Dr. Katia (00:00:00):

That’s how we often think about things. We a default to thinking about the negative and making negative self attributions. And we b default to thinking that we’re alone and fighting this fight on our own. And so I think the community element is a really significant portion of it too. Yeah.

Dr. Sarah (00:00:24):

Neuropsychological evaluations can be a powerful tool for parents. These assessments can provide a deeper understanding of your child’s strengths and challenges, offering a roadmap for how to help them thrive. But let’s be real. Words like testing and diagnosis can feel scary. After all, what do these evaluations actually measure? When is the right time to get one? And how do you talk to your child about the results in a way that feels empowering rather than limiting? To answer all of these questions and more, I’m joined today by the founders of Neuropsych Moms and the authors of the amazing Different Thinkers children’s book series, pediatric Neuropsychologists, Dr. Yael Rothman, and Dr. Katia Fredriksen. In this episode, we are going to explore how neuropsych evaluations can unlock a better understanding of your child, why a strengths-based approach is key but shouldn’t tip into toxic positivity. And the three questions to ask yourself if you’re wondering whether your child might benefit from testing. Plus they clear up some of the biggest myths and fears around diagnoses like ADHD and autism, and share their best advice for how to talk to your child about their results in a way that fosters confidence and self-acceptance. So if you’ve ever wondered whether a neuropsychological evaluation could be helpful for your child or if you’re just looking for guidance on how to best support them, this conversation is for you. Let’s dive in.

(00:01:52):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is securely attached.

(00:02:21):

Hello everybody. Welcome back to the Securely Attached podcast. We have two guests here today with us, Dr. Yael Rothman, and Dr. Katia Fredriksen. Welcome.

Dr. Yael (00:02:36):

Thank you so much.

Dr. Katia (00:02:37):

Thank you.

Dr. Sarah (00:02:38):

So glad to have you. So we’re going to get into a lot of interesting conversations today, but before we get into all the nitty gritty, I would love if you wouldn’t mind just sharing with our listeners how you guys got into working together, maybe a little bit about the work that you do professionally and then also some of the books you’ve been writing. I know another one just came out.

Dr. Katia (00:03:07):

Well, so we’re pediatric neuropsychologist, which means that we are trained as clinical psychologists and then we do post-doctoral specialization in neuropsychology. And so that means that we essentially, we don’t do therapy, we don’t teach, although, well, I guess that’s kind of what we’re doing now a little bit, but not formally, but we do evaluations and pediatric populations. So kids may be surprised here, but we think of you as pediatric until your early twenties. So that would be up through college. I think many adolescents would be outraged to hear that. And so what we do is we work with children to perform and teenagers and young adults to perform evaluations to help them learn about how their brains work, how they think and learn. So we look at things like attention, executive functioning, learning socio-emotional functioning, all different sorts of components that make up a person’s unique profile of strengths and weaknesses. And then we share that information with kids, with parents, with other relevant people in the children’s care or lives. Yeah. Do you want to?

Dr. Yael (00:04:22):

Yeah, and we met by working in the same private practice outside in the suburbs of DC of Washington dc I got there, I think Kaci had already been there for maybe five years or so, and I joined in and then we were very, I think we have very similar styles and passions and beliefs and sense of humor.

(00:04:49):

Sense of humor, yes. And we talk a lot about sharing information with kids. And what we were searching for were resources that would be helpful for children to understand diagnoses, different diagnoses that they had, and we couldn’t find exactly what we were looking for. There’s a lot of really lovely books out there for children that talk about symptoms, but not necessarily completely about diagnoses. We also wanted a resource that would not just skew only to positives the superpowers, the gifts, but to also talk about that all of us, all of us, no matter what, if you have a diagnosis or not, we have a profile of strengths and challenges and how we can support that. So that got us to writing this children’s book series for elementary age kiddos, and we’ve now have a book about different thinkers, ADHD, and different thinkers, autism. And hopefully we’ll have another book next. So

Dr. Sarah (00:05:58):

Amazing.

Dr. Yael (00:05:59):

We’re looking forward to that. And now Katia and I do not work in the same place. I moved to New York and she’s still DC area, but we’re still collaborating all the time.

Dr. Sarah (00:06:11):

Yes, that’s awesome. And I think I have so many questions for you and so many thoughts, and I really want to get into specifically this idea of language being, putting so much thought into how we give language around these diagnoses to kids in a way that both helps ’em understand, helps them not feel like they’ve done something wrong or there’s something wrong with them. But that also helps name the struggle because to your point, Dr. Rothman, yes. I think a strength-based approach to neurodiversity is so important beyond critical, and I think it is important that there’s ways to help kids see all the benefits and strengths that come with having a different kind of brain. But I think you’re onto something so important by acknowledging the fact that if we’re not naming the parts of this diagnosis that might feel hard or might have caused you to have consistently run up against challenges in your life, that you might have a story in your mind that’s like, I’m just really bad at this, or people always get mad at me for this, or people think I’m lazy or people think I don’t care about them, or I’m clumsy all the different things.

(00:07:33):

And we could talk all about why those particular symptoms might actually be something we want to help kids make sense of. I just think that’s so important.

Dr. Yael (00:07:43):

I think what we want to do is empower children and adolescents and young adults by learning how to become their own best self advocates and by hiding part of that from them, oh, this is all positive, superpowers, gifts, I think that’s doing a disservice. You’re not giving them all the information. Now we will talk today, we talk about all the amazing strengths that come with neurodiversity. We definitely include that in all of our feedbacks and our books, everything. And that’s so important. And we talk about that some things might be harder when you see the world differently and the world wasn’t made for a different thinker. That can be tough at times. And so here are the ways.

