What is a Neuropsych Evaluation? Dr. Jonine Nazar-Biesman on Navigating & Learning From Assessments

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Do you have a true understanding of what a neuropsych evaluation is? I know the assessment process can be daunting and complicated to navigate, especially in recent years as a result of Covid, so I’m  excited to share my conversation with pediatric and adolescent young adult neuropsychologist, Dr. Jonine Nazar-Biesman. As you’ll hear, Jonine’s work is about taking into consideration the whole child and the big picture when assessments are being done. 

In our conversation, we talk about what parents should think about when vetting psychologists to assess their child, the difference between a neuropsych, a psychoeducational, and a psychological evaluation, and how parents can navigate getting a better assessment if they believe their child got the wrong diagnosis. We also talked about what to do with all the feedback parents get from a neuropsych evaluation and how that feedback can best be relayed to our kids, and to their schools.

 

About Dr. Jonine Nazar-Biesman

Dr. Jonine Nazar-Biesman has over 25 years of experience specializing in assessing and treating children, adolescents, and young adults with neurodevelopmental disorders such as Autism, ADHD, learning differences, and genetic conditions. She works closely with families, treatment teams, schools, and the community to ameliorate social-emotional, behavioral, and educational challenges. Her office provides both comprehensive evaluations, in-office therapy, home visits, and tele-health sessions. For young toddlers and children, she offers neurodevelopmental assessments and works extensively with parents in formulating early intervention programs for children ages 0-5. Dr. Biesman also specializes in forensic neuropsychology to assess damages due to traumatic brain injury, birth insults, and environmental toxins.

 

Things you’ll learn from this episode

  • What parents should think about when looking for someone to do an assessment for their child, as well as tips for vetting evaluators
  • The difference between a neuropsych, a psychoeducational, and a psychological evaluation
  • How Jonine works with students and adjusts the evaluation process during the assessment in response to what she’s discovering
  • How parents can navigate getting a better assessment if they believe their child got the wrong diagnosis
  • Whether or not a neuropsych evaluation would benefit every neurodivergent child
  • How feedback is ideally shared with parents, kids, and schools after an assessment has been completed
  • How the COVID pandemic has impacted the assessment process
  • How parents can best use the detailed feedback they receive as part of the neuropsych evaluation process

 

Resources mentioned on what is a neuropsych evaluation

 

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Episode Transcript

Debbie Reber  00:00

Tilt Parenting is proud to partner with Outschool this podcast season. Outschool’s unique approach to education empowers differently wired kids ages three through 18 to dive into their interests in small live classes designed to foster a love of learning, create connections and cultivate independence. Learn more at outschool.com/tilt.

Jonine Nazar-Biesman  00:23

If there’s one tidbit of information I could encourage parents, it’s just to really don’t shy away from that communication piece with a person who you’re bringing your child to see whether it’s a therapist or your assessor have that open communication. If you’re not happy with something or you have a question about something. Don’t feel like you have to defer to the professional. Be honest, and be open to having the process be collaborative so that you can be the good self advocate for your child that you are and were meant to be.

Debbie Reber  01:03

Welcome to Tilt Parenting, a podcast featuring interviews and conversations aimed at inspiring, informing and supporting parents raising differently wired kids. I’m your host, Debbie Reber and I know that the neuropsych assessment process can be incredibly daunting and complicated to navigate, especially in recent years as a result of COVID. So I’m excited to share this conversation with pediatric and adolescent young adult neuropsychologist Dr. Jonine Nazar-Biesman. As you’ll hear Jonine’s work is about taking into consideration the whole child and looking at the big picture when assessments are being done. In this episode, we talk about what parents should think about when vetting psychologists to assess their child. The difference between a neuropsych, a psychoeducational, and a psychological assessment, and how parents can navigate getting a better assessment if they believe their child got the wrong diagnosis. We also talked about what to do with all of that feedback that we get from a neuro psych evaluation and how that feedback can best be relayed to our kids and to their schools. And let me tell you a little bit more about Jonine before we get started. Dr. Nazar-Biesman has over 25 years of experience specializing in assessing and treating children, adolescents and young adults with neurodevelopmental disorders. She works closely with families, treatment teams, schools and the community to ameliorate social, emotional, behavioral and educational challenges. Jonine also specializes in forensic neuropsychology to assess damages due to traumatic brain injury, birth insults and environmental toxins. And before I get to that, a quick reminder that Seth Perler, my friend, colleague, executive function coach, and a frequent guest of this podcast is getting ready for his next executive function online summit. The summit runs August 5 through the seventh and honestly, Seth over delivers on this event. He has an incredible lineup, and it’s all centered around practical yet unconventional strategies to help kids who struggle with any kind of executive functioning challenges to succeed. You can learn more by going to tilt parenting.com/tefos. That stands for the executive function online Summit, TEFOS. And I just have to say, I’m a speaker for this event, but I learned so much from it myself, I guarantee that this is one summit you do not want to miss again, just go to tiltparenting.com/tefos to learn more and to register. And now here’s my conversation with Dr. Jonine Nazar-Biesman.

