Assessment

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In order to have an accurate picture of how a person learns, we must have a thorough assessment of cognitive and motor functions. This assessment will identify strengths, weaknesses and likely contributors to their learning, language or sensory difficulties – a relieving discovery to both child and adult clients.

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Screening

Prospective clients will meet with Dr. Conway before treatment. A formal ‘meet and greet’ allows families to field questions in a comfortable atmosphere by licensed professionals. Client history is discussed and established, as well as treatment options based upon the client profile before testing.

Phase 1 Assessment

The primary purposes of the Phase 1 evaluation are a broad Neurodevelopmental Evaluation, an evaluation of attention/focus skills and a limited range of processing skills, and a determination of whether or not the individual is a good candidate for TMC’s extensive range of treatment services. Specifically, the Phase 1 evaluation includes the following components:

1

The physician conducts a standardized, neurodevelopmental evaluation that identifies the client’s particular strengths and weaknesses in areas of language, vision, learning, fine/gross motor and attention abilities. Also, information is collected from additional sources, e.g. parents/caregivers, teachers, tutors, other healthcare providers.

2

Determining if a disorder in attention/focus exists. The specific questionnaire, evaluation and history data helps determine if an attention disorder is present; there are three different possible diagnoses which include ADHD-Inattentive, ADHD-Hyperactive, or ADHD-Combined Type. ADHD may interfere with cognitive, academic and behavioral skills, as well as academic achievement.

The Phase 1 evaluation typically takes 1.5 days to complete (or 1 week to complete if a classroom observation is conducted) and includes the following components:

Background information

Prior to scheduling the Phase 1 evaluation, we will ask you to complete detailed questionnaires asking specific information about the client’s medical, developmental and academic history. Also, we request that you provide copies of previous evaluations, test results, or treatment summaries from other clinics (speech/language, academic, psychotherapy, occupational therapy, tutoring, etc.). All questionnaires, forms and previous records must be returned to TMC at least 2 business days prior to the first part of the Phase 1 evaluation — which is a meeting with the Psychiatrist or Psychologist, called a “Diagnostic Interview”, see below for details.

Questionnaires

In addition to the background forms, there will be several standardized questionnaires about attention and behavior. You and a teacher will need to complete and return these questionnaires prior to scheduling the first evaluation appointment. Significant concerns about attention, behavior, or social skills at home, school or work may be identified by the responses to the questionnaires. If so, then we may ask to conduct a classroom observation or talk with a teacher.

Diagnostic Interview (1 hour)

During a meeting at TMC between you and the neuropsychologist, the professional will thoroughly review the primary concerns, medical, developmental and academic history. Also, behavior, emotions, personality, and social skills will be discussed, as well as any previous treatments for the primary concerns or problems identified.

Evaluation of Attention and Behavior (1 to 2 hours)

The neuropsychologist will complete a formal evaluation of attention skills – the ability to focus, sustain, divide and switch one’s attention between various tasks that may or may not be of high interest. Attention is usually assessed using tasks that involve auditory (hearing) tasks and visual (seeing) tasks. Since 50-70% of children with learning disabilities also have attention disorders, it is important to determine whether attention problems could be contributing to the learning difficulties or primary concerns. If can be problematic to assume that attention abilities are fine and to skip formally evaluating attention. Undiagnosed and untreated attention disorders may cause additional evaluations of academic, language, sensory motor or other skills to be invalid or to provide vague information about attention versus cognitive abilities. For example, in a child with attention problems it is very difficult to determine whether low scores on a reading test are due primarily to attention problems or to problems reading words. We will discuss options for addressing attention problems, if needed, prior to proceeding to the Phase 2 of the evaluation process.

After the Phase 1 data collection is completed, then a series of meetings occur which includes:

Diagnostic Staffing

The transdisciplinary team of professionals (Neuropsychology, Psychiatry, Speech-Language Pathology (SLP) & Occupational Therapy (OT)) discuss all current Phase 1 evaluation results and answer or determine the following:

1

Is a clinical diagnosis of ADHD supported by the Phase 1 evaluation results?