Dr. Katia (00:08:31):

It’s been interesting. I think to, and I might be going off piece here a little bit, but it’s been interesting to watch the evolution of the field in that regard. I mean very much, I think many of us mean especially prior generations. And I think us too, to a certain extent in our training, there was an emphasis on this more medical model of disability or disorder or this, right? Sort of more things seen as being problematic, being highlighted. And then the pendulum I think swung the opposite way for many good reasons. And I think we need to find a balance where we show respect for the challenges. We don’t try to minimize them, and yet we also promote and enhance the strengths.

Dr. Sarah (00:09:18):

I think that’s such a beautiful way of putting it. I also find, and I’m definitely curious anecdotally, what your experience has been having given feedback, diagnostic feedback to so many families where you have to sort of name, okay, all of the data is suggesting that this is the diagnosis and we have a lot of resources available that we can recommend and all these things. But I find that there can be sometimes apprehension both from the clinician to the parent, but also from the parent to sharing with the child anxiety around what is this going to mean to receive this diagnosis? And I think that points to a lot of the shame and stigma that’s kind of has enveloped a lot of these diagnoses for so long. I think it’s really changing and I think books like yours do a really good job at moving that change forward. But I also find that nine times out of 10 when I’m working with parents who are ambivalent about telling their child about their diagnosis because they’re scared of how their child will interpret and internalize this thing that they’re learning about themselves, that more often than not there is such relief at like, oh wait, there’s a way to explain all these things that have been hard for me. That’s not because of something wrong with me, but because there’s this thing I have, oh, that makes me feel so much better.

Dr. Katia (00:10:53):

Well, and there’s a community, it’s not just me struggling on my own, I think. So that’s how we often think about things. We a default thinking about the negative and making negative self attributions, and we’d be sort of default to thinking that we’re alone and fighting this fight on our own. And so I think the community element is a really significant portion of it too.

Dr. Yael (00:11:18):

And this is probably the number one parent worry that we hear when we say, Hey, we want to now share this information with your child, and it’s, oh, I don’t want them to think that they’re broken. I don’t want them to have a negative label. I don’t want them to look this way, but what you just said, children are so much more aware than we give them credit for, and they already are likely giving themselves a negative label when they don’t have the right words like you said. So instead we’re reframing, we’re giving a new narrative, we’re empowering like you were sharing. So it’s a valid worry for parents to be thinking about, but their children, they’re already thinking about this and knowing something’s going on and often in a negative light.

Dr. Sarah (00:12:12):

So when a parent has, whether they’ve received a diagnosis from a therapist or a pediatrician or through a neuropsychological evaluation, and maybe it would be helpful too. I’ll circle back to this question, but how people get the diagnoses if you are like, Ugh, I know something’s up and I need information. What are the different paths a family could take to receive a diagnosis? Maybe we start there and then I’ll ask my follow-up question after that.

Dr. Katia (00:12:46):

Good point. I think there’s no one right or wrong way. I mean there are multiple options. It really depends on the individual in terms of what the question is and how broad the question is. So for example, if you suspect ADHD in isolation without any broader concerns, you might go via and you don’t necessarily have the time or the money to spend on a full neuropsych, right? I mean that is a time and financial commitment. You can go via your pediatrician and then the diagnosis will be based on your report and on questionnaire data that you and the teacher complete. So there won’t be testing of your child’s actual capacities. It’ll be based on other people’s reports and sometimes that’s perfectly adequate, but at other times, if it’s not clear what’s going on or if there appear to be multiple things going on, or perhaps you’re seeing knock on effects, well, I wonder about ADHD and I’m noticing something academic. Are these two separate things? If there’s a more complex multilayered question, then I think it’s useful to look in the direction of the sort of evaluations we do.

Dr. Yael (00:14:01):

You could also go to your school and ask questions there. The school evaluation is different than a private neuropsychological evaluation, but it does offer assessment services and interventions, not necessarily a medical diagnosis, but that could be another path to take. There are special medical professionals, developmental pediatricians, neurologists, the common pediatrician who…

Dr. Katia (00:14:39):

The garden variety pediatrician.

Dr. Yael (00:14:40):

Garden variety pediatrician, that can always be consulted as well.

Dr. Sarah (00:14:45):

Psychiatrists too, right, can give the diagnosis as well as psychologists. But, I mean technically I have confirmed, I’ve been like, yes, this is what I think we’re dealing with. And I’ll anecdotally do, like we were saying, some self-report measures, sending that to the teacher, sending it to the parent just to collect data. But when I am ever looking at something more complex like, okay, there’s this anxiety going on, there could be some learning differences going on. There’s other stuff that’s like we don’t know what’s driving what we are seeing as symptoms. I always recommend getting that map. I think a neuropsych. And I’m also curious if there are times at which you think it’s more beneficial than others?

Dr. Yael (00:15:38):

Oh, for sure. I love what we do. We are so fortunate. Both Kaci and I talk a lot about this, that we are so fulfilled and love our profession, but not everyone needs a neuropsych for sure. And I think that’s important and I want everyone to hear that, that really to come and get this very thorough evaluation completed. Usually we’re looking at multiple components. If the question is only is it X, you might not need a full evaluation for all, sometimes, maybe sometimes not. But katya’s question, is it ADHD? Do you need a full neuropsychological evaluation to answer that? No. Could it be helpful then you’d figure out how the executive function is impacting learning and memory and sure, yes. So then you kind of pick and choose to see what it is. If someone calls me and says, I’m just wondering, does my child have anxiety? I’d say, great question. I don’t think you need a full neuropsych to answer. If that’s your only question, I would wonder if you’d want to go to intervention instead and work with a provider and see about that. And so for sure that I tell people, you’re coming to me, this is your specific question. I don’t know if you need an assessment, you might need intervention, you might need to talk to your pediatrician, you might need this. So definitely to direct people in different paths.

