What a Neuropsychological Evaluation Actually Reveals About Your Child

0:00Really, a neuropsych is an opportunity to say, oh, wait, my kid is awesome. And yeah, it's not great that they have to go through a language-based curricula, but like, I get it. And I know how to help them, and I know how to tell them about their strengths, and they're going to understand themselves, and they're going to feel good about themselves, which is the most important thing you can get out of school.

0:17Dr. Aliza Pressman:If you've been told that your child needs a neuropsych evaluation, or you suspect that your child needs a neuropsych evaluation, That's the first step. But then finding a neuropsych evaluator, finding out what you're supposed to ask, what you're going to figure out, how it will benefit you, what the problems might be. Those are all of the things that we're talking about today with my friend and colleague, Dr. Joanna Jacobs, who is a brilliant neuropsychologist who works with families all the time and helps them rethink what a neuropsych evaluation is actually for and how it can truly help you understand your child.

0:56Dr. Aliza Pressman:I'm Dr. Aliza Pressman, developmental psychologist, New York Times bestselling author, associate clinical professor at the Icahn School of Medicine, and the host of Raising Good Humans podcast. I am so glad you're here. I feel like you're a gift for everybody because how many people are told, we wanna recommend that you get a neuropsych evaluation? I'm not asking you to answer that. I'm just telling you so many people. But what does that mean? Why is it happening so often? What do we get out of it? What is the landscape? Talk to us about like, okay, you've been told something's up, but it's so vague.

1:41Dr. Aliza Pressman:Like when and how do we know? Do we really need a neuropsych evaluation? So I think if there's an adult out there that cares enough about your kid to say your kid needs a neuropsych, you pay attention to that. Okay. So a neuropsych is an evaluation that is conducted to understand how the brain affects what we think, what we do, how we behave. So we do a series of tests and they measure things like problem solving, memory, executive functioning, how we how our brain gets things done and how efficiently and how much energy it takes us to do that and emotional functioning. And then we also talk to people.

2:21We talk, we do lots of interviews with the child, with teachers, with anyone who has any interaction with the child who may be able to inform how they function in multiple environments. But of course, neuropsychs are not just for children who aren't functioning perfectly at school. So we're talking just about a specific kind. We also use them in college awards to track the toxicity of treatments, post-concussion, for dementia. There's tons of them. These we're We're talking about for students who are not functioning up to their potential at school.

2:58Dr. Aliza Pressman:So let's say there's a parent of a young child or a school age child who feels like, I don't know why, but I feel like something is adrift and I want a neuropsych evaluation. But the preschool teacher or the elementary school teacher does not seem to see a reason for it. I say trust your gut. I love it. Okay. And what kinds of, so like, what are the kinds of things that might happen in a school setting or home that would bring up those questions? In my practice, I only see kids six and up. Okay. For younger kids, it would be like not meeting developmental milestones. A parent might see that their kid is not functioning at the same level as their age peers.

3:46And that, of course, I think is always best to listen to parents. They know.

3:51Dr. Aliza Pressman:Okay. In latency age kids, school age kids, it is a parent who sees a kid who is working harder than they need to be. They come home, they cannot self-regulate at the same level, maybe as their peers or the teacher says, you know, it should take 10 minutes to do this assignment and they see their kids becoming dysregulated or procrastinating or avoiding. Neuropsychs really, or psychoeducational evaluations, it's sort of synonymous. It's a good tip to have. They are really to understand a kid and to help them live their best life possible. It's really about, so when a parent sees a kid's suffering, it's important to pay attention to it.

4:40Dr. Aliza Pressman:Is the suffering typically in categories like it's they're suffering a social emotional suffering or they're suffering. Suffering constantly. OK, so you can suffer every way. Right. Isn't that so nice? Yes. If the child feels like let's give some scenarios here, not for diagnosis, but for scenarios that parents experience where and I hear this a lot. parents are like, the teachers say everything's totally fine, but my child's coming home and melting down, to which I'm usually feeling like that's just because they feel safe at home and not at school. But is there a point at which it's like, something else is up?