Debbie Reber  03:52

Hey, Janine, welcome to the podcast.

Jonine Nazar-Biesman  03:54

Hi, Debbie. Thanks so much for having me.

Debbie Reber  03:57

I think this is an interesting and maybe overdue conversation that we’re going to have today because it has been a couple of years, maybe even four years since we’ve really explored the assessment and evaluation process. And I think there’s some things that have probably changed or I know there are questions that have come up because of COVID that my listeners will be interested in as well. But I would love as a way to start if you could just tell us in your own words a little bit about the work that you do in the world. And I always love to know either your personal why for doing it or where you find the most joy in the work that you’re doing.

Jonine Nazar-Biesman  04:30

So I’m a pediatric and adolescent young adult neuropsychologist, which means that the training goes beyond just typical clinical psychology into a couple of years of postdoc understanding brain development, neural circuitry, how things wire up and the why I went into that specialty is just truly fascination about the brain and how it Got burns and operates everything. And truly understanding things from a brain perspective, how behavior is shaped by what the brain is doing. So I think the favorite part of my day is just sitting with students chatting with them, getting to know them, taking them in, really trying to capture and appreciate their individual differences. During testing, that’s what I’m doing, really enjoying the process of discovery, working with kids almost as a detective to figure out the best things about their brains and how they work and how they learn and think and organize information. Probably the least favorite is all the documentation that follows after that assessment process. But I’ve also always taken pride and felt it’s really important in doing assessment to be a practitioner to also be a clinician to treat to intervene to understand what it takes to help a student arrive from point A to point B, and construct interventions and strategies that work particularly for them. So I always carry my own therapy caseload, I’m out in the community, I’ll do school observations, home observations, work to coach parents, bring in family systems and conduct family sessions. So when I am writing recommendations in my reports, they’re really applicable to real life, not just sitting in a testing bubble and spewing out some numbers. And this is how your child compares based on the average. But really taking into account the whole child and that big picture.

Debbie Reber  06:42

That is music to my ears. I think that is something that so many of us raising neurodivergent kids certainly most, if not all listeners of this podcast, at some point, are needing to find a good neuropsych to do this work with our child. And we want someone who really will take the time to get to know who our kid is, and understand their unique profile. And I will just say, I have a pretty active Facebook group where this comes up all the time, you know, looking for recommendations, I’m trying to find someone to do this evaluation. So maybe that would be a good place to start. Because I really would love to get into the nuances of what you do as well. But when parents are looking for someone to do an assessment for their child, what should they even be thinking about? How do they go about vetting someone to assess and evaluate their child?