Dr. Sarah (00:17:17):

Yeah. And this comes up a lot once a family’s like, okay, we know we need to get a neuropsych. It’s just a matter of when. Are there ages or years in school where you find it to be a more useful snapshot?

Dr. Yael (00:17:35):

That’s a great question. I think we see younger ones, and there is sometimes in your validity statement, you do talk about how this isn’t always completely predictive at time active over time because IQ stabilizes a little later on. And so the scores, sometimes parents are like, wow, look at how high their cognitive abilities are and then they can level out a little bit as you get older. But it still can be a wonderful help because people come to us not because things are all going well, they come because there’s an issue. So if there’s an issue at the age of 5, 6, 7 that’s getting in the way, then you need that support, then maybe you might need a reevaluation in three years. But if you’re concerned and Kaji has a nice, I feel like you have three questions you ask. Is that right? The six months of Yeah, do you remember them?

Dr. Katia (00:18:40):

Well, here’s what I wonder about. Okay. Okay. I like how you set me up there. At first I wasn’t exactly sure what you were talking about, but then I figured it out. So there are three things I wonder about, and this is often when parents are asking me about medication.

(00:18:55):

So the same sort of applies when it comes to do an evaluation. So are the concerns in question, are they affecting the child’s academic progress? Okay, number one, are you getting concerning feedback, grades are dropping, distress at home and homework, those sorts of things. Number two, are the traits in question affecting them socially? So say we’ve got the impulsive poking or the kids are getting upset easily and engaging in behaviors that are off-putting with peers, et cetera. Are the behaviors in question affecting them emotionally is my final question. And of course that loads on the previous too as well. So if you’re seeing raised anxiety affects and self-esteem, I think those are all times too start to think about tearing off the bandaid as opposed to maintaining the wait and see. I think it’s very tempting to wait and see.

Dr. Yael (00:19:47):

You commented to a family, and I think I’ve said this now, is how long have you been thinking about this? Yeah, you have to give a deadline to it and put it in your calendar. Okay, you have this worry, you have this check in again in two months or three months, and are you still concerned? Are other people telling you about this concern?

Dr. Katia (00:20:08):

We’re all so busy, it’s just life is so overwhelming in general. It’s hard to keep our on top of those things that we’ve put on the back burner. And so yeah, a hundred percent. I just had a case recently where parents are sort of struggling with the idea whether to try medication or not for a DH adhd. And I said, well, if you’re not sure, why don’t you wait until the end of the school year? We’ve got a couple months here and you can get feedback and see you’re going to try these behavioral strategies. In the meantime, you can see if you notice any positive improvement. If you’re still concerned, maybe recheck in, sit down and have a family meeting and discuss it.

Dr. Yael (00:20:42):

I do this with my own kids. I did this recently with my son. I put a little note, I was like, okay, something just came up. I want to check in a few months and see if this is still going on. And it wasn’t. And I was like, okay, great. And if it was, I’d be like, great, now I want to ask about it a little bit more.

Dr. Sarah (00:21:02):

That’s such a good mom hack. Honestly, if I have a worry, because there’s two things that can happen. One is we avoid the other is we ruminate.

Dr. Katia (00:21:11):

We obsess.

Dr. Sarah (00:21:13):

And I feel like that strategy is good for both of the situations because for the avoidant moms, it’s great to be like, oh my God, I completely avoided and forgot about this and now I have a reminder in two months to ping me to go back to that and reevaluate how things have been going with respect to whatever that worry is. And then for the worry moms that ruminate, it’s like, no, no, no. I have given myself permission to wait until X date to dig into this. If I’m still worrying, then if I check back in then and it’s still a concern, I could take action. I have a plan, but I’m also permitting myself to not ruminate on it for the next two months.

Dr. Katia (00:21:54):

I think that works in lots of different scenarios too, how your kid is doing academically, how things are going at work. Sometimes things are, there’s a passing sort of a flare of stress or difficulty and we don’t want to overreact in the moment, but nor do we want to put it off too long.

Dr. Sarah (00:22:12):

Right. I agree. And things change so fast with kids because their development is also catching up to a lot of things and the demands of their environment are also changing a lot. So I think it’s good to remember that there’s cyclical movement in, cyclical isn’t the right word, but episodic development does not linear. It’s almost like more like a staircase than a straight diagonal lineup. They have these leaps and then a plateau and a reconsolidation and then a leap and then a plateau. And so I think sometimes the plateau can make us anxious and then there’s a leap or a lot of times with the leaps, there’s a lot of chaos and disorganization and then having to reorganize all these new cognitive assets and it can be kind of a hot mess for a while when a kid has a big cognitive leap.

Dr. Yael (00:23:14):

I definitely think so. And I also want parents to hear that they don’t need to be experts in child development either. I have a lot of parents who come to me and they’re like, but I don’t know if this is normal or not. And you don’t need to. That’s okay, ask the question. I do. I think another one of catches tips is I should make a poster. I like it is even if you are not hearing this and you don’t think it’s really impacting completely the child’s development, but you are feeling this parents’ intuition is something to trust and ask just your pediatrician or the school. And I always think that’s good. I don’t think parents who come to me and say, I just don’t know. I’m like, you don’t have to. That’s okay. That’s why you’re here. That’s what we’re going to help you with.

