How To Obtain an Evaluation If You Suspect Learning Differences in Your Child (Living With Labels Series, Part 2)
In Part 1 of IOH’s “Living with Labels” series, we faced our fears of stigma head-on and shared how faith is our most powerful ally.
Today, in Part 2, we will walk you through the steps involved in obtaining an evaluation and include a little-known tip for helping families in need secure an evaluation for a reduced fee.
DISCLAIMER: We are a homeschool family. When discussing the evaluation process and procedures involved, we will be referring to the steps you need to take to pursue a private evaluation outside of the public education system. Just as homeschool laws vary from state to state, so do evaluation procedures and options. For more information on how to utilize your local school district’s resources as an evaluation source, check out the Homeschool Legal Defense Association’s website.
Where To Begin
Typically, the first place parents turn to when searching for referrals is their family physician or pediatrician. Most physicians keep a referral log of providers in various specialties and can provide you with this list upon request. You should note that if you plan to use insurance to cover some of the costs, oftentimes authorization from a primary care physician, family physician, or treating pediatrician is required.
If you plan to try and use insurance to cover some of the cost of testing, be advised that insurance plans and coverage vary. Contact your insurance provider to ask about your plan’s coverage and request a list of approved providers in your area.
Ideally, a multidisciplinary team of professionals (i.e., a family physician or pediatrician, a child psychologist or neurologist, and an occupational or physical therapist) should be involved in evaluating your child. The type of provider referrals you will need will also vary based on what type of evaluation you are seeking. The type of evaluation you will need is based on your presenting problem (i.e., speech, motor delays, hyperactivity, poor focus/inattention, learning challenges).
For example, if your child is experiencing motor delays and struggles with balance and coordination, and you suspect a diagnosis of Developmental Coordination Disorder (DCD/Dyspraxia), you will want an evaluating professional who is familiar with DCD, such as a Pediatric Neuropsychologist or a Neuropsychologist. Post evaluation, if a DCD diagnosis is confirmed, you will want referrals to a Physical Therapist and/or Occupational Therapist to assist with intervention.
If you suspect your child may have a Specific Learning Disorder or Learning Disability such as Dyslexia, Dyscalculia, or Dysgraphia, then you will need referrals to a Psychologist (Clinical, Educational, Neuropsychologist, or School) to perform the evaluation.
Talk with your primary care provider about your concerns and ask them to help guide you to the proper referring specialists.
Know Your Reasons for Seeking An Evaluation
Your reasons for seeking an evaluation are important.
As a homeschool parent, I use the information from my son’s evaluations to help guide ongoing treatment goals to foster his development in adaptive living skills, socioemotional functioning, and academic achievement.
As a homeschool family, we have the freedom to accommodate and modify curricula as needed. I work closely with our therapy team to develop appropriate accommodations for his learning at home. Our therapy crew is a vital resource in promoting my child’s success.
Our view of success goes beyond textbooks. Learning to tie his shoes, dress and care for himself independently, and ride a bike is just as important as writing legibly in my book. These are life skills that foster self-esteem and help him grow as a person. Academic benchmarks aside, I want to help my son grow as a person, learn how to adapt, understand his needs, and learn how to self-advocate for these needs as he grows.
You need to know your reasons for wanting (or not wanting) a label. Although my son has been receiving services since he was a toddler, I recently asked our Occupational Therapist to perform a handwriting assessment. While we have always accommodated as needed by scribing, encouraging typing skills, answering questions orally, and limiting the number of handwritten assignments, our fourth-grade year was presenting some challenges with the increasing amount of written work that naturally results from a child advancing in grade levels. The results helped provide a clearer picture of my son’s needs and helped guide treatment goals moving forward.
My son is a bit of a perfectionist. We are working on “good enough” handwriting. Being able to rule out an official diagnosis of Dysgraphia allowed us to focus instead on building hand strength, endurance, and self-acceptance. Now, we focus on self-confidence, perseverance, and best efforts supported through relaxation and therapeutic listening.
Proper diagnoses guide proper care. Proper care facilitates progress.
Obtaining an Evaluation
A multidisciplinary team is ideal, but not necessarily commonplace. When we first sought an evaluation our son was a toddler. We met with our pediatrician and received occupational and physical therapy referrals.
We were fortunate enough to form a treatment team early on that was familiar with DCD. With our treatment team’s help, we were also able to rule out other possible neurological or physical causes for our son’s developmental delay, such as a closed spina bifida.
Typically, referrals begin with the child’s pediatrician or family practitioner, as this is the health professional most often in contact with the child. Parents are already worried enough about their children before they step foot into a provider’s office. I find having a checklist of tips and pointers helps lower the overall stress level, helps things run more smoothly and efficiently, and makes for an overall more positive experience with the process.
As our primary diagnosis is DCD, below is a sample list of recommendations that may prove useful if you suspect your child may fit the criteria for a diagnosis of DCD. Simply follow the same steps, minus the specific DCDQ Questionnaire, to help you initiate the evaluation process:
Prior to your appointment, make a list of your observations and concerns about your child.