2

Are there weaknesses in skills that would justify explicit SLP, OT, Academic/IQ/Achievement and/or neuropsychological testing to provide detailed analysis of scope and breadth of these weak skills?

3

A plan for a comprehensive Phase 2 evaluation – the primary focus of TMC’s evaluation services is to guide planning for effective treatment(s). These can help individual’s weak skills become stronger, lead to improved skill development, and support improved functional abilities in academic and/or occupational skills, which are consistent with an individual’s true potential.

Interpretive Meeting

The clinic’s director and the psychologist or psychiatrist who participated in the Phase 1 evaluation will meet with you to review the trandisciplinary team’s Phase 1 evaluation findings and their recommended assessments for the Phase 2 portion of our unique evaluation process. The next step in the evaluation process will either be pursuing comprehensive treatment of ADHD before the Phase 2 evaluation or to begin scheduling the detailed Phase 2 evaluation. This will include a cost estimate for Phase 2 evaluation.

Phase 1 Summary

This Team Includes:
  • Nurse Practitioner or Developmental-Behavioral Pediatrician

  • Clinical Psychologist or Pediatric Psychiatrist

  • Consultation with the Director of The Morris Center and the Speech-Language Pathologist

Neurodevelopmental Evaluation Covers:
  • Medical and Developmental History & Exam.

  • Screening of all brain systems including neuromotor, perception, learning, attention, speech, language, memory, motor planning and cognition.

  • Nutrition, sleep, behavior, allergies, medical, etc.

Psychological Diagnostic Interview Covers:
  • Psychosocial background

  • Educational background

  • Behavioral background

  • Family history

Phase 2 Assessment

Based on the information obtained during the Phase 1 evaluation, a comprehensive evaluation plan is developed for Phase 2 testing. These evaluations use professionally developed tests that compare you or your child’s current performance to a nationwide sample of same-aged peers’ performance on these same professional tests. Phase 2 evaluations are scheduled based on the individual’s age, ability and stamina – children’s evaluations typically occur in the morning and last from 3 to 4 hours per day; high school students, college students and adults may complete 4 hours of testing in a morning, have an hour lunch break and then complete 2-3 more hours of testing in the afternoon. We aim to obtain the best measurement of an individual’s performance in each professional discipline (i.e. Speech-Language, Occupational Therapy, and Psychology/Neuropsychology evaluations).

1

Cognitive (2 hours)

The psychologist/neuropsychologist or psychometrician tests general intellectual abilities (Intelligence Quotient – IQ) and other cognitive skills, such as processing speed, learning, and memory.

2

Academic (3 to 4 hours)

The psychologist, psychometrician or speech-language pathologist conducts age-appropriate measures of reading, written language, and math skills. Reading skills include decoding (sounding out words with phonics and phonological skills, as well as visual memory of sight words), reading comprehension and reading fluency (reading quickly and accurately). Writing skills include spelling, writing sentences, writing an essay and writing fluency. Math skills include performing basic calculations, word problems, applying math concepts to everyday problem-solving and math fluency. Typically, the academic testing occurs on the same day as the cognitive ability testing, but this depends on the child’s age and stamina.

3

Speech and language (3 to 4 hours)

The speech-language pathologist and/or psychometrician tests phonological processing, naming, receptive language and expressive language skills. Other speech skills, such as articulation, may be tested.

4

Sensory motor/sensory processing (2 to 3 hours)

The occupational therapist tests fine and gross motor skills, balance, body awareness, reflexes, postural control and the ability to process and modulate sensory information, e.g. visual perception/processing. Also, she will meet with you for 30 minutes to review one of the sensory processing questionnaires and to listen to your specific concerns about sensory, motor, sensory processing and functional abilities at home, school and in other settings.

Transdisciplinary Diagnostic Meeting — A Unique Feature of The Morris Center

After all components of the Phase 2 evaluation are completed, the transdisciplinary team meets and discusses the test results across each discipline in a comparison and contrast format — e.g. do the speech-language test results influence the interpretation of the occupational therapy, academic or psychological testing and vice versa between all disciplines. Next, the team develops a profile graph of the individual’s specific strengths and weaknesses, determines specific diagnoses, and creates an individualized treatment plan which may include speech-language therapy, occupational therapy, behavior management/parent training, medication management, and psychotherapy/counseling.

