Part 2 in a series of strategies to enhance and optimize learning, whether virtual, in-person, or a combination
Click here to view this article on Medium.
Category: ADHD
Part 1 in a series of strategies to enhance and optimize learning, whether virtual, in-person, or a combination
Click here to view this blog post on Medium.
Often overlooked and under-rated, breaks are a critical and essential component of reaching your potential
Breaks are an extremely important, though often undervalued, component of education, work, and mental health. Far too often, “being productive” is viewed as constant busy-ness, an immediate response to any issue that comes up (regardless of urgency or importance), and a never-ending to-do list of tasks that need to be completed. Unstructured, unscheduled “down-time” is viewed as time wasted and something to be avoided. However, this non-stop culture of doing and rushing contributes to a number of adverse outcomes, including increased stress and anxiety, decreased physical health, higher rates of burnout, and an increase in maladaptive coping skills (such as addictions and compulsive and impulsive behaviors). Being constantly connected to social media or work through electronic devices begins to blur boundaries and contributes to feelings of pressure, overwhelm, and, ironically, disconnection. When you are always striving for the next thing, you lose the security of feeling grounded and the creative and innovative ways of thinking that are found when you allow your mind more freedom and flexibility. Additionally, the lack of breaks means that you actually have to work harder to learn and to complete tasks because your approach tends to be more haphazard and lacking in focused direction. And so, you begin to perpetuate a cycle of constant doing, rather than leading a life with clarity, intention, and purpose.
The Neurobiology of Breaks in Learning
From a biological perspective, your brain requires time to consolidate newly-learned information. As much as you may think that you can just keep pushing more and more information into your brain, neuroscience has shown that there is a limit to the capacity to learn new information. This limit is individualized and occurs along a spectrum: some people will find that they can sustain their effort over a longer period of time or can hold more new information in mind at once than others, but all of our brains eventually reach a limit. And the limit also varies within an individual, depending on their interest in the material, motivation, physical state (such as level of alertness, whether you are hungry or tired), level of stress, and other factors related to the individual or the environment. Think of experiences where your learning was at its peak; it was most likely because the material was highly interesting and engaging, you were well-fed and well-rested, your level of stress was at a manageable level, you had some previous relevant knowledge or experience to relate the new information to, and the material was taught in a way that resonated with how you learn. In these situations, you learned the material with relatively little effort and it was retained over time much more easily and effectively. In contrast, recall times when your learning was negatively impacted by one of the above factors and when you had to exert much more effort in order to learn effectively. In this second scenario, your “limit” for learning new material was substantially lower. Thus, the limit of how much new material you can learn at once can vary depending on a number of conditions and situations.
Once you’ve reached your limit, additional efforts to acquire more information are likely to be ineffective until your brain has had the chance to consolidate the newly-learned information. And what is the best way to consolidate newly-learned information? Engaging in an unrelated activity. In fact, studies have shown that sleep is one of the most effective methods of consolidating information, as it reduces additional stimulation and input to the brain and allows the brain the time needed to consolidate the new information. But sleep is certainly not the only way to consolidate new information. Exercising, getting a drink of water or a snack, engaging in mindfulness activities or meditation, socializing with others, or shifting to a different activity are all ways of giving your brain a “break” from what you are learning and provide an opportunity for consolidation. In fact, learning new material tends to be much more effective if short breaks are interspersed at regular intervals rather than attempting to sustain attention, effort, and engagement over extended periods of time. The need for breaks takes on even more importance if you have difficulties with sustained attention, processing speed, and executive functioning, as these challenges often require additional energy and effort to manage when learning new material.
Effects of Breaks on Mental Health
Breaks are not only important for learning; they are also essential for mental health and well-being. Poorly defined personal and professional boundaries contribute to increased levels of stress, anxiety, and depression. You may find that you are more emotionally reactive and impulsive. You begin to lose some of the ability to make choices about your emotions and behavior and consider the longer-term implications of your reactions.