Jonine Nazar-Biesman  07:33

Sometimes parents will be given from a school or referring party, maybe you know, three to four different names, maybe up to 10? Like I’ve had calls before where a parent may say yes, the school just gave me, Bridges Academy, just gave me two pages of people. How do I go through this? So I think there are some good, important upfront questions that can be asked that I would ask as a parent, you know, I would want to know, how do you approach assessment? I would want to know, how do you get the best out of my student in that time limited framework within which you have to assess what happens if my students are tired that day? Or you’re not really getting the best of them? You know, how would you adjust accordingly? So I would ask those questions I would ask subspecialty areas, I would ask levels of experience. If a parent really is seeking a neuro psychological evaluation versus a psychological assessment or a psycho educational assessment. And I know all of this lingo can get confusing. You do want to make sure that you truly are with a neuro psych, somebody who’s had the postdoctoral training and understanding how a brain works, and how they apply that to test interpretation. Because you know, anyone can really administer a test, all you do is just, you know, read the administration rules, and there you go. But it’s the process by which somebody is going about problem solving or thinking about something or reacting to a question that really is most valuable and the sweet spot of evaluation where you really need to get in. So as a parent, I’d be curious about how all that works, and how a student is supported through the process. I don’t believe in just you know, bringing a student in for you know, an eight hour day and cramming all of these tests in front of them and saying, okay, you know, we got our results, we got our numbers great, we’re good to go send me the next person, you know, so I can do my next set of testing. I like to break it up into sections into digestible, you know, sound bites depending on the age of the student and their tolerance levels, how much really makes sense to try to get a sense of their true capacity. So I do think those are some important questions to ask, you know, I would want to know, you know, what’s their philosophy in understanding a student’s individual profile?

Debbie Reber  10:11

Lots of questions already one day could you explain the difference between a neuropsych, a psychoeducational and psychological assessment? I bet there are listeners who have been recommended one or all of them and may not understand how they’re differentiated.

Jonine Nazar-Biesman  10:26

So there are different degrees that people can get to give tests. You know, one degree might be a school psychologist. So when your student is getting assessed by a school psychologists say a triennial review, as part of you know, federal law that requires testing be updated every three years, that school psychologist has a master’s degree typically, and is going to look at testing in a much more narrow lens. Somebody who’s conducting a psychological assessment is often a licensed clinical psychologist, but they don’t have training and neuro psych or brain development of neurochemistry, or the structure of the brain or how to translate and interpret those results based on what’s going on in the brain. So may just look at a results correlated with one specific function and say, Oh, well, this is a strength or this is a weakness without looking at a pattern of scores within the brain. And then psycho Educational Testing might be limited just to looking at some IQ testing, looking at some academic achievement, but not uncovering more layers. In neuro Psych. We’re looking for example, at memory and learning at attention and executive functioning at different kinds of motor skills, visual motor integration, different aspects of sensory processing, and sensory integration, and social emotional variables really getting a sense of personality traits that may be driving you know, behaviors, or you know, just again, how all of the emotional information is being organized and interpreted by a student. So it’s a much deeper dive in neuro Psych. It’s really making sure that no stones are left unturned. And we’re really answering referral questions as thoroughly as possible, understanding what a brain is doing and what a brain is not doing, and maybe what a specific brain needs to continue to develop and thrive.

Debbie Reber  12:35

I love that you mentioned before, it’s like being a detective, because that is definitely the experience that I observed. When my child Asher, who’s now 17, was I think, 13. And we did a couple of days neuro psych with someone who really specialized in twice exceptional kids. And I would joke, oh, my gosh, I know more about my child’s brain than any parent should ever know about their kid’s brain. But it was so fascinating in the whole process to see how adaptive it was depending on what was going on. And so I’d love it if you could maybe talk a little bit more about what your process might be like when you’re working with a student, how you might pivot and how you might just react or respond to what you’re learning as the process goes on?

