I hit the lottery when Dr. Karen Wilson, a Pediatric Clinical Neuropsychologist from West LA Neuropsychology, agreed to spend time with me for this episode. I think I have a thing for Neuropsychologists. Even though I've interviewed another Neuropsychologist on my channel, I'm always drawn to the way Neuropsychologists think, analyze, and evaluate. They expand my thinking and mesmerize me with their skills. They're like the special ops of psychologists (oh wow, I just made psychologists sound so cool...nice move, me!).
In this episode, Karen helps me split hairs. We talk about how Neuropsychologists are different than Clinical Psychologists and School Psychologists. It comes down to 1) having a doctoral degree and clinical training as a psychologist and then 2) going the extra distance with 2-3 years of laser-focused training in neuropsychology, which (over)simply put, is how the brain develops at different times and what can happen functionally when development is interrupted.
I get this question a lot and honestly, I have struggled with this myself. What is the difference between a neuropsychological assessment and a psychoeducational assessment? Both are used in Individualized Education Programs (IEPs) to direct services and interventions. So, what's the diff?
Karen helps us understand that it's all about interpretation. You can have really comprehensive psychoeducational assessments done by Clinical Psychologists and School Psychologists that use similar tests and measures as Neuropsychologists. The difference is the lens by which each professional uses. A Neuropsychologist will evaluate the complex relationship between the way a person's brain works and the resulting behavior. Then Neuropsychologists will use their clinical experience and the research to determine if and how the brain can be reorganized to reduce pain points.
To take it even further, clinical neuropsychological assessments are the most comprehensive psychological assessment you can get. Underlying processing issues are also evaluated and include attentional functioning, encoding information into memory, and executive functioning. Fully understanding the underlying processes helps to address the mechanism or "why" things are breaking down. Psychoeducational assessments, which typically focus just on academic issues, can miss the underlying problem or problems, which then lead to futile interventions and services.
Ok, if you've seen any of my other videos (enter shameless plug to watch other videos on my channel), you know I love me some conversation about executive functioning (EF). You might wonder why I'm so obsessed with this very complex suite of skills and it's because it THE difference-maker (like the ranch dressing+ketchup dip to my fries) for living a well-balanced and joyful life for every person on this planet. Yes, I feel that strongly about EF. The ranch+ketchup dip should've tipped you off.
What is executive functioning exactly? Well, Karen helps us understand that it's not just one thing. It's a suite of skills that starts developing when kids are around 2 years of age and these skills are coordinated and allocated to achieve a certain goal. Let's take Hedwig's Theme from Harry Potter, masterminded by one of the greatest composers of all time, John Williams (yes, I'm biased). Playing this song is the goal. Now, the maestro is executive functioning, directing all the instruments to play this song with the right volume, speed, and intensity. All the instruments are important, but without the conductor, the je ne sais quoi is lost.
What are the instruments in the EF orchestra? Task initiation (getting started on a task), planning (knowing where you're going and developing the step-by-step process to get to the goal), organization (efficiency), time management (prioritizing, duration of attention), decision-making (judgment), metacognition (thinking about your thinking), and inhibition. With all of these skills coordinated and in-sync, beautiful music is made. EF is the essential life skill(s).
Individuals who seek neuropsychological assessments are struggling. For realz. Sometimes, something happens like a concussion or a brain injury, which triggers an assessment. Less obvious is when an individual has been struggling for a while or not responding to interventions as we might expect. It's this person who is a great candidate for a comprehensive assessment that looks at the "why's."
Karen and I geek out on the importance of getting identified clearly and as early as possible. We both know how quick the mind works and the rationalizations that fill the space of ambiguity. When people struggle, negative things happen. Not only is there a potential for misunderstanding or misinterpretation, but what I call, "moral diagnoses," set in. You don't find these diagnoses in our DSM (the book we psychologists and medical doctors use to diagnose), rather they are no see ums, biting and attacking the psyche. What do these sound like? "I'm never going to get this." "I'm sooooo stupid." "Everyone is smarter than me, what's the point?" "My student is lazy and unmotivated." No amount of bug spray or repellent gets rid of this devastating narrative on one's self-concept.
This is why Karen is obsessed with asking "why?" "Why is this kiddo struggling?" Also, knowing that 40-50% of individuals who have a learning disability also have secondary diagnoses, Karen also asks, "What are we missing?" and "What else is going on?" With deep understanding comes a plan, and with this plan comes the right intervention that gets right to the heart of the matter. Then, relief happens. Relief leads to better self-confidence. Self-confidence leads to a love of learning. The love of learning leads to more expansive and robust living. It's like the path to the light side (credit, Master Yoda).
This is to all of the 18-25-year-olds (and society) out there. Spoiler alert, nothing magical happens at 18. No wands are waved and no special abilities are granted. We are a culmination of the skills we've learned. So, you can do what you've done. That's it. Many times, parents are surprised by how little their young adult can do. I tend to ask these questions: "What opportunities did your young adult have to learn the skills they need to be independent?" "How often were these skills practiced?" "What were your expectations of their independence and did you actively promote it on a daily basis?" Sadly, skills are not learned through osmosis.
As Karen educates us, the frontal lobes (the part of the brain which distinctly makes us human and separates us from animals) don't fully mature until the mid-20s and that's in young adults who don't have a disability. Add a learning challenge and these young adults can have as much as a 3-year delay in EF development. Those of us who've been on the planet for a while know that living life with joy is much more than academic functioning. Actually, we become distinctly aware of demands increasing as we get older and these don't go away. #adulting
Even though there's bravado, young adults are vulnerable. They are more prone to depression, anxiety, and substance use during this time. They don't just need academic support, they also need social and emotional support. This is a brain thing that needs engaged and supportive parents and systems. The instinct to hand out an attitude adjustment may be strong, but it might be important to hear the message of the song underneath the operatics.
Please don't. There are people like Karen out here. If you've been struggling and can't figure out why, maybe a neuropsychological evaluation is one way to get to the bottom of things. Getting an excellent neuropsychological evaluation by a savvy evaluator who is practical, promotes understanding, and gives a path forward maybe your light at the end of the tunnel. If you're in the Los Angeles area, I can't recommend Karen enough. She's absolutely incredible. Check out our full interview. A big thanks to Karen for making me better!
If you're interested in getting in touch with Karen, check out her website, I don't think you'll regret it.
Click here for a copy of this interview's transcript.