Specialized Evaluations

A psychological evaluation for Autism spectrum disorder, also referred to as ASD, is critical to determine the evidence-based therapies that will support your child’s communication skills, social skills, adaptive daily living skills, and attention regulation.  

Early assessment is about correctly identifying what challenges your child is experiencing in order to provide the correct therapeutic supports.  By identifying Autism early, your child can access therapy at a time when their brain is more “plastic,” meaning treatment can potentially change or improve the connections in the brain.

After a period of treatment, you can have your child re-evaluated and see if they still qualify for the diagnosis or measure symptom improvement. Research shows that 3% to 25% of children diagnosed with ASD will show symptom improvement to the point that they no longer meet criteria for the diagnosis.

ASD is a neuro-developmental disorder, something that occurs in the early formation of the brain. Children with Autism Spectrum exhibit differences relating to other people socially.  As infants, children with ASD are likely to experiences delays in language development or use language in ways that are atypical. For example, children may use their vocabulary for labeling items, or to meet their basic needs, but may not engage in social interactions or may not combine gestures or eye contact with verbalizations. Other children with Autism may have language skills but have trouble knowing how to start a conversation, or may recite scripts from favorite videos or TV shows, or may have trouble sustaining a conversation that is of mutual interest.  

Children with ASD tend to have a different style of play. Children tend to play with parts of toys, such as spinning the wheels of toy cars or flicking the eye lashes to a baby doll. Children can also form attachments to hard objects as opposed to stuffed animals.  Sometimes, these differences are confusing to parents / guardians because the child may show better communication and social skills with close family members within the home but not use those skills with others in public. 

It is common for a child diagnosed with ASD to become fixated on topics that most other people would consider unusual and the children have trouble letting go of these topics. This can create an awkward feeling during  a conversation. Many children become consumed with following rigid routines and a strong insistence on sameness. There is a tendency for many children to have difficulty with transitions, especially if they are not prepared ahead of time.  This may lead to meltdown and tantrums. 

Additionally, children with ASD may engage in motor activities that appear odd and purposeless. These may include hand flapping, rocking in place, jumping up and down repeatedly, pacing / running back and forth, or walking on tip toes. Some children are also interested in the parts of toys as opposed to the whole toy. 

The Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5) defines Autism Spectrum Disorder as differences in two core areas: social-communication and repetitive behaviors. These differences in social communication and restricted and repetitive behaviors vary in degree of severity within children as well as across children, often making it difficult to fully understand why a diagnosis may have been given. For example, a child may have mild repetitive behavioral tendencies,  but have more pronounced social difficulties or vice versa. Alternatively, one child may have severe  challenges across symptoms, and another child may present with only mild differences which do not  significantly impact his or her ability to function in daily activities. For this reason, the diagnosis has been termed a “spectrum” in which characteristics can vary to any degree across the core domains (i.e., social communication and repetitive behaviors/interests).

Early evaluation is crucial to accessing the appropriate early intervention.  Unfortunately, certain therapeutic supports are only accessible after a diagnosis is determined by a comprehensive psychological evaluation.

Children with gifted intelligence may appear bored, unmotivated, and/or act silly in the classroom.  Children with gifted intelligence may have big emotions and perfectionistic tendencies or anxieties.  It is important to assess whether or not a child possesses above average intelligence and may benefit from accelerated academic programs or different social-emotional supports.   

Children and adolescents with learning differences experience difficulty with learning and applying academic skills.  Some children with a learning disability read at a very slow rate or have difficulty comprehending the material.  Children may have difficulties with writing, such as misspelling, omitting words or letters, or planning and organizing their thoughts in written form.  Other children may have difficulty with mastering numeric facts, arithmetic computations, and mathematical reasoning.  There are many interventions and supports for children with learning disabilities that will facilitate their self-confidence and achievement at school.

Children with communication disorders experience difficulty acquiring and using language, and these disorders may present differently.  For example, some children may have reduced vocabulary, difficulty with grammar and sentence structure, stuttering, or reproducing speech sounds.  Other children may experience difficulty following the rules of a conversation (e.g., taking turns) or difficulty changing their communication style in accordance with the setting or the listener (e.g., speaking at different volumes in the classroom and the playground).  Conducting an evaluation to define these areas is important to pinpointing the appropriate therapeutic supports that will help your child develop.

Some children, adolescents, and adults experience difficulty regulating their emotions and behaviors in response to an event, interaction, or thought.  Those with disorders of emotional dysregulation react in an emotionally exaggerated way that is out of proportion to the stimulus.  Examples of emotional overreaction include an exaggerated startle response, bursts of anger, crying and excessive sadness, making accusations, passive-aggressive behaviors, and creation of chaos or conflict.  Emotional dysregulation is a feature of many different psychological conditions, such as AD/HD, attachment issues, Post-Traumatic Stress Disorder (PTSD), mood disorders (e.g., depression and Disruptive Mood Dysregulation Disorder), or anxiety disorder.

There are many ways a child or adolescent may demonstrate feelings of anxiety.  Young children may experience anxiety about being separated from a certain person.  This anxiety may manifest itself so that the child appears fearful or reluctant to go to school, and the child may experience nightmares.  Some children are fearful of speaking, such that children with selective mutism will not speak in specific social situations despite speaking in other situations.  

Other children may have a fear or anxiety about a specific object or situation.  For example, some children are fearful of storms, heights, choking, loud sounds, or costumed characters.  Children may cry, scream, or avoid the objects or situations.  Others may be fearful of public transportation, being in either open or confined spaces, or being away from home alone.

Children and adolescents diagnosed with anxiety often suffer its most comment symptom: panic attacks. These recurrent attacks are characterized by pounding in the ears, trembling and shaking, nausea and dizziness, and fear of losing control.  Panic attacks may be due to concerns, fears, and expectations or due to a specific situation.

It is important discuss symptoms of anxiety with your medical provider because symptoms related to anxiety may be a reaction to a medication or due to a medical condition.

 An evaluation is strongly recommended if your child is diagnosed with ODD or described as oppositional.  This is a controversial diagnosis that describes a set of behaviors that may be the result of something else.  Children and adolescents diagnosed with ODD are typically described as irritable and short-tempered. They are often disobedient at home or school, apt to ignore or rebel against rules, and may be quick to blame others for mistakes. These behaviors are most typical in children.  Children are frequently misdiagnosed with ODD when in fact there are other reasons for the behaviors. This is important because the treatments and therapies will be different. 

There are many forms of depression, and can consist of persistent feelings of sadness, worthlessness, and lacking / decreased desire to engage in activities. People often feel hopeless and have decreased energy.  Children tend to express depression differently than adults, in that they are often more irritable and angry.  Some children may display a predominate mood of irritability and may respond to situations with emotions that are too intense for the situation.

School-related challenges may be anything that a parent or child struggles with at school. Two prime examples are bullying and victimization.  Other examples include difficulty transitioning to a new school after a move, or the receipt of an Individualized Education Plan (IEP) and special education services.  Some children experience difficulty transitioning back to school after a head injury, such as a concussion or traumatic brain injury.  These children need a support system and specific plans to ensure a safe, healthy, and successful transition back to the learning environment.  They may require special education services or a 504 plan for a brief period.