PSYCHO-EDUCATIONAL ASSESSMENT

This method of evaluation examines a child’s learning strengths and learning patterns through the detailed review of cognitive, processing, academic, and social skills, and emotional well-being. With the assessment, interventions can be put into place to insure improvement in school performance, social relations, and the child’s general positive adjustment.

WHY ARE PEOPLE REFERRED FOR NEUROPSYCHOLOGICAL ASSESSMENT?

Children are frequently referred to me by a counselor or psychologist, doctor, teacher or parent due to one or more of the following:

• Difficulty learning, reading, shortened attention span, behavioral, social, or emotional difficulties

• A developmental problem that affects the brain (i.e. autism, epilepsy, prematurity, etc.)

• A brain injury from an accident, birth trauma, or other physical stress

Common diagnostic considerations:

• ADHD

• Learning disabilities (reading, writing, math)

• Depression and anxiety affecting cognitive skills

• Autism Spectrum Disorders

• Developmental disorders

• Epilepsy, Stroke, Tic disorders

• Genetic Disorders

• Concussion/Brain Injury

Adults are frequently referred for a neuropsychological assessment to address concerns such as:

• Memory or longstanding attention problems carried over from childhood which impact work, relationships, etc.

• Depression, anxiety, or other emotional difficulties which are impacting cognitive functioning

The benefits of neuropsychological assessments for families and professionals include:

• Quantitative, evidence based data of individuals skill in various areas

• Comparing said skills with the skills of other individuals of similar age, indicating nature and severity of the patients problem

• Helping detect the effect of developmental, neurological, and medical problems, and provide a baseline against which to measure of various interventions or a child’s development over time

• A differential diagnosis (as for example, whether a child’s attention difficulties stem from anxiety, depression, language or a primary attentional deficit disorder)

• Allowing for a better understanding of each individual and a starting point for developing interventions and target areas to maximize success across various settings

What does an evaluation Entail?

Our evaluation process includes the following:

• Face-to-face testing in our office (about 3-6 hours)

• Scoring and Report Writing (about 4-8 hours) done behind the scenes and can be done on different day and time than the actual Face to Face Evaluation

• A review of previous records

• Collaborating with involved professionals

• Final results session to review all findings and discuss recommendations

• A final copy of the report (12-15 pages)

• We will do our best to deliver the report in approximately 3 weeks due to an increased volume of patients. Please be patient, we haven’t forgotten about you!

• Before results of the evaluation are released, payment must be received by our office. Methods of payment can be discussed with the doctor.

• If requested, after our final results session, Dr.Boscan or staff will connect with involved parties, such as schools, tutors, physicians, etc. to review evaluation results and assist with the initiation of interventions and accommodations.

WHAT TO EXPECT IN AN ASSESSMENT OR EVALUATION?

Through a wide range of diagnostic tools we aim to compose a diagnostic evaluation with utmost completion and accuracy. Through recognizing and molding to suit unique patient circumstances and situations, my and my colleagues diagnostic examinations assess problems with awareness of physical, genetic, developmental, emotional, cognitive, and social components of the case at hand.

Our goal is to create a working diagnosis and a fully individualized, comprehensive treatment plan, for the patient and his or her family. Each diagnosis and treatment will take into consideration patient individuality, challenges, and strengths. Both I and my colleagues are trained and experienced in relevant forms of therapy and able to execute a customized treatment plan in collaboration with all individuals invested. Treatments can be expected to involve a combination of individual psychotherapy, medication management, yoga, nutritional consultation, a personal trainer, family meetings and group therapy, marital therapy, or play therapy for children as agreed to by the patient’s family member.

You can expect us to:

• Arrange a diagnostic interview with the patient and parent/significant other

• Detailed review of medical history including medications, medical illness, and a detailed medical assessment

• Review of previous testing, evaluations, school or work reports, medical and psychiatric records

• Coordination with pediatricians/primary care physicians and therapists, only with full patient consent, and collaboration with teachers

• Diagnosis, Treatment Plans, Review, Explanation, and Discussion of all aspects of evaluations

WHAT DOES THE EVALUATION OR ASSESSMENT INVOLVE?

