✐ BEGINNING THE ASSESSMENT PROCESS
Dr. Sarah Burger works out of our office as an independent evaluator to provide thorough evaluations for a wide range of disorders. Her background and training in pediatric neuropsychology and developmental pediatric assessment and diagnosis makes her exceptionally qualified to provide the most comprehensive and accurate assessment for your child. At the conclusion of your child’s evaluation, we will work with you to determine if services at our facility are the right option for your child’s treatment, or if we think they require the services of a different qualified provider.
There are many providers to choose from when deciding to pursue an Autism Evaluation, and since it is typically a foreign territory, how do you know that you are choosing the right doctor to perform the evaluation? For a disorder where early intervention is critical, it is imperative that the correct results are achieved with the first evaluation.
It’s okay to not know where to begin or where to turn. Our goal is to serve as a resource for parents so that all children in the Valley receive the care that they deserve. We have been there, and we have conducted research with our parents to find out what they needed to know, and what they wished that they knew when embarking on the assessment path.
HOW CAN WE AT SPBS HELP YOU?
We have done immense research on what’s out there currently when it comes to superior Autism Assessments, which is why we are confident that Dr. Burger is capable of conducting the best possible evaluation for your child. Your child should not be sitting on a waiting list when they could be receiving care. Our collaborative approach with Dr. Burger allows for a fast track for treatment in our clinic if needed, or a full treatment plan to be carried out by another service provider if that is the best option for your child.
ASSESSMENT FREQUENTLY ASKED QUESTIONS
HOW DO I KNOW IF MY CHILD NEEDS AN ASSESSMENT?
Typically, your pediatrician will alert you to certain indicators that may signal a developmental issue during your child’s routine well visits. Additionally, if you have a history of genetic, developmental, or cognitive disorders in your family it is probably a good idea to have your child screened in order to diagnose or rule out any disorders. As a rule of thumb, if in doubt- have your child assessed. It can’t hurt, and if you wait too long to begin therapy it can be less effective as their brains become less adaptive with age.
WHAT IS THE VALUE OF A GOOD DIAGNOSTIC ASSESSMENT?
No matter what the diagnosis, a comprehensive assessment provides critical answers. Finding out that nothing is wrong is a valuable piece of information. Getting an accurate diagnosis that you and others can have confidence in is one of the best things you could do in preparing to pursue the most appropriate treatment for your child. There is no risk in having your child assessed. There could be significant costs by waiting or delaying the assessment process.
WHAT DOES A TYPICAL PEDIATRIC NEUROPSYCHOLOGICAL ASSESSMENT ENTAIL, AND HOW DOES IT FALL SHORT?
This process works reasonably well for typically developing children when behavioral concerns are limited. The process falls short for kiddos with significant behavior problems and in populations where functioning is relatively low by typical developmental standards. Either problematic behaviors get in the way of the child engaging fully in the assessment process or the assessments themselves are too difficult. Scores are universally low in these cases, and there may be a disclaimer stating “this is likely an underestimate of the child’s functioning”...but when you want to use the assessment to determine that child’s relative strengths and relative weaknesses and to try to direct future interventions, this sort of a conclusion is dissatisfying...and frankly doesn’t tell you anything you don’t already know. This is where we are piloting a new method of assessment, and we ultimately hope to create a new standard for assessing complex cases.
Typically, a neuropsychological evaluation process is streamlined to include in-office data collection during a single day...or maybe over two days. The assessment day begins with the clinical interview, followed by assessment/testing. There is often a lunch break followed by more testing, or the child may return a second day to complete testing when it is felt that a single long day would be too much for them (this is more common with younger kiddos). In these settings, the testing is typically done by a psychometrist, with the psychologist meeting directly with the child during an interview of sorts, but with most data collected directly by the psychometrist. However, there are some problems that may arise when conducting an assessment in this manner.
WHAT MAKES THIS SERVICE AT SPBS DIFFERENT THAN THAT OF OTHER PROVIDERS?
