns about their adaptive functioning? 17:49 We also want to know are there any emotional factors going on that may be able to explain or are exacerbating underachievement. 17:58 My child was a straight a student before koven. Why is he or she is struggling? Now? 18:04 This is probably the most common referral question we’re seeing now. And it’s really, really important when we’re doing this evaluation, to get as much kind of historical information as possible. 18:16 So, parents providing us with a timeline will ask questions like, When did these difficulties begin? When did you see them at their worst things of that nature? And I’ll talk more about specifically the interview and the intake when we talk about the evaluation process. But it’s always important to kind of establish a timeframe of reference when these difficulties began to occur. 18:38 Another one we’ve seen a lot more in recent years is, I’ve noticed my teens, anxiety, and tics have increased around school. 18:46 Do they need accommodations and were able to answer questions like that. 18:52 We’re also able to help identify if or why there may be social or communication difficulties. 18:59 My teen has trouble making friends. Why is that. 19:02 Is it that they’re not engaging in conversations with others? Are they having trouble kind of being reciprocal in their interactions and by reciprocal or social reciprocity? I mean: are they able to take the perspective of somebody else? Are they able to kind of share interests with other people? Are they able to listen to other people’s interests and kind of keep up a dialog with them? 19:25 Or, is it not reciprocal? It seems more one-sided. The individuals only talking about their interests, they’re not inquiring about the other person’s thoughts or experiences. It seems very one-sided. 19:39 Another question is why can’t my child keep up in conversations? 19:43 Could be due to a whole range of things or are they inattentive hyperactive? They can kinda sustain their focus even for short periods of time to hold a brief conversation. 19:52 Is there an underlying language disorder? Is it that they can’t understand what’s being said to them or they can’t effectively express what they want to communicate? 20:01 Oregon, is it autism? Is it that they just really kind of need a lot of effort and help and mindfulness about how to engage what kind of skills they need to be implementing to sustain a conversation or keep up in a conversation? 20:16 We also are able to help understand behaviors. So, a lot of teens or families come to us saying, You know, My child has trouble adjusting to changes. Why is that? 20:26 Is that due to maybe some rigidity, anxiety? We’ve seen a lot of different adjustments in recent years. Is it kind of stress from recent stressors or life experiences recently? 20:38 My child has so many tantrums each day. Why is that? 20:42 Is there an underlying language issue? Is it more kind of impulsivity or any disruptive behavior problems going on? We’re able to figure all that out and provide the families with some insight indirections. 20:56 In the context of medical conditions, we can, again, give some updates about neurocognitive functioning. So if my teen has epilepsy, how are they doing now? It’s been a few years since their last seizure. What’s their cognitive functioning like now? 21:10 Or in contrast, my child has been having more seizures recently. How has this impacted their neurocognitive functioning, and we can take a look at that. 21:20 Same thing with genetic conditions, my child has a concussion, or a traumatic brain injury, or a TBI as it’s known, what is their functioning like now, immediately after the concussion or the TBI down, the lining years to come? 21:36 We can also assess to see if there’s been some improvement over time with the implementation of interventions as needed. 21:43 So for example, a lot of times we will get individuals coming to us for ADHD, not on medication. 21:49 And what we’ll do is we’ll, of course, give a bunch of different assessments, but one of them is considered to be a continuous performance test, which is about a good 7 to 15 minutes. And we want to get kind of a snapshot in time of how well they can focus. 22:04 And after, let’s say if a diagnosis of ADHD is warranted, families may turn to medication, and maybe in about six months or a year from now, they may come back And we’ll repeat a test like that with them on medication, to see what it’s like with that intervention in place. So we can give some insights and kind of speak briefly to what it’s like at that moment in time, with the aid of medication. 22:28 We can also help to describe an individual’s strengths and weaknesses. And this can help tailor specific recommendations. So, does my team need extra time on tests? How can we prepare for their future, for college, Things like that? We often have seen a lot of students come in right around the beginning to middle of high school, especially if they’ve had ADHD over the years, and if they’ve benefited from accommodations. Does my team need help on the sat, or do they need extra time, or testing over multiple days? 22:58 Things of that nature, we’re able to give some insights to. 23:02 The most common pediatric outcomes, I would say, are a lot of these kind of diagnostic labels and disorders that we see, mostly all from the DSM five, With the exception of the fourth one, down, in that box, non-verbal learning disability. 