Jonine Nazar-Biesman  13:21

Absolutely, especially with 2e kids, we want to make sure we are tapping into those competencies. And I’m a true believer that standardized testing is just not always the way for all students. So my process is taking some time initially, just to make sure students are comfortable in the office that they feel welcome warmth at home. It’s about chatting and asking about their passions, their interests, their wishes, their goals, giving them a good framework for what to expect as we move forward, but letting them know that it’s a flexible process. And if they need a break, or they have a question, that it’s interactive, and it’s collaborative in that way, it also requires a lot of attunement. So I really use to steep attunement and the assessment process really trying to tap into where a student is at. Sometimes I can see it’s just written all over their face that they’re just baked, they’re done. They just they’re not really answering in a way that honors what they truly know. So we’re just done that day, it’s just cut off that day, we come back another day, hit it maybe at a better time of the school day or the flow of their week, and make sure that it is dialed in according to those needs. So we may have a structure when we may have certain sessions that are already mapped out and scheduled, but often those need to be adjusted. They need to be made shorter, or you know we need to give more breaks within the test session. Sometimes we need to get off scripts completely. So I’m a big believer, because when you’re giving a standardized test, there’s rules. So the rule may be after a student gets three of these incorrect move on to the next test, well, we never really stopped there. Number one, I want to know why something was incorrect. I always test pass limits. So even if a student has reached a standardized ceiling on something I’ll go beyond, because often students will get items Correct? Well, past time limits or well past where you normally would have cut off. And I think that’s really important information to glean and ascertain. So we’ll make sure we’re always testing limits, and seeing true capacities. And sometimes we’ll even go back and try something again, even though there are a lot of psychologists or testers who will complain, Oh, I can’t give this test. Again, there’ll be practice effects. But it’s actually practice of text that we want to get a little insight into. All right, if there has been some exposure, and some opportunity for students to practice with this item, what does it look like after that? Did it result in improvement? So we really take our time to unravel all of that. And to look at the various pathways, you know, from point A to point B,

Debbie Reber  16:19

It sounds like it would be really fascinating work because every child is so different, right? Right.

Jonine Nazar-Biesman  16:25

Absolutely. I can maybe having a meltdown and not wanting to test at all, well, okay, you know, but then we’re going to talk about what’s going on, we may sit on the floor and play for a little bit, we may bring a parent and to help with some co regulation, we may just honor what their sensory needs are in the moment, we may pull out some different kinds of you know, fidgets or just try to offer some it like interventions in the process just to help regulate, and then you know, we can try again. So sometimes our timing is not a student’s timing, and we need to adjust accordingly.

Debbie Reber  17:01

I’m so glad you shared that because that is something also that comes up a lot within my community is when a child is being assessed, if they had an off day or and a lot of times, it is just a one day thing. And then they get this label or diagnosis based on what they don’t believe is really their child’s true profile. For parents who are listening to this if they have a child who they believe just had a really off day, like how would they navigate trying to get a better assessment in that case,

Jonine Nazar-Biesman  17:30

I think what we talked about initially, just taking some care and vetting in the beginning, although you know, no one has a crystal ball to see how it all comes out. But I do believe in this sometimes happens, at least in the state of California, there’s an ice process where a family can get an independent educational evaluation, if they disagree, you know, this is if a set of testing has been conducted at school, and parents really feel like God, this is completely off base, you missed my child completely. So I would in that case, since parents are 24/7, they know their students best. And we should all defer to parents because they truly are the experts. And listen, if a student hasn’t been captured accurately, I think that’s very important information for a parent to impart and advocate that there needs to be some degree of reassessment or reconsideration, even if it has been done at a high level. And there should be open lines of communication where a parent can feel not daunted by this, but just to be forthright, and say, You know what, like, maybe this part of my child sounds accurate, but this part does not, you know, so how did you get to the How did you arrive at this place? And you know, it should be an open discussion, because you I wouldn’t want anything necessarily in writing about my kid that didn’t really capture the essence of them.

Debbie Reber  18:58

That’s such good advice. I think so many parents feel just overwhelmed generally, especially if they are raising a kid who isn’t thriving in school, and they may be going down this path and don’t have the insight and information. And so we often just rely on the experts who are giving feedback and may not trust their judgment. If they feel like this isn’t a disconnect or may not feel like we have a voice to push back and ask for more. So I really appreciate that is getting a neuro psych something that really every neurodivergent kid would benefit from I mean, it seems like having a really good understanding of how this human’s brain works and where their strengths are and where their relative weaknesses are, and what kind of support they need would be so beneficial.