Dr. Sarah (00:24:10):

I think that’s really reassuring. Okay, so we’ve got a parent, they’ve done the work of checking in. This is something that they’re definitely want to get some information on. They’re going to get an neuropsych evaluation. They get this whole process through this whole process. And at the end there is some sort of diagnostic conceptualization that comes out of this. How do you guys talk to parents about this? And then how do you encourage parents to continue those conversations with their kids? I’m sure you are doing some of the conversing with the kids directly too, and modeling for families how to communicate this to kids. How do we share this kind of information both from what can parents expect to be learning and then how do we want to help kids understand whether it’s diagnosis of a DHD of autism of a learning disability? What are some of the other things that sometimes get diagnostic clarity from a neuropsych eval?

Dr. Katia (00:25:16):

Well, so in regard to how we would sort of approach it with a parent, I mean I suppose we all have our own sort of little modus operandi. I mean, I like to start and I just did a feedback right shortly before this so it’s all fresh. I like to start just by taking care of any little housekeeping type stuff, what works so they know what to expect during the course of the meeting.

(00:25:44):

I think we feel more comfortable and we know what’s coming. We know sort of what the plan is. Do I need to take notes? Should I interrupt if I have a question? I like to just tell people those things ahead of time so they understand what I’m expecting. And obviously if they break what I’m expecting, it’s fine, but I just think people are more comfortable to know that and checking in about how things have been going, et cetera. I think I have a starting off with a little sort of light brief, basic mechanics conversation is soothing.

(00:26:17):

I tend to personally, again, I don’t know that there’s a right and wrong here. And then I like to sort of go through what the data is. I have who I spoke with, how the child was during the testing. Again, we’re sort of easing and nuts and bolts and chatting a little bit. I tend to then speak about the areas that people describe as strengths and things I see as strengths in the testing. And I’ll circle back to that because oftentimes of course people are anxious and they may not hear that because they may just be waiting for the big kahuna or whatever their biggest concern they had. So I like to highlight those things first. I think they’re so important, but I will circle back in case anybody’s in a fugue of anxiety and can’t really take those things in. And I think it’s important to build on what the parents, and I just say parents, because typically parents bring the kids in.

(00:27:07):

Sometimes there’s a school referral or it’s via the department of social services or whatever, but usually it’s parents. And so I like to sort of reflect back on what the referral questions are so that we’re grounded in why we started this thing, why we’re here and what was on their minds. And then I tend to, some people will present diagnosis outright. I tend to sort of build data and here’s what you noticed, here’s what I notice. And try to pull together the pieces and explain how they relate. And then if there’s a diagnostic category associated with that to share that diagnosis and get reactions and discuss, I dunno what your progression typically is.

Dr. Yael (00:27:48):

There isn’t a right way to do a feedback. I have a thing where I kind of start a feedback even during the interview because when I hear parents asking me certain questions, I’ll say, have you ever thought about this diagnosis? Has that ever been something anyone’s ever told you before or thought about? And how would that feel if he or she met criteria? And I would tell you that, would that be expected or unexpected? So I try to gauge where I’m meeting the family at the beginning. I think now being on my own in practice versus being in a group practice, I am doing all my own intakes too. So I’m listening to the family and getting to do the interviews. But sometimes family would come for an autism evaluation without being told they were coming for an autism evaluation because the intake provider heard, okay, there’s these social concerns, I think you should do X and I would want to share, I don’t want you to walk into my office knowing I’m looking for these social cognition challenges without realizing why I would be looking for that.

(00:28:58):

So I’m trying to plant a few different seeds gauge. I’ve had different supervisors over the years with different methods, and I love learning and hearing what everyone does. One supervisor of mine would just, when the family sits down, they would just immediately say, and they met criteria for X. So then like, oh, you’re holding onto this. That’s your number one question. I’m going to put it on the table and now we’re going to talk about everything else. So you can refocus. Sometimes that’s helpful. Sometimes I do not think that’s helpful at all. So I think it’s really individualized. When I talk to parents, I do a verbal discussion when I talk to kids, I do a visual, I use a PowerPoint presentation. I know some of our colleagues do that for parents as well. And I think maybe that’s really excellent and something to consider. But we give a visual with our report to the parents there too. But I’m sure you’ve seen those reports. They’re not easy to take in.

Dr. Sarah (00:30:03):

No. I literally, because a lot of times people will get reports from outside of my practice and bring them to me and I will translate them for them because even if, I’m sure they got feedback and it was helpful at the time, but it might’ve been two years ago, and they are like, oh, by the way, here’s my kids’ old neuropsych. And I’m like, do you know what this says? And they’re like, not really. I don’t.

Dr. Yael (00:30:30):

That is definitely a pitfall of our profession, a fear. I think we all have. I had one mentor of mine talk about that a family will leave with so much information and make sure there are three things that they can take away. So I try at the end to be like, okay, here are three things, the diagnosis, here’s what I want you to do next. Please call this therapist that I’m going to give you the name of. I want you to give this report to school. So I’m like, here are your takeaways. It’s a lot of information, but I also want families to reach back. So even that family from two years ago, I hope. Please, all the parents listening call back your provider and say, I need a little check-in about this because…

Dr. Katia (00:31:22):

Well, you put a lot of time and money into this. It’s really just so unfortunate because what I love is when families come back and either they come back for a reevaluation or they bring a sibling or whatever, and you see them again and they’re like, we were just looking at Jimmy’s eval from two years ago and reflecting on that parenting strategy you recommended. And we like it to be an ongoing tool.

