September 18, 2020

Dr. Gwen:         Hi, I'm Dr. Gwen. I'm a clinical psychologist who's been empowering disabled individuals, their families, and the systems that support them for over 20 years.

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                        In this video, I interview Dr. Karen Wilson of West LA Neuropsychology. Karen is a pediatric clinical neuropsychologist with over 16 years of experience. Karen helps us understand the difference between neuropsychological assessments and psycho-educational assessments when one person might need a neuropsychological assessment, and that the results of any assessment should be practical in order to promote real meaningful change.

                        We also spend time with how neuropsych assessments can be helpful in developing transition plans for adolescents and adults with disabilities. Karen's experience as a professor at Cal State Dominguez Hills and UCLA definitely shine through as she beautifully breaks down what executive functioning is and the complex connection between our brains and our behavior.

                        Please enjoy this interview with Karen.

                        Hi, Karen. Welcome. Thanks so much for agreeing to do this today.

Dr. Karen:         Hi, Gwen. It's such a pleasure to be here. Thank you for having me.

Dr. Gwen:         Yes, absolutely. So, why don't we start with you telling us about yourself?

Dr. Karen:         Sure. I am a pediatric neuropsychologist. And, I also see young adults. So, I do evaluations of kids who are struggling with what seems to be neurodevelopmental challenges, learning, processing, or even social-emotional issues, and parents bring their kids to me to figure out why they're struggling and to help them work out a plan to help them thrive.

Dr. Gwen:         Yeah. You have a really great way of peeking into the brain, putting that magnifying glass into the brain, and putting some words to it to let us know how someone is approaching learning in the world. So, that's great.

                        Karen, there's so many different types of psychologists out there. I'm a clinical psychologist and I'm not a neuropsych, but I'm wondering if you can just give some background about the difference between a general psychologist or a clinical psychologist and a neuropsychologist.

Dr. Gwen:         Sure. I think probably the biggest distinguishing factor is the fact that both clinical psychologists and clinical neuropsychologists have the exact same training at the basic level in terms of clinical psychology, but neuropsychologists have additional training in neuropsychology.

                        So, neuropsychology being the real study of the relationship between brain and behavior. So, with neuropsychologists, we typically have an addition to the clinical psychology training. We have training in neuroanatomy and neuropsychology, neurodevelopment. And so, we really specialize in that particular area.

Dr. Gwen:         Yeah, yeah. That's great. That's great. Sometimes I think of neuroscience as special ops. We need skilled people to get in there. And so, I think about neuropsychs a lot of times that way.

                        Another question that comes up especially when these types of assessments are used in the educational setting to inform intervention strategies accommodations, learning plans, et cetera. What's the difference between a neuropsych and a school psychologist?

Dr. Karen:         So, again, the neuropsychologist has that specialized training in neuropsychology that the school psychologist typically does not have and neuropsychology typically doctoral-level psychologists. And, when I talk about neuropsychology training, I'm talking about an additional two to three years of training, post-doctoral degree. And so, these are individuals who have their doctorate degree and then complete typically a post-doctoral fellowship. And, it's usually two to three years where you really get to hone your skills in neuropsychology.

                        And so, when we're talking about neuropsychological assessment, we're typically talking about a neuropsychologist who's conducting an evaluation and who's really taking into consideration how the brain develops at different times and what things can kind of occur when there's an interruption in development at any stage.

Dr. Gwen:         Yup, yup. And then, sometimes when some of our students are identified under an IEP--

Dr. Karen:         Yes.

Dr. Gwen:         A lot of times assessments come along with this. And so, from a school setting, a school psychologist will typically do a psycho-ed assessment.

Dr. Karen:         Yes.

Dr. Gwen:         And then, sometimes an IEE or Individualized, I'm sorry, an Independent Education Evaluation gets called or is asked for, right? And, at that point in time, sometimes neuropsychs get involved. So, maybe we can even make the differentiation here and you can help us understand the difference between a psycho-ed assessment, which I know can be done by a psychologist and a school psychologist and a neuropsych assessment, which are really done by neuropsychs. But, maybe you can talk to us about the difference in their kind of frameworks or the way in which the assessment is completed.