The pressure and stress of operating at a frantic pace without any down-time coupled with the guilt-laden feelings associated with taking a break can lead to declines in both physical and mental health. Rather than seeing breaks as opportunities to care for our physical and emotional health, they are seen as signs of weakness and missed opportunities to do more or get ahead. But the hidden irony is that the lack of focus on self-care results in decreased efficiency, productivity, and effectiveness, as well as a reduction in coping skills. If you keep filling your cup with more pressure, demands, responsibilities, and obligations, it will eventually spill over in ways that are unintended and possibly harmful. The key to managing stress is not to strive toward the impossible goal of eliminating all sources of stress, but to take the time and make the effort to both reduce and manage stress as much as possible. The saying, “An ounce of prevention is worth a pound of cure,” is completely applicable here; in many situations (though certainly not all), you can much more effectively reduce stress when it is at a low level, and possibly prevent, or at least reduce, further escalation and worsening of the situation.
Breaks Provide Opportunities for Creativity
When most of your time is scheduled and structured, you have little opportunity for creative and innovative thinking. When you are focused and engaged in a task, your brain tends to rely on habits, patterns, and past experiences. There is a saying among neuropsychologists that “the neurons that fire together, wire together,” which refers to the concept that the brain develops characteristic ways of responding to certain situations and scenarios. The more often you respond in the typical, expected manner, the stronger that connection becomes. Over time, your responses to repeated scenarios or situations become highly practiced and almost automatic, occurring quickly and with little effort. In many ways, this tendency is helpful; it allows you to conserve your energy for new tasks and situations and makes your problem-solving and behavior more efficient. Take basic math calculations, for example. When you were first learning addition, you likely had to use a lot of time and effort to solve a problem like 6 + 4. You may have had to imagine 6 objects and 4 objects and count them or get actual objects to count, such as your fingers. With practice and repetition, however, you no longer needed to exert the same amount of time, effort, and energy to solve the problem. Indeed, you then had more “brainpower” available to apply that knowledge to other situations in your life (such as making a purchase) or to use it in higher-level math procedures and computations.
Think of a time when you tried to change a habit and the amount of effort required to do so, if you were even able to do so. If you can’t think of an experience, observe how you brush your teeth in the morning. You probably start on the same side every time and move about your mouth in the same general pattern. Once you know your pattern, try to change it in some way and notice the difference in the amount of effort you need. Try to brush with the opposite hand or start on the other side of your mouth, for example. These slight changes tax your brain in a new way and require increased effort, attention, and focus to do.
All of this efficiency and energy conservation comes at the expense of creativity and novel problem-solving. In general, this level of automaticity is a good thing; think of how difficult it would be to get through the day if you had to start fresh each and every day and figure out how to do everything that you normally do automatically. At the same time, you can probably think of experiences where you had a sudden burst of inspiration or clarity when you were engaged in another activity, such as taking a shower or falling asleep. The brain needs time and space to think creatively and flexibly; when you are constantly going from one task or activity to another, you don’t allow leave any space for that creativity. The result is you end up stuck in a pattern or habit with little understanding of how you got there and how to get out. Taking breaks allows you to reflect and think about things in new ways.
Building Breaks into Your Routine
The above-stated reasons have hopefully convinced you that breaks are extremely powerful, essential, and critical to learning, mental health, and creativity. Incorporating breaks into your day can improve productivity, focus, stress management, and problem-solving. But in a culture that emphasizes constant connection and availability, how do you start? What do you do? Here are a few suggestions to get started:
- Set clear boundaries. With all of the connection through electronic devices and social media, there is a constant pull toward a loosening of boundaries. Checking and responding to work email after hours or on weekends, posting highly-personal information online, or getting sucked into scrolling through social media news feeds are all examples of activities that reflect weakened boundaries between work and home life and our public and private selves. Try setting specific times or time limits around some of these activities (e.g., only responding to work emails during working hours or limiting the amount of times you check social media). Need more help? Try using apps that block notifications from these apps during times that you set or removing certain apps from your phone altogether. If you have to actually go over to your laptop and turn it on to check your work email, you are less likely to just check it “really quick” when you are not in front of the laptop.
- Schedule your breaks. Treat your breaks like any other appointment. Block out the time in your calendar to exercise, meditate, write in your journal, socialize with friends, etc. and protect that time like you do other responsibilities and obligations. By protecting this time, you are setting the intention that this activity is a priority for you and is just as important as your other activities. If you absolutely have to change it, reschedule it to another time, rather than removing it from your schedule altogether.