By examining thinking, behavior, social and emotional functioning through standardized tests and procedures, our evaluative procedure will include measures of:

• Intelligence

• Problem Solving

• Attention

• Planning, organization, impulse control, ability to multitask

• Learning and Memory

• Processing Speed

• Language

• Academic Skills

• Visual spatial/perceptual skills

• Depression and anxiety

• Social skills

WHAT IS THE DIFFERENCE BETWEEN A SCHOOL EVALUATION AND A NEUROPSYCHOLOGICAL EVALUATION?

• School evaluations focus on qualifications for special education programs or school interventions, strictly focusing on enhancing academic achievement within the school setting

• The school evaluation determines IF a child exhibits a problem with an academic skill, while the neuropsychological evaluation focuses on WHY a child is having problems in school, home, and community settings.

• Neuropsychological evaluations work across settings and apply knowledge of neuroanatomy and brain behavior for greater understanding of a child’s strengths and weaknesses

• Neuropsychological evaluations are comprehensive evaluations of academic skills such as thinking, problem solving, language, attention, learning, and memory skills, etc.

• Neuropsychological evaluations provide intervention recommendations across all areas of life, not just school

• The benefits of neuropsychological assessments for families and professionals

• Quantitative, evidence based data of individuals skill in various areas

• Comparing said skills with the skills of other individuals of similar age, indicating nature and severity of the patient’s problem

• Helping detect the effect of developmental, neurological, and medical problems, and provide a baseline against which to measure of various interventions or a child’s development over time

• A differential diagnosis (as for example, whether a child’s attention difficulties stem from anxiety, depression, language or a primary attentional deficit disorder)

• Allowing for a better understanding of each individual and a starting point for developing interventions and target areas to maximize success across various settings

WHAT DOES AN ADHD/ADD EVALUATION CONSIST OF?

Our comprehensive ADHD/ADD evaluation includes:

• Clinical interview and evaluation by an experienced educational psychologist

• Teacher and Parent Rating scale for ADHD / ADD while also screening for other disorders such as depression and anxiety

• ADHD Self-Report Form

• Conners’ Continuous Performance Test (CPT), which is a task-based assessment of attention disorders and neurological functioning and can also screen for or diagnose ADHD/ADD, monitor treatment, test the effects of medication, and optimize drug dosage.

• Feedback and education of symptoms and recommended treatments with a detailed Q&A Session

EVALUATION AND TREATMENT

The diagnosis and treatment of ADHD involves active collaboration of parents, teachers, and experienced health professionals. Determination of a true Attention Disorder includes a combination of medical and family history, information provided by parents and teachers, questionnaires and clinical interviews, and the administration of a brief continuous performance test (CPT). These tests will determine whether these symptoms are consistent with the diagnosis of ADHD or are caused by other factors such as anxiety or depression. ADHD alongside other co-existing disorders are important to individually identify and address in the evaluation in order to insure correct treatment. Further difficulties such as executive functioning and/or sensory processing issues can indicate attention difficulties. All of these areas are included in the ADHD evaluation to analyze an individual’s day to day functioning with these added difficulties.

The foremost goal of our evaluation is to determine the underlying cause or causes of the current difficulties experienced by the patient. After an evaluation and diagnosis has been performed, information will be provided to help the patient best understand how the patient’s specific type of ADHD impacts your functioning in the school, work, and home environment. Our treatment plans are individualized and may include recommendations for counselling, skills training (organizational, social, academic, and/or workspace), accommodations, and a consult for medication. We also focus on providing ongoing support in the form of educational material, Parent Support Groups, updated information accessible through our website, school consultations, and follow-up testing to assess the effectiveness of medication and other treatments.

Our modified Adult ADHD evaluations are designed for adults who may have suspected ADHD but have never been formally assessed or diagnosed. Many adults may come to a conclusion about themselves during the process of their child or adolescent receiving a diagnosis, or encounter difficulties with their job or relationships after years of struggling with focusing, time management, procrastination, organization issues or impulsivity. This evaluation is similar to our general evaluation, however it is intended for adults only and can be used to share with a provider for possible medications. To learn more about what options work best for you, please email or call us directly, to schedule a consultation.