Jonine Nazar-Biesman  19:47

On a theoretical level, I would say yes, absolutely. And as a neuropsych I see the value in that but on a practical level, you know, I try to talk parents through especially If they don’t have the time or the resources, because not everybody does, you know, have the benefit of being able to pursue this. Maybe even just consulting with a neuro psych, sometimes I may just look at test results and offer that have already been done and offer a little bit further or deeper interpretation. Or I may be picking up a student for therapy who’s already been assessed, but you know, I’ll see just through behavioral observations, something that may seem like a gotten missed, and so there’ll be an open conversation about that. But it can be absolutely valuable. But I also understand that, you know, we work with what we have. So we work with budgets, we work with resources, sometimes some information is better than no information on it. Also, based on functioning, you know, it’s not necessarily vital if a student’s thriving, doing okay, happy at home involved in some activities, has some friends, you know, not huge, you know, complaints at school. If your child is happy and thriving, then maybe it’s not the most absolutely necessary, of course, it would add a layer of deeper understanding and insight, but not absolutely necessary. So sometimes we just base it on what’s going on with a student. And in some cases, where if things are a mystery, and parents are struggling so much to understand what’s driving the behavior, what’s driving the responses, or the reactivity, or the discomfort or the anxiety, then it can be extremely helpful to educate parents because then they have those aha moments and understanding of their students not seeing it as oppositional behavior. Just as an aside, I don’t really even go to a diagnosis of Oppositional Defiant Disorder ever, because I just feel it’s kind of a throwaway, useless kind of diagnosis. We understand if a student’s being disruptive and oppositional, we can see that, you know, we don’t need to call it something, but we need to understand why. And so I think that’s the time in which a neuropsych eval can be insightful.

Debbie Reber  22:07

Yeah, I appreciate that. What about age wise, is there an ideal window for when a child would have this kind of comprehensive neuro Psych?

Jonine Nazar-Biesman  22:16

It always depends on what’s going on. I mean, sometimes it is very wise to try to at least get some look with a professional as early as possible. If it involves putting together an early intervention plan. Again, it really, you know, just depends sometimes it’s very helpful to get in at a kindergarten level, per se, if a parent is very worried that information is not being retained, letters, numbers, shapes, colors, no matter how many times it’s gone over a justice and seem to be sinking in, may be wiser to get in and see if there’s a little something brewing in terms of learning differences, rather than waiting till third or fourth grade, which often school districts will say, Oh, well, don’t worry, you know, but if you wait till third or fourth grade, you may have a much more severe, let’s just say dyslexia, or dysgraphia that you’re dealing with, it could have been remediated, you know, through some good educational therapy or something like that. Or we may get a 12 month old in or an 18 month old man who’s just showing signs of, you know, disengagement or poor joint attention, and we have an opportunity to put together a great early intervention plan, then that makes sense. And then I will say it can be helpful at major transitions. Sometimes if a parents are deciding on which middle school or which high school, or you want to make sure that your student is going to get fair and appropriate accommodations moving into college, those transition points can be good times at which to reassess or do an initial assessment.

Debbie Reber  23:51

I’m actually interviewing someone later today about the transition to college and how to kind of navigate that. So that’s interesting. I’m just curious, do you have a favorite age group or profile? Yeah, where’s your sweet spot?

Jonine Nazar-Biesman  24:05

I know, I’m like a kid in a candy store. You know, I really do kind of cross the range. I learned a lot from my teenagers. They teach me a lot of lingo and a lot of new things going on. So they’re always fun to be with and fun to have conversations with. I also enjoy very little kids and playing I do have a floor time background. So I’ll often employ just floor time techniques and strategies and playing with children. I’m a sucker for babies. So anytime we have little EVPs come into the office. I’m always so happy. But no, I’d say I enjoy kids in general. I just love kids and I do find working with students to be very rewarding in the sense that I feel there’s still so much time to make an impact and to alter and affect brain development. And because we know experiences do change the way in which your brain organizes and adapts and functions. So to be able to be part of that process is really rewarding. But yeah, I can’t say I have a favorite pic. That would be like asking me, you know, which is your favorite kid? I can’t, I just you know, you love all age ranges for different reasons.

Debbie Reber  25:21

Fair enough, fair enough.