23:18 This is a clinical title that we use to describe a certain profile that we often see, where a child has really nicely developed, or really strong, verbal skills, but not so strong visual spatial skills. And there’s what we call a discrepancy, meaning that across a lot of tests, you’ll see that their visual scores are kinda lower, but their verbal scores are much, much higher. 23:42 And an individual with this profile tends to have difficulty reading graphs, reading charts, maybe navigating their way around certain spaces, like going in the hallway and trying to locate a room. They also tend to have some emotional or social difficulties. So they may have trouble kind of interpreting or understanding social cues, especially if they’re non-verbal, like changes in people’s facial expressions and things like that. So it’s important for us to tease that apart from perhaps an autism spectrum disorder or ADHD. 24:14 Another common pediatric diagnosis we often see is related to a specific learning disorder as well. But a lot of these kind of fall within the neurodevelopmental area. And then there’s some mood, behavior and adjustment disorders to that we also see. 24:32 So what is the evaluation process like? So here’s a general overview, and I’ll kind of walk us through each step, but typically, the way it works, is that there’s some concerns that are going on. So people come to us, oftentimes, because there’s a problem, there’s some difficulty in, this could be at home, in school, or in other settings. Once these concerns arise to a problematic level, they tend to see a pediatrician, a neurologist. 24:59 And they’re often the ones that refer those patients to us, will make contact with the family, ask them to fill out some papers in advance, will meet with them for an intake. 25:08 And then depending on the age of the child or the teenager, have them involved in that interview, Then we’ll start our testing, And this could be anywhere between 2 to 9 hours altogether. It could be across 1 to 4 days. So, I’ve been at Sites where we do 2, 3 hour sessions, like we do at my current site, and they’re typically scheduled about a week apart. 25:30 I’ve had other sites where we’ve scheduled 3, 3 hour sessions, and they may be within the course of 1, 2, or three weeks. A lot of it is dependent upon the referral question, and the age of the child or the teenager coming to us. 25:44 I would say most commonly, with the younger ones, like toddler’s. Those sessions typically only last about an hour or two, because toddlers really don’t have that attention span to kind of engage in activities for much longer than that. 25:57 After all, the testing is complete. We’re writing up the report or scoring all the measures and then we provide feedback to the family. So, through the feedback, we’re kind of going over, you know, what is the red thread, what’s the big picture that we’re finding here. What’s important for you to know about how your child’s functioning, We’ll go over our conclusions, will provide you with the report. 26:19 And again, a lot of times, if a diagnosis is provided, not all the time is one provided, but if one’s provided, What direction you need to go in from there? Whether it’s interventions at home, or at school? Or at work even. 26:33 So, information gathering takes place first because we need to better understand the referral question. This involves a thorough chart review, so we may ask families to submit records to us, such as school records, report cards, if a child has or previously had an IEP, if they’ve already been seen by a neuropsychologist recently or years ago. This way we can kind of see, you know, what has the child had already in terms of testing? What was their functioning like before, and how can we help? 27:02 We also, like I mentioned before, wanna get collateral reports. This could be in the form of getting teachers to fill out questionnaires, are talking with them over the phone. 27:11 If a therapist provided a referral, speaking with a therapist, if a, if a child comes from perhaps a family that has parents who are separated, and there are step parents involved, it’s always good to get an idea of how the child functions at both houses, if they’re in the care of two parents, as well as from step parents to kind of see, you know, and get a good, some insights into how they are across different contexts. 27:38 We also want to be sure that we’re defining the problem. We want to get some concrete examples. We want to get a timeline. When did the problems start? When was it at its worst? one of they changed over time and what made it better? We want to get as specific as this because somebody might come to us and say, My child is having tantrums all the time. 27:57 Well, what does a tantrum look like? 27:59 Depending on the age of the child, it’s gonna look different. 28:02 So, maybe perhaps a tantrum for one child is, they’re yelling, they’re stamping their feet, they’re crying. 28:09 But maybe for another child a parent means that a tantrum for them is slamming the door, yelling into a pillow. So again, the behaviors are different and we want to make sure that we’re all on the same page and what we’re referring to. 28:21 We also want to understand if there’s any impairment, again, looking at it through a clinical lens. We’re looking for impairment or distress, So how upsetting is this problem and how is it impacting their functioning on a day-to-day basis? 