Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is securely attached beyond the sessions.

(00:41):

Hi Emily. Welcome back to beyond the sessions. Good to see you.

Dr. Emily (00:48):

I know we haven’t seen each other for, actually we have not seen each other for a little while.

Dr. Sarah (00:52):

I know I’ve actually really missed you. Emily’s been away on her summer vacation and I’ve missed you. I know.

Dr. Emily (01:00):

It was nice. I did unplug, so it was good.

Dr. Sarah (01:02):

That’s so good. I feel like that’s going to relate to the question that I’m going to read you right now because I feel like, well, we’ll get into it, but I think any parent who’s going to write a question like this probably needs to make sure they’re doing things for themselves to unplug and rest, not to bury the lead. Let me tell you the question. Okay, so this mom wrote in, hello, my son was just diagnosed with ADHD and I want to make sure I’m doing everything I can to support him. What are the next steps I should take and how can I navigate the school support systems to ensure he gets the help he needs? Thank you.

Dr. Emily (01:44):

Great question. I almost don’t know what I should say. Congratulations. Because sometimes getting diagnosis is like, oh, okay, this makes sense. This all the things I’ve been worrying about or wondering, okay, now I have somewhere to go with. And on the other hand, it can be very overwhelming and there’s a lot of pieces to that. So it’s a great question and I hope we can help a lot of people with that.

Dr. Sarah (02:09):

Yeah, yeah, that’s a very good point actually. I think mean we can talk a little bit about our own experiences in working with families through these very things. I was just actually working with someone today, a couple, a parent couple who’ve been working with, and we were talking about, I think we finally put a name on the possibility that we might be looking at an ADHD diagnosis at some point. And it was interesting because both parents, it wasn’t brand new news to anybody.

(02:47):

Also there was a sense of like, oh wait, is that how we can explain all of this stuff? And there’s a bit of relief in being able to say there’s an explanation for all of the things that we’ve been navigating in our parenting journey with this child that it felt really confusing and overwhelming at times. And even though no one was surprised about that, just naming it was like, oh, I could settle a little bit.

Dr. Emily (03:11):

Totally. I think I’m going to go one step back too and say to get to a diagnosis, I just want to put it out there for parents who are like, I kind of think my kid has ADHD, but I don’t know what’s going on. The school is giving me hints and I can see stuff at home. I just want to put out there before you get the diagnosis. This person has already gotten it, which is great. That means they’ve found the right resources. But some people are like, I went to my pediatrician and so I think it’s really important to say clinical psychologists, we can diagnose ADHD and we can do an assessment and an evaluation and we can give that formal diagnosis that you might need for the next steps that we’ll go into in a bit. A psychiatrist, which is an MD who treats kids can also do an assessment and evaluation, and sometimes that means measures meaning some worksheets that a parent fills out about their child and their experience and a teacher might fill out and then an in-person assessment.

(04:11):

Or you can do a full assessment, which is a battery or what we call a battery, which is basically a list of questions and tests that go through all of these different criteria and as a kind of a bigger, more intensive investment. But you don’t actually need that for a diagnosis of a DH adhd. So I like to put that out there to parents. Some parents are like, I was told I need to get this really expensive neuropsych testing thing. What do I do? And I’m just trying to get a diagnostic clarification and believe me, we love neuropsych. They’re so great, but you don’t always need that as your first step. So I want to say to parents who are just right a little bit ahead behind this parent in terms of the process just to say there’s other ways you can just go get a consultation, an evaluation and a discreet diagnosis without having to go through a huge process. Sorry, if I didn’t want to.