Dr. Karen:         Right. And, I think it really depends. We're talking about the difference between a neuropsychological assessment and a psycho-educational assessment, a lot of it, particularly when you're talking about a psycho-educational assessment, has to do with who's administering it and how they administer it. Because I have seen very comprehensive psycho-educational evaluations that incorporate a lot of the measures that we use as neuropsychologists, but oftentimes the difference can be depending on the evaluation in the interpretation.

                        So, when I do a neuropsychological assessment, I can be administering some of the same tests to someone who is doing a psycho-educational evaluation, a comprehensive one. But, I'm going to look at it through the lens of a neuropsychologist. So, I'm going to look at the relationship between brain and behavior. I'm going to look at it and I'm going to interpret it as a result in terms of what does this tell me about the way this child's brain is organized. And then, I'm also going to look at what can we do. What does the research tell me about brain reorganization and the opportunity for brain reorganization with specific interventions?

                        So, as a neuropsychologist, even though there can be overlap in the tests that we administer, the lens through which I look at the evaluation, the results of the evaluation may be very different. Also, when you talk about a clinical neuropsychological evaluation, it tends to be the most comprehensive kind of evaluation that you typically get. So, a basic psycho-educational evaluation may have academic measures, it may have a measure of general cognitive abilities, and that will also be included in a neuropsychological assessment. But, in addition to those measures, a neuropsychological assessment will also look at processing issues that can interfere with learning.

                        So, in addition to reading, writing, and math skills, and general cognitive abilities, problem-solving abilities, I am going to also want to look at attention, your ability to pay attention to things you hear versus things that you see because those are organized in different areas of the brain. I'm going to be looking at your ability to encode information into your memory and I'm going to tease those apart because sometimes, for example, I get parents who say, "My child is very forgetful." He's forgetting everything.

                        And, in my mind as a neuropsychologist and sometimes they come in thinking it's a memory problem or the teacher might say they have a memory problem, but I'm also looking at memory but also considering attention because what I often tell parents is that you can't remember something you didn't pay attention to in the first place.

Dr. Gwen:         Yeah.

Dr. Karen:         And so, I'm going to look at both of those systems to see where things break down.

                        And so, in addition to the processing, attention, memory, I'm going to look at executive functioning because again, those executive functions can impact academic performance. And, if you only look at the academic issue, you may miss an underlying issue that's contributing to the academic struggle. And, I'll use writing as an example.

                        I've seen kids who come in and parents say, "He's really struggling with writing." You put a blank page in front of him and he doesn't know what to do. We think that there might be an issue with writing. And, sometimes what they'll do is they'll get him a tutor, right, who will help him with his writing. And then, do a neuropsych assessment and realize expressive language is fine. He's got these great ideas in his head. He knows what he wants to say, but the task of writing is so overwhelming because it's so complex. He's struggling with organizing the information, planning what it is that he wants to say, initiating the task, and then summarizing it all in the end.

                        And so, what you can find out from a neuropsychological assessment is that the writing difficulty is really the result of breakdown in executive functioning. And so, that's one of the beauties of doing a neuropsychological evaluation is that--it helps you to really identify where the breakdown is because that tells you where to intervene. And, that's really how you help kids thrive is when you address the why in terms of the struggle and then you can really have a targeted intervention that addresses the area of difficulty and helps them to access their curriculum and helps them to be successful in a number of different ways.

Dr. Gwen:         Yeah. It's like getting down to the mechanism of it. What is the mechanism driving the problem that we observe?

Dr. Karen:         Yes.