Interpretive Meeting — TMC’s Team of Professionals & Parents or Adult Client

During this meeting, which typically takes place a few days after the diagnostic staff meeting, the transdisciplinary team reviews the results of the evaluation with you in depth. The team answers your questions as they explain the individual profile of strengths and weaknesses and provide individualized treatment recommendations. At the end of this meeting, if treatment at TMC is something you choose to pursue, some logistics will be discussed including: an estimate of treatment costs, typical or available daily/weekly treatment schedules and the next available treatment start date. Until the Interpretive Meeting has been completed, we cannot determine or guarantee an exact start date for treatment with TMC’s unique team of professionals and research-based treatment programs. Start dates for treatment at TMC are open-ended and are based on availability on a first-come first-served basis. A cost estimate for the individually-prescribed treatment plan (listing discipline, duration, frequency, intensity for treatment) will be provided. A financial deposit is required to reserve treatment services at TMC.

Phase 2 Summary

In summary, the entire Phase 1 and Phase 2 evaluation process may take 2 to 10 weeks to complete (if ADHD medication is needed) or 2 to 4 weeks (no ADHD medication), will provide detailed information about the client’s strengths and weaknesses from a state-of-the-art transdisciplinary perspective and will guide the development of individualized, research-based treatment plans.

At any time, if you have any additional questions about the evaluation process at The Morris Center, then please ask Jana, the Gainesville clinic’s Office Manager. She will either answer your questions or relay your questions to the appropriate professional to get an answer for you as soon as possible.

Is there a tool to give self assessment?

Learning difficulties do not go away with age or time. Children do not “outgrow” learning difficulties. Without the proper treatment, children with learning difficulties can grow up to become adults with learning difficulties. Only the proper treatment can change their weaker learning or academic skills into strengths; commonly our clients have strengths in other skills too. Our unique transdisciplinary team and treatment program can dramatically improve learning, language, sensory processing, attention, behavior and academic skills. Our individually-tailored treatment programs are highly successful regardless of whether our client is 4 years old or 78 years old; the brain’s ability to develop or improve skills follows some consistent principles at all ages and new scientific evidence supports that the human brain is able to develop or improve abilities at all ages.

 Warning Signs

There are warning signs for parents and individuals who suspect that they or someone they care about has a learning disability.

Speaking

Trouble with articulation, mispronunciation of words; using correct verb tenses, plurals, pronouns

Listening

Trouble appreciating rhyming, sound or word games

Word finding

Knows colors, but can’t name them when asked

Sequencing

Difficulty telling an event/story in orderpronouns

Fine Motor Skills

Has difficulty learning to cut with scissors, tying shoes, blowing nose

Coordination

Clumsy, messy eater

Sensory Processing

Overreaction to some senses (light touch, different textures, smell,

Speaking

Mispronunciations, slow word finding; grammatical errors earlier have diminished

Phonological Awareness

Cannot appreciate the individual sounds in words heard, spoken, or read

Reading and Spelling

Difficulty learning to sound out words for reading and spelling – relies on sight words, reading is slow and effortful

Sequencing

Errors when reading – was for saw; telling an event order

Auditory Memory

Has difficulty holding multi-step directions

Handwriting

Awkward pencil grip, presses hard on the paper

Focus

Trouble concentrating/wears out before a task is done

Self-esteem

Begins to experience failure and frustration

Speaking

Mispronunciations and slow word finding

Auditory Memory

Has difficulty holding multi-step directions; holding alphabet in head for phonebook, and dictionary use

Reading

Slow, avoids it; relies on sight words; guesses

Spelling

Poor carryover after spelling tests

Writing

Avoids it; when he has to, sentences are short

Handwriting

Effortful, messy, awkward grip

Language Expression

Has difficulty getting ideas in words and sequencing appropriately

Foreign Language

Hard to learn

Focus

Trouble concentrating; wears out before a task is done

Achievement Tests

A discrepancy between performance in math versus reading

Self-esteem

Increasing frustration and poor self-esteem