Dr. Sarah (05:02):

Right. And I want to just clarify one thing that I think is worth underlining is, so what I’m hearing you say is there’s a distinction between how do I get the diagnosis, I can get the diagnosis from a diagnostic evaluation from a psychologist, a diagnostic evaluation from a psychiatrist or another licensed mental health professional that can diagnose like a clinical social worker. Other people who have a license in mental health can do that. Or I can go to have a neuropsych evaluation, like a full and formal neuropsych assessment or battery. The benefit to that would be, in my opinion, if you aren’t sure or there’s a lot of potential things that could be going on, and a DHD is just one of many things we want to rule out. Sometimes the nuance and the clarity that a formal neuropsych evaluation can give is really helpful When there’s a complicated differential diagnosis or a lot of things going on that makes the picture kind of fuzzy, or if there’s high acuity, the symptoms are really severe and we’re trying to figure out what exactly is causing this level of severity that we’re seeing. Then again, having a bigger, being able to really dial in and test objectively what is going on and how is it impacting the kids’ functioning and in what different areas or if there’s other things going on a possible learning disability.

(06:48):

Then I would say go neuropsych because it just gives you a lot more data. But if it’s like, okay, we’ve just been circling the track over and over and over again, we really kind of know what’s going on and we just need to have someone who says, I have really assessed this child and they meet all of the diagnostic criteria for ADHD and I just need to confirm what we already know or are feeling pretty strongly that all signs point to this, then you do not have to have a neuropsych battery to get that diagnosis.

Dr. Emily (07:24):

Or at least as not as the first step. I always say to parents, sometimes it’s better to step by step-by-step walk through this process. So if your first step is like, okay, so I’ve confirmed a diagnosis of a hunch I’ve had for a long time, you might eventually get a neuropsych like you’re describing, or if you’re in a public school setting, you might request the school does some further assessments or testing to get a little bit more information, which we can go into a little bit. But I think you’re definitely right. I think listen, ADHD has a high level of comorbidity as we know, right? I’m sure there’s a number out there that maybe we can pull the magic of Becca background we’re getting, but it’s a really, really significant amount of comorbidity, which means…

Dr. Sarah (08:11):

Overlapping diagnoses.

Dr. Emily (08:13):

Exactly, more than one diagnoses like ADHD and anxiety, very common. So a neuropsych really does help sort of suss that out a little bit, but so can a clinical diagnostic evaluation as well. But I just like to put that out there for parents. It can feel like I’m not, I’m just figuring this out and jumping into a full assessment can feel like a big jump. So maybe you do a first step of getting a diagnosis, but that doesn’t mean you might not eventually get a Neuropsych.

Dr. Sarah (08:45):

And this parent obviously got the diagnosis and now they’re navigating the school support system. Which just to tie back to one other thing you said, which I think is worth saying again, is you can ask the school to do evaluations if there is reason to believe that there is things like a learning disability or other types of issues that can impair a child’s ability to function in an academic setting that is the purview of the Department of Education, and they have to test a child. If you ask them to test your child, they don’t test for ADHD.

Dr. Emily (09:24):

Correct. They cannot diagnose for A DHD. Correct. Yeah, but you’re totally right. You have, as a parent, you have the right to ask for any assessments. You just have to put that in writing and typically ask your school personnel who the person is in your district that you put that formal request into. But I always encourage parents to explore that. It can only add to your level of knowledge and what’s going on. For sure.

Dr. Sarah (09:48):

And it helps get the school system involves earlier on in the process so that when you do get your diagnosis and now you’re going to take that step of reaching out for a 504 meeting or an IEP meeting, which is I think where this parent is kind of the next step in their path. If you want to get the school support systems activated for your child and want them to match onto the specific needs your child has, you’re going to want to call and request a five oh four or an IEP meeting and we’ll put a link in the show notes to a really helpful article in our blog that kind of gets into the difference between an IEP and a 504, but high level broad strokes. Emily, what’s the difference between a 504 and IEP?