Dr. Gwen:         And, I think we forget. I think everyone gets that the brain is a complex thing. I think we forget, really, how complex it really is. And, I love this idea-- and, maybe we can get into executive functioning a little bit because it's a term that gets tossed around quite a bit. And, I'm not sure that people fully understand what executive functioning is. Maybe we can actually tackle that really quick, if you can just define that for us, Karen.

Dr. Karen:         I can't define that. So, executive functioning, it's an umbrella term to describe a number of different functions. And, I can talk about some of those. So, it really has to do with how you allocate resources, right, how the brain allocates resources and gets things done. So, some of the executive functions are task initiation, getting started on a task. And, sometimes that's where the breakdown is, it's just in task initiation. And, these are kids who procrastinate, they know what they have to do, and they just have a difficult time actually getting it started. But, once they get going, they're fine.

                        And so, task initiation is an executive function, planning as an executive functioning. So, knowing where you're going and having a step-by-step process to help you get there. And, organization is another executive function, so you may have a lot of information. You have to organize it well so that you can execute a task efficiently. And, it's not only academics that are impacted by executive functioning, it's life skills, right? And, we've all seen the kids who are really struggling with disorganization.

                        And so, it's not just academically it's in their rooms, it's where are your socks, and if things are everywhere, what does your backpack look like, and it's completely disorganized. You've got a sandwich in there. You've got papers from last year. You've got a whole bunch of different things. So, it's organization. And, we know that organization is the key to being efficient at what it is that you're doing. It's time management. It's utilizing good judgment. It's decision making. And, it's self-regulation. It's being able to regulate your emotions, regulate your thoughts, knowing what to say, how to say it, when to say it.

                        And so, we really think of a lot about these executive functions as a lot of them has higher level functions, right? But, they start developing when kids are as young as two. And, even probably before that and some of the skills if you think about planning. I often use the example of have you ever seen a child who's just learning to crawl, and you put a TV remote on the floor. That child will find a way to get to that television remote, right?

Dr. Gwen:         Right, right.

Dr. Karen:         Even if-- army crawl across the room, they are planning, they are executing, they are coordinating those movements to achieve a goal, which is really what executive functioning is. It's all those things that you need to achieve a goal. It's goal-oriented.

Dr. Gwen:         Yeah, yeah, absolutely. The motor planning example is such a great example of how it really gets laid down so early and how important understanding and being in our body is because our body executes so many of the things that we think about. And so, how important that is. And then, the other life skill that I see executive functioning impacting is social skills.

Dr. Karen:         Yes.

Dr. Gwen:         Right. And, how quick social interactions can be and how much information needs to be encoded and organized and then acted upon in kind of a short period of time.

Dr. Karen:         Absolutely.

Dr. Gwen:         If you will. And so, this is a really critical skill. And, I see a lot of this in my adults down to like paying for something or taking a bus somewhere, or even an Uber for that matter. They do have to have some planning and organizing skills in order to execute that. So, that's great. Thank you for that little side, but I do like to talk about executive functioning because like I said, I think it's a term that gets thrown around a lot. And, I don't think we have a full understanding of how complex it is and how many skills it actually incorporates.

                        Self-regulation or just social-emotional learning skills, that's huge in and of itself between self-awareness and self-regulation and social skills and social awareness. You and I could go on and on.

Dr. Karen:         Right, absolutely. Even when you think about metacognition, your ability to think about your own thought processes. That's an executive function.

Dr. Gwen:         Absolutely, yeah. Because you do need to have some reflection of yourself and introspect in order to shift or change behavior in the future. I mean that's necessary. So, getting down to like these little mechanisms, right? I'm so glad you just called writing out as a huge executive functioning task because it is.

Dr. Karen:         It really is.

Dr. Gwen:         It really--it's so hard. It's one of the hardest things I feel like for many of my clients, anyway. Even though I've articulate, guys and gals, they're very articulate, but writing, it's a whole another thing. I'm so glad that we just are looking at mechanisms and the impact because the other thing that I think is really helpful in neuropsych assessments or where they've helped me anyway is to say-- Where are these emotions coming from? Is there an underlying frustration with something? Am I not visually taking in information accurately or efficiently? I think neuropsych assessments really help to really, again, get down to the mechanism. And then, the intervention can be very laser-focused and then be effective.