(00:31:46):

It’s part of the reason why the information is so dense. It’s not just for the next month, it’s the next couple of years of this child’s life you’re trying to help maybe even further depending on what the, and so there is a lot of information and it’s not all action items at once. So yeah, I was saying this idea of let’s fine tune here are our top three priorities right now. And then for future, maybe he’ll benefit from this or maybe with kids with this profile might like to do that or whatever it is. But it’s not all for right away.

Dr. Sarah (00:32:16):

Also, I think that’s such an important point. I think parents should understand. I’m sure you guys do a very good job of communicating this to parents, but these are, yes, they’re a snapshot of their functioning in this moment, but the reports and the recommendations of reports are meant to follow your child for at least a number of years and forecast. And if one of the recommendations is to seek clinical intervention or therapeutic or behavioral supports, you definitely want to be cross pollinating those providers. I I approach always a multidisciplinary treatment team approach whenever possible. If I’m working with a family, I want to speak to the neuropsychologist that did the report. I want to be speaking to the pediatrician. I want to be speaking to the teachers because it’s not helpful when we’re all working in a silo. Most of all, all of us are so happy to connect and collaborate on a treatment plan. And I don’t know that parents always know that that’s an option.

Dr. Yael (00:33:27):

I’m so glad you said that. And I also want parents to know, if you do go to a provider, a psychologist, a neuropsychologist, whoever to do an evaluation, if they are not reaching out to gather collateral information from other sources, I would ask them to. That should be a main feature of an evaluation is to collect data from other sources.

Dr. Katia (00:33:52):

Well, kids look so different in different settings. Yeah, absolutely. And I question, it’s so hard to think about looking at a child’s social functioning without hearing from the teacher. I do sort of wonder sometimes when you read reports that don’t have that information unless there’s some clear teacher was on medical leave, whatever. I mean, there’s something, and then I think it’s respectful as well for the other people involved in the child’s care to show, Hey, we understand that this kid really well and you have a lot to contribute here and we can learn from you. So yeah, very important.

Dr. Yael (00:34:29):

And it builds a case. You have been able to hear from four different people in this person’s life that they’re all seeing the same challenges with need for movement, executive functioning issues, social challenges, emotional. It really shows. Oh, okay, that makes sense. Look at this pattern.

Dr. Sarah (00:34:51):

Yeah, no, I think that all is all really important. And I do think, one, obviously not all neuropsych evaluations are the same, and some are maybe a little more thorough than others, and it’s good to be a discerning customer. You want to know it’s okay to ask these questions at the beginning like, Hey, what is your process? What kinds of collateral are you going to collect? Meaning, who else are you going to reach out to collect information about my child’s functioning in different settings? When you do provide recommendations for interventions or accommodations, how do you help the teachers know what to do? How do I advocate for them in an IEP or 5 0 4 meeting with this information? You get to ask these questions. And it’s good to be an educated consumer of a neuropsych eval because like you guys said, it’s not a light lift. It’s a big commitment. It’s take a long time. It’s typically not covered by insurance. It can be expensive and we want it to last as long as we can and be as depth. We want it to be as robust as we possibly can get it so that we can use this report as something that is a tool for this child’s next couple years.

Dr. Katia (00:36:14):

And by that same token, we love it when people, and we’ll ask if they don’t, but when people bring in prior evaluations, report cards, all that kind of stuff lets us track out the child’s trajectory over time and is really valuable. So more data the better.

Dr. Yael (00:36:33):

Just one note, if you are getting an evaluation that is covered by insurance in a hospital setting or something like that, it is helpful to note that that might not be the same level of thoroughness that you might receive in a private assessment. And that’s because insurance does limit some of that. So working in an academic medical center for a while, I definitely did not do as much language testing or academic testing that I can do now. So just for everyone out there listening, it is still great to get that done, but just it might be a little bit of a different package sometimes.

Dr. Sarah (00:37:10):

Yeah, yeah. That’s so hard because the insurance companies, they literally limit how many hours of testing you can do. They definitely, it’s not.

Dr. Yael (00:37:19):

Although, something exciting in New York. I’m not sure if you heard this, that the governor passed a law recently making all private insurers pay for dyslexia testing. Amazing. So I’m hoping that we’ll spread across the country. That was not covered at all, but that’s very exciting.

Dr. Sarah (00:37:37):

Yeah, it’s exciting. We’ll link to that in the show notes in case people are curious about that.

Dr. Yael (00:37:41):

Oh, yeah. Yeah. It started in January this year.

Dr. Sarah (00:37:44):

Amazing.

Dr. Katia (00:37:44):

What an important thing to catch early. I mean, really.

Dr. Sarah (00:37:48):

Yeah. So with that, maybe we could talk a little bit about the kind of diagnoses that do get clarified in a neuropsych eval, and then maybe how different diagnoses lead to different kinds of conversations with families.

Dr. Katia (00:38:05):

Well, so different. So there is a broad array of diagnoses that we are always sort of having on our mental rule in rule out list. People come in, of course, whatever brings them in raises questions. But we just have, I’m sure all of us, we haven’t discussed this directly before yet, but I’m sure we just all have a big checklist because just because someone hasn’t raised something doesn’t mean it’s not there. So you’re wanting to look very thoroughly. So possible diagnoses that may emerge include intellectual disabilities, language disorders, fine motor coordination, difficulties, ADHD, executive functioning difficulties, learning disorders, autism, anxiety, depression, disruptive mood dysregulation disorder. What else? I mean, sometimes people are coming in for more sort of psychiatric questions, which maybe OCD or something along those lines. Some of those things are outside our purview. I personally would say.