The key difference between our service and others is the fact that we have decided to begin offering assessments as a courtesy to children who deserve this care. We aren’t out to start a diagnosis factory, outsource to other clinicians to complete the paperwork, or to profit off of this new branch. Rather, we see a need in the field which isn’t currently being filled to the caliber that it needs to be. We pride our therapy clinic in delivering quality over quantity care, and our evaluations are held to the same standard. Dr. Burger believes in spending a significant amount of time one on one with each child to ensure that she is able to obtain a complete diagnostic understanding. A full diagnostic assessment should not be a quick in and out appointment. If it seems like your evaluator is in a rush and isn’t dedicated to spending quality time with your child, it may be a red flag.
THE AsSEsSMENT PROCESS
THE FOUR MAIN COMPONENTS OF A PEDIATRIC NEUROPSYCHOLOGICAL ASSESSMENT:
1. CLINICAL INTERVIEW
2. DIRECT ASSESSMENT
3. DIAGNOSTIC PROCESS
4. FEEDBACK APPOINTMENT
Using this model, we have worked hard to establish what we believe to be the best process for assessing and diagnosing cognitive, emotional, behavioral, and genetic disorders and diagnosis’. Read below to learn more about each step in the assessment process.
STEP 1. MEET & GREET
We want you to feel comfortable here and trust us. We are extremely proud of our state of the art facility and we invite all prospective families to come take a look at the work we do here. The first step of the assessment process is a complimentary meet and greet and tour with Dr. Jacob Boney, clinic owner, and director. During this meeting, he will gather information on what you are seeking, a quick briefing of your child’s medical history, and help to determine whether your child will be a good candidate for the diagnostic assessment. While Dr. Jacob is meeting with you, one of our registered Behavior Technicians will administer a short, 20 minute, pre-assessment. This will be filmed and, along with the notes, Dr. Jacob collects, sent to Dr. Sarah Burger so that she can prepare for the formal clinical interview if it is decided to go down that route.
STEP 2. CLINICAL INTERVIEW
During the clinical interview, Dr. Burger will be looking to accomplish a few things:
While Dr. Burger meets with the parents to conduct the clinical interview, your child will participate in a pre-assessment custom designed to determine whether your child is ready to engage in the full diagnostic assessment. Sometimes there may be certain behaviors present which can collude the results and findings of the full neurocognitive assessment, and by determining beforehand whether they will excel in the real assessment or may not perform as well, we can ensure that they trust assessment is given. If Dr. Burger finds evidence of problematic behaviors based on the results of the pre-assessment, she will recommend behavior therapy treatment to modify those issues before administering the assessment. If Dr. Burger does not find evidence of problematic behaviors based on the results of the pre-assessment, the formal assessment can be scheduled to take place in as early as two weeks from that day. This portion of the process is estimated to take between 90-120 minutes.
STEP 3. DIRECT ASSESSMENT
During the direct assessment portion of the evaluation, Dr. Burger is looking not only to formally assess a child’s neurocognitive strengths and weaknesses, but also to make direct observations of their social skills and of their ability to detect and respond appropriately to nonverbal cues. A child is taken through a series of highly structured, one-on-one assessments designed to assess their neurocognitive strengths and weaknesses. The assessment provider does most of the writing/recording, with the child asked to respond orally to questions, to solve puzzles, to manipulate blocks, and to otherwise engage in tasks arranged by the administrator. The assessment tools vary depending on the child’s age and developmental level, but are designed to provide a broad assessment of brain functioning. Domains assessed generally include: intelligence, memory, higher-level thinking (executive functioning), language functioning, and motor functioning. Academic achievement can also be assessed as needed. A child’s performance on these assessments will be compared to that of other children around the same age, allowing us to build a profile of current strengths and weaknesses that will serve as a baseline for use in future comparisons. Total testing time can range from 3 to 7 hours, and can be spaced out across 1-2 assessment days. After the report is conducted, Dr. Sarah will begin scoring and writing the complete diagnostic report.