Dr. Karen:         Right, exactly.

Dr. Gwen:         Yeah, it's the worst when we put a tutor on a kid and it's not really that. And then, what inevitably happens is that kiddo or that family have no choice but then to look at the kid as like either-- I call them the moral diagnoses, not working hard enough, lazy, not interested, not motivated, whatever that is. And, it's like, "Oh we didn't actually address the real issue.

Dr. Karen:         Right, exactly.

Dr. Gwen:         So, that's fantastic.

Dr. Karen:         That's an important point because the key really is to understanding, right? That's the whole reason why we do these evaluations is to understand the struggle so that we can intervene. And, that example of a tutor is so important because really it's not about just helping them with their homework which oftentimes, is what a typical tutor would do.

Dr. Gwen:         Yeah.

Dr. Karen:         We want them to develop skills in the areas where they're weak, right? We want to reorganize those brain pathways that may be organized in an inefficient way.

Dr. Gwen:         Yeah.

Dr. Karen:         And so, that's really what it is that we want to do.

Dr. Gwen:         Yeah. And, that you and I both know this, skills equal confidence.

Dr. Karen:         Yes.

Dr. Gwen:         Right. When we know we can do things that are effective or efficient, we feel confident in those areas, whatever area that is, but that's what skills do.

Dr. Karen:         Absolutely.

Dr. Gwen:         And, I always feel self-confidence is always based on the truth.

Dr. Karen:         Yes.

Dr. Gwen:         Kids always know what they can and cannot do, or where they worked hard and achieved something, or whether praise is just getting thrown around and it's not really hitting the mark for them.

Dr. Karen:         Right, absolutely.

Dr. Gwen:         So, that's awesome. Yes, when you said, "Understand the struggle," I was like, "Oh, the struggle is real" because the struggle is real.

                        Karen, who is a good candidate for a neuropsych eval?

Dr. Karen:         There's a couple different kiddos and adults for that matter. A lot of times when I think about a good candidate for a neuropsych eval, these are kids who have struggled for a while and parents or the educators have tried different things and they haven't worked. Because again, they haven't addressed the underlying issue, they don't know what it is. So, there hasn't been an evaluation to really determine the root of the struggle, the why, oftentimes what I refer to as the why.

                        And so, that's a kid who would benefit from a neuropsych eval because you don't know what you're looking at, you don't know if it's attention, you don't know if it's memory, you don't know if it's a learning disability. Is it a social-emotional issue? Is it something neurodevelopmental? When you don't know, oftentimes a comprehensive evaluation will be very helpful, particularly when you've tried a number of different things.

                        A neuropsych eval is also helpful if you know that there's been some issue that has impacted brain function. Sometimes that might be a premature birth. There may be some issues that happened during birth where there might have been lack of oxygen to the brain during certain part of development. There might be a head injury on the playground where a child was doing fine and then all of a sudden had an injury during the sports and now, they're struggling with attention or memory or focus in a way that they hadn't before. So, that may be where a neuropsych evaluation would be warranted.

                        Even when kids have been identified as having a learning disorder, maybe they've been identified through an IEP process, and they have an IEP but they're not really responding to the intervention in the way that you would expect. So, it may be that they've been identified as having a specific learning disorder in reading and they have an intervention in the school, but they're still behind, or they're seeing other things that are emerging, and they feel like they just have not identified all of the issues, then a neuropsych might be appropriate then as well. Because what we know from kids who have a formal diagnosis, 40 to 50% of them have another diagnosis, right?

                        And so, if there's comorbidity, we want to make sure that we're addressing all the issues that they're struggling with because the child who has dyslexia and ADHD, if you only address the dyslexia, then you're going to miss a very important piece that's going to impact them in a number of different ways. And, it's also going to impact their ability to really respond to the reading intervention. So, you want to make sure that both have been identified.