If you suspect DCD, consider downloading and completing the Developmental Coordination Disorder Questionnaire (DCDQ), a brief screening tool for parents of children with motor coordination challenges. The tool is available free of charge.
Take the list and DCDQ results with you to the appointment. Doctor’s offices can be intimidating places (especially to already worried parents).
Carry a handout on DCD with you to the appointment. Having information in front of you can help facilitate a dialogue between you and your care provider. (Check out our Freebies Page for a printable handout or Infographic.)
Ask for a referral list. Most doctor’s offices have a comprehensive list of providers including occupational, physical, and speech therapists, as well as psychologists, psychiatrists, and other specialists.
When contacting your specialist for an appointment, ask if the provider is qualified to evaluate for your areas of concern (i.e., ADHD, DCD, learning disorders) If you are requesting an evaluation for DCD, be sure to take a copy of the completed DCDQ with you to the appointment.
Be sure to sign Releases of Information at both your Pediatrician’s/Family Practitioner’s Office and the evaluating professional’s office so all professionals can communicate with one another about your child’s care.
Below are a few videos to explain the process involved in evaluating Learning Disabilities.
and Developmental Coordination Disorder:
Be Prepared to Make Multiple Office Visits
Typically, evaluations are completed over the course of several sessions. Depending on the measures administered, multiple office visits may be required. Intelligence and achievement tests alone (standard components of the psychoeducational battery of tests) can take a few hours each.
Furthermore, if you are seeking evaluation for comorbid (co-occurring) conditions, you may be visiting the offices of multiple practitioners, such as Occupational Therapists, Physical Therapists, your child’s Pediatrician, or other specialists such as Neuropsychologists or Educational Psychologists. Each of these professionals may have their own instruments to administer. (Hence the importance of signing releases so each member of the treatment team can easily communicate with one another.)
The assessment process can be quite lengthy. Children tend to fatigue. Who am I kidding, adults fatigue with this process! Take a snack for your child (maybe one for you, too,) and be sure they have a full tummy and are well rested the morning of evaluation day.
Spreading the assessment across multiple sessions increases the odds of obtaining a child’s best efforts. Best efforts coupled with an accurate assessment of their capabilities and/or deficits increase the chances of an accurate diagnosis (which is why you wanted an evaluation to begin with).
In our family’s case, a simple handwriting assessment that normally takes 45 minutes was spread across two office visits, and with good reason. Our son is a bit of a perfectionist. He began to perceive he was performing poorly and became frustrated. Frustration led to a meltdown and the meltdown led to a shutdown. Had his OT pushed forward with the attempt to complete the assessment on the same day, we would not have secured an accurate diagnosis. An inaccurate diagnosis would have steered our treatment goals in the wrong direction, only further complicating the issue.
Reviewing the Results
Once the testing sessions have been completed, your clinician will score the instruments administered and compile a written report. You will be given a copy of this report at a follow-up session.
Oftentimes this report is filled with technical jargon, charts, and data. Even for a parent who has a background in psychological testing like myself, the stack of stapled papers and the information it contains can be overwhelming. Ask for a copy of the report in advance to review at home prior to your sit-down follow-up session with the examiner.
Doctors’ offices and professional offices tend to put all of us a bit on edge. The white-coat syndrome is a real thing. When we are anxious, we do not process information as well as we would like. Unfortunately, our brains are simply not wired to do so. You will want your first look at the results to be in a comfortable environment where you can relax and focus your full attention on the page in front of you with more than five minutes to spare before being required to discuss it in depth.
When you have a few moments to yourself, sit down, perhaps with your spouse or a trusted close friend or family member, and take your time reading through the report. Read through it once and check your feelings. If there is information contained that you find upsetting, put it down again. Come back to it again in a few minutes or later in the day when you are calm.
Once you are calm, then you can begin to make notes in the margins for your upcoming sit-down session with the evaluating clinician. These notes should help clarify any confusion and assist you in formulating any questions you may have about the next steps.
Financial Considerations
How much does testing cost?
The short answer is it varies. Many factors come into play, such as the experience of the clinician, the types of instruments administered, and the amount of time required to score the instruments and write a report beyond the testing sessions themselves.
The below video provides only one example, an ADHD assessment with a certain specialist, utilizing a certain technique known as brain mapping, in the specific region of St. Louis, MO (yes, geographic location can also impact cost). Keep in mind, that this is only a single snapshot in a reel of possibilities.
Does insurance cover the cost?
Again, the answer is “it depends.” Insurance plans differ greatly. If you plan to use your insurance company to try and cover some of the costs then you need to contact your insurance company prior to setting up appointments for assessment. Inquire in depth about what sort of testing is covered, including if you have a co-pay or if you must meet your deductible.