STEP 4. DIAGNOSTIC PROCESS
A data-driven differential diagnostic process ensues after data collection is complete. This is where neuropsychologists are the puzzle solvers, of sorts. We collect puzzle pieces from wherever we can - parental reports, observer reports, medical records, direct observation, test data...and review of all of those pieces culminates in a lengthy clinical report detailing the relevant history, assessment findings and associated diagnostic clinical impressions. Specific recommendations are made on the basis of this process, addressing any specific referral questions and making recommendations about how best to direct future neurological development. That is the neat thing about doing an assessment of a child. Their brain is still developing, and we can use data from a neuropsychological assessment to direct that development in a principled way. What are their current strengths? How can we use those to minimize the impact of clinical weaknesses and to help them learn best when it matters most? And where should we stretch them? What skill sets are lacking and in need of targeted practice? All of these questions will have answers in the final report. One month after Dr. Sarah receives all records and supplemental references and payment, the feedback appointment will be scheduled.
STEP 5. FEEDBACK APPOINTMENT
The feedback appointment is critically important. While I provide lengthy reports (8-10 pages minimum and often upwards of 15-20 pages) for all of the kiddos I assess, these can be overwhelming to digest on your own. In a feedback appointment I begin with a big picture general diagnostic overview, review data directly with parents, discuss my recommendations and answer any questions they have at the time. I also orient them to the report...where should they look for what? And how can they use this report to help solicit any services their child may be needing? They then take the report with them to review at their leisure, and are encouraged to contact this writer thereafter with any additional questions they have.
DIAGNOSTIC ASSESSMENT FAQ
How Long Does The Assessment Process Take?
The assessment process here will not be completed in a single day, but over a series of appointments. The number will depend on the child. Each assessment will begin with a clinical consult interview with parents. While the parents are engaging directly with me in a clinical interview, one of our team members will be interacting with their child in a testing room. The interaction will be principled. The team member will be engaging them in an assessment screening process, designed to determine their assessment readiness. The child will be asked to respond to oral questions and to participate in tasks that are similar in their demands to a neuropsychological assessment task, but that aren’t the assessment tasks themselves. This will be filmed, and I will review the film directly with parents following the interview consultation to discuss whether I feel their child is ready to engage in the assessment portion of the evaluation. Any problematic assessment-blocking behaviors will be identified at that time, and the behavioral team will then work with that child to target those behaviors before the direct assessment process commences. Once the child demonstrates assessment readiness, the testing process will commence, directly with me. And this process can be halted and re-started as needed should new problematic behaviors arise. The goal is to get the best snapshot possible of current functioning, with the data collected then serving as a baseline for use in future comparisons.
Does My Child Need To Be Re-Tested? And If So, How Often?
Repeat neuropsychological assessment can be really important in children, and the neuropsychologist conducting their evaluation should make specific recommendations about when repeat testing would be advised. In general, when an ongoing condition impacting brain functioning/development is identified, I recommend testing every 2-3 years. Think of the assessment as a way of measuring that child’s progress, and of assessing the effectiveness of the treatments they are engaging in during the time between assessments. Remember, an assessment gives you a snapshot of their brain functioning...how are they faring at that point in time? If the recommendations are tailored to direct future development in a principled way, shouldn’t we see how well that is working and be able to make adjustments as needed? With a repeat assessment we are no longer limited to comparing that child to other children...we can compare their functioning to previous measured levels! Repeat assessment can also be important when something unexpected happens that can impact ongoing brain functioning or development...such as following a head injury, with cancer recurrence requiring interventions known to impact brain functioning, etc.
How Much Should I Expect to Budget For an Assessment With Dr. Burger?
The cost of our complete neuropsychological assessment is $3,000.00. This includes the two meetings and pre-screening assessments with our doctoral staff at Scottsdale Pediatric Behavioral Services, the formal complete assessment, a report with observations and recommendations, and a feedback meeting with both Doctors to discuss findings and treatment recommendations.