28:37 With regard to the assessment process, once we have all that background information, and we understand the referral question, we’re able to select and administer all different tests as needed, depending on the concerns that patient’s age test norm. So what are these tests appropriate for their age and gender, things like that. 28:56 We also want to take into consideration behavior observations. This is a big part of an evaluation. And a lot of times, these behavior observations kind of speak more to us than some of the test data. 29:09 So, what I mean by that is, for example, if a parent has concerns about a child’s ability to tolerate distress or frustration, saying that, oh, and they get upset, they throw things, they yell they don’t like doing schoolwork, they avoided all the time. 29:23 Well, they come to us. We try to bribe them with stickers and prizes, get them as engaged as possible, but when we present them with schoolwork when we present them with challenging activities, how do they respond to it? Then, even though this is a smaller setting, and we’ve never met them before the child, how are they responding to these instances? 29:44 And I’ve had a share of children who get very distressed, very upset, break down crying, yelling, screaming at me, throwing objects very similar to the behaviors that the parents are reporting. 29:57 Other times two, we’ll see the opposite. We’ll see kids putting forth great effort. 30:01 We want to also kind of take note, especially for example, if the question is a learning disability, looked at the pattern of errors that they’re making is a child’s MIS spelling words because they’re being an attentive. They’re kind of all over the place they’re chatty, they can’t stay seated. 30:16 They’re being careless with their work or is there spelling kind of more disconnect? Meaning that the letters don’t even match up to the sounds, in the words, and there’s some underlining learning difficulties there. 30:27 So, a lot of times, the observations can give us a lot of insight as to the test data that’s provided from the formal measures. 30:35 Once we administer everything, we want a squirrel of our measures, make sure by that point too, we’ve gathered all of our collateral information. So, if we gave rating scales to teachers or therapists or if you’ve had phone calls scheduled, get that information all in. 30:51 As I’ve alluded to before, we can look at a variety of different domains and all different ways. I will say a lot of times more, so for the emotional, behavioral, and social piece, that’s where a lot of the collateral reports are most informative. 31:05 Again, because we’re able to get insights from different people involved in the person’s care, about how they’re doing across different settings, again, whether it’s at school, or at home, or in other therapeutic environments. 31:19 The other measures, we can look at anything ranging from cognitive skills to receptive and expressive language. We can look at how well they understand visual information, solving patterns, looking at even finding gross motor skills. So this can involve writing, and drawing, and their motor control and speed. 31:38 Executive functions and attention are some of the big ones that were a little look at as well. So are they having weaknesses in their ability to seen as tension? 31:47 Are they carefully monitoring their work consistently on these tasks that we’re giving them? Are they able to kind of plan out their work efficiently? 31:56 Do they need more time than other kids? Are they rushing through, or are they taking too long to get started on tasks? All of our measures can give us that insight. 32:05 How are they doing with remembering and learning information? Do they do better when information is repeated to them, over and over again, in a rote format? 32:13 Do they do better when it’s organized for them in some meaningful way or semantic like a story? Do they do better with visual or verbal information? And how does this affect their academic skills, are their underlying weaknesses in their areas of reading, writing, or math? 32:32 Once all that information is collected, we’re able to look at all the data, integrate it, consult as needed. 32:39 So for example, seeking out supervision, and we want to conceptualize the case, We want to look at everything as a whole, So not just the test data, We want to consider all the background information, All the standardized tests and all the reports we’ve gathered from collateral informants. And our goal is to find the red thread. What’s the pattern we’re seeing, especially as it relates to the referral question? And then based on that, will decide is a diagnosis warranted. 33:08 Whether or not it is will develop appropriate recommendations across settings as needed. 33:14 And the recommendations are striving to be practical, and it must align with the data. We wouldn’t recommend something that doesn’t make sense based on a person’s profile. So we really want to be as practical as possible, so we can realistically support the patient in real life. 33:32 Once all that’s gathered, we’re able to provide feedback, then to the family, and we want to do this in a way that really makes sense to them. So they can kind of get the big picture and understand, you know, what is effectively going on with their child. We offer relevant resources, like books or websites, I often have families asking me, where can I learn more about ADHD or autism? Or, how can I help my child at home with reading. And I provide resources, like books or websites for that, for them. And we send the report to the family. And again, depending on the outcome, especially if we’re recommending school recommendations, we let them know, you know, we encourage you to share this with the school. We encourage you to share this with your therapist. This way, they can get a sense of what the child’s functioning is like and what their needs and their strengths are. 34:23 So, now, why would somebody want to get an evaluation? So, what are some of the benefits or outcomes that I’ve already alluded to? 34:30 So, as I’ve mentioned, it helps to determine current functioning how is my child’s performing now? 34:37 compared to same aged peers? So a lot of our measures and tests are looking at a snapshot of a persons, current abilities at that point in time. So it’s really just a data point. 