- Set a timer. When you have to work on an activity for an extended period of time, set a timer both for the time you are expecting to work and for the break time. Remember that the amount of time you can work on something is likely to vary, as will the number of breaks you require and how long they need to be. For things that are interesting and engaging to you, you may be able to work for a longer period of time, followed by a shorter break (e.g., 45-60 minutes of work followed by a 10-minute break). For activities that are more challenging or less interesting, you may find that you need to substantially reduce the amount of work time that occurs before a break (e.g., 15 minutes of work followed by a 5-minute break).
- Start small. Finding the time for breaks can be challenging at first, especially when you are feeling overwhelmed by all of your responsibilities and obligations. However, as mentioned earlier, it is very likely that some of your responsibilities and obligations are taking longer because they are not being done efficiently because you are not allowing yourself breaks (remember the cycle?). You have to start somewhere. Start with an activity that you can complete in 5-10 minutes and then find that time during your day. Set a goal of consistency in setting aside 5-10 minutes per day, rather than increasing the amount of time. For example, perhaps your initial goal is to take a 10-minute walk in your neighborhood after work, 3 days per week. Do not add additional time or days until you are consistently meeting that goal and if you’re not meeting that goal, take the opportunity to re-evaluate it and determine whether it is realistic or if you need to make other changes.
- Develop a mindfulness practice. I consider mindfulness to be a way of training your brain to be calm and still, taking a break from the pressure and pace of daily life, and managing stress and anxiety. It is a powerful way of taking a break physically, cognitively, and emotionally that allows for greater clarity in thinking and purpose and intention in actions and behaviors. While silent meditation is one mindfulness approach, it is certainly not the only one. It is important to find the one that works for you, whether it is yoga, mindful walking, listening to calming music, or doing a guided meditation. Consistency is key here, too, in that it is important to regularly engage in the mindfulness activity you’ve chosen, rather than only engaging in it when you feel stressed and overwhelmed. There are a number of apps and resources available to help you start and maintain a mindfulness practice.
What if you could make career decisions with intentionality and clarity, even in uncertain economic times? Or re-evaluate and redesign your career to better align with your values, interests, strengths, and abilities? Or find a career field that matches your unique skills and abilities, even if you have a learning disability, attention problem, or other neurodevelopmental disorder or disability? Or craft your own type of work as an entrepreneur that inspires and motivates you? The key to all of these questions is developing self-awareness and insight into yourself as a person and as a professional. This level of awareness helps provide you with clarity about what gives you energy and purpose; where your natural abilities lie; the skills you have worked to develop through learning, effort, and experience; your areas of passion and interest; and the values and ideals that are the most meaningful for you.
The uncertain economic climate can lead to decisions that are fueled by fear and anxiety. In your career, this fear and anxiety-fueled decision-making can have a range of consequences. You may be tempted to take a potential job opportunity without fully appreciating and evaluating all of the components or aspects of the job and how they match with you, as a person and as a professional. You may take on job responsibilities that are not well-suited to you out of fear of losing your job if you refuse. You may impulsively and abruptly change career fields. In the best case scenario, you will be lucky and end up in a position that is a good fit for your personality, abilities, values, and interests. At the same time, you may also end up in a position that does not fit with one of these areas or is in active conflict with one. Over time, you may begin to feel drained by this position, both physically and emotionally. You may lose your energy and motivation for the job, regardless of the other benefits it provides and even if you are able to continue to meet your job-related standards and expectations. You may begin to feel bored and unmotivated. At worst, you may begin to experience burnout or your job performance may begin to suffer.
In contrast, self-awareness and insight can help in making decisions that are intentional, informed, and aligned to your values, interests, abilities, and skills. Ideally, you may be able to find or craft a career that suits all of these areas. At the same time, if your circumstances or situation does not allow you this flexibility, you can still make decisions with more awareness and a greater sense of purpose. For example, perhaps you are taking a position that does not align with one of these areas as a “stepping stone” to getting where you want to be. Or you are taking on a temporary position due to your current economic situation while you continue to take steps toward your ideal career. Or, you can find outlets and hobbies outside of work that meet some of your values and interests that your job does not satisfy. The goal is to see your career as a journey that will continually evolve over the course of your working life while also having clarity about the destination.
Values
Understanding and awareness of your own personal values is key to setting goals and taking steps to reach them. Values are the guiding principles and ideas that are important to you. While many core values may be stable in your life, the relative importance of each one or the attention and focus on one may change over time or related to your circumstances. Additionally, personal and professional values may overlap, though they are not always the same for everyone. Therefore, engaging in regular self-reflection and values clarification exercises are crucial components of developing a clear vision and direction for your career.