Dr. Yael (00:39:13):

And we only work with children, but there are definitely adult providers who would look at dementia and different many other memory related conditions and…

Dr. Sarah (00:39:23):

Traumatic brain injury.

Dr. Yael (00:39:26):

Sure.

Dr. Katia (00:39:26):

That would be along that list. And then, go ahead Yael.

Dr. Yael (00:39:31):

Or traumatic brain injury or other medical related pieces. Again, at the hospital, I would see many individuals with epilepsy or hydrocephalus, and there are specific neuropsych profiles that go along with these diagnoses as well. Right.

Dr. Sarah (00:39:48):

But your specialization tends to be in these pediatric diagnostic questions, mental disorders. Yeah. And do you find that there are some of these disorders specifically? I mean, I’m thinking most of the people in my practice that come in for testing or who are getting referred to testing the differential, the question we’re trying to answer is usually, is it ADHD? Is it a learning disability? Is it autism? Is it something else? Or is it a combination of some of these things? Not all the same questions for the same people, but those tend to be, when those questions are present, that usually triggers a conversation around getting more data and getting an actual evaluation at some point. Because like you were saying, Katya, if the impairment is there, if you’re seeing distress in academic settings, in social relationships, in emotional functioning, in just day-to-day life, that’s going to be kind of the benchmark really. But the why is that stuff happening usually is the question. Could it be one of these things or a couple of these things?

Dr. Katia (00:41:00):

Yeah, those are the heavy hitters, I guess I would say. Yes.

Dr. Sarah (00:41:04):

And I mean, you wrote the book, different thinkers, A DHD for a reason and near new on different thinkers. Autism also is, it’s speaking to the prevalence of this diagnostic question, I would imagine.

Dr. Yael (00:41:20):

And how we share this information with young people. And I think, again, neuropsychologists are going to do this a little differently from one to the next. The field has changed over time where it wasn’t as offered. I think earlier in my training at least, it was you tell the parents and the parents set up all these systems and then the child eventually learns about it, something like that. And now we have more and more people who are offering the feedback session for the child themselves. Some of us more than others. I offer it for every single client that comes to me from an ICH round six to 19. And the way we present it is also different from one to the next. I like with a child to give something tangible that they take with them. And there are many different resources out there for providers.

(00:42:22):

There’s one of our colleagues has created a book to teach kids about their neuropsych profile. It’s called the Brain Building book. Another I heard there’s a research study about a fable that you teach a child about their profile, which I thought was interesting. I do a PowerPoint presentation and I share, and this is how we actually tell the family to do it, if they want to do it on their own as well, where you share strengths, challenges, what is this called, and where do we go from here? So it’s kind of just a standard, a structured way to share information with your child. And our books kind of map similarly there, but we have three characters in each book that present with very different presentations of these symptoms. So trying to show that there’s variability, and then we try to go through the strengths and the challenges and then have the child write in their information as well, what are my strengths? What are my challenges?

Dr. Sarah (00:43:32):

I like that There is a way, obviously, I mean the book is great because I think it personifies, I think kids do well with a person or character they can identify with, but I think it personifies the differences in the different ways that because ADHD is not one blanket thing. And I think as we’re learning more about ADHD and more about the brain and neurodiverse thinking, I think we’re realizing, one I, I dunno, have a personal belief that it’s a very poorly named diagnosis, a DH, adhd, because it’s not a deficit inin at all. It’s a deficit in regulating attention and regulating other executive functions.

Dr. Yael (00:44:15):

I think we actually write that in all of our reports, right?

Dr. Katia (00:44:19):

Yeah, it’s ridiculous. It’s such a misnomer.

Dr. Sarah (00:44:21):

Oh, good. Tell me what you guys hate about the diagnosis, because I feel like it’s confusing. People are like, but my kid can focus for hours on the thing they like. I’m like, yeah, yeah, yeah.

Dr. Katia (00:44:32):

That’s the main thing I hate is that whole deficit thing. I think if we’re going to keep the DI think it should be attention dysregulation, hyperactivity disorder, and not deficit. Because again, just as you say, it’s to do with regulating attention so that if it’s a preferred activity, it’s a whole different ball game versus if it’s something that’s perceived as dull or challenging or stressful. And that is, as you say, a number one misperception.

Dr. Sarah (00:44:57):

Which is why I think the feedback sessions that you have for both the parents and the kids are so important because it offers this opportunity to like, Hey, there is so much that is poorly under, there are a lot of myths around these diagnoses, and this is an opportunity to kind of clear them up.

Dr. Yael (00:45:15):

And that is what happens in the conversation with kids. I did a feedback, I think 14-year-old girl recently who had the diagnosis of ADHD, and she goes, but the kid in my class who has ADHD is yelling and throwing, and I don’t do any of that. And I was like, you’re right. You’re a hundred percent, you are not like that kid. And then we talk about how it presents so differently, and if you meet one person with ADHD, you only have ever met one person with ADHD. You talk about how different it can look, and I love that conversation. That’s so important.

Dr. Sarah (00:45:53):

And it’s great that it can happen with some, that’s why I think it’s best for a kid to be in the feedback sessions because a parent, I definitely want parents to learn how to talk about it with their kids too. But you’ve been talking about it for decades. You have the language and you know how to translate this stuff in a way that kids can hear. And I feel like it’s the difference between something so well you can answer any question, whereas if you are starting to learn it, you can repeat an answer to a question, which is not the same thing. So yeah, I think that that’s really helpful. And I think it’s a real case that if you’re on the fence about how do I bring my child into this conversation? Do I bring my child into this conversation? I think we’re really starting to understand as a field that more information from really good sources is better than less.