Debbie Reber  25:26

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Debbie Reber  26:32

So you mentioned helping the kids and I’m just wondering, what is your approach to providing feedback to students? Obviously, you know, it’s the parent who comes to you and wants this information. And you’re writing these detailed reports, which may be for schools and other people to check out. But how do you actually then work with kids and do work with kids of all ages to help them understand their unique profile,

Jonine Nazar-Biesman  26:57

I’m glad you brought feedback up because I think feedback, of course, is the most important part of the process. Initially, doing feedback with parents will give feedback often across more than one session, because it’s a lot to take in and one sitting. So we’ll try to make ourselves available and offer developmental surveillance and just become part of the team. We conduct feedback with kids very often. But sometimes it depends on the child and what the parents want. We won’t, you know, do feedback with a two year old or a three year old, but we may you know within as early as elementary school, and when we do what we call student friendly feedback sessions. They’re very different from our parent feedback sessions, were really trying to focus on their strengths, all the good things about them, help them you know, just get jazzed and excited about what they did make sure we answer their questions. And sometimes we’ll meet with students just because again, depending on the student, it’s helpful for parents to have an outside person create a little bit of buy in and motivation and explanation around some of the suggestions that may be offered through an evaluation. So you know, we take time to explain it to the students. But really, it’s about just telling them the best things about themselves and thanking them for everything they shared with us, and creating a little story of themselves. Sometimes we’ll ask parents or students do you want us to write a little story about you? That’s like the story of yourself. And you know, that can be another lovely way to give feedback to kids.

Debbie Reber  28:36

I love that. I mean, I think it’s so important. And it’s such a gift to get to know yourself on that level. As an adult, it’s easy for me to say, Oh, what a cool thing you can really learn so much about yourself. And also as an adult who’s worked with so many adults who have discovered the neuro divergence in their 30s 40s and 50s, who would have loved that information earlier. I also imagine there are some young people who don’t want to hear what you have to say or who aren’t maybe as open to embracing their neuro divergence. I’m just wondering how you navigate that or what your approach is.

Jonine Nazar-Biesman  29:09

It’s very true. It’s a slippery slope, and something that we have to navigate gingerly again, depending on the student, some parents have their kids come in for feedback. And the kid really, the student doesn’t really care, you know, or they’re not really invested or understanding of the value at that point in their development. We have based on parents’ requests before for example, and this doesn’t happen often but let’s just say with an autism spectrum diagnosis or even if it’s very high functioning, and we’re highlighting the assets of that and the gifts that come along with that. We’ve had some students who have taken issue with that and become offended and really don’t you know, want that information about themselves and then we have to adjust again and we have To explain that this isn’t something that defines them and not a label, but maybe just a little information about them to understand how they think and where their gifts are stemming from. But then for other students, it’s quite a relief, you know, we have a lot of students who come in, and they’re very grateful, and you know, very pleased to receive the information. So it really just depends on what’s happening in the moment. And when we see students kind of upset, you know, by information, we’ll have to back off and talk them through that and just work through the feelings, have it and guide them and make sure that they’re okay. And then in those cases, we will follow up, we will make sure that they’re, you know, okay. And some days, it’s fine. Sometimes a few days later, or a couple of weeks later, we’ll get reports from parents. Yeah, you know, they’re fine. It was a little, you know, much in the beginning, but now they’re starting to think about it a little bit more, and it makes more sense, or they’re asking more questions. So you know, we’ll just navigate it accordingly.

Debbie Reber  31:02

Thank you for that my mind has now gone to COVID. This is another thing that has come up a lot is so many assessments have happened virtually. And so I’d love to know what your experience has been on the efficacy of a virtual assessment, and evaluation, and then anything else that you’ve observed in the way that COVID has shown up in the work that you do, and your interaction with kids.