Dr. Gwen:         Yeah. And, that one treating one thing and it not resulting again, in what you might anticipate as the response is also a frustrating endeavor for that child or that person and their family who are like, "We were told to do this and we're doing it. And, it's not resulting in what we expected or it's not easing that pain point, it's not releasing some of that pressure that we've been feeling." And then, what happens? Then, we start distrusting the system or we just start distrusting interventions.

Dr. Gwen:         You know what I mean?

Dr. Karen:         Absolutely.

Dr. Gwen:         There's a cascading effect. And, I think that ultimately that idea of why or how do we understand you accurately. How do we see you accurately is so critical not only from an academic standpoint, but I think from an emotional standpoint as well.

Dr. Karen:         Really asking about what else could be going on that could be causing a child to struggle in a way that we wouldn't expect, given the level of intervention that they're receiving and the support that they're receiving.

Dr. Gwen:         Mm-hmm, yup, yup. You referred to this earlier, Karen. The benefit of a neuropsych assessment, we've been talking a lot about it for kids. Can we shift to that like teens and adults, specifically with neurodevelopmental disabilities or even intellectual disabilities for that matter? But, can we shift there and maybe play around with how a neuropsych assessment could be helpful in transitioning to adulthood or preparing for adulthood?

Dr. Karen:         Yeah, absolutely. I see this a lot and I even have evaluated some kids who come back for re-evaluations when they are getting ready for college or even starting high school and they want to have a second look at where they are, where the gaps still exist, and what they need to be successful in an environment where there's increased academic demands for them and increased life demands. And, one of these things I think about is this emerging adulthood period, which is typically between the ages of 18 and 25. And, when we think about emerging adulthood, it's really this remarkable prolonged period during which neurodevelopment continues, right?

                        And so, what's interesting is that we often think about kids or young adults when they reach the age of 18, now they're adults, that they're fully actualized adults.

Dr. Gwen:         Yeah.

Dr. Karen:         When in fact, the brain is continuing to develop into their mid-20s. And, what we know from the research is that individuals who have learning delays or ADHD, there can be as much as a three-year delay in the development of the frontal lobe in those areas of the brain that are associated with executive functions. And, a lot of parents don't realize that even though young adults may have been identified as having these learning challenges. So, what I often say is that when you have a 17-year-old who you're sending off to college who has a diagnosed or identified learning or attention struggle, you're really sending a 14-year-old in terms of brain development to call it. And, think about the support that a 14-year-old would need to be successful in that environment, right?

                        And so, you can be at grade level academically but still have some gaps and delays in the development of executive functioning. And, what we know about executive functioning is that the demands for executive functioning increase over time, increase with advanced age. As you get older, the executive functioning demands increase.

Dr. Gwen:         Yeah.

Dr. Karen:         And, those challenges don't go away. So, those challenges don't go away when a child reaches 18, they don't magically just disappear.

Dr. Gwen:         Right. And, magic is the word because I feel that happens a lot like, wait a minute, nothing magical happened between 17 years 11 months 29 days, nothing magical happened there. I love that you're bringing up this developmental appropriateness, if you will, because it does shift our expectations about what we should be expecting of our young adults or emerging adults. And, that sometimes I think we expect too much of this age group in general without good supports or skill-building leading up to this time. And then, we punish them.

                        And so, it's this idea of this can't versus won't. Can they do that on their own or won't they? Is it an attitudinal behavioral issue or is it a legit issue of I'm not actually ready for this yet and I still need some support?

Dr. Karen:         Right. And, I think the literature really supports that as the brain is continuing to develop that they need to develop in the context of still-present parental and societal support as they figure it out this. Because when students transition to college, and again, when I talk about the executive functioning demands increasing, at home they may have just been responsible for going to school, coming home. They may have some chores around the house. And then, throughout they're responsible for their own laundry. Nobody's waking them up to get up in the morning where they may have had that cue at home. They may have classes at different times. They have a lot of distractions that they have to inhibit. And, it's a new environment, it's a novel environment, they're responsible for their own finances and managing how much they have to spend every month.