Interests
Your interests are the areas where you feel inspired, are driven to work hard, and seek to continually learn and grow. Interests and passions provide the motivation and energy to reach the goals you set based on your values. If you have a passion for a specific goal, then you are much more willing to expend the effort to meet that goal. You are also less likely to give up when you encounter an obstacle or unexpected challenge. Your interests may inspire you to think about or solve a problem in a new way or develop expertise in a specific area. Because you are heavily interested and invested in these topic areas, engaging in them can often be an enjoyable experience.
Abilities
Abilities are the things that come naturally and easily to you. While there may be debate about whether abilities are inherent and due to genetics or are the result of the combination of strong interests and practice, we all have natural tendencies and gifts that can be assets in the workplace. Abilities are the things that develop with very little effort on your part and are usually present from early in life. For example, strong musical or artistic inclinations and abilities, quickly and easily performing mathematical calculation, systematic and logical thinking, or strong visualization and mechanical abilities. You may be unaware of how you developed these abilities or why these things come so easily to you when others have to work at them. Finding a career that aligns with your abilities helps you to use these talents in a productive way. It also allows you to contribute your abilities and thinking processes in ways that complement those of others.
Skills
Skills are areas of competence and expertise that you have developed with effort and experience. Unlike abilities, you have had to work to develop these areas and will only become proficient (and maintain your proficiency) with practice. Initially, you will have to exert a high level of effort when you are learning a skill; however, with regular practice over time, skills become more natural. If you have developed skills in areas that correspond to your interests, the process of learning and practicing the skill is likely to be much more enjoyable and tolerable than developing skills in areas where you lack interest or motivation. Additionally, your abilities can help facilitate the development of skills over time. Because you have had to work to develop these skills, you may be more aware of the process of acquiring them and better able to teach others to do so. The specific process and practice of acquiring skills also influences your eventual proficiency; in order to keep progressing, you must continue to challenge yourself and put yourself in novel situations that force you to use your skill in a new way.
Conclusion
Uncertain economic times do not have to force you into career decisions that are fueled by fear and anxiety. Instead, the intentional development of self-awareness and insight can lead to making decisions with purpose and clarity.
Extended time is one of the most common accommodations given to individuals with attention problems. It is usually granted on the assumption that the person is easily distracted when completing tasks and, therefore, needs a longer time to complete them. While this assumption may be true for some people with attention problems, it is not true for all of them. Granting extended time can also lead to unintended negative consequences. Therefore, extended time should be granted to an individual based on data that demonstrates a need for extended time. Some of the common benefits and pitfalls in granting extended time for individuals with attention problems are described below.
Benefits of Extended Time for Attention Problems
Some individuals with attention problems work at a slower pace on tasks. They may struggle to balance speed versus accuracy. In other words, when working at an appropriate or expected pace for their age, these students are more vulnerable to making inattentive errors. They need to work at a slower than expected pace in order to work accurately.
Other individuals are slow to process information. They may appear to be daydreaming or in a fog and may move and respond more slowly than others. They may lose their train of thought or appear confused. They complete tasks more slowly and often do not finish tasks in the time allotted.
In these cases, extended time may give these individuals the opportunity to fully demonstrate their skills and abilities in a way that would not be captured in a situation where they were under more rigorous time constraints.
Pitfalls of Extended Time for Attention Problems
Many individuals with attention problems have difficulty sustaining their level of attention, concentration, and effort over an extended period of time. Some may be more active or impulsive than others and need to get up and move around frequently. Others may be easily distracted and have a difficult time re-focusing on the task. Their performance may dramatically decrease the longer a task goes on. For these individuals, extended time is likely to be ineffective and might actually lead to decreased levels of performance. Extended time does not correct for difficulties re-focusing on the task-it simply allows the person to be off-task for a longer period of time. A better intervention might be “stop-the-clock” breaks as needed to get up and move around, as well as direct instruction in strategies and techniques to monitor one’s level of attention and focus and self-direct back to the task, as needed.