34:50 But the bigger picture comes into play when we put multiple data points together. 34:56 And it’s kind of like I said, a snapshot of their abilities at that moment. This could be used then as a baseline to monitor future changes in their neurocognitive functioning. 35:07 Like I mentioned before, this could be related to medical treatment. or if there was an accident, a TBI, or a head injury, we can use kind of a baseline measure to see how they’re doing later on, or with the implementation of some kind of intervention. 35:23 It also gives us insight into how an individual learns and processes information. 35:28 Are they slower than other individuals, their age? So does that mean they need more time on tasks, Do they have trouble remembering or understanding visual information, but they do much better? How can we accommodate that in their real life? 35:45 We want to identify their strengths in areas of difficulty, So why is my child struggling to keep up with their peers? 35:52 Again because our evaluation is comprehensive, we can provide a lot of insight as to why that might be. 35:58 So for example, my child has trouble finishing tasks on time. 36:02 Why Wallach into possibilities such as anxiety? 36:07 Is it slow processing speed? 36:09 Are they distracted? 36:11 Do they have weak executive functions? 36:13 Executive functions are the set of skills that we all have that help us make our work and tasks more efficient. 36:21 These are things like time management, planning ahead, staying organized. So if they’re coming to us saying that they’re having a hard time keeping up in school, they’re not able to turn their homework in on time or finished tasks on time. It could be due to a variety of factors. And one of these areas may be a significant weakness. Or it could be a combination of a lot of them. 36:44 Similarly, my child my child has trouble reading fluently. Why is that? 36:50 Could also be, Is it due to anxiety? Are they reading out loud and perhaps there’s underlying social anxiety? 36:57 Is it due to slow processing speed? 37:00 This could also be due to anxiety. 37:02 Could also be due to ADHD. 37:04 Could also be due to some motor weaknesses Or does my child have dyslexia? 37:10 Individuals with dyslexia, you’ll often see have weaknesses and difficulties with reading accurately or reading quickly and fluently, decoding new words and spelling words. So even though these are two distinct referral questions, you’ll notice that some of the areas are overlapping and other areas can be used to help fill in the gaps and give us some insight as to where the underlying difficulty may be. 37:39 Ultimately, our goal is to provide families with diagnostic clarity. Does my child have? 37:45 So enzo? 37:46 We’re able to provide answers whether we’re ruling in or ruling out a certain diagnosis. 37:53 This way, it provides families with validation or confirmation. 37:57 And the reason we would provide any diagnosis is because it helps us to guide treatment. 38:02 We want to know what is the appropriate treatment for my child. 38:07 Now, there’s a lot of misconceptions as well, out there about some individuals having learning disabilities, or having autism, or having ADHD and out growing. These labels are the grout growing these diagnoses. And I will say, the research does show, for example, with Autism. 38:24 that a very small percentage of children, no longer meet criteria after years of support or intervention, but I kind of preface that in the context that a lot of these diagnoses that I’ve been talking about so far. especially autism, ADHD, or learning disabilities are considered to be neuro developmental disorders. Which means that they are brain based. So these are children who have differences in functions of their brains. And with the proper intervention, sure, we can get them to a point where the features of ADHD, or the features of Autism or the features of a learning disability are not quite as impairing as it might be at this point in time. But that’s not necessarily to say that they’re going to outgrow the symptoms. They may always have difficulties, but, just to a varying degree. And, especially when families come to us with school, age children, I’ll say, I’ll always let them know that a re-evaluation is really helpful too. Especially again, once an intervention is put into place. 39:30 We can see what the features of these diagnoses look like over time, if more support is needed, less support is needed, or so forth. 39:41 And it also provides direction to families. 39:43 So once you’ve kind of given them some validation or confirmation, or some answers and insights into what they’re seeking, a lot of times they say, OK, so what do we do next? What are the next steps? What can we do with this information? 