5:17Yeah. I mean, kids are very, very motivated in elementary school and beyond to preserve their appearance as a competent, independent kid. So it's much more, yes, they feel more comfortable at home, But they're also very invested in preserving that look to their friends. We all have a certain amount of energy units that we have the start of the day to get through the day. And if you're using too many of them or more than most of your peers are at school to sit still when your body needs to move or to decode when everyone else is reading fluently or to parse some sort of nuanced social nonverbal communication, you're working harder.

6:04You come home and you're depleted. So, yes, yes, of course, kids feel safer at home. They're not filtering what they're saying. But also it could be an indication that they're working harder at school. So it's not, um, not academically, but in every other way, in every other way.

6:20Dr. Aliza Pressman:Is there a world where when parents hear, I recommend a neuropsych evaluation, what, what, what do you see happening for parents? So scared. Yes. And it is, it is a shame because, because a A neuropsych is an opportunity to attune yourself to your kid and to understand them. And yes, of course, it's scary. We all have our kids and think, you know, I think we're all sort of built like if something goes wrong, something's wrong. But of course, something's going to go wrong. There's not, you know, so of course, it's not fun to hear. Yeah, your kid's not keeping up with the pack. But it is so important to know why.

7:03And it's so much worse not to know. So it's always, well, I understand as a parent, it's petrifying. It's such an opportunity because so much the way that our school system is designed, this like tradition of verbal language based curricula is devastating to all the kids that don't have those strengths. strengths and they walk, you know, they go through the system misunderstood, unseen. Really, a neuropsych is an opportunity to say, oh, wait, my kid is awesome. And yeah, it's not great that they have to go through a language-based curricula, but like I get it and I know how to help them and I know how to tell them about their strengths and they're going to understand themselves and they're going to feel good about themselves, which is the most important thing you can get out of school.

7:49Dr. Aliza Pressman:Okay. So you just mentioned something that I think we really need to address, which is let's say your child is going to have a neuropsych evaluation and you do the evaluation and you feel like there is a diagnosis. There is an explanation for some of this. What do you recommend parents do? Because some parents I'm imagining are like, I don't want to tell my child there's a problem because they'll think the problem is with them and they need to be fixed. We should talk about diagnosis. Let's talk about that. And profile. Yeah. Diagnoses are wrought, first, because they're misunderstood and they're not incredibly specific and they're very necessary for parents to access insurance reimbursement or to access care or services from their school district or to communicate with other clinicians in shorthand, but they're not descriptive.

8:53Like what is ADHD? And ADHD can mean something very, very different for every kid. And it's not helpful until you understand what it means for your kid, which is why a neuropsych is so helpful because it is that breaking down everything. Okay. This, this is, these are, these are the behaviors that you're concerned about and here's why it's happening. So a diagnosis is really the last thing that I talk about in feedback meetings, because I think it's most important to really understand your child. So when talking to a child, now listen, everybody's very interested in a diagnosis, even kids, because of TikTok.

9:31Dr. Aliza Pressman:Right, right. Yes, I want to get into all of that. Yes. I usually find it most helpful to describe what I'm seeing and to have a conversation with parents when they can say, yeah, yeah. And then, you know, ideally they're like, oh my God, yes, I see that. And this is the pattern I see at home. And there's a real conversation around who their kid is. and then talk about, okay, the best diagnosis to capture this is X. It's not the most helpful piece of information to get. And then in terms of talking to you about the kids, it's not one size fits all, obviously. Generally speaking, I'm a big believer in not keeping information in the shadows because it makes it scary and dark and ugly.

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12:27Dr. Aliza Pressman:Let's really talk through that. So if you do have a diagnosis because the clinician wants to help with insurance because the clinician needs to find the short hand. Because it's the language we speak in. Right. It's the language we speak in thus far. Do you find a situation with parents where they're like, I don't want my child to hear a label? And can you address that? I hear it all the time and I get it. And I think it's founded. It's well-founded. I mean, the interesting thing about diagnoses too, is that they're environment specific. So for example, if you send your kid to a very, well, we all send our, we send our kids to schools that have a very specific demand.

13:16And therefore, if you're sort of poked in your wound, it looks like a disorder.