In addition to being inappropriate for some individuals with attention problems, extended time can also set up a student for frustration and a never-ending game of “catch up.” Students who are granted 1.5 or double time to complete all tasks and assignments have to find the extra time within the day to complete them. Often, this may mean missing break periods, recess, or cutting back on extracurricular activities in order to have enough time to complete school work. However, breaks and recess are critical periods for students with attention problems; as described above, many of them need the time to move around and take a break so that they can come back to learning more refreshed and attentive. Extracurricular activities can also be an important way to build feelings of confidence and competence in individuals who may not feel very confident or capable when it comes to academic work (especially academic tasks that require high levels of attention and concentration, thereby emphasizing their areas of weakness).
Some students who are granted extended time, but who don’t actually need it, may develop anxiety and a sense of incompetence around timed tasks. They may become overly worried about time and time pressures, which reduces their attention and focus on the task at hand. They may see themselves as incapable of completing a task within the allotted time and never give themselves the opportunity to challenge this belief. For other students, having extended time simply reinforces poor study and time management habits. Simply granting a student additional time to complete a task does not mean that he or she will automatically know how to use that time effectively.
Finally, extended time does not make up for poor study skills or a lack of preparation for a test or exam. While extra time can result in higher levels of performance for students who actually work more slowly than others and need the time to better demonstrate what they know, it is not going to result in higher levels of performance for an individual who has not appropriately learned or studied the material. Therefore, direct instruction in effective and efficient study strategies may be a more useful approach than simply granting extended time.
In conclusion, the decision to use extended time as an accommodation should not be based on diagnosis alone. Rather, the accommodation should be granted thoughtfully, with consideration of the individual’s unique strengths and weaknesses, as well as his or her circumstances, lifestyle, and values. Even in those for whom extended time is appropriate, it must be used judiciously so that the individual is not set up to fall further and further behind and so that it does not have an unintended detrimental effect on both academic performance and emotional functioning. Other strategies and techniques may be more effective at addressing underlying attention and behavioral regulation difficulties and should be paired with extended time.
Hard work is a value that is often celebrated and rewarded in American culture. The notion that anyone can do anything that they want as long as they work hard is an ingrained belief for American society. But what happens when working hard simply isn’t working? Many children and adults with learning or developmental differences work hard but do not always see the types of outcomes that they expect. They may spend exorbitant amounts of time studying, reading, reviewing, getting tutoring, and still perform more poorly than they expect on tests and exams. They may feel that their grades don’t reflect the amount of effort they have put in to trying to learn the material. They may feel overwhelmed by the process of learning. Over time, some individuals develop anxiety around studying and feel guilty spending time in any activity that is not studying. Other individuals may become frustrated and burnt out by repeated failures, leading to diminished effort. However, learning often does not need to be such a labor intensive, frustrating, and seemingly unsolvable problem. For many individuals with learning and developmental differences, learning strategies to work smarter and more efficiently is going to be much more effective than simply putting in more time using an inefficient or ineffective approach. And the earlier these strategies are implemented, the more they can prevent subsequent poor outcomes.
Working smarter and more efficiently starts with a comprehensive understanding of a person’s strengths and weaknesses and how those strengths and weaknesses impact the learning process. Many factors can affect how well someone learns, including his or her underlying cognitive and reasoning capacities, as well as the demands and expectations of the learning environment. In addition, factors such as attention, behavioral and emotional regulation, and social skills can all impact how well a person learns. Health and environmental factors, such as a neurological condition or living in poverty, can impact learning. A comprehensive evaluation conducted by a psychologist or neuropsychologist can help to clarify where a person is struggling and the factors that are impacting their difficulties.
Take reading problems, for example. For one student, problems with attention make it difficult for her to pay attention to what she is reading. She tends to speed through without taking time to focus on getting the main idea. Another student has dyslexia; his brain has a hard time understanding and making connections between sounds and symbols. As a result, he often misreads information and reading is much slower and more effortful for him. Another student is highly anxious and re-reads sections of text over and over to make sure she hasn’t missed anything. A fourth student is so overwhelmed by sensory stimuli in the environment that he cannot effectively focus his attention on the reading material given to him. A fifth student missed breakfast this morning and is wondering when it will be lunch time. Another student has a sick parent at home and is worried about them. In the classroom, it may appear that all of these students are struggling with reading. But the underlying source of their difficulties is very different and requires very different types of intervention. Working harder may help some of these students, though it will not address the underlying difficulties for many of them.