WHAT VARIETIES OF OTHER LEARNING DISABILITY EVALUATIONS DO YOU PROVIDE?

Through an academic assessment, our evaluation will help identify how the child learns best in regard to their strengths and weaknesses.

• Individualized Education Plan (IEP) and Section 504 Plan Assessments /Meetings

  • In collaboration with teachers, school counselors, and other practical personnel involved with your child we help schedule a school Individualized Education Plan (IEP)/504 meetings to insure measurable goals and objectives and receive services and accommodations based on your child’s unique needs. Through open lines of communication during the IEP process with the parent, they will be an equal part of the educational team.

• Educational Consultation / School Collaboration

  • To understand and meet the special needs of a child with a range of disabilities, we will maintain strong communication with teachers, special educators from multiple disciplines, and parents as we observe the child in varying learning or social settings to experience firsthand, authentic interaction with the child’s environment.

• Educational Consultation for Gifted and Talented students (GATE/SEMINAR program)

  • For students which possess unique intellectual talents that require a different curriculum and more enriching opportunities, we can serve as educational consultants.

• Student /Parent Coaching

  • To optimize learning strategies and self-advocacy, we can help students with organizational skills, study habits, time-managing strategies, note-taking, and test preparation through student coaching. Through parent coaching we will place the parent in the student’s position and help parents learn strategies that can develop their child’s strengths and mitigate his or her weaknesses.

• Classroom Observations/ School- Based Therapy and Behavior Support

  • We can work with students in the school setting to better target problem behavior, find appropriate behavioral substitutions, and implement an intervention plan. Furthermore, we can recommend school based occupational therapy.

• Social Skills Training

  • In order to address and correct presenting difficulties of children, adolescents, and teenagers with relating to others, social skills training is an effective form of behavioral therapy.

• Advocacy Services

  • We believe that it is vital to advocate for children in their school systems and with other service providers, and we help parents navigate the maze of assessments, services, and professional selection to insure the best treatment for the child. Out goal is to insure a team dynamic between parent and child in order to address his or her disabilities and how it affects his or her educational ability, instead of shifting blame and harboring negativity.

WHAT ARE THE BENEFITS OF PSYCHOTHERAPY FOR DEPRESSION & ANXIETY?

• Help you find ways to deal with everyday stressors

• Can give you new perspective on problems

• Can encourage you to use your medication and to stick with treatment

• Testing has proven that combinative treatment of psychotherapy and medication can best alleviate symptoms of depression & anxiety

• You can learn how to deal with side effects from your medication

• Learn how to discuss your condition with other people

• Can help catch early signs if your depression and/or anxiety is getting worse

Attention Deficit Hyperactivity Disorder (ADHD) and Autism have a tendency to share many similar symptoms. Both show signs of: problems with focus, inattention, hyperactivity, impulsivity, communication, trouble with school work and with social interactions. However, the two are completely different conditions. Autism is a developmental disorder whereas ADHD impacts the way the brain grows and develops. And possibly, you or your child can have both. According to researchers, roughly two-thirds of kids with ADHD have at least one co-existing condition, and Autism Spectrum Disorders (ASD) are among the conditions that commonly occur with ADHD. Some studies suggest that up to half of kids with ASD also have ADHD.

There are two main differences between the two conditions:

1. ATTENTION

   While children with Autism will struggle to focus on things that they want to do and fixate on other things, kids with ADHD simply lose interest.

2. COMMUNICATION

   A child with ADHD may talk nonstop, interrupting or attempt to dominate conversations, while a child with Autism may have a hard time communicating thoughts and feelings.

WHAT IS EXECUTIVE FUNCTION?