                        So, there are a lot of new things that they're having to manage, at the same time you want them to be successful academically. And so, they're negotiating new relationships. And, also, when you think about emerging adulthood and young adulthood, it's also a very vulnerable time.

Dr. Gwen:         Yup.

Dr. Karen:         It's a very vulnerable time from a social and emotional perspective. It's at those times where young adults are more prone to depression, more prone to anxiety, more prone to substance use and abuse. And so, those are things to keep in mind as well. So, it's not only about making sure they have-- young adults have academic support as they're transitioning to career or to college, but do they have the social and emotional support that they need to support them as they're continuing to develop?

Dr. Gwen:         Yeah. There does need to be. And, sometimes I think that we don't-- because we think something magical happens at 18. We don't back up and think to ourselves what are the skills or what are the routines or what are the behaviors that we can work on now at 15? Because I'll speak for my clients, they typically need more time and more repetition. They can get it just with a little bit more time and repetition. But, how can we just work on a few of those skills at a time and get them under their belt so that when they do go off, they can utilize their resources that they have on things that are changing versus things that we could have just routinized before they left like, getting up or responding to an alarm, or cooking for yourself. And something as simple as cooking for yourself simply, that is an interesting prospect or doing laundry. I can't tell you how many of my clients have either shrunk loads of laundry or died loads of laundry just because they didn't know how to separate and they didn't realize they had to switch the temperature of the water or whatever. And, it's just like one cascading thing after another where it just feels completely overwhelming.

Dr. Karen:         Right.

Dr. Gwen:         So, that's social, emotional support. I also see it in like you never developed an awareness of how you manage stress or how you cope with demands. It's all of these other tools that aren't academic.

Dr. Karen:         Right, right. And then, it really boils down, again, to skill-building, right?

Dr. Gwen:         Absolutely.

Dr. Karen:         What kinds of skill can you help your child, your young adult develop as they're preparing for that transition?

Dr. Gwen:         Yeah, yeah, yeah. I think, skill-building is just the most honest and effective way to prepare our young people for adulthood.

Dr. Karen:         Yes.

Dr. Gwen:         And, it's experience, practice and experience, and doing it over and over and over again until it's like you don't even think about it anymore. And so, I love to see more of that shift from a social-emotional perspective.

Dr. Karen:         Yes.

Dr. Gwen:         And, I find myself doing a lot of coaching and mentoring surrounding a--self-awareness with my clients who are in this emergent adult phase. And, they have a hard time describing themselves. And, I had a client that had to pull out his driver's license to tell me how tall he was, how much he weighed, what his eye color was. And so, I was like, "Okay, we can do this, but we got a ways to go." And, he was 22.

Dr. Karen:         Right.

Dr. Gwen:         So, interesting. Okay, awesome.

                        So, I think we've kind of covered this, but maybe we can get explicit with this, which is, what do you hope comes out of your neuropsych assessments? Yeah. If this happened, you'd be like, "Nailed it. Yes." that's exactly right, that's all that time, all that energy because these take a lot of resourcing. I mean, from a time perspective. So, yeah, what are your desired outcomes from these assessments?

Dr. Karen:         Yeah. I think the desired outcome, it's multifaceted. I think, first, we want to increase understanding. And, I've said that before or we want to understand why the child is struggling because what I often say is that there have been so many rationalizations for a lot of the kids I see for so long either he's lazy, if he'd just try harder, if he just works harder, he'd be fine. He's just not an academic kid. All of these rationalizations.