Jonine Nazar-Biesman  31:28

COVID has been very interesting, you know, in our office, initially, you know, when things first unfolded in 2020, we try to not counsel too much and do what we could do of assessments virtually, but found, or I found, even with verbally based items, or things that we might just be able to administer through conversation, it definitely wasn’t ideal, efficacy wise, you know, when you’re trying to really observe something closely. And I don’t know how people were doing it, when it came to like manipulating things or having to, let’s just say, put a hole in a peg or manipulate a block or have a clear, you know, picture of something that they were going to see, I would imagine some of those assessments that they were trying to do all of that virtually or on an iPad are probably not the best. So we’ve just moved things back to the office as soon as we could and took precautions and just honored people’s comfort levels. And you know, try to do as much as we can to adjust. But I think with certain aspects of assessment, just face to face is something that’s irreplaceable. So even just with masks and reading facial expressions, and understanding social perspective taking and reading of facial cues, you know, those I think, are important thing. So unfortunately, I just don’t think it’s a process that’s conducted with a high degree of efficacy via, you know, zoom, or some other formats, although people do it, and I’ve been on listservs, reading how people are doing it, but for us, we preferred the face to face. There are implications of COVID were just much higher rates of depression and anxiety that we were seeing in kids. A lot of parents coming in and noticing attentional challenges, because they were now able to see for the first time, not able to attune to a screen and fidgeting and getting up and avoiding and whatever else. And they’re like, oh my gosh, like my child can’t focus on what’s going on? Or, you know, questions about well, is this a true learning difference? Or was this just the last year of learning? You know, how do I decipher the two. So it’s been interesting, and we’re starting, or they’re starting to be studies just on the neurological impact of long COVID Or people who got hit in a certain way. So just trying to understand those variables and different strains of COVID. So we’re starting to try to work into our intake more about COVID and the impact and whether you know, somebody contracted it, and work that into the interpretation of results.

Debbie Reber  34:17

And if a child is depressed or struggling with anxiety, or their mental health has really been impacted, as you mentioned, you saw much higher rates during COVID. Does that also affect the neuro psych process? And how does that kind of play out in other areas?

Jonine Nazar-Biesman  34:36

It absolutely can. I mean, for any of us, it might affect our processing speed, it might affect our concentration, it might affect our stamina or motivation or energy levels. So we always just take that into account and think about priorities. You know, it always always priorities our mental health, well being you know, happiness, just Generally, you know, being able to take care of oneself. So if any of those pieces are too far out of balance, you know, we may say, Let’s treat this first, you know, we’re not even at a baseline for, you know, this students, you know, let’s have a stepwise approach, sometimes we might, you know, defer a more full evaluation, if it’s very clear that there are other variables that are interfering.

Debbie Reber  35:26

Okay, thank you. We’ve covered a lot of ground, I’ve got a sheet of questions, and you’ve touched upon so many in your responses, which is wonderful. And I would love to, before we wrap up, talk a little bit about the results. I know I received like a 45-page document and was good nighttime reading material, very in depth and included recommendations, I was very thorough. And so I’m just wondering, how do you recommend parents who are receiving this detailed feedback from a neuro psych evaluation? What should they do with it? What’s the best use of that? How should they engage with it? And yeah, just general advice that you have,

Jonine Nazar-Biesman  36:07

it is a little bit of your Bible moving forward, it is a little bit of your roadmap, like your evaluation, we too will make that a robust section of the report with the intent of helping to carry parents over and students over for the next few years. So we advise parents to use the recommendation section really, as a resource library. And as a reminder of options that they may have for their student, you know, maybe things they might do over summer, or things that they might consider at different times and help make it a little bit of a decision tree. You know, we’ll break it down into sections of academic versus therapeutic will add in things for home, will add in ideas for community, whether it’s volunteering, or a really interesting philanthropic cause or trip or just different activities that may be really valuable that a student may want to get involved in. And we’ll be very specific, you know, with goals that might be addressed in particular interventions. But we remind parents that as much as we can, because it is overwhelming, you’re not to go out and do all of this stuff at once. This is not expected, you know, this really is just your set of resources, of ideas and options of things that are available, but we we do try to do is say if there was one thing I would pick to do right now, or the two top things I would pick to do right now, you know, do this, you know, focus on this for the next six to 12 months, you know, let’s meet back, let’s see how things are going. And then we have all of these other like menu of options truly, from which to choose, depending on, you know, how things are unfolding or developing, but we will try to streamline it and do a short list because it is very overwhelming the list of you know, maybe 15, you know, 20 different things that may be cool opportunities. But of course, there’s only so much time in the day. So we’ll try to help prioritize,

Debbie Reber  38:12

as you were talking listeners couldn’t see, but I just went across my forehead, because yeah, you know, it’s been four years. And I’m realizing well, there’s so many things that we just didn’t even do, I’m gonna go back and read that roadmap and just kind of refresh my memory because it is such a good resource if you’re able to get that kind of detailed recommendations that are really unique to who your child is, our schools interested in this kind of feedback, or how do schools engage with this detailed report, if they do at all.