Dr. Emily (10:39):

Yeah, so an IEP is an individualized educational plan under the auspice, the umbrella of special education. So that means that your child does not receive the curriculum in the same way that a typical classroom would be administering it. So it really means that sometimes it means your child needs to be pulled out maybe for additional reading help, for example. That’s a great way to describe it because the way they’re teaching reading in the general classroom isn’t working for your kid. And so the distinction between that and a 504, a 504 is an accommodations plan, and that means you can learn in your regular classroom. You don’t need to change the curriculum, but you need some tweaks in the environment to make you learn best. A common one is that maybe your child, particularly with ADHD, might be seated near the front of the classroom.

(11:40):

They learn best if they’re right in front of the teacher and the teacher can keep a close eye on them and attend to them. So those are just sort of high level one is you modify the entire curriculum. That’s an I individualized Educational Plan, and one is more or parts of the curriculum I should say, and one is more that you’re okay with the curriculum, how it’s delivered, how school is taught, but you need a little bit of extra things to receive that learning best. Maybe a standing desk, maybe you sit in the front of the classroom, those types of tools to help you with your learning.

Dr. Sarah (12:15):

Got it. And so let’s say this family, because obviously we’re going to pull from this question some guesses, right? I don’t exactly where this person is and their process. She says she wants to make sure she’s doing everything she could do to support her son, and what are the next steps after getting this diagnosis? It depends too on have you already met with the school? Have you had an informal meeting with the teachers in the school and now you want to formalize it? What would be the benefit of formalizing it with an actual official 504 or IEP meeting.

Dr. Emily (12:57):

Yup.

Dr. Sarah (12:57):

Versus just being like, ah, my teachers and I already know we already have kind of an informal plan, but then your kid’s going to move into a different class every year.

Dr. Emily (13:07):

So I think a lot of school districts will, and especially this parent seems on it, they’ve gotten a diagnosis, they’re sort of a parent who’s tuned in and really trying to advocate from their kid from the start. They probably have had meetings with their teacher and maybe a team at school, maybe a school counselor or something along those lines. I think the benefit and the school often will provide it. Public schools will often provide what they call soft building services, which means it doesn’t have to be official, it’s not a document, it’s not written down, but they’ll seat your kid at the front of the class because you have a relationship with the school and a teacher and the teacher. They all want what’s best for your kid too. And so everybody’s working together to try to do that, and that can be informal. And there’s a lot of those things in best practices in many school districts and amazing teachers that do these things just always right.

(14:04):

They sort of read a classroom and know how to do that. I think the benefit of having either a 504 or an IEP is that this travels with your child and it’s also modified every year. So I think a lot of parents are like, oh my gosh, I don’t want it to follow my child. And so one of the things I always say is you can drop them, you can add to them, you can modify them at any time, but it does help. It’s like in our world, Sarah, it’s like a handoff, which is a cheat sheet. It’s like, oh, here’s all the things you should know about my kid before somebody else takes them over. And that really helps. Say your teacher goes on maternity leave, right? Oh, now you have a new teacher and you have to really be rebuilding all of those connections and the skills that other teacher just did back of mind, they just automatically put into place.

(14:56):

So it a little bit memorialize, it formalizes a little, and you’re right. Or if you move, let’s say you move, that happens not only year to year, but if you were to change schools or to move to a different state or it goes with you and then you’re not reinventing the wheel each time. And I think that’s a real, again, it’s also, I think personally, I’ve gone through this process with one of my kids and I actually think formalizing it also clarifies what I’m asking for myself and for my kid. So it sort of crystallizes and makes a more executable thing as opposed to help my kid please we’re struggling. You really sort of break it down into different tasks and skills and areas that they can actually execute, and I think that’s really helpful for everyone.

