Trust? the “Expert”
Navigating the complicated world of academic and clinical evaluations
Bringing your child to receive an evaluation requires access, vulnerability, and an immense amount of trust. The evaluator is depicted as an expert; someone who will get to the bottom of a child’s difficulty, no matter how subtle. Often, the clinical language used in the evaluation process is foreign to the child’s stakeholders. Who are they to second guess the evaluator- the expert?
As a clinician, I ask parents to trust me every day; it is an integral part of any successful therapeutic relationship. My reliance on trust is one of the reasons why poor evaluations leave me at a loss for words.
I recently reviewed a Speech and Language Evaluation that left me speechless. The clinician measured the child’s vocabulary using one subtest (in non-clinical terms: one task). In one breath, the evaluator praised the child’s performance on the subtest. But, in the next, she mentioned that the child answered with, “incorrect responses that were close but not quite accurate.” She went on to mention that following an incorrect response, the child revised their answer after she, “talked it out.”
If this clinician recognized inaccurate responses, such as “freezer” instead of “refrigerator”, were indicative of word-retrieval inefficiencies, she would have administered an assessment that specificity measured word-retrieval difficulties. On a specialized, sensitive assessment task examining word retrieval, each time the student responded with an incorrect answer or had to, “talk it out” it would have been an error. Assuming this pattern was consistent, she would have been flagged for a word retrieval difficulty.
Now, without getting too far down a rabbit hole, word retrieval difficulties are tied to language disorders and learning disabilities (especially, dyslexia), and should be targeted with speech and language intervention. By glossing over these errors, this clinician administered an insufficient evaluation. Moreover, by only using one subtest to measure her expressive language, this clinician did not provide a comprehensive evaluation that was sensitive enough to identify the child’s language-based weaknesses.
Now, back to the idea of trusting the expert. What is this family to do? Well, most likely, they will do what they suspect is correct: trust the expert. They will move forward as she suggested and one day, the word retrieval difficulties (and possibly, other language-based or learning weaknesses) will rear their head again. This child will have to go through another evaluation and hopefully, the difficulties will be identified at that time. How. Frustrating.
Or, maybe, the family has a gut feeling that this evaluation missed the mark. Maybe, they will take show it to a trusted friend for a second set of eyes. Maybe they will seek out a different clinician to give a follow-up evaluation. Hopefully, their next expert will recognize the flaws in the previous report. But, what if they don’t? What if they, as many clinicians do, use the data from the previous report to inform the current evaluation? What if they don’t look into language because it was shown to be “average” before?
These “what-if” questions aren’t meant to be alarmist. They are simply the questions that have accumulated after years of watching insufficient evaluations shake the lives of trustworthy kids and families.
So, what’s the solution? An excellent and complicated question. Although we don’t have all of the answers, here are a few tips for setting your child up for a helpful and individualized evaluation:
1. Do your best to have a general understanding of your child’s difficulties before entering an evaluation. Before beginning the assessment process, do your research. If you can communicate your concerns to the evaluator, it may allow for a more comprehensive and individualized evaluation. Here are a few trustworthy websites for language and literacy milestones and red flags:
2. Have honest conversations with trustworthy families. Learn from any mistakes, and follow their suggestions (within reason) for who to reach out to for help.
3. Consult with the experts. Trust your instinct while talking to them. Do they seem to understand your child as an individual? Are they willing to dive deep? Can they speak to how comprehensive and individualized their evaluations are?
4. Don’t be afraid to get a second opinion, ask questions, and engage in the process. You’ll find most exceptional clinicians will talk the time to make sure the parent(s) understand the evaluation process, results, and subsequent plan.
5. Gather opinions from other important stakeholders. For example, teachers, clinicians, family members, and your child may have valuable insights into what feels frustrating or difficult.
6. Don’t wait. If you sense your child is having unexpected difficulties, do all you can to learn more and seek out professional guidance.
As always, email email@example.com with any questions or comments about this post. Or, if you’re interested in connecting with The Learning Doctor, visit www.seattlelearningdoctor.com to inquire about a free consultation.