Once an individual’s learning strengths and weaknesses have been identified, specific areas of weakness can be more directly targeted. Without a comprehensive evaluation and understanding of a person’s learning, interventions and strategies may be implemented that do not effectively address the underlying areas of weakness or build on areas of strength. As a result, time may be spent trying lots of different types of interventions with minimal levels of success, rather than focusing on those strategies that are most likely to be helpful for that particular person. In the meantime, the person may continue to struggle with learning and fall further behind. Emotionally, they may become frustrated, angry, depressed, anxious, or unmotivated. Family members and teachers may see the student as lazy, a behavior problem, or disinterested in learning. The student may get the message that if they would only work harder, they would do better; yet, their hard work may go unrecognized and be overlooked. They may be spending lots of time using a strategy that doesn’t work for them or they may give up entirely because they don’t know what strategy will work or help. Early recognition and accurate identification of difficulties through a comprehensive evaluation can help to prevent, or at least reduce, these secondary difficulties. An individual can then employ his or her hard work, motivation, and dedication in a much more intentional, effective, and rewarding way.
When a child is struggling with learning, parents may wonder what to do. Usually, the first step is to get a comprehensive evaluation in order to identify the nature and severity of the child’s problem and determine what interventions are likely to be useful and helpful. Under the Child Find provision of IDEA, states are required to find and evaluate any student suspected of having a disability, even if the child attends private school or is homeschooled. Specifically, IDEA states that any child who needs special education and related services is to be “identified, located, and evaluated” (IDEA, Section 300.111). In many states, this requirement falls to the local school district to evaluate any child who may need special education and related services at public expense. In other words, the school district is ultimately responsible for ensuring that a child with special needs is identified and evaluated. However, some parents may choose to pursue a private evaluation, for some of the reasons below. In this article, I am hoping to clarify the main differences between evaluations conducted in the public education sphere and those in the private realm. (Disclaimer: I am not an attorney and nothing I have written should be construed as legal advice. The information presented is my opinion based on my experience and understanding of the regulations. Please refer to an educational attorney in your area for more specific guidance and information).
Choice of Evaluator
Typically, parents do not have a choice in who will evaluate their child in the public school environment. Most often, the evaluation is assigned to a specific school psychologist who is assigned to that child’s school or grade level (in larger districts, there are sometimes school psychologists who specialize in certain types of evaluations, such as autism spectrum disorders). In the private realm, parents are free to go to an evaluator of their choice, provided that evaluator has the appropriate credentials and experience to conduct an evaluation. Parents may seek out an evaluator with experience and expertise with the issue their child is facing, specialized knowledge and training (such as a neuropsychologist), or who is referred by family members or friends. Parents often have more access (or can request access, such as asking for a CV) to an evaluator’s experience and credentials in the private realm.
Evaluator Training, Experience, and Credentials
All school psychologists working in a public school district are required to meet certain minimum education and training standards, though these may vary slightly from state to state. For example, to become a certified school psychologist in Pennsylvania, the individual must have a master’s degree that covers specific educational content, a supervised internship of at least 1000 hours, and must pass both the basic skills Praxis exam, as well as obtain a minimum passing score on the School Psychology Praxis exam. Since these are minimum requirements, there are many school psychologists with higher levels of education and training or specialized training in specific areas. However, as noted above, parents often cannot choose which school psychologist in a district will be responsible for their child’s evaluation. At the same time, because the evaluation is conducted by a school district employee, families do not need to be concerned about whether the report will be accepted by the district.
In the private realm, states vary in terms of their requirements for who can conduct an educational evaluation. Continuing with our example of Pennsylvania, to practice privately a psychologist needs to have a doctoral degree (though some who were licensed in the 1980s and early 1990s were able to do so with master’s degrees), at least two years of supervised training and experience, and pass both a national and state exam. Parents and families looking for a neuropsychologist should look for someone who has specific training and expertise, beyond the doctoral level, in the study of brain-behavior relationships (in Pennsylvania, there is no separate license or credential for neuropsychologists; instead, they are licensed as psychologists). However, public school entities are not required to accept a private evaluation and can choose to have their school psychologist conduct an evaluation. If the outside evaluator is also certified as a school psychologist in Pennsylvania, then the district is required to acknowledge the evaluator’s report and conclusions (though they may still conduct their own evaluation). Thus, knowing the credentials of an outside evaluator is important and may affect whether the evaluation is accepted in the educational setting.
