Assessment: What to Expect?
Boris Gindis, Ph.D.,
NYS Licensed Psychologist
The Family Focus
Families For Russian & Ukrainian Adoption
What assessment do the parents of a delayed and struggling
internationally adopted child need, and what should they expect
to see in the clinical report? Here are typical questions adoptive
parents ask when calling for a free consultation or referral.
Question: I was told I should do a neuropsychological
assessment of my child, but is there any difference between it and
a psycho-educational evaluation?
Answer: You need
to request a neuropsychological assessment when your child:
- Has a neurological condition (such as cerebral
palsy, certain genetic disorders, or specific medical conditions
related to a brain injury as a result of an accident or an infection
of the brain);
- Had been exposed to toxins such as lead or had
been exposed to alcohol prior to birth;
- Needs a differential diagnosis: The child was evaluated
by a school multidisciplinary team, but interventions resulting
from that assessment failed to help.
A neuropsychological assessment done for a school-age
child will assess such areas as general intellect, achievement skills
(such as reading and math), executive functions (such as organization,
planning, attention, self-regulation), auditory and visual perception,
memory (short-term and long-term), language, visual-spatial-motor
integration, emotional/behavior patterns and social skills, learning
style, and other psychological functions. Some abilities may be
measured in more detail than others, depending on the child's needs.
A detailed developmental history and data from the child's parents
and teachers may also be requested. Observing your child in order
to understand his or her motivation, cooperation and behavior is
an important part of this evaluation. The goal of a neuropsychological
assessment is not only to measure the level of functioning and separate
skills, but to determine strengths and the ways these could be utilized
to compensate for the child's weaknesses.
The neuropsychological assessment aims at understanding
the roots and the specific nature of the child's disability(ies)
- including those caused by deprivation, abuse, and psychological
trauma typical for internationally adopted children - while a psycho-educational
assessment tends to obtain a profile of the child's psychological
and educational abilities and strengths/weaknesses in order to improve
the student's overall school functioning. Although both types of
assessments may use similar tests and procedures, the neuropsychological
evaluation is more comprehensive and in-depth, while the psycho-educational
evaluation is more focused on school issues.
Question: Will a large number of tests
the clinician uses be a guarantee that the entire assessment is
thorough and will not be a waste of time and money?
No. Tests, questionnaires and clinical procedures are just instruments,
tools of the trade. Some are better than others and can provide
more data, but it is up to the professional who uses these instruments
to give an interpretation and explanation. Thus, it's crucial for
the professional working with your child to have experience with,
be knowledgeable of, and be sensitive to the issues related to institutionalization
and international adoption in order to be able to interpret the
data. Unfortunately, too often even good specialists in their disciplines
are confused by post-institutionalized children and may either overlook
or dismiss the important issues. When you bring your internationally
adopted child to the office of a psychologist, the professional
often sees a well-groomed and nicely dressed child accompanied by
somewhat nervous but otherwise "regular" middle-class, well-educated
parents. If the child has been living in the country over a year,
his communicative English will be indistinguishable from that of
his /her peers. In the perception of a psychologist, this will be
a typical family with typical issues. (The issues may be serious,
but still will be "typical"). Even when the history of the child
is known, it is difficult for a psychologist who never dealt with
post-institutionalized children to change his mind-set and re-examine
his ways of assessing and interpreting the results. This is especially
obvious in the assessment of developmental disabilities and issues
related to language processing.
Question: What should be the outcome
of the neuropsychological assessment of a school-age child?
In plain words, this kind of assessment must provide parents with
a clear, structured and usable plan of how to work with your child
at school and in the family over the next 12-18 months to address
his /her developmental and educational needs. Some experts, though
skillful clinicians, may still be unfamiliar with special-education
procedures and the linkage between assessment and intervention in
schools. They may end up with purely medical diagnoses and/or unrealistic,
vague, and irrelevant recommendations, which will be rejected by
your school as inappropriate. Other clinicians will give you an
endless list of recommendations that are not structured, pretty
much "one size fits all," and which would take up 25 hours of your
child's day if indeed implemented.
Question: Will a neuropsychological assessment
be covered by my health insurance?
It depends on your plan, but a neuropsychological assessment may
be reimbursed under medical or mental health services coverage,
particularly when a child is referred by a physician. Be aware that
a neuropsychological assessment is usually covered if testing is
conducted to establish a diagnosis as a basis for medical treatment,
to evaluate the functional impact of medical treatment (baseline
testing), or to assist in selecting treatment. For example, for
some children the use of medication may be the best approach when
behavior problems occur, while for other children the use of a behavior
plan or psychotherapy is the best approach.
Neuropsychological assessment may be covered
if your child has cognitive or emotional/behavior problems and has
a history of brain injury or has a current medical problem that
may be affecting brain development. Many insurance plans will require
a letter from your physician indicating the medical necessity of
an assessment that explains the need for additional information
to help him/her provide care for the child. Please note that most
insurance plans will deny coverage for an assessment used to establish
an educational classification (e.g. learning disability). Medical
insurance carriers view this as the responsibility of your school.
However, coverage will often be provided if the assessment is done
to substantiate a relationship between an academic problem and some
other medical problem or medical treatment.
Question: What can be done to ensure
that a clinical report resulting from a neuropsychological assessment
is useful for the school and that the parents are well-informed
about what has to be done after they receive the report?
As with everything else,
- Do good research before you commit to any assessment:
The time lost on a useless procedure cannot be recovered for the
- Make sure that your chosen specialist is qualified
for the job, experienced with the issues of internationally adopted
children, and is capable and willing to analyze the developmental
history of your child. (Sometimes it's really a sizeable amount
of documentation). A lot of problems are rooted in this history;
underestimating the child's history leads to direct misinterpretation
of the existing problems.
- Get a clear and detailed explanation of what is
going to happen and whether the goals you have in mind for this
evaluation will be addressed by the professional. Look for details
(such as referral issues, goals of an evaluation, expected outcome)
- Remember that the ultimate goal of an assessment
is a recommendation plan that is tailored to your child's specific
situation and can be implemented by the educational institution
that your child attends. Ask your clinician if he/she has experience
with school-related procedures and regulations and can write a
report that will withstand the school's critical review.
For those who need to further educate themselves about
specific psychological issues of international adoptees or are looking
for native-speaking Russian professionals in this field, here are
some recommended sites, publications, and online classes:
- Gindis, B. (2006). Cumulative Cognitive Deficit
in international adoptees: its origin, indicators, and means of
remediation. The Family Focus, FRUA (Families for Russian
and Ukrainian Adoption) newsletter, Spring 2006 (Part I) Volume
XII-1, pp. 1-2; Summer 2006 (Part II), Vol. XII-2, pp. 6-7. Available
online at: http://www.bgcenter.com/BGPublications/CCD_in_international_adoptees.htm.
- The University of Washington (Seattle) FAS Center
site at http://depts.washington.edu/fasdpn/htmls/whatisfasdpn.htm
- A set of articles on assessment of internationally
adopted children available online from the International Adoption
- A list of bilingual (Russian/English) professionals
in different adoption-related fields available online at: http://www.bgcenter.com/bilingualExtention.htm
- Sites with useful information on Neuropsychological
and Psychological Assessment http://cpancf.com/Psychological_Neuropsychological_Assessment.asp
- Sites on Benefits of Neuropsychological Assessment
- Online classes: