Neuropsychological Assessment

For those who have had their kids undergo a psychological assessment and gotten an expected diagnosis, was it worth it? 

We can't easily afford the assessment cost (but could pay for it if we had to) and I'm pretty sure we know what our child's general diagnosis might be--so if that diagnosis is confirmed for nearly 2k, what then? We already have access to any medication and therapy options we're going to be offered through our insurance. They don't need any accomodations at school. All the behavioral symptoms schools would care about only present at home and there are no accomodations at school that would help them--it's not an issue of needing an aid, extra time for work, the ability to have breaks, etc.

I'm wondering if we should put that assessment money towards a non-network therapist--or more sessions--or anything that helps our child. We also are already spending a lot of money on the issues we see. 

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We had an assessment done and it was the most valuable investment we ever made - but that was because it got our daughter who has high-functioning autism as well as ADHD and generalized anxiety the help she needed at school (speech language to help with social cognition issues and to help her learn to recognize her and others’ emotions, an aid to help her with attention and executive functioning, breaks for walks in the garden to help when she has anxiety attacks/tantrums). An IEP isn't necessarily first and foremost about testing accommodations - we don’t have any - but the emotional support has been invaluable, and helps her classmates and teacher too so that my child’s occasional outbursts don’t become the center of attention. You don’t say what you think your child I guess the one thing I’d suggest is that you have a frank conversation with your child’s teacher to find out if the behaviors you’re seeing at home really aren’t manifesting at school. We went through all of daycare/preschool, K, 1st, and most of 2nd without really realizing there were issues at school. My child loved school and would come home reporting great days, though maybe some disagreements, so it was hard to imagine a big problem. I was motivated to get the assessment when school stopped last spring and suddenly I was the one there all day. Only after the IEP, now that I have a more consistent conduit to learn about school behavior, do I realize that the things I was assuming were only home behaviors were always also school behaviors, and my child wasn’t getting the social emotional instruction she really needed to help her and her teacher. I can’t tell you how much having the IEP has revolutionized school for us, and getting the 20-page private assessment detailing a battery of tests really paved the way (also $2k isn’t bad - we paid $5k for an eight-hour assessment).

So a psychological assessment (or even a psychoeducational one) and a neuropsychological assessment are qualitatively different. A psychological assessment typically covers history, intellectual capacity, some basic academics, and social/emotional/personality. A neuropsychological assessment will cover that in addition to things like learning and memory, attention and executive functioning, basic motor functioning, language, and also put all those things together (e.g., language skills are top-notch, but because of fine motor weaknesses, the child writes the minimal amount possible, and so doesn't get much practice at writing, which in turn leads to poorer writing skills over time).  One of the benefits of a neuropsych eval is that you can get a nuanced understanding of the ways in which a child presents with a certain diagnosis, which can be important to developing recommendations and accommodations, and helping parents to scaffold a child in a way that supports development. But I suspect $2k is closer to a psychological eval, not so much a neuropsych eval.

I suspect you are on the right track in trying to define what your and your child's needs are in pursuing an evaluation and in a way that might answer your own question. It might be that the accommodations and supports put in place are not helping your child make progress, and in that case, having a roadmap to a better understanding of what is needed IS likely to be an important investment before you spend money on other providers. On the other hand, it might be that you feel like your child is already making all the necessary progress with the supports already put in place (or the supports are currently working but there is a separate need that everyone agrees could be satisfied with an outside provider). From what you've said, there might be several different elements at play: in one case, your child might be doing everything they can to hold it together behaviorally at school and the effort is so much that they fall apart when they get home because they are exhausted - in which case, maybe there are other pieces to a school plan that would help; an alternative might be that your child is a little more of an orchid and needs a particular parenting touch, and so a provider who can help you tweak your parenting may help the situation at home (And just to be clear, I'm really just spitballing here - no assumption on what your particular situation is, just playing out some of the hypotheticals). In this latter case, going straight to a private provider would probably be the way to go.

And all this said, there is a real financial element, and what can be done as parents within those constraints might be different than what you would do without them. One final suggestion is that many psychologists and neuropsychologists will give you a circumscribed initial intake call for free - usually to discuss your particular situation and to answer your questions about their work. If you are very clear in laying out your questions around what an evaluation can and cannot provide, and can give them a little more detail on the particular issue you are trying to solve for, they could hopefully help you think through the options as to how to proceed.

Best of luck with a complicated decision!

IMHO, the answer to your question depends on some things that weren't mentioned in your message.... like the age of your child, what the diagnoses you suspect are? If they are academic/learning issues, then there would be some nuances that a neuropsych could shed more light on than a psychiatrist. But if you're looking at something like ADHD, a psychiatrist can do a good deal of testing to learn more about that. 

The thing about the academic/learning issues is that they're not static.... they can change and they can affect your child more at different points in their academic career, depending on what they're challenged with. And a neuropsych is a glimpse into the moment in time when it is completed..... so if your child is younger it might make sense to wait until middle school to spend the money and get the data. Maybe they'll need accommodations then.

If you're looking at psychiatric issues, then the same is true in a way. Those will affect them differently at different points in time. If this what you're dealing with, I'd invest the money in developing a good relationship with a very good experienced psychiatrist and therapist. I would not have done a neuropsych for psychiatric symptoms alone, though if they were severely affecting my child's life, perhaps I would. But I feel that we've gotten more from psychiatrist/therapist around mental health issues and then lots of very good insightful information about neurocognitive issues from a neuropsych evalulation.

It's not easy having to make these decisions. I wish that there was a better system in place.

If you are in Oakland and go to a public or private school in Oakland, OUSD will assess your child. If you are in OUSD, you simply need to request assessment. We were mildly concerned that our child may have a learning difference, the assessment result did not confirm this and I am not sure how thorough the assessment was to be honest but the tram was friendly, seemed competent, and the assessment seemed thorough spanning over multiple sessions. It was interesting to learn about how our child’s brain works and areas of her strength and weakness. We switched from OUSD to private school but the district continues the assessment and told us that Oakland residents who go to private schools are entitled to the service. So, please try and see if you can get this through the district. I was told private assessment costs $5k.