Dr. Sarah (15:52):

Yeah, that makes me think too, I’ve sat in on a lot of 504 and IEP meetings on behalf of the families that I work with, and that’s oftentimes news to a family that they can have someone come with them to their meetings. And it’s so helpful to have somebody who’s, maybe it’s the person who did the neuropsych eval. Maybe it’s a person who’s treating the child, maybe it’s someone who’s doing parenting support with the parents, but somebody who can speak to the diagnosis and to that specific child’s strengths and challenges and how from a professional standpoint, you can see specific things either from an academic curriculum-based delivery of the curriculum, kind of methodology from an IEP kind of type of bullet points or from that behavioral and environmental support system, like a kid who needs to chew gum in class or have access to fidget toys or a kid who struggles actually with staying in the classroom because of anxiety and needing to go check stuff. And so we want to help the child to help the teachers understand, okay, actually we’re going to let them go once, but then we’re going to hold a boundary. So it’s not always even how do we accommodate the environment to meet the needs of the child, but also how do we support the needs of the child when they bump up against the environment that’s the most effective for them. So there’s all kinds of things that advocates can do in these meetings with you as part of the team.

Dr. Emily (17:40):

I also think it just helps you feel less anxious As a parent, I’m a psychologist, I do this for a living, and I go into these meetings and it is hard. They are uncomfortable, and it’s hard to hear all the things that are going not so right with your kid and having someone there that’s on your side, not that the school isn’t, but really having someone there that can help support you, I think makes you have a clear mindset as well. I think that’s a really important piece of it. And I think this person who’s asking, where should I start? I actually think the first place to start is with the person who gave you a diagnosis. What do you think is my next step? Do you think my kid needs an IEP? Do you think my kid needs a five oh four? Should I just call a team meeting with the school and maybe have you come?

(18:27):

Those are all viable options that I think the professional that helped you figure out this diagnosis can sort of guide you towards, because it might be okay to just have a team meeting with your school. I don’t want to dissuade families who feel that that’s the right path for them. That can be really helpful, particularly in the elementary level as a first step. Again, I’ll say this a million times, this is a journey. Having an ADHD diagnosis is a chronic lifelong thing, right? It’ll ebb and flow in terms of how challenging it is and how you grow and change, but it’s probably going to be a long runway. And so step one might, it might be okay to have step one, be team meeting with your school and the provider that helped you with that diagnosis. Step two might be requesting an IEP or a 504 meeting depending on what the feedback you’re getting is.

(19:18):

And I think those are like, that’s where I think just knowing that those are your options, knowing that that’s your, here’s my map. I can do lane A, lane B, lane C. I just think that that is enough to get you started. And then I think to your point, adding on an advocate or a support person in the field who knows a little bit about this and who can guide you and also just educate you on your rights and what is available to you, at least in public school education, maybe what’s available to you in your school period. Your school might have great resources, public or private, that they might be able to implore for your child. That might be small things can make a big difference. And that is where I would start with any child or family is trying to figure out what path I’m going to go down and then building in the questions I want to ask for each of those paths.

Dr. Sarah (20:16):

And I think too, even if let’s say for whatever reason you don’t want to bring someone to your meeting, you can still craft a ask list or a wishlist with that professional to then bring to the meeting based off of, for example, if you’ve gotten a neuropsych eval, there’s a whole section at the end of a neuropsych evaluation with recommendations.

(20:43):

And they should be very detailed in terms what specific things would be helpful for this child to thrive in an academic setting based on, because the whole thing about a neuropsych eval is it gives you a really, really nuanced map of what parts are working and what parts are struggling. Because as anyone who knows, a kid who has ADHD will understand kid A doesn’t look like kid B, it’s a very, very unique way that these cluster of symptoms will present. And so some kids will really be able to have very specific areas where they’ve got strengths and where they struggle and they’re going to look very unique to that kid. And so leaning into the strengths and having those strengths inform some of the strategies, some of the behavioral or education plans, and also looking where are there lagging skills? Where do we need to scaffold them more? That’s going to also inform some of the recommendations. So looking at your recommendation section and going back to the person who wrote it and asking any questions you have about, okay, if this is, I get this in theory, but how would I actually implement this in a classroom if it’s not specific? And then making a list and going with that to the meeting to be like, these are the things based off of the recommendation section that I want to ask for.