13:20Dr. Aliza Pressman:Right. But if you are, let's say, put on an island where you have to figure out how to survive that verbally, you know, astute child will die. It's not that right. Well, not thrive, not get the A. So it's very environmentally, you know, dependent. And so that's why the word disorder is just terrible. Diagnosis is about putting language to something in the service of what we need to figure out right now. but disorder why isn't my kid doing well in this classroom with this teacher with these kids right that's a much better way to in our family yeah right versus um thinking is this disordered or not so even going into a neuropsych evaluation thinking we're asking a question that's context specific absolutely well said that can really change yeah the experience of the parent and and the kid.

14:21Yeah, really. The most, the worst thing about not being successful in school is that you, you know, it just wreaks havoc on your confidence and your identity as a competent person, right? When it's such a narrow assessment of competency.

14:40Dr. Aliza Pressman:When you're talking to a family or a child, what do you do if the family, like what, what would you say to the family? that's like, I, I'm not, I don't want to label them. What's the language that they can use to address that issue? Because you think you explained it really well in terms of context, but then going further, what do they say to their kids? A lot of parents like to use the word neurodivergent, um, which I think is not a bad way to say, Hey, your brain works differently than the academic setting you're in and it's going to feel harder and it is a challenge and it is a struggle. It doesn't mean that you're not a competent person.

15:24Right. I think it's really important also to validate the difficulty of, for example, being a dyslexic kid in any school, in any school. Right. It is hard. And so that is not a disorder. That is an evolution. That's a, that's part of human evolution. That's important and necessary. But what do you do? Disordered because it makes life very difficult for a dyslexic kid.

15:43Dr. Aliza Pressman:Okay, so then translating disordered or retranslating it to, it makes life difficult for you. And so we're going to try to figure out ways to adapt in this context or move you out of this context if it's totally unacceptable. Yeah. I think that's language that's much more generous and easier to work with. Validating. And validating than your disorder. That's about parental attunement, which I think is one of the best things that come out of Neuropsych. Yeah. Is parents can see more clearly. Understanding the motivations behind their kid's behavior. Instead of feeling like they're just oppositional or.

16:21Right.

16:21Dr. Aliza Pressman:And so what do you do if they are, what if, well, you probably don't do this then. Like, what if they have, are you diagnosing oppositional defiance disorder? I don't like that diagnosis. Yeah. I bet you don't. It's a symptom. Right. Right. It's a symptom of a misfit between the kid and his environment. Okay. Right. So a lot of this sounds like figuring out what's happening in the context the child is in and how much of that. Given the brain the child has. Given the brain the child has. And then deciding with the family, because they might not have a choice, right? Like that might need to remain the environment the child is in.

17:05Dr. Aliza Pressman:True. So then it's finding the support systems that can help them be in that environment or no? Yeah, I think it's finding the language, like creating the narrative, finding the supports in the system, finding the supports at home, teaching the child how to navigate the obstacles that they will encounter and teaching the child to understand why their body, you know, why they have anxiety around certain situations and what to do. I mean, it's not different than any other, you know, disorder and what to do to help navigate it. I really want to stress that I love how you explained that disorder is really like we just shouldn't think of it as like you have a problem brain.

17:47Dr. Aliza Pressman:It's or you are a problem. It's it's just disorder for this environment that you're in. I really believe we need all those brains, like evolutionary standpoint. I mean, yes, because yes. If we all have the same brain, we would be goners. Everybody needs one person who's really anxious. I'm probably that person. And we're very available for that role. Let's keep it in line. I just, I think it, no, but it is interesting. It's like when you, even in a silly way, when you look at families, like one person is probably like, everything's safe, everything's fine. Don't worry about it. And the other person's like, yeah, but I just noticed this thing.

18:30Dr. Aliza Pressman:What if? And so you need both of those people. So let's go back to neurodivergence, telling the kid the diagnosis. Right. I think the more that we keep information in the shadows, the scarier it is for a child. I think that most children, when they end up, at least in my practice, coming to me, they know something is wrong. They know they're different. They know that there's displeasure and they are scared out of their minds that there's something wrong with them. I know. I know. When you name it, I mean, obviously, we know this, right? It opens up a world of conversation and connection. And it doesn't necessarily pathologize.

