Neuropsych for 8yo?

[Anonymous]

Wondering if it’s worth getting a neuropsych evaluation for my 8 yo DD. We are doing ok this year but have had some tough times, and I’m fearful we’ll have more ahead. If we got an eval at children’s would it be comprehensive enough?

We really struggled with behavior when she was a toddler and preschooler (emotional regulation and impulse control, specifically hitting, it was bad).
Now, in general she is still very emotional (ups and downs) but not aggressive, a model student (and organized) but hates school because of having to sit for so long (lives for recess and and really needs downtime after school), energetic and plays more physically/in a silly manner (doesn’t seem to be as mature as some peers), shy & awkward around new kids or when nervous, has some repetitive hand movements (touching fingers together) when bored or nervous, prefers comfy clothes over fashion, struggles with anxiety (the thought of being late or having to do something different like buy lunch instead of bring), does not take a deep interest in anything (loves to simply play imaginatively with siblings, friends or by herself), low frustration tolerance and dislikes games with rules or directions, loves her friends but really prefers to stick with who she knows and not branch out.

Thoughts?

[Anonymous]

Is cost a concern? What's the downside besides cost?

[Anonymous]

Yes, cost. And the concern it would be non conclusive.

[Anonymous]

If cost is a concern, you should get on waitlists wherever they take your insurance. My dc's cost $150 and we waited 8 months (this was some years ago and we are not local, we actually are planning another one and I think it will be $225 this time).

[Anonymous]

I think if you do a neuropsych you should go to someone with expertise in autism. Not because I think this sounds like autism but because there are some characteristics and an expert can definitively diagnose or rule it out. Many psychologists lack expertise in autism. I have had two friends who had psychologists say their kid just had anxiety, then a subsequent evaluation found autism.

You could also look into a psychiatric evaluation. These can also diagnose autism or adhd and then you will be set up with a psychiatrist if there is a need for medication.

[Anonymous]

A neuropsych won’t get you the information you want. I would start with therapy (for you as a parent to handle difficult behaviors) and go from there.

[Anonymous]

Anonymous wrote:Is cost a concern? What's the downside besides cost?

I think there's more downside to not doing it. Even though you think that she is doing well in school, a neuropsychological will tell you if she is using some strengths in one area to compensate for weakness in another area. That's something you want to know now because kids with special needs sometimes decompensated when the work steps up in 3rd, 6th, 9th or college.

[Anonymous]

Anonymous wrote:A neuropsych won’t get you the information you want. I would start with therapy (for you as a parent to handle difficult behaviors) and go from there.

I agree with this. Start small, gather feedback from therapists and do neuropsychological testing only if necessary.

Take a look at the recent thread on a similar topic. There is a time and place for neuropsychological testing, but it is not always the best place to start from.

https://www.dcurbanmom.com/jforum/posts/list/1321950.page

[Anonymous]

OP here. She is in 3rd and this is the year she has started to hate school (but still doing well). Very social too, but definitely needs her down time.
We went to therapy and OT from 4-7yo. They mainly thought anxiety.
Agree that knowing how to parent her is a huge part of this and we’ve come a long way.

I don’t feel like (from what I read) she fits into one clear box for a diagnosis. Am I wrong? We have looked into children’s, but I also question how they would help much from meeting her for one day. Am I completely off and will they get to the bottom of this and give helpful recommendations?

[Anonymous]

Anonymous wrote:OP here. She is in 3rd and this is the year she has started to hate school (but still doing well). Very social too, but definitely needs her down time.
We went to therapy and OT from 4-7yo. They mainly thought anxiety.
Agree that knowing how to parent her is a huge part of this and we’ve come a long way.

I don’t feel like (from what I read) she fits into one clear box for a diagnosis. Am I wrong? We have looked into children’s, but I also question how they would help much from meeting her for one day. Am I completely off and will they get to the bottom of this and give helpful recommendations?

OP, you nailed the key issue with the neuropsychological evaluations. They cannot figure this out from meeting her for one or even two days. They heavily rely on your feedback, feedback from her teachers and previous therapists. It is a highly subjective process. This is why doing therapy for a several months might give you better idea of where you stand.

Typically, neuropsychological evaluators will not want to sit with you through multiple sessions to comb through behavioral history. You get 2-3 hours tops and this is for “an interview” where they choose questions to ask you and pick answers that they deem relevant.

[Anonymous]

We just did one, at Children's National. What I appreciated most was the one hour call with the evaluators afterwards. They went through everything in detail. In our case, they found nothing that met a diagnosis threshold. But, they had many suggestions on things to do where my kid was "slightly below average."

There is no downside in my view (other than cost if your insurance doesn't cover).If your kid doesn't meet a diagnosis threshold, they will still pinpoint things to work on and ways to help.