(22:15):

It could also be that if you’re not getting a full-blown neuropsych eval, you can still ask those same questions to the person who gave the diagnosis because presumably they have insights into the specific strengths and challenges that your child demonstrated for them to land on that diagnosis.

Dr. Emily (22:34):

And I’ll say that I’ve had a couple of neuropsychs done on one of my children, and the recommendations are wonderful, and the recommendations don’t directly translate to what the school can do. So it’s super, super important to understand that even as a professional, I was like, what do you mean you can’t do that? And they were like, but this isn’t how it’s set up. Or it can’t read like that in the IEP or 504 document, for example, in a 504 document, it’s like a dropdown menu. You can write some things in, but you have to select from a dropdown some of the accommodations that your child is getting. So it’s not, in my mind, I was like, I’ll just write a sentence and it’ll be like, this is what my kid is getting. And that’s not at all. You have to pick a category that most aligns with that thing you’re asking for.

(23:26):

So even the best neuropsych reports, I mean, I think that our practice is unique and does this differently personally, and because of this personal experience that we’ve had with this and not doing it like this, but I’ve had very excellent, extremely reputable neuropsychs, not at our practice done that. The recommendation sections the schools have been like, right? They’re not necessarily applicable. So I think talking to someone or seeing if someone can, to your point exactly, help translate those into actionable items that are realistic based on experience with what schools can offer and what are in plans or what is available in the plan is super important. And even me, I was like, what? Great. I have this neuropsych with all the pages of amazing recommendations that when I showed up at my meeting, they were like, that’s not, I don’t know. How do I translate that into an actionable item in a 504? And it’s just a skill and it’s something that we pride ourselves on taking a lot of time doing, but it is something you really do. I needed an expert to help me and I do this.

Dr. Sarah (24:34):

That’s why I think we created at up psychology group. So Emily and I, if you guys don’t know if you’re listening, Emily and I have a group practice in Pelham, New York, and we’ve been working with our team. We have an awesome psychologist on our team who does a tremendous amount of neuropsychs. We are building out that program. But one of the things we realized in building it out is like, oh my gosh, we really need a place to just have people who can come in for just someone to look over another eval and say, okay, here’s a recommendation. Let’s revise the recommendations section so that it translates into what we can actually advocate for our kid.

Dr. Emily (25:15):

Super important and super passionate about that. Really making it a digestible, actionable thing rather than just an intellectual exercise. And it’s great. It’s really important to understand your kid, but you do need to be able to turn that into something really useful and that feels very empowering. The feeling of going into a meeting, knowing that you have actionable items for your kid is really empowering and makes you feel like, okay, I got this. I feel hopeful I’m getting my needs met for my kid. And you should never, I always say this, I always apologize at my own, personally at my own. I’m always like, I’m sorry for being such a pain, but I want these five more items on my, and the response I get most of the time is never apologize for advocating for your child. And so I just want to say, never apologize for being a little bit of a squeaky wheel. Ask. Ask. I had two meetings. I said I wasn’t ready to sign off at the end of my meeting, which you’re allowed to do, which I don’t also want to put out there. If you have a meeting for a 504 or an IEP and the meeting time is run out and you still aren’t ready, you can say, I’m not ready. I’d like to schedule one more meeting to finish this out.

Dr. Sarah (26:28):

And another thing I think just to close this out that I think is so important is it can be so high, it can feel really overwhelming to go into these meetings. It can sometimes feel like, okay, I want this and the school is, their position is to try to give me as little as I can. And that’s really not, I mean, think it’s so important to go into this from a collaborative and sort of team approach and to really go into this from a place of openness and how do we all work together to support this child in the way that works best, realistically, appropriately. And also, so you get to be that squeaky wheel. Don’t apologize for advocating for your kid. I love that. And also if we come in thinking it’s like an adversarial or a scarcity kind of, we have to fight for these things. That energy is going to bring this sort of defensiveness to the table that’s going to elicit defensiveness on the other side. I think in contrast, if we kind of come in with this sort of abundance mindset of like, Hey, we are all here for the same reason. We all have this kid’s best interest at heart. We all want to make this work. How do we come together on these topics? And that just brings, it just helps everyone lean in.