                        So, if we can address the rationalizations and have some truth in that and say, "You know what, it's not laziness, it's not a lack of motivation or an interest in learning, this is really an attention issue." And so, if we can increase that understanding and have parents and that young person have this aha moment, it's often a relief. Because now, it's like, "Now, I understand why." I'm not just lazy because a lot of those young people and those kids have internalized it. Because even if you're not seeing it explicitly, they're picking up on the cues, they're picking up on the eye rolls of other kids in the classroom.

Dr. Gwen:         Absolutely.

Dr. Karen:         Or not getting the attention from the teacher, body language, they're picking up on all of it, and they're forming their own impressions of themselves, which speaks to the self-concept issues. And, it's incredibly frustrating to realize it's taking you two hours to do a task that takes most kids 30 minutes. Right? And so, you're increasing that understanding.

                        And then, once you understand, you have to have a plan. That's the other thing. You have to have a plan. How can I address this issue? And so, the outcome that I would like is to go from understanding to having a plan, an intervention that targets the area of weakness, the struggle, the challenge, the disability. And then, on the other side is that you see the improvement, right, because that's the whole reason why we do this. You see the improvement in the area where a child has been struggling. And then, with that, you see that self-confidence, and you see that relief, and you see a decrease in the frustration, and you see a higher self-esteem.

                        And, one of the things that I think is really important is you have that motivation and that love of learning because oftentimes, that can get squashed when kids are struggling. They just lose interest in the learning process because it's so hard.

Dr. Gwen:         Yeah, yeah. And, the payoff isn't very good, is it? It's a lot of work for a little bit of payoff. And, I think that sometimes we forget that there are emotional costs to those processes and those experiences. You're right. It's that little stuff that I roll, the sighing. That's felt very strongly by my clients who are quite sensitive actually because they're really picking this stuff up. Really I feel like sometimes just to compensate for what they're struggling with. So, I love it. Understanding, plan, intervention, improvement.

Dr. Karen:         Yes.

Dr. Gwen:         Love that. That feels so good. That even feels good to me. I mean, right now like, "Ah, I can breathe."

Dr. Karen:         Right.

Dr. Gwen:         So, Karen, how do people typically access your service if they're listening to this and they're saying, "Gosh, I'd love Karen to do a neuropsych assessment on my child or my adult child." How do people typically fund your service?

Dr. Karen:         A lot of-- the funding comes from a number of different resources. Sometimes they will self-pay and so they will find a way to fund it for themselves. Sometimes they will go through the school district if they're not happy with the school's evaluation. They will work with the school to get approval for an Independent Educational Evaluation, an IEE. And then, the school will pay me to do a neuropsych assessment or someone for my practice to do a neuropsych assessment or a comprehensive psycho-educational evaluation. And so, that's typically how the funding happens in my practice.

Dr. Gwen:         That's great. Having multiple ways of having this kind of assessment funded is really nice because it allows for accessibility to this service, which is for people out there, it is a commitment of time. How long would you say... ...testing goes for? I mean, how long do you spend? I mean, I know it varies, Karen, but, just so people can get an idea of how comprehensive this evaluation is.

Dr. Karen:         It can be upwards. I mean, on the low end, it's about 20 hours of work in terms of what's involved in doing it, right? There may be eight hours of face-to-face testing but then you've got a 90-minute parent interview, you've got a 90-minute feedback session where you're talking about the results of the evaluation. You're talking to teachers. You're talking to pediatricians. You're talking to the intervention team if there is one. You're also scoring up all the tests, we just talked about that when we started. You're scoring up all the tests that you administer.

Dr. Gwen:         Yeah.

Dr. Karen:         You're analyzing the information, putting all the pieces together. You may have to look up some literature to see how this profile is consistent or inconsistent with what we know from the research. And then, you're writing the report, you're summarizing all of this data, and you're writing it in a way that people can understand and know what to do with the information, right?

Dr. Gwen:         The last part of what you said is really critical because I'm familiar with all of the tests and I assess myself.

Dr. Karen:         Yes.

