Therapy in L.A.

  article of the month
May 2002
By Alan M. Solomon, Ph.D.

Parents often seek help for their children for school related difficulties. Two scenarios, not uncommon in my twenty-three years of practice, follow (names have been changed and identifying information is excluded to protect confidentiality, of course):

- Jim is a nine-year-old fourth grader, plagued by poor grades in school. While he seems bright (most adults who encounter him say so), often curious, willing to learn, and a friendly youngster who tries to please, he chronically fails to complete assignments in class, forgets to bring home materials needed to do homework, and then may not turn in homework the next day when he has completed it. Math is his weakest subject, though he can still perform close to grade level, compared to his above grade level abilities in reading, spelling, and other language tasks. Handwriting is often very poor ö barely legible at times. His teachers and his parents are frustrated by the ongoing struggles to complete tasks, finish homework, and stay involved, since Jim often rushes through his work in a ćmad dash to get it doneä. Homework completion has become an intense battle almost daily. The most frequent observation: ćIf he would only try·heās more than bright enough to do well.ä

- Nancy is a thirteen-year-old eighth grade student, very well liked by her peers and teachers. A cheerful, upbeat girl, whose early adolescence is marked by very mild teenage rebellion that hardly bothers adults, she struggles with most of her junior high classes. Intensive efforts, help from her Mom nightly, long hours of study for tests ö all have produced passing grades, but not much more. Basic spelling is problematic. Reading is complicated by ongoing difficulties sounding out words, as well as understanding the increasingly complex texts and literature that are assigned. Writing essays, even short ones, is a protracted labor of repeated re-writes, as Nancy often has difficulty clearly expressing her ideas and sequencing them in a logical order. Math is a bit better, but not much, since she struggles to remember basic addition, subtraction, and multiplication facts. Ask her about school and she focuses on the social parts of it: friends, cheerleader activities, service clubs, and being an aide in the office.

In both of these families, various efforts to help have been mildly successful at best. Tutors, reward systems for completed assignments, careful coordination between teachers and home to monitor completion of work, serious consequences for less than adequate work (no TV, reduced weekend privileges, taking away spending money, etc.) ·all have had little or no lasting impact. Whatās been missing in these efforts to help?

Psychological testing is a powerful way to begin the helping process in these kinds of situations. It is the most efficient way to identify strengths and weaknesses in a childās skill levels, develop a comprehensive and deeper understanding of the child, and carefully formulate some initial plans to help. In 5 - 6 sessions these goals can be met, a written summary of the assessment completed, and a treatment plan provided to the parents with which to begin focused efforts to help the child.

The same amount of time spent in counseling efforts are likely to gather meaningful history, generate impressions, create hypotheses about psychological issues/concerns, and begin a psychotherapy process that might be very beneficial in psychological, social, and behavioral realms, but would not address other areas of possible concern. Counseling would not likely identify and clarify difficulties regarding intellectual functioning, academic skills, learning disabilities/processing deficits, and/or issues about attention, focus, and impulsivity.

A typical assessment battery involves:

  • an initial interview with the parents of the child to gather background, history, and current information about the child; some information about each parentās background is also helpful, especially in areas related to academic history, family issues of drug/alcohol use, and other psychological concerns;
  • 3 - 4 sessions with the child to evaluate intellectual abilities, academic skills, the possibility of a learning disability, which includes ADHD and other processing deficits, and psychological/emotional areas;
  • a follow-up meeting with the parents to discuss the evaluatorās observations, test scores, and impressions about psychological areas, as well as to provide specific recommendations for needed services.
The individual sessions with the child employ standardized instruments that have been in use for years, so that they are reliable, valid, and as scientific as possible in identifying a childās strengths and weaknesses. In making recommendations, the childās strengths are considered as sources for compensatory skills and techniques to be developed through a variety of interventions that may include:
  • adjustments to the childās school program and/or curriculum materials;
  • seeking additional services in the form of tutoring, educational therapy, psychotherapy or counseling for the child, parents, and/or family;
  • seeking additional input from other professionals who can complement the psychological evaluation with additional input from different disciplines; this may include speech and language experts, psychiatric evaluation for possible medication, neurological or specialized medical assessment.
A written summary is provided to the parents at the follow-up meeting to explain all of the findings and recommendations in language that communicates clearly to the parents, and in a format that is useful for any other professional who may become involved in helping the child. This summary is as comprehensive as possible so that the family has a complete guide with which to begin a targeted, focused effort to help their child. The recommendations are as exhaustive as possible, in as many areas as possible, to generate an intensive program of helping interventions.

While school districts are required by federal law to evaluate children when the parents make a formal request for this service, their evaluations are generally less comprehensive and less in-depth than an evaluation provided by a skilled, experienced private practitioner. Private practitioners are trained to a doctoral (Ph.D.) level, compared to school district staff trained to a masterās level. Private practitioners often devote more time to each evaluation, as compared to the heavy caseloads of school psychologists who are often delayed and limited in time to provide services. Ph.D. psychologists are trained in some instruments, especially those in psychological/emotional realms, that school psychologists usually do not administer. A private practitionerās evaluation therefore, is usually more comprehensive and complete.

The cost of an evaluation is substantial ö often in a range of $1,500 ö 2,000. This fee compensates the psychologist for the extensive time needed between sessions to carefully review the data, score the tests, make telephone contact with other professionals who may have valuable input, and write a well organized, carefully integrated written report. The report is individualized for each child to be sure it matches that childās particular needs. Quality work, to truly be of lasting help to the child, demands this kind of care and time.

While insurance coverage may reimburse for some of this cost, it often covers only a part of the fee. Insurance companies usually do not recognize the additional time needed for psychological testing to be skillfully done, so they generally refuse to provide compensation for this additional time. Some significant out-of-pocket cost is often necessary.

Jim was found to have strengths in verbal, language skills, weaknesses in visual, fine motor skills, and attention deficit disorder. A remedial program of educational therapy, a medication evaluation or neural feedback program for his ADHD, adjustments in his school program, and educational input for his parents was recommended. He is now performing consistently better in school and closer to his potential.

Nancy had serious difficulties with auditory processing - hearing sounds accurately, developing phonics, and reading comprehension. Her strengths were in social skills, psychological coping skills, and visual memory. It was recommended that she be engaged in an intensive educational therapy program for the summer to develop her phonics and reading comprehension skills, to be followed by ongoing educational therapy during the school year. Specific adjustments in her school program were suggested. Her performance is slowly, but consistently improving.

These are but two examples of how psychological testing can be a powerful tool in helping children. A clear map can be developed to begin a remedial effort that can change a childās life in a positive direction.

Dr. Solomon is a psychotherapist in practice in Torrance. He is a member of the Independent Psychotherapy Network.

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