Dr. Emily (27:59):

Yeah, I totally agree. And I think in my personal experience in the meetings, actually the best advocates are your teachers because your teacher has no skin in the game. My teacher, in terms of administrative…

Dr. Sarah (28:14):

Resources, resources, the thing is sometimes these accommodations cost money. That’s really a big thing. The school has limited resources. They are going to try to, of course, meet your kids’ needs, but from a place of how do I maximize the amount of budget I have available to these resources.

Dr. Emily (28:30):

For the most amount of kids.

Dr. Sarah (28:31):

So that everybody’s going to get what they need. And so there is someone there from the department of education whose kind of job it is, again, not from a withholding standpoint at all, but from a egalitarian standpoint of I want to meet this family and this child where they’re at and also manage the needs of the school. And the teacher, however, doesn’t have that same, they want their classroom to run smoothly and to service the whole class and this child too. So they want it to for their classroom.

Dr. Emily (29:05):

And also, I just think they have a realistic view I ever got. And I totally agree with you. Going in with abundance and not a scarcity mindset and not adversarial is really important. But if you feel that that is something that can happen in these meetings, you’re not crazy. It can happen a little bit. And I think my way of relieving that is I’ll turn to my teacher and I’ll say, do you think that will work? Really? Is that I know that I’m pushing here. Just worried. Do you think that what we’ve landed on will really do it? Will that really help? And I think the teacher can really be, they can say, yeah, I think that’ll be enough, but maybe you could add X, Y, and Z. Maybe you could add a little bit. I think they just really know your kid. And so they’re helpful. And again, to get out of that adversarial sort of feel to say, okay, how do you think that would work in practice? Can you just walk me through it? You have every right to say, walk me through what that would feel like and what that would look like in the classroom. And I just want to make sure that it’s hitting what I’m hoping it would.

Dr. Sarah (30:09):

Yeah, I love that. So yeah, if you take anything away from this episode, it’s definitely never apologize for advocating for your kid. I think that’s so important. Someone once told that to me and I literally started crying about me and my kid. I was like, thank you for saying that, because it is so hard to, sometimes, I dunno, we’re trained to people please. And sometimes it is very difficult to sort of push back and say, this is what my kid really needs and I need to keep going with this. We’re not done. But yeah.

(30:47):

Well, so back to this whole thing I was saying at the beginning, if you were writing a question like this and if you were listening to us talk about this and you’re like, oh man, I am here. It’s also really important that you’re a parent that’s advocating for yourself and taking good care of yourself, because it’s hard work to have a kid who’s grappling with a diagnosis of a DH, ADHD and kind of figuring all this out. It’s a lot of administrative work, it’s a lot of emotional work. It’s a lot of just life crazy work. So yeah, be good to yourself. I really hope this was helpful. I hope we answered your question. I feel like we did, but if you have any follow ups, just write in. Let us know.

Dr. Emily (31:28):

Don’t worry. We could do this for a long time. We have lots to say on this topic.

Dr. Sarah (31:32):

Oh my gosh, I know we could never, 30 minutes, not long enough. But we’ll let you guys go on to the next podcast of your day. Hopefully it’s another securely attached episode, but we know you should be binging these because they’re so good. Talk to you soon.

Dr. Emily (31:50):

All right, bye.

Dr. Sarah (31:51):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions, it really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate, or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer insecurely attached beyond the sessions. That’s drsarahbren.com/question. And check back for a brand new Securely Attached next Tuesday. And until then, don’t be a stranger.