39:56 So we’re able to give guidance about services and supports that might be warranted at home in school, we can connect families to different resources as well, and it helps inform treatment planning, too. 40:10 So we know what the appropriate interventions are based on the individual’s profile, and based on our diagnostic outcomes. 40:20 Some common school recommendations that we may make related to a variety of different disorders may be related to a Section 504 Plan or an IEP. So these are basically just legal documents that children have and it helps to kind of establish what accommodations or services are warranted in school. And, again, as I mentioned, the Child Study team or the CST, would be the ones to determine eligibility so we can recommend it, but they’ll be the ones that have the final say. But in our evaluations, we can make comments on or recommendations for class placement, should it be a small setting for children with autism? Should it be a gifted and talented program? Should it be an inclusion or an integrated classroom with two teachers? 41:06 We can make recommendations about different types of interventions needed based on reading, writing, or math abilities. 41:13 If a child has disruptive behaviors in the classroom, we may recommend behavior supports, such as a functional behavior analysis, or a behavior intervention plan. The FBA would essentially be somebody going into the classroom, usually, the school counselor, observing the child in that setting. And the goal is to identify what’s leading up to the problematic behavior. 41:35 What is that problematic behavior, and how long does it last? 41:39 And how does it get resolved? What is the function of that behavior? Is the child looking to escape or avoid something? Are they seeking attention? And with that information, they’re able to develop the VIP, or the Intervention Plan, that helps to kind of lay out what should be done in instances to help reduce those moments of problematic behaviors. Some instances may be, for example, having a child, or being, having a child be provided with a behavior power or aid, Somebody who can kind of give them the level of support that they may need on an individual basis. 42:14 Some other related services that we might recommend are speech, occupational, or physical therapy, individual or group counseling, or social skills groups, and we may even recommend an extended school year. And this is typically used for kids who there may have been, previously, a regression of skills, or over the summer months, they would benefit from having ongoing speech, occupational or physical therapists to help keep them up with those services. 42:42 Common accommodations are related to extra time. Having tests read aloud. Having tests broken up over multiple days. Use of assistive technology. So, for example, typing on a laptop, using speech to text, having foreign language waiver. So if a child has dyslexia, or in a language disorder, giving them a substitute for a foreign language, instead of making them take a foreign language class Using a calculator or typing or dictating instead of writing. 43:13 Common treatment interventions. I’ve kind of introduce some of these earlier, but in terms of mental health therapy, could be CBT or DVT, behavior therapy, depending on what the concern is for Autism, or for parents. It will be ABA, PCIT, or PMT. We also may make recommend having a medication consult, so, for example, with ADHD, if we think medication will be helpful, we recommend they will reach out to a psychiatrist for an appointment. We may recommend some private tutoring or private therapies outside of school. We also might recommend some coaching services, like vocational or life coaching, for teens who are looking to kind of establish a career or get an idea of what they want to do in or out of college. Executive function coaching to help students work with a clinician, so they can learn to be more organized and more efficient with their time and their homework. We may also recommend groups like social skills groups, or support groups. 44:10 We also probably recommend some at home strategies. I like to kind of tailor a lot of these strategies, obviously based on the child’s age, based on their areas of concern. So, if a child is really disorganized, I’ll provide some practical strategies about ways to stay organized at home, how to break down and prioritize tasks. A child’s presenting with a learning disability, depending on their ability level. I’ll give some strategies or activities that parents can work on with kids at home. 44:38 Visual spatial difficulties. I’ll provide some practice exercises, with behavior management tips, and coping skills. These are basically kind of lists of things that parents and patients can try at home to help manage disruptive behaviors, or to help perhaps manage anxiety and depression. And I also provide resources and recommendations about other eligible state funded programs in the area, as well as books and websites. I try to provide some websites and books that are also related to the child, for the child to understand and read. 45:10 A lot of times, when I’m delivering feedback, it’s often to the parents and the child isn’t necessarily there. 45:16 So the question often is, well, how do I explain this to my child now, and that’s where some of these resources that I’m going to provide you guys with common. 