19:11No, yes, the names in of themselves, we can do better. We can do better.

19:15Dr. Aliza Pressman:And is that something you can say? To? To the child. We can do better with these names? Yes, of course. I mean, every eight-year-old kid knows seven kids with ADHD that are completely different. Right. And every woman of a certain age is presenting those same inattentive features, but maybe is very calm looking. Right. For example. Yeah. So pretend you're talking to a kid right now. Let's do the version where I leave the conversation like feeling great. I feel great about how I just articulated this. That usually happens when I talk honestly about the kids struggles. Like, okay, so you came in here and we know you're having difficulty, you're feeling left out, you're feeling, you know, frustrated, you're feeling overwhelmed.

20:08overwhelmed um and then you know have a conversation get buy-in with the kid who's talking to you about their struggles who feels like oh my god this is great and also a little scary that we're talking about this in front of my parents and now they know I struggle and now maybe they won't love me you know what I mean yeah because that's just like what a little kid thinks they want to please it's all about competence at that age right and how you show your devotion to your parents and if they're failing it's like so lonely and scary so like the idea is to communicate to the kid like you're not alone in this and yes you're not crazy it is harder for you you've sort of connected with this child you've you've validated their experience right and now there's a word there's a word that people use you're not the only one that's going through this okay that word is dyslexia it makes it harder for you to learn to read even though you are smart as a whip, even though you are quick like lightning.

21:06Right. Right. And then sometimes I'll say, does it sometimes feel confusing to you that you can do other things as easily or more with more facility than other kids? And yet you can't get this reading down. You're not crazy. This is a thing, you know? And then I like to throw in the famous people. That's exactly what I was going to ask you.

21:26Dr. Aliza Pressman:And then do you start to say, like, do you know all these people that have had wonderful successful lives yes most most are neurodivergent most of those people high up on the hill yeah okay so that's a good thing to go about ai and how neurodivergent brains are the most protected yeah because they can't be programmed they think outside the box what a great point i know and it's like you know it's true because not to like you know poo poo verbal learners i'm absolutely a verbal learner school is my I'm good at it. Yeah. Yeah. No, we're not poo-pooing it. We are both obviously by nature what we do.

22:04Dr. Aliza Pressman:Yeah, we need all brains. We need all brains. But people, for example, who excel in nonverbal reasoning, like fluid reasoning, visual spatial reasoning, means, I'll define, being able to solve problems on your own without the benefit of someone giving you a sequence of how to complete or finish that problem. problem and if you think about it that sequential learning is very like computer-y right it's like very ai-y yeah you know if x then y i'm very programmable same i listen and i do what i'm told same i am the most boring and we were really good in school yeah because it's like yeah here's what you have to do and if you do it you get to this so i have this like little game i play with myself with kids it's kind of crazy like i'm sitting with them and i'm like okay i'm stuck we're on a life boat like we were on a cruise and it's just me and this kid and like a boat that survived okay are they gonna be a liability or are they gonna save my life you know oh yeah and it's like a it's amazing i would be a liability no you wouldn't i would i would not come up with anything that's okay i found a thing that works for me i'm like i'm very straightforward i like but if you put me on a boat right and you're right because i'm the verbal learner i'm like Will this kid be thinking about the things that like I can't see?

23:27Yeah. I would be thinking, well, what are the rules? Right. Like what does one do in this situation? What do you do in this situation? Let me read a book and then I will get back to you. You can be sitting with six year olds and be like, that kid will save my life. You know what I mean?

23:38Dr. Aliza Pressman:I think we can all, I am picturing right now, who, who are those people that where you're just like, yeah, yeah. That one, that one, that one, I'm going to be fine. Yeah. This one maybe is not going to be in a great position. but the reading comprehension is a game yeah so i think and not to diminish the value of that too like obviously that's just underrepresented and they're unseen and it's like really a problem not to be like panicky but society wise we need to nurture those brains those are the most you know those brains need need nurturing too yes and they really are not they are missed like this talent is missed.