**For a comparison of school-based versus private-based evaluations check out the below video from Understood.org
Red Flags To Look Out For
It is my goal to take as much fear out of the evaluation process as possible. However, I would be remiss if I did not share with you some potential “red flags” to look out for as you pursue this process. Just as there are great teachers, great mechanics, and great doctors, unfortunately, the reverse is also true.
While it has been over twenty years since I worked in testing and assessment, during that time I witnessed my fair share of both great examiners and examiners who perhaps should consider a career change. I am not referring to the typical range of “good days” versus “bad,” I am speaking in terms of patterns of behavior.
Here are a few things to consider either prior to and/or during sessions:
Check credentials. Prior to making an appointment check your clinician’s credentials. Ask about their educational background and if they are currently in good standing with their professional license. Personally, I recommend going a step further and checking with your local state board to ensure they are up to date on their license without any restrictions to practice.
Inquire About Testing Experience. Possessing a current license in good standing is of the utmost importance in due diligence. Your next step before setting foot in the front door of a practitioner’s office is to inquire about his or her testing experience. Explain to the clinician (or receptionist) what type of testing you are seeking (ADHD, Learning Disability, DCD/Dyspraxia) and inquire about your examiner’s experience with the diagnosis as well as the battery of tests required to confirm or deny said diagnosis.
Does the clinician have a lot of experience with this type of service? On a regular basis? Or did they perform one assessment a few years ago?
Poor Communication. It goes without saying that, at a minimum, providers in helping professions should be effective communicators. Unfortunately, that is not always the case. This does not mean that occasional misunderstandings do not happen, as both client and clinician may struggle at times to effectively explain needs, expectations, concepts, and outcomes. As human beings, we are flawed and at times those flaws reveal themselves in the form of miscommunication.
However, just as the therapy relationship is unidirectional (i.e., flowing only from clinician to client as opposed to reciprocal in friendships, family, and spouses), the burden of clarification falls to the provider. It is the examiner’s responsibility to ensure the client has a clear understanding of what services will be rendered, the cost of said services, and possible outcomes of participating in services (positive and negative). This is part of the informed consent process for clients when they agree to participate in treatment.
The clinician should be able to put you at ease with the testing process by answering your questions both patiently and thoroughly. Overuse of technical jargon, unwillingness (or inability) to use layperson language or clarify confusing terms, or an inability to effectively listen to a client’s concerns are all red flags and a sign to seek services from a different professional.
There is much to be said for due diligence. A little bit of prep work ahead of time can save you a lot of frustration, and perhaps money, down the line.
Hidden Resources
For families in need of a psychoeducational evaluation for learning disorders, and who can also demonstrate a financial need, there are options.
Local Universities. Look no further than your nearest college psychology clinic. If you are fortunate enough to live near a university with a graduate-level program in clinical, counseling, educational, and/or school psychology, then there is a high likelihood you may be able to find a gem of a resource.
Graduate-level students require practical hands-on training to learn their craft. While under the careful watch (supervision) of a team of licensed psychologists, these students are a treasure trove of information and opportunity. Most university-level psychology clinics offer services for either a reduced fee or as a sliding scale fee option based on income.
This practice is fairly commonplace. It provides a mutual benefit to both the university and the community. Students are granted an opportunity to learn while providing a vital service to families in the community and helping alleviate a financial burden.
Type “universities with graduate psychology programs” in one of the specializations I mentioned above (i.e., clinical, counseling, educational, and/or school psychology) into your favorite search engine. You can also locate programs through GradSchools.com.
Once you find a university in your area, search for the psychology clinic (in a pinch even the psychology department can point you in the right direction). When you call the clinic, simply ask about what kinds of services they offer (testing and evaluation, therapy, treatment), and their fee schedule. Inquire as to whether they offer reduced rates, sliding scale, or both. Proof of financial need may be required.
Teaching Hospitals. Similar to graduate students learning how to hone their skills through either free or reduced-rate services, teaching hospitals may also offer free or reduced evaluation and/or intervention services. These services benefit the hospital by providing a pool of research participants for ongoing projects. Not only will you be getting high-quality services at a reduced rate, but you will also help to further advance studies in the area of disability research. Check with the education, psychiatry, psychology, or neurology departments.
Advocacy Groups. The Learning Disabilities Association of America (LDAA) also offers resources to help families find low-cost testing and tutoring services in their area.
Coming Up
We hope we helped take the sting out of the evaluation process with this post. Join us next week for the final part of our “Living with Labels” blog post series, “You Have A Diagnosis, Now What?”
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Blessings,
Kimberly
IOH Mom
This website is not a professional counseling website and nothing here should be construed as professional counseling advice. Although Kimberly Bennett, LPC is a Licensed Professional Counselor, she is not your counselor, and no counselor-client relationship is established unless she has signed an agreement with you. All information provided through this website is for informational and educational purposes only.This post may contain affiliate links. Please read my disclosure statement. Thanks for visiting!