EXECUTIVE FUNCTION ASSESSMENT

Executive Function is an umbrella term that refers to brain functions that activate, organize, integrate and manage other functions. Furthermore, it allows individuals to make real time evaluations of their actions while considering short and long term consequences, planning and modifying their behavior as necessary if outcomes are not desirable. The proper function of this process insures academic and subsequent occupational success, deficits of these skills can result in disorganization, difficulties in getting started and finishing work, remembering homework, memorizing facts, writings essays or reports, solving complex math problems, reading comprehension, long-term products, being on time, controlling emotions, and generally planning for future events. A useful metaphor to understand this concept is by comparing executive function to the role of a conductor in an orchestra, according to an expert in the area of Executive Function, Dr. Tom Brown. Dr. Russell Barkley, a noted authority on ADHD, reported that 89-98 percent of children with ADHD have deficits in executive skills. Dr. Barkley believes that evaluating and understanding a person’s executive function, breaking it down across several domains, is a better predictor of real world functioning than merely reporting they have a deficit.

Executive Function can be broken down into six different clusters:

1. Activation: Organizing, Prioritizing and Getting Started on Tasks (getting started; paying attention; organizing time, projects, materials, and possessions, finishing work)

2. Focus: Focusing, Maintaining and Shifting Attention (changing activities, stopping existing activity, stopping and thinking before acting or speaking)

3. Effort: Regulating Alertness, Sustaining Effort, Processing Speed (complex problem solving).

4. Emotion: Managing Frustrations and Regulating Emotions (ability to tolerate frustration; thinking before acting or speaking)

5. Memory: Using Working Memory and Accessing Recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory.)

6. Action: Monitoring and Self-Regulating Action (self-monitoring and prompting, using “self-talk” to control one’s behavior and direct future actions)

Understanding which area(s) of executive function are impaired allows recommendations for accommodations and support be the most successful in helping an individual in their daily life.

WHAT IS SENSORY PROCESSING & SENSORY PROCESSING DISORDER?

SENSORY PROCESSING ASSESSMENT

Sensory processing (SP), sometimes called sensory integration (SI), is a concept that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Everything we do, from exercising, eating, to reasoning, requires processing sensation or sensory integration. A Sensory Processing Disorder (SPD) is a neurological condition in which sensory information is received but isn’t organized into appropriate responses then what is typically expected.

A useful metaphor coined by pioneering occupational therapist and neuroscientist A. Jean Ayres, PhD, compares SPD to a neurological “traffic jam.” This jam of signals prevents certain parts of the brain from receiving the signals needed in order to interpret the sensory data accurately. A person who struggles with SPD can find it difficult to process and act upon information received by the senses, creating countless, seemingly simple everyday tasks more difficult.

Signs of SPD may include:

• difficulty planning and organizing

• carrying out self care skills and activities of daily living

• completing school work or job tasks

• avoiding activities

• frequent distress or agitation

• fear of trying new things.

This disorder can affect people in a single sense, for example just sight, or in multiple senses, giving the impression that there is too much or too little sensory input. For example, a person whose SPD leads to over-stimulus may find clothing, physical contact, food, sound, light, etc. to be unbearable. Some who suffer from under-stimulus may show little to no reaction to stimulus, even pain or extreme temperatures. An impairment of sensory processing of the muscles and joints can further negatively affect posture and other motor skills. Children who develop an appetite for perpetually increased sensations are sometimes misdiagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

SENSORY PROCESSING DISORDER AND ADHD

ADHD and SPD have several striking similarities, and one can easily be confused for the other. Both disorders lead children to display issues and behaviors with hyperactivity, lack of focus, fidgeting, and impulsivity. Children may run or skip through the halls to class, struggle to focus on reading assignments, and fidget by repeatedly touching a toy or moving their seat. Both SPD and ADHD can cause difficulties with learning, pear relationships, and the ability to comply and complete activities.

SHOULD I CONSIDER MEDICATION?