45:25 So, this first page is more about referrals if individuals are looking for a neuropsychologist for themselves or for children. I put some in here, so the first one is us, and like I mentioned, we’re located in New Jersey and Pennsylvania. The next one is a site I formerly worked at in New York City, and they are accepting new patients in New York in California, and then the last three or more, on a general sense, you can find a neuropsychologist across New York as well as nationwide, and these, I had distinguished, which ones are kids, and which ones are adults for those providers. 46:01 But, as I was mentioning, you know, families do ask, How do I tell this information to my child? So, underneath our website here, I did put also a link to doctor Liz …. She is a psychologist out in California. She has a great website with a lot of resources, one of which is how to talk to your child about what testing is and what that looks like, but also ways to kind of explain diagnoses to children in a very age appropriate way. So I highly recommend her website as well, and I also just put some general resources down below, related to children, as well as kids health, and learning difficulties, or differences. 46:39 So, with that being said, I appreciate all of your time. And I am happy to take some questions from the chat. 46:50 OK, Christina, sorry, it took me a minute to find the right button to unmute myself. 46:58 Um, someone asked is, can you provide a list of books or websites for ADHD or learning disorders. 47:09 Sure, absolutely Kat, and I’d be happy to. 47:12 OK, great, You indicated a couple of times that you can make recommendations to the school, but they don’t have to follow your recommendations. 47:27 If a child has an IEP, and you’ve suddenly discovered that they have Dyslexia, the school doesn’t have to follow your recommendations. 47:43 Don’t follow every recommendation that we provide. A lot of it is based on the resources that the district or the school has. So for example, if a parent decides to keep their child in a certain district and that district doesn’t have a dyslexia specific interventionist, the school will not be able to provide that, or provide that to the family. They also, again, like I said, if we find there’s been cases sometimes where we’ve identified very early on dyslexia, or very subtle, or mild dyslexia. And the child perhaps might be bright enough that they’re compensating in school. So the school on the other hand doesn’t see that educational impact. They’re not want to say not doing poorly enough. 48:28 So the school has one set of criteria, and each district is a little different. 48:32 And we have our own set of clinical criteria. 48:36 So, that’s kind of where we **** heads at times, but in instances like that, where we are very sure that a child needs more support or specific recommendations and interventions, we refer families to educational advocates and they often help the families along the way, OK. 48:54 Is there any insurance coverage for such assessments? 48:59 Yes, there actually is, and I worked at a couple of different sites where insurance was accepted and insurance was not accepted so I will say at and our abilities, we do accept a lot of insurances and if you go to our website, you can look at the ones that we accept. Oftentimes, medical insurance plans will require a referral, So that’s why, I had put in, like the overview of the evaluation process, most patients are referred to us by a neurologist or pediatrician. Either within our own practice or outside and that helps with the medical part of things. There’s also, if we don’t take your insurance, there, are out of pocket ways to kinda get this assessment started. 49:40 And then we can always provide a bill which are able to submit to your insurance company but reimbursement is not guaranteed. But I will say a good portion of neuropsychological evaluations are unfortunately out of pocket. 49:55 We’re one of the very few that takes insurance, OK, great, well, not so great for those are covered by insurance, but OK, you talked about using an evaluation for a baseline, especially for maybe someone who’s playing sports or, you know, has had a hero consequently ends up having a TBI or traumatic brain injury, is that, you know, do you ever find families who have a history of Alzheimers come in to do, have baselines done? 50:44 So in the pediatric population that doesn’t come up often. We do, though, ask about family history for, let’s say, Alzheimer’s, dementia, things of that nature, Parkinson’s, but won’t the kids that we’re seeing as young as they are? We wouldn’t see any of those potential effects at that time, but it is always good to note in the family history that, hey, down the line, this is something to keep an eye out for. 51:10 Um, all right. 51:13 And mm. 51:17 Somebody else have a question. Not the mm hmm hmm, hmm. 51:21 I know I think one of was submitted ahead of time about pans and pandas. This is a really kind of complicated diagnosis, and we do occasionally see parents coming to us presenting with from other doctors, this diagnosis. The reason why it’s so difficult is because there’s really not a formal, consistent set of criteria. And especially in the area of neuropsychology and psychology, it’s not in that big DSM five book like I mentioned. 51:54 So, similar to like the Envy LD profile or that non-verbal learning disability, it’s a clinical title that we, as psychologists and neuroscientists allergists use to describe a profile. 