Comprehensiveness of Evaluation
Both public and private evaluations vary significantly in how comprehensive and thorough they are. Thus, careful choice of an evaluator and examination of his or her credentials and experience is key. In general, though, evaluators in private practice (especially those who are private pay) have lower caseloads than those who work in school districts. As a result, the private evaluator likely has more time to work with your child. Additionally, if the evaluator has advanced training and experience, such as a neuropsychologist, he or she may be able to evaluate areas of function that are not typically included in standard psychoeducational evaluations in the public school setting (including memory, executive functioning, attention). Private evaluators are not beholden to school district regulations, policies, or procedures regarding what is included in the evaluation. Thus, they may be able to evaluate the child in a deeper, more comprehensive manner.
At the same time, school district evaluations are typically multidisciplinary. If your child also needs a speech, occupational therapy, or physical therapy evaluation, these can be included in the school district psychoeducational report. In the private setting, these types of multidisciplinary practices are much more rare; a child may need to see several different providers who all do independent evaluations.
Diagnosis and Conclusions
Public school evaluations typically determine whether a child meets one of 13 educational classifications, which are defined by IDEA. In order to be eligible for special education, a child must meet the criteria for at least one of these categories and show an educational need. Thus, some children may have a diagnosed condition that does not affect education; this child would not meet the criteria to receive special education and related services. Often, school districts will not make diagnoses for conditions that are not defined by IDEA, such as attention-deficit/hyperactivity disorder (ADHD) or dyslexia; instead, they will refer to an outside provider to make these diagnoses. In the public school setting, classification decisions are also typically made by a multidisciplinary team, following the policies and procedures of the district. It is important to keep in mind that school districts often have limited resources and competing interests and goals; these factors can explicitly or implicitly impact the conclusions that are drawn and the recommendations that are made.
In the private realm, evaluations typically determine whether a child has a diagnosis, as defined by specific diagnostic criteria. Whether the diagnosis affects education and learning is irrelevant in this type of evaluation. For example, a child with a severe fear of dogs may be diagnosed with a specific phobia and require treatment to reduce his anxiety and fears. However, this diagnosis is unlikely to affect school functioning, especially if there are no dogs present in the school environment. At the same time, school and learning comprises a large portion of a child’s daily life; therefore, many diagnosed conditions have an educational impact. Private evaluators are not beholden to school district policies and procedures; therefore, their conclusions and recommendations are often viewed as more objective and more aligned with the child’s best interests. At the same time, private evaluations are sometimes criticized as being unrealistic for an educational environment. Nevertheless, an evaluator who is experienced in working with educational settings and has a good understanding of the school environment can usually make recommendations that are relevant, applicable, and flexible enough to be implemented in the school setting.
Timeline of the Evaluation
IDEA regulations require that school district evaluations are completed with 60 days. States vary on whether the 60 days are counted as 60 school days or 60 calendar days and whether summers count toward the 60 day timeline. In any event, school districts are legally required to complete the evaluation under specific timeline guidelines.
Private evaluators vary significantly in their availability. Some evaluators may have immediate openings, while others may be scheduling out several weeks or months or even have a waiting list. Private evaluators are not required to follow a specific timeline; therefore, it is important to inquire about a private evaluator’s availability and typical report turnaround time.
Cost
Evaluations conducted by the public school entity are done at no cost to the family. In contrast, private evaluations can be costly, sometimes up to several thousand dollars. Many evaluators do not accept or participate in insurance for these evaluations; in fact, most medical insurers will not cover testing for primarily educational purposes, stating that this is an educational service that should be provided by the educational entity, not a medical service that should be covered by health insurance. At the same time, some families are approved for an Independent Educational Evaluation (IEE), which is a private evaluation conducted at public expense (typically, the school district contracts with the private evaluator and pays him or her directly). Finally, some families are able to request reimbursement from the school district for private evaluations that they had done, especially if that evaluation was done because the school district evaluation was not done, was inadequate, or did not identify conditions or learning issues that should have been identified and addressed.
Parents of children with special needs or those facing behavioral or emotional challenges are often told to have their children “evaluated.” Similarly, adults with learning differences or challenges, neurological injuries or illnesses, or behavioral and emotional concerns may be told to get an “evaluation.” But what will an evaluation tell you about your child (or yourself)? And when should you consider an evaluation for yourself or your child?
First and foremost, a psychoeducational or neuropsychological evaluation will help to determine whether there is