Monday, April 26, 2010

Evaluations: Developmental Pediatrician and Neuropsychological Evaluation

When you first discover your child might have a developmental or learning issue, it is hard to know where to turn. There are so many different people to turn to. One would think that the pediatrician or a teacher would be a good source of information. But actually, regular pediatricians seem to know very little about developmental and learning problems. They are excellent to consult if your child has strep throat or needs a vaccine, but they are not trained to diagnose developmental and learning problems. Often the pediatrician will assure worried parents that everything is fine and there is nothing to worry about. But, from the stories I have heard and my own experience, they are very likely to overlook developmental problems because they just don't have the expertise, training or time to discern whether a developmental or learning problem is serious or not. Teachers are also not the best sources of information about whether your child's behavioral or learning problems are cause for concern--they also seem to dismiss most parental concerns. From speaking with parents, parents seem to catch problems way before teachers and pediatricians.

If you see a problem with a younger child, who is under three years of age, you can call Early Intervention or your state's birth to 3 program and request an evaluation. Anyone can make a referral for an evaluation. It doesn't have to come from a doctor. Services for young children with developmental problems are excellent because the money spent toward early intervention services pays off--children get better faster the younger you intervene. Sometimes it is necessary to get a private evaluation through a developmental pediatrician to see if there is a problem, because sometimes early intervention will not give services to children because they are not delayed enough to receive state assistance. You need to be delayed by a certain amount for the state to pick up the tab for services and some kids who actually need help will not qualify for state assistance--even if they could benefit from help and intervention. If early intervention says that the delay is not a problem, ask them when it would be a problem. If your child is not meeting a certain milestone and the evaluator says "it's not a problem", ask "at what age would this be a problem" in order to get more specific information. You can also ask your regular pediatrician the same question if they say a delay is not a problem.

A developmental pediatrician is specially trained to do specific testing to diagnose a developmental or learning problem. They can give you an idea of why your child is not walking or talking and what might help get them back on track. An evaluation from a private developmental pediatrician can also assist you to get Early Intervention services that were denied if the developmental pediatrician thinks they are necessary and recommends the services. Seeking an evaluation from a developmental pediatrician is almost like getting a second opinion.

A neuropsychological evaluation is a comprehensive evaluation done by psychologist to get a better understanding of a child's strenths and weaknesses and it is more focused on school-aged tasks that involve learning and intelligence. The report is given to the parent to assist with school placement and to pinpoint any learning problems that might be overlooked in a more casual testing setting. It helps to rule in or out serious learning problems, but it can also help to find out where in the learning process the child is having a hard time. The final result of the "neuropsych evaluation" is a report which includes test results, impressions and recommendations. In addition, it can summarize the reports of various people working with the child and past testing.

Susan Luger, who is an advocate for children, had a very good analogy for the complexity of learning and why testing might be necessary. She said "Mary can't drive a car. WHY CAN'T MARY DRIVE THE CAR? Is she blind? Is she afraid of driving the car? Has she never been taught to drive the car? Does she have no interest in driving the car?"

Well, you get the idea that if you are having problems talking or walking or learning, sometimes it is necessary to dig deeper to get specific answers as to WHY the problem is occurring in order to get a better idea of how to help the child. Often, casual evaluations do not get to the cause and more specific evaluations are necessary.

WHAT TO DO: Albert Einstein said "The only really valuable thing is intuition." Trust your gut. If you think your child has a problem then follow up and get answers. If they do have a developmental or learning problem the sooner you catch it, the better. Sometimes kids do change and problems do disappear without any intervention. But bigger kids can also mean bigger problems.