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Psychological services for internationally adopted children
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Q: What are the differences in evaluations done by school psychologists, clinical psychologists, and neuropsychologists?
A: Basically your choices are between the three branches of contemporary psychological services: school, clinical, and neuro psychology. Your choice of the specialist depends on the nature of the problems and your goals. Let me briefly describe the specificity of each specialty and point to the advantages of using each one in certain circumstances. (It is assumed that all three types of psychological services are provided by a doctoral level [having either Ph.D. or Psy. D. titles after their names] licensed psychologist specializing in working with children.)
Clinical psychologists assess and treat children with a wide variety of psychological problems, but particular with emotional/behavioral issues. They may be found working in hospitals, community health centers, or private practice. Although most clinical psychologists are generalists, who work with a wide variety of populations and problems, some may specialize in a specific population and specific disorders (e.g. attachment or post-traumatic stress disorder). They are trained in universities or professional schools of psychology and may not be very familiar with school settings. Clinical psychologists provide both assessment and treatment (psychotherapy).
School psychologists are involved in enhancing the development of children in educational settings. They assess children's psychoeducational abilities and recommend actions to facilitate student learning and overall school functioning. They are typically trained in the Schools of Education at universities and work in school systems, community-based agencies, or private practice. A few may specialize in a particular school-related problem such as learning disabilities or ADHD. While specializing in educational issues, they may not be well trained in medical-based disabilities and disorders. School psychologists usually administer both norm-based psychological tests and criterion-referenced educational (achievement) tests.
Neuropsychologists represent a specialized discipline within the field of psychology that mostly focuses on cognition (the ability to think, remember, learn, etc.) in relation to the effects of brain damage and organic brain disease. A neuropsychologist can administer standardized psychological and neuropsychological tests to patients in private office and hospital settings, may offer various forms of cognitive rehabilitation, and usually furnishes clinical opinions regarding the presence, scope, and treatment of cognitive disorders and behavioral disturbances as well as certain mental illness. The neuropsychologist uses knowledge of brain development, brain organization, and the effects of various forms of brain injury on development to guide this assessment and to interpret the results Please note that damage to brain functioning could be due not only to organic (physical) injury (a severe blow to the head, stroke, chemical and toxic exposures, organic brain disease, substance abuse, etc.) and also to non-organic means such as severe deprivation, abuse, neglect, mental disorders, and severe psychological trauma as found in many internationally adopted post-institutionalized children.
  All three specialties use standardized psychological tests (SPT) as their major instruments (professional tools), as well as observations, interviews, and different questionnaires. Standardization is a clinically established procedure developed to diagnose and quantify behaviorally-expressed mental conditions. Resulting SPT have clinically-validated norms; the amount of deviation from established norms helps determine the severity and scope of the mental condition or pathology being manifested. SPT, administered in oral, written, and tactile forms, are quantifiable, often using standard scores and a percentage. Please note: IA children are not a part of any standardization sample and a psychologist must understand the limitations in using standardized tests with them. In addition to the same tests that are used by clinical and school psychologist, a neuropsychologist can administer specific neurological tests. These are also standardized, clinically-established procedures, developed to assess the severity and scope of existing cognitive/emotional impairment. These tests are usually administered to high-risk/seriously deficient patients who exhibit obvious symptoms of cognitive dysfunction and impairment. A typical neuropsychological battery may include up to 8-12 specialized tests selected by an attending professional and can take many hours to complete.
The most profound disadvantage in using a neuropsychlogist in relation to school-based issues is that some experts, being 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 unrealistic and irrelevant recommendations that can be easily rejected by your school as "inappropriate." They may use instruments and procedures that are suitable for hospital settings but are irrelevant for school settings (e.g. some projective procedures). Therefore, when hiring an independent evaluator, parents must be sure that this person is not only qualified to perform the required evaluation, but also has the training and experience needed to collaborate with school staff in developing programs and interventions for students.
First and most important: whatever specialty the professional working with your child, he/she should have experience with, be knowledgeable of, and be sensitive to the issues related to post-institutionalization and international adoption. If the specialist has no prior experience with or knowledge of these very specific patients (and you have no one else to go to), at least educate this professional by giving him/her articles to read or refer him/her to relevant websites on the Internet before the first appointment. Unfortunately, too often even good specialists in their disciplines are confused with PI children and may either overlook or dismiss the important issues. When you bring your IA child to a psychologist's office, the professional sees a well-groomed and nicely dressed child accompanied by somewhat nervous but otherwise "regular," middle class, well-educated parent(s). If the child has been living in the country over a year, his English (communicative) will be undistinguishable from his/her peers'. So in the psychologist's perception, this is a typical family with typical issues (perhaps serious issues, but still "typical"). Even when the history of the child is known, it is difficult for a psychologist who has never dealt with PI children's issues to change his/her set of mind and to re-examine the ways of assessing and interpreting the results. No wonder: not many professionals in contemporary America have experience dealing with the type of overwhelming deprivation, lack of nurturing, and abusive neglect found in children from orphanages abroad. Many pay lip service by acknowledging the specificity of this group of children, but are not professionally ready to critically reassess their assessment and treatment strategies.


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