Dr. Katia (00:46:57):

So not TikTok you’re saying?

Dr. Sarah (00:46:59):

Yeah.

Dr. Yael (00:47:02):

And I think that that is so important for parents to hear, and it’s again, having these feedbacks with these young kids too. Parents get so nervous about it. The kids don’t have the stigma associated with these diagnoses though. And those are some of my quick, easiest conversations. And all it does at this age, as a 6-year-old, you’re just planting a seed, you’re just talking a little bit about it. And that child might not revisit that again for a year or two or whatever it might be, which is fine, but as long as you planted that seed and it’s growing and that our books are meant for parents to really share with their kids. So if you don’t have the words and don’t have the plan, this could be a way to start the conversation there too.

Dr. Sarah (00:47:49):

And your new book, right? Different Thinkers: Autism.

Dr. Yael (00:47:53):

Yes.

Dr. Sarah (00:47:54):

I’m curious. I mean, just anecdotally, yes, there it is. For those of you who care listening and can’t see, we keep holding up the books it really we’ll in the show notes for all of them though. But okay. Anecdotally, I have found that families are more often to actively seek a diagnosis of ADHD or seek treatment for ADHD and are less, maybe compared to autism spectrum disorders, share less anxiety or stigma around, I think people are a little bit more trepidatious around seeking. They don’t want to confirm the fear. There’s more weight. I think, and I don’t believe this is reasonable is not the right word. I understand exactly why this is happening, and I just want to allay the worries of anyone who is listening who might resonate with that fear. It is so okay to get a diagnosis of autism spectrum disorder, but I think for our society is still a little bit more comfortable with an ADHD diagnosis than an autism diagnosis. And I’m curious if you guys see that too, how you help families navigate a diagnosis of autism spectrum disorder. How do you help them understand it?

Dr. Katia (00:49:18):

I think to your point, there are sort of varying, as you say, degrees of response to different things. And then I’m sure it’s the same in the New York area, but here in the DC metro area, some parents act like you’re totally crushing their hopes and dreams if you say their child has average iq, right? I mean, so just this broad range of what’s deemed acceptable or what’s considered to be scary and not scary is just so interesting. I mean, I think a big part of it is setting the stage by explaining changes in what we know about autism, right? Relative to when we were kids. I’ll often just a lie with, I mean, I’m a parent and a lot of the parents of the kids I’m evaluating are in my age range. Some of them are younger, some of ’em are older. So thinking back to when we were kids might not be exactly the same time, but regardless, there was a different conception of what autism was.

(00:50:14):

And the vast majority of kids who I think were diagnosing are kids who would not have been diagnosed back then just because of the lower understanding of the more subtle presentation or how autism looks in brighter kids. And so I think there’s a lot of psychoeducation that goes into it. I tend to sort of, so for parents for whom this is coming out of the blue, so some parents are coming in and they’re asking, right? And they’re curious, and this is something that has crossed their radar and they’re specifically wondering about it. And other parents, you’re presenting the diagnosis completely out of the blue. And so the minute I introduce the term and you sort of see the faces, I just always, so let me just tell you a little bit about this, and then we’ll walk through the diagnostic criteria together and discuss them. I want them to understand that this is sort of a collegial thing here. I mean your child best, and I want to get your thoughts on here’s what I’ve heard about X, Y, and Z from you, from your child, from the teacher.

(00:51:12):

How does that sound to you? Does that make sense? Et cetera. And so I want parents to feel as they should be that they’re part of this process and this sort of big part of their child’s life. And so debunking sort of misconceptions, updating, understanding, and then just walking through the criteria and explaining them very carefully and giving specific examples and checking in after each one. How does that sound? Does that make sense to you? What do you think? Right. And then I think people start to understand how as you go, using their own examples, their child’s teacher’s words, their child’s words, how this maps onto the kid they actually know, and it changes their understanding of what they may have associated that diagnosis with.

Dr. Yael (00:51:55):

That’s exactly what I was thinking about is you’re using their words a lot of the time, because many of our diagnoses that we’re talking about are, we do a lot of interview to gather some of the data here or much of the data. So then you share it back. Remember when you said that having a back and forth conversation can be really tough with Charlie or whoever.

Dr. Katia (00:52:23):

That’s my husband’s name.

Dr. Yael (00:52:25):

I dunno why that came up. And remember when you said X and your child said, yeah, it’s really hard to read people’s body language. Did you know that? Or that they find that it’s uncomfortable when they have to handle the unexpected or, so again, you’re using those words of theirs. Is that correct? Did you say that? Oh, it is true. Do you know, that’s actually one of the criteria and kind of walking through that. So I do like to do as much as I can to use the examples that were given to me and then be corrected sometimes like, oh, actually what I meant was, okay, great, so let’s talk about that too and make sure we’re all on the same page.

Dr. Katia (00:53:10):

And to, I think you have to be comfortable. This is not always easy to know. It’s not always easy to figure out. A lot of the cases we see are the more subtle ones, and you have to be sort of content with the idea that, okay, we may tick some of these boxes and not all of them, and maybe we’ll revisit this down the line, or maybe we’ll just know that there’s this overlap in this child’s profile, and there are important things that we can learn from what’s effective for bright autistic kids that may apply to your child kind of thing.