Dr. Gwen:         But, there are some neuropsych assessments that I have a hard time understanding because... ...it's a lot of information that hasn't been integrated into the framework that this clinician's experience is informing, and the literature is informing.

Dr. Karen:         Right.

Dr. Gwen:         And so, I love that you said that in a way that parents and others can understand because you want it to be useful.

Dr. Karen:         That's so important because it doesn't make any sense to, at the end of this process, have a report that you don't know what to do with. I've had parents actually come to me to interpret someone else's neuropsych report. I've had a parent in my office who had a 65-page neuropsychological assessment report and said, "I don't know what this means." And so, I had to review the report and then they didn't even know that their child had ADHD because it wasn't clearly outlined in the report.

Dr. Gwen:         Right, right, which is so frustrating because obviously there was a pain point or a pressure point that led to the assessment in the first place.

Dr. Karen:         Right.

Dr. Gwen:         Right.

Dr. Gwen:         And, you've touched upon that. Because the interventions are working, we're seeing improvement. We've got skill building and skill-building leads to self-confidence, and improvement, and self-esteem. And now, motivation comes back and it's a spiral, this love of learning comes back. Actually, I do like to learn.

Dr. Karen:         Yeah.

Dr. Gwen:         Now that I figure that out, I do like to learn. That's what you want to see. That's the relief that an assessment can lead to. And, if you went through and you now have a 65-page assessment, I mean I've got parents who go, "I don't understand any of this but I feel like I should because it's really long."

Dr. Karen:         Yeah.

Dr. Gwen:         It looks very formal and it's very long.

Dr. Karen:         Right.

Dr. Gwen:         So, yeah. So, again, back down to you kind of go back to practicality. Where's the rubber meeting the road.

Dr. Karen:         Yeah.

Dr. Gwen:         How are we going to meaningfully help this child, this adult, this person, this family, this system, whatever this is, so that it can be empowered? > Dr. Karen: Yes, absolutely.

Dr. Gwen:         Yeah, I love that. Okay. Karen, I like to end all my interviews this way. If you could only choose one skill to empower an individual with, what would it be and why?

Dr. Karen:         I think it would be self-advocacy. And, I think that's a missing piece for so many kids because they really need to be able to tell people what it is that they're struggling with. How they feel about what it is that they're experiencing, and to ask for help. Right? To ask for help. There's so many kids suffer in silence and they think it's them. And, I think it's really important at an early age to empower people to ask for what it is that they need and that can be life-changing.

Dr. Gwen:         Agreed, agreed. I mean, we'll accept self-advocacy as one skill even though you and I both know it's made up of a lot of stuff. I'm just giving you a hard time. So many skills, but I completely agree with you. Something that I speak to my adults about that I work with is when you can't communicate, what it is you feel, want, or need, other people make choices and decisions for you that you may not like.

Dr. Karen:         Yes.

Dr. Gwen:         And, it is such a disempowered place to be and it reinforces this kind of narrative of "I can't, it's no use anyway, oh, well, I'll just deal," right? And, it's just such a terrible place. What you said, I don't want my clients to suffer in silence.

Dr. Karen:         Yes.

Dr. Gwen:         Yeah. And, that's what happens actually. And then, you and I both know where the mind can go.

Dr. Karen:         Yes.

Dr. Gwen:         Those types of things because the mind is a very powerful thing.

Dr. Karen:         It really is.

Dr. Gwen:         So, Karen, what's the best way for people to get in touch with you or find out more about you?

Dr. Karen:         Sure. They can go to my private practice website, which is westlaneuro.com. They can also email me directly at [email protected].

Dr. Gwen:         Perfect. And, I'll put that in the description below so that people, if they missed it, they can find it.

Dr. Karen:         Wonderful.

Dr. Gwen:         Awesome. Thanks, Karen. Thanks so much for spending time with me.

Dr. Karen:         This conversation, it's been great.

Dr. Gwen:         Thanks.

                        Hey, thanks for watching. If you're interested in finding out more about Karen, her information is in the description below.

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