It can be a challenge for parents to decide if their child would benefit most from ADHD medications. In order to insure that ADHD children reach full potential at school, at home, and with friends, medication can be of great help. Although medication will not cure ADHD, it will allow children, adolescent, or adults to better manage their ADHD and improve overall functioning in school, work, home, and in the community. A combination of treatments (academic, behavioral, psychotherapeutic) with medication can be the most effect method to being able to live full and productive lives with ADHD. With proper prescription, ADHD medication can help with focus and concentration, while reducing hyperactivity and impulsiveness, all while leaving the child’s personality unaffected. In order to find the proper medication and treatment, close collaboration between the doctor, the family, and the therapist is essential. While some children may no longer require treatment as they enter their late teens, many ADHD symptoms persist into adulthood. ADHD symptoms are known to change over time, specifically with decreased hyperactive behaviors in teens and young adults, however inattention and impulsivity can persist into adulthood and negatively affect everyday life. Proper treatment in children reduces their hyperactivity and inattention, insuring better development. Teens and adults with ADHD often notice a significantly greater ability to concentrate on tasks and less inclination to boredom and restlessness. An experienced health-care provider or psychiatrist to prescribe useful medication is essential. Following your evaluation, should medication be a recommended part of your treatment, you may be recomeded a list of ADHD experienced Psychiatrists in the community. other providers may be provided upon request should medication be a recommendation of your evaluation.

Children of divorced parents do best when,
1. There is proper co-parenting

2. Good communication between both parties

3. Staying "kid-focused" during conversations

4. Parent's learn to compromise and respect different opinions

5. Giving kids space to adjust to transitions

6. Have an established routine and staying consistent

7. Establish a strong support network for yourself & your child

8. Keep each other involved in the lives and events of both parties (birthdays, special holidays)

9. Legitimize the child's feelings during transition and encourage honesty

10. Heal yourself first

Parents who are divorced should avoid?
1. Venting their negative feelings to their child

2. Using the child as a messenger

3. Exposing children to visible conflict, heated discussions or legal talk

4. Strong disruption to the child's daily routine and personal space

5. Being secretive about what is happening entirely

6. Stopping the other parent from seeing the child (depending on custody or visitation agreements)

7. Ignoring physical and verbal signs of distress from the child

8. Making promises you won't be able to keep

9. Radically changing the family dynamic

10. Using your child as a weapon or turning them against the other parent

Technology is both a transformative and an unavoidable consequence of our modern day life. As adults we may have learned to manage our impulses with age and maturity, not every flashing advertisement garners our attention, however, children are the most susceptible to marketing schemes and the addictive nature of certain games. Studies have shown that games with a “gambling” system and the development of fixation around playing said game, shares many similarities with real world gambling addictions. A pattern we’ve noticed while treating many patients and parents who struggle with children’s lack of “video game self-control”, games with “In-App” purchases, microtransactions, and “loot boxes” bore the greatest resemblances to the similar serotonin induced thrill of gambling. Our strongest recommendations is for parents to monitor there children’s games and the amount they spend on them (compared to the time they spend outside or doing schoolwork) and steer them to games with a “strategy” or “problem-solving” basis. Multiplayer games can be further beneficial to your child’s social development as he learns team-work when completing tasks.

Below we will go over some points about the warning signs of childhood game addiction and tips to combating it.

Symptoms and Bad Effects of Video Game Addiction

• Obsessive behavior

• Lack of Sleep

• Lack of physical exercise

• Other Physical problems

• Social isolation

• Having gaming as his only focus in life

• Neglect of school activities and responsibilities

• Lack of interest in reading and other hobbies that have educational benefit

• Escaping life problems instead of confronting them

How to Address & Treat your Child’s Video Game Addiction

• Address the issues with your child directly & help put their video game in perspective

• Determine and agree of a reasonable time for your child to play in moderation

• Set specific boundaries and be firm about it

• Create consequences for not following agreed on boundaries

• Make game time a reward

• Track your child’s game time & the type of games they play

• Use tools to set limits for the game time (most electronics have screen time restrictions)

• Be ready for pushback from your child but remain firm

• Discourage “gambling” games & encourage “strategy” games

• Place games in a visible, public space where they can play out in the open in front of you

• Encourage your child to spend more time with their friends in the real world

• In a worst case scenario, you may have to make the child quit “cold turkey” and confiscate the games entirely

• In further extreme cases, bring up this concern to therapists as early and decisive intervention is the best strategy