Dr. Sarah (00:53:38):

So there’s really, I mean, obviously we know that autism is on a spectrum, but even that, there’s a spectrum beyond the spectrum that sort of Yeah, that’s true. Maybe I like the way you put that. There’s like, okay, maybe there’s some overlap here with the profile that your child is presenting in an ASD profile, and maybe we’ll just leave it there and see what we can pull from that information to craft an individualized treatment plan for this child, regardless of diagnosis. I think diagnosis, I mean, you’re not getting a neuropsych eval and not getting the point of it is to get diagnostic clarity, but at the same time, at the end of the day, we don’t treat a diagnosis. We treat symptoms and we think about a person, not as a diagnosis, but as a whole person, and looking at all the ways that we can support them and build up what needs scaffolding and let fly what is a strength and not hinder it.

(00:54:46):

That’s why this is so important to, I like it. It creates a lot of data, and we can use the data however we want. If the diagnosis is not fully black and white crystal clear, we can still use this information. But I do think most of the time the diagnosis can be pretty clear. And then it’s also about coping with what our feelings are about that, or maybe reassessing some of the narratives that we have internalized about what that means or the fears, uncovering some of the fears and maybe working through them and perhaps releasing them because I think it’s not, again, it’s a really good thing to know what’s going on so we can effectively treat it.

Dr. Yael (00:55:41):

That is actually one of the first steps we recommend for a parent before they talk to a child, is make sure they feel comfortable with this. Have they done their research? Have they asked their questions? Does this sound, are they at ease with this diagnosis and the information? Because if not, your child will hear that and they’ll hear judgment or cynical feelings or whatever it might be that comes through when you don’t mean it to it just you have to feel comfortable though with this information. And if you don’t feel comfortable, I want you to ask questions and find out more. Because if you completely don’t agree with the findings and neuropsychologist isn’t working with you to try to figure that out, you need to ask and find out some more information to see how to be helpful here. But while both of us think that it’s very important for children to hear how they think and learn best, we also want to meet families where they’re at. And if they are not ready to share information with their child, we talk about other ways to support them. And again, like I said before, we plant that seed. And I’ve had families come back to me three years later and they were ready, and I shared that information and that’s where we go on this journey together.

Dr. Sarah (00:57:05):

That’s so nice too. I think to remember a testing is a discreet event, but the relationship you have with your neuropsychologist is not discreet. You can come back anytime, I would imagine, and I would to reconnect and continue the conversations. People can return. It’s like a revolving door kind of relationship, not a, tell me about your test results and goodbye.

Dr. Katia (00:57:35):

It’s so nice when they do. I mean, when you have a longer term relationship with a family and maybe you evaluated a child multiple times with their siblings, or even just when people check back in and, oh, Johnny’s at college now and he’s doing, I love to hear that because I mean, I really enjoy what we do, and I like that we do sort of this surgical strike, but the sad part is that you don’t get to see what happens. You don’t get to follow along. And so when people check back in, it’s really a pleasure.

Dr. Sarah (00:58:02):

And I think people maybe don’t know that they can do that. They’re like, oh, I don’t want to bother them. It’s like, no, no.

Dr. Katia (00:58:07):

I always tell them to, but sometimes they do and sometimes they don’t.

Dr. Sarah (00:58:13):

But not just with updates, but even with questions.

Dr. Katia (00:58:16):

Yeah, totally. Yeah. So we’re going to middle school now and we’re encountering X, Y, Z. What do you think we should do? And I’m happy to just chat with people and Yeah, absolutely.

Dr. Sarah (00:58:27):

That’s amazing. If people want to connect with you guys, learn more about the work that you do, pick up these books for their kiddos or themselves, where can they connect with you?

Dr. Yael (00:58:39):

So we have an account on Instagram called Neuropsych Moms, and we have a website, neuropsychmoms.com, and you can connect with us there. If you are looking for private evaluations in the DC suburbs, you can connect with Dr. Fredriksen at the Stixrud Group or with me, you could look me up at Rothman Pediatric Neuropsychology. But I think the easiest way to connect with both of us is Neuropsych Moms.

Dr. Sarah (00:59:10):

Amazing. We’ll link to that in the show notes, and we’ll link these books. And yeah, thank you so much for coming on. This was really interesting conversation. I’m really glad.

Dr. Katia (00:59:22):

There was so much interesting material, isn’t there? We just need a coffee or something and we can just sit here for a while.

Dr. Sarah (00:59:30):

Yes, we should.

Dr. Katia (00:59:33):

I was going to say glass of wine, but then I was like, maybe that’s not appropriate.

Dr. Sarah (00:59:36):

I’m down for a glass of wine.

Dr. Katia (00:59:38):

Okay, phew. Alight, just checking.

Dr. Sarah (00:59:41):

Amazing. Well, thank you so much and we’ll talk soon.

Dr. Katia (00:59:43):

Thank you.

Dr. Sarah (00:59:44):

If you think you or your child could benefit from neuropsychological evaluation and testing, I’m going to put a link to my group practice Upshur Bren Psychology Group into the episode description. Whether you are navigating concerns about learning differences, ADHD or anxiety, our comprehensive testing consultation and advocacy services help parents gain a deeper insight into their child’s cognitive, emotional and behavioral patterns and guide you towards actual next steps. So just go over to our website, upshurbren.com, that’s U-P-S-H-U-R-B-R-E-N.com to learn more about our services and to schedule a free 30 minute consultation to get our recommendation of supportive services that best align with your unique needs. Or like I said, you can just go to the episode description wherever you’re streaming this podcast to get a link to schedule your free call. So thanks for listening, and don’t be a stranger.