Jonine Nazar-Biesman  38:46

We will often send a shortened school version that’s less to read for a school district and really focused only on the academic portion of things and perhaps services or placements, we may be recommending and will sometimes you know, present the results to an IEP team and just try to highlight the main points but often you know, parents will not want to share certain aspects of the neuro psych eval with a school district and we’re very flexible about that we’ll edit accordingly it’s they hold the privilege to that information. So we’re happy to take out whatever they’re not comfortable sharing with the school district but we will really will try to shorten it and just get to the point of what’s relevant to school. I mean, for our parents, we may include lists of you know, books and websites you know, often Debbie will help you know your information or your resources that you offer and amazing you know, I call cast of characters that you’ve had, you know, over the years or you have the privilege to work with, you know, we’ll make those recommendations we make quick Eat a very short list of things like that that may be helpful for teachers, but it’s edited so that it’s, you know, not as overwhelming, perhaps because it probably won’t get read. And depending on the IEP team, sometimes the IEP team is so grateful for the outside information. And sometimes they’re very defensive about it. And you know, they’re basically like, okay, okay, well, okay. But you know, here’s what our evaluation says. And so based on our evaluation, even though we’re supposed to be considering outside information, our evaluation says this, and they’re more rigid.

Debbie Reber  40:34

Wow, fascinating. This has been so interesting. And again, we’ve covered so much I so appreciate everything that you shared, and just the work that you do. And I think kids who get to work with you and families who get to learn from you are very lucky. I’d love to know two things before we say goodbye one, I believe you’re in Southern California, if parents want to connect with you, how can they do that? And secondly, if there’s one word of advice, or something you’d like parents to leave this conversation, if this has sparked them, something you’d want them to know about this process?

Jonine Nazar-Biesman  41:10

I’ll start with a second question. Because I think that’s really important. And if there’s one tidbit of information I could encourage with parents, it’s just to really, don’t shy away from that communication piece with a person who you’re bringing your child to see whether it’s a therapist, or your assessor have that open communication. If you’re not happy with something or you have a question about something, don’t feel like you have to defer to the professional, be honest. And be open to having the process be collaborative, so that you can be the good self advocate for your child that you are and were meant to be. And then in reaching us, just our website, but I’m, you know, we can bypass that since I feel very uncomfortable with anything that’s self serving, but thank you for asking.

Debbie Reber  42:02

Okay, well, listeners, I will have links on the show notes page. So if you want to connect with Janine and her resources and learn more about her work, you can do that by going to the show notes page. I really appreciate what you’re doing. And I so appreciate you sharing everything that you shared with us today. So thank you so much for coming by the show.

Jonine Nazar-Biesman  42:21

It was such a pleasure, Debbie. Take care.

Debbie Reber  42:26

You’ve been listening to the Tilt Parenting podcast. To go deeper into this episode, visit the extensive show notes page. For every episode, there’s a dedicated page on my website with links to all the resources mentioned, a full transcript and a podcast player with key takeaways marked so you can easily go back and re-listen to the sections you’re most interested in. Just go to tilt parenting.com/podcast and select this episode. The Tilt Parenting podcast is hosted by me, Debbie Reber, author of the book Differently Wired and the founder of Tilt Parenting. This episode was edited by Andrea Curtis-Amezquita and show notes were put together by myself, Andrea and Lindsay McFadden. If you get a lot out of this podcast and want to help cover the costs of its production, please consider joining my Patreon campaign. On Patreon you can sign up to make a small monthly contribution as little as $2 a month and it’s super easy to sign up. Just go to patreon.com/tiltparenting To learn more, or click on the Patreon link on any show notes page. To follow Tilt Parenting on social media go to @tiltparenting on Instagram and Twitter and on Facebook. Lastly, please help this podcast stay visible and easily found by the listeners who need it by subscribing and leaving a rating or review on Apple podcasts or wherever you listen to podcasts. Thank you so much. And that’s all for this week. Stay safe, stay well and take good care. And for more information about this podcast or any of the resources that Tilt offers, visit tiltparenting.com

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