Just to add, they have a long wait list, 6-12 months, unless your primary care or another doc refers you for a specific concern. So, get on the list, at a minimum.

[Anonymous]

Anonymous wrote:We just did one, at Children's National. What I appreciated most was the one hour call with the evaluators afterwards. They went through everything in detail. In our case, they found nothing that met a diagnosis threshold. But, they had many suggestions on things to do where my kid was "slightly below average."

There is no downside in my view (other than cost if your insurance doesn't cover).If your kid doesn't meet a diagnosis threshold, they will still pinpoint things to work on and ways to help.

Just to add, they have a long wait list, 6-12 months, unless your primary care or another doc refers you for a specific concern. So, get on the list, at a minimum.

Me again. This evaluation took 6 hours (with a lunch break). Plus a one hour call with me beforehand, three sets of form filled out by both the teachers and myself. This was not a 2 hours and we're done.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We just did one, at Children's National. What I appreciated most was the one hour call with the evaluators afterwards. They went through everything in detail. In our case, they found nothing that met a diagnosis threshold. But, they had many suggestions on things to do where my kid was "slightly below average."

There is no downside in my view (other than cost if your insurance doesn't cover).If your kid doesn't meet a diagnosis threshold, they will still pinpoint things to work on and ways to help.

Just to add, they have a long wait list, 6-12 months, unless your primary care or another doc refers you for a specific concern. So, get on the list, at a minimum.

Me again. This evaluation took 6 hours (with a lunch break). Plus a one hour call with me beforehand, three sets of form filled out by both the teachers and myself. This was not a 2 hours and we're done.

How much time did they spend with you (not your DC), collecting the feedback?

We got 2 hours with a large number of quick questions and without an opportunity to delve deeper into issues that we see at home. There was an initial set of very high level forms that we were asked to fill out as well. But, that was it for our feedback.

[Anonymous]

Anonymous wrote:OP here. She is in 3rd and this is the year she has started to hate school (but still doing well). Very social too, but definitely needs her down time.
We went to therapy and OT from 4-7yo. They mainly thought anxiety.
Agree that knowing how to parent her is a huge part of this and we’ve come a long way.

I don’t feel like (from what I read) she fits into one clear box for a diagnosis. Am I wrong? We have looked into children’s, but I also question how they would help much from meeting her for one day. Am I completely off and will they get to the bottom of this and give helpful recommendations?

A neuropsych is not some kind of roadmap or even differential diagnosis. It is a series of cognitive tests - like a super duper IQ test. It’s not going to tell you how to parent your kid or differentiate between personality vs anxiety vs subclinical autistic traits. It doesn’t even sound like you are articulating any issue or challenge.

[Anonymous]

Anonymous wrote:OP here. She is in 3rd and this is the year she has started to hate school (but still doing well). Very social too, but definitely needs her down time.
We went to therapy and OT from 4-7yo. They mainly thought anxiety.
Agree that knowing how to parent her is a huge part of this and we’ve come a long way.

I don’t feel like (from what I read) she fits into one clear box for a diagnosis. Am I wrong? We have looked into children’s, but I also question how they would help much from meeting her for one day. Am I completely off and will they get to the bottom of this and give helpful recommendations?

This is when a neuropsych can be useful. It sounds like your kid is has had some pretty impactful struggles in the past. Now at 3rd grade when school is becoming much more difficult she is starting to struggle again. I think a good neuropsych from someone who can confidently diagnose and/or rule out neurodevelopmental and mental health issues and untangle them as well as tease out any weaknesses that may be impacting them educationally even if they are able to compensate can be so useful. With the emotional regulation piece, understanding what might be driving it can help to address it.

The money is an issue. We went with a private evaluation because we were told that and KKI and Children's evals can really vary in quality. We didn't want to go through all that and then as you say get something unclear, inconclusive or incorrect. These reports take time to write so I can definitely see how taking insurance might limit the time the evaluator can spend on a given child. We were able to switch to an insurance plan that reimburses most of the cost for out of network providers so the financial piece was not as much as an issue for us, and I get that we are fortunate in that way.

Because of my kid's history I have really leaned into being proactive in addressing potential issues. I don't really believe in watching and waiting mainly because of trying that approach when DC was young and really regretting it later. And that might not be the right approach for everyone. But from my perspective I think a thorough evaluation sounds like it could be really useful in your kid's case and much better to do it now than waiting until the issues get more complicated in the tween and teen years.

As far as whether the psychologist will really be able to get to know your kid, make sure to gather any reports you may already have. We had early intervention reports and an OT eval and the evaluator was able to talk with the OT that had been working with my kid for months. We were also super detailed in the intake forms. We didn't have concerns that the psychologist didn't know our kid well enough, but definitely I can see how if it was just based on the parent interview hat would not have felt sufficient.