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. |
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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. |