52:05 But there’s not a common set of criteria established just yet with the pans or pandas. It’s more of a disorder kind of based on exclusion. So, you want to rule everything else out. And it becomes really complicated, because a lot of the symptoms I’m presenting features overlap with psychiatry, neurology, neuro cognitive functioning. So a lot of times before we see individuals with Panzer pans as they’ve already been kind of evaluated by those providers, and they’re coming to us for kind of questions related to their cognitive functioning. A lot of times, a lot of those features are more so behavior oriented. So typically are very commonly, I should say. The course of pandas happens after repeated strep throat, or kind of not being responsive to treatment for strep throat, and then there’s this sudden onset of obsessive compulsive behaviors and parents report a lot of perhaps even ticks or things like that. 53:05 So, we’re able to even observed for some of that stuff, like I mentioned, behavior observations are really important, and this is also to why it’s really important to get a thorough history and timeline of when did these things come about? Now, we, as neuropsychologist, may not necessarily confirm a diagnosis like that again, because it’s more of a medical base diagnosis, and it’s a diagnosis of exclusion, So, meaning, everything else under the sun needs to be ruled out. And we’re just one data point in this individual’s evaluation as compared to neurologists or pediatricians or psychiatrists. But it is always good to just kind of have a sense of in the context of pans or pandas. What is their cognitive functioning like? Are these obsessive compulsive behaviors interfering with their functioning in some way? Whether or not we want to call those obsessive compulsive behaviors, panzer pandas related or not. 54:00 The presence of those behaviors is still there and no matter what label we want to give it, we want to make sure that they’re being accommodated for if accommodations are needed. 54:11 OK, How do you get the kids buy in for the, for this testing? And is there a specific time of day? Or you try and avoid for all of this testing? 54:23 That’s a great point. 54:25 So, with little kids, we do. And like I said, we see them as young as toddlers. We definitely prefer morning sessions as much as possible. And especially for the younger ones, like the age of 2 or 3, We’ll even ask families. one, is their nap time. Is this going to interfere with their nap time? So, we’ll often schedule, like I mentioned, like in three hour blocks. So it might be, for example, a 9 0 AM to 12 PM testing session. But especially for a toddler, it certainly won’t take that long, but at least we’ll have that amount of time. 54:57 If the child becomes really distressed or upset, or is not easily engaged, we kinda have time to workaround that. 55:04 First school aged kids, like elementary and middle school. Again, tying the morning is preferred, but we do also offer afternoon session, so like 1 to 4. A lot of times, parents often choose to keep their child home, which is usually recommended. This way the child is not at school all day in the morning, they had woken up early, and then they’re coming to us kinda fatigued or bored or tired. 55:30 For teens, I would say, a lot of times, they come to us, and even college students, they may want to do a full day of testing in one shot, or they’ll kind of spread it out over the course of a couple of afternoons. We typically don’t schedule appointments after 1 0 PM. We just find that later in the day, a lot of individuals just tend to be more fatigued because there were a lot of activities going on in the morning or whatnot, so we try to keep it no later than one PM. 55:57 Asked for the buy in. With covert, we’ve actually switched over to iPad activity, so we have less paper books in the office because we can’t really wiped down a paper book though. Sheets will rip right off. So we do get some buy in by showing them. You know, we have some activities we’re gonna do today, Like on the iPad, there’s gonna be some puzzle games. We do try to have as many manipulatives as possible and a lot of the games are engaging like that. 56:23 So we have blocks. We have a computer game. We have some puzzles. Sometimes, I also just upfront tell them to, you know, some of the games might be boring, so some of these might be Word games, or I’m gonna read things to you over, and over, and over again. Some of it might look like school stuff too, but some of it might be really different. Just try your very best. And if you have any questions along the way, let me know. 56:47 For kids who are really incentivized by stickers or tokens, we have those available to, like, sticker sheet. So after every couple of activities, they can get a sticker. We easily have a prize box to write on site that kids will let them know ahead of time that they can pick some prizes from there at the end if we finish everything. It’s also helpful, especially for a child who perhaps has a lot of difficulty with engaging in some of these tasks to give them as much choice and control as possible. 57:15 So, letting them know, kind of writing out all the activities on a piece of paper, This is everything that we have to do, what do you want to do first, what do you want to do next, or, Here’s all the school stuff, and here’s the fun stuff, not the school stuff. What do you want to start with? 57:31 Um, it helps to kind of give them a sense of control over the situation. So, like I said, we just try to keep it as engaging as possible. We’re very open to families, bringing snacks and stuff like them to throughout the evaluation. 57:43 They can have that, especially if it’s an afternoon session, and we take breaks as needed. So maybe they need a break every 30 minutes. And that’s something important to kind of note in behavior ops, because it can also help to inform recommendations about supports and accommodations a student might need in school or outside of school. 58:02 OK, so, um, little off topic but it will ask it anyway: Are you seeing female adolescents manifesting this newly discussed topic of sudden onset of conflict ticks related to social media Management? 58:21 I have not seen that specifically. But we have seen an increase in, I would say, older adolescents, young adults, both females and males. I will say a little bit more females coming in with concerns about autism for the very first time in their life. And a lot of it is that they’ve seen it on Tiktok or on Instagram. The other teens have self diagnosed this. And it’s not to say that it’s a bad thing, necessarily. It could kind of be sometimes people, you know, just think, oh, this is what my behavior should be, or everyone has these difficulties, or challenges. And this may be a way to provide some insight as to know there might be something else going on. 59:02 So I always recommend that people, especially if they want to learn more about themselves, whether it’s about the sudden onset of ticks or whether it’s about autism, it can’t hurt to learn more about yourself. I think knowledge is power, so if they’re coming to us and we find that a diagnosis is warranted, we’ll provide one, but there are certainly quite a few times, especially in that population of older adolescents, young adults referring themselves. 59:29 Because they saw something on social media where the diagnosis doesn’t fit, but that’s not to discount their experience. So we’ll let them know, we do still see that you are having texts or we do see, you know, you are having these social difficulties, but it’s better explained by something else or it’s not explained by autism. Let’s see how else we can help you and still point them in the right direction while validating their experience. 59:57 OK. 1:00:00 Gathering information from so many different sources. 1:00:07 Do you try and gather information like you have parents in the household, but sometimes their grandparents as well? Do you try and gather information from them? Is there a different perspective, often between parents, what parents are seeing and other people in the household? 1:00:27 Yeah, that’s a great point, too. So, we tend to always start with, first, whoever the parent is bringing them in, and we’ll have them complete some questionnaires in the office. And then beyond that will ask right away for teacher e-mail addresses. And we’ll reach out to teachers and ask them to fill out a survey. And it’s usually about 1 or 2 teachers, or perhaps a teacher, and if they have, let’s say, a learning specialist, or they have a therapist in school that they work closely with. Or, if the concern is about social skills, someone who can kind of speak to their social abilities in that setting. So, it does depend, too, on the referral question. 1:01:00 Outside of that, if let’s say it’s a grandparent bringing the child in because parents aren’t necessarily involved if the grandparent is the primary caregiver will absolutely get questionnaires from them. 1:01:13 I’ve even had some times where I’ve had two parents come into the office, and they’re both reporting different things. So, I’ll give both parents questionnaires, and kind of see the differences, or I’ll have a child come in who their parents have split up. 1:01:27 And they’ll come in and bring parent one with Step Parent one on the first day, and then parent to step parent to on the next day. And I’ll ask them all to fill it out. And I will, of course, have a lot of different answers. 1:01:39 I find, the larger you cast your net, the more kinds of things that you capture, which could be a good and bad thing. 1:01:46 But it certainly makes for a lot more report, writing and scoring, but it can be helpful to kind of get some insights as to what people are seeing and why they’re seeing that. 1:01:55 Oftentimes, I find maybe parents have a different set of rules at different houses or with grandparents. So depending on the role of the grandparent in the child’s life, it wouldn’t be out of the question to ask them to complete a questionnaire. 1:02:08 OK, great, well, Christie, or what I am. 1:02:15 You gave us a lot of information. It was very, very informative. I want to say thank you for your time this evening, and we look forward to working with you further, and there’ll be, for the audience, there is a survey as you leave, or we’d appreciate that you fill that out. 1:02:41 As you go, if you don’t fill it out, then we do, you will be getting an e-mail asking, even if you did fill it out, you’re gonna get an e-mail saying, Hey, here’s here’s the survey, if you hadn’t filled it out. 1:02:54 We’ll also include a copy of the recording of tonight’s webinar. 1:03:02 If you have any additional questions, we do have a blog that’s open that doctor Sparrow’s will be checking for the next week, and answering questions that are in the blog descends tonight’s Webinar. And thank you, doctor Sperrazza, for your presentation. And, thank you, everyone, for attending. 1:03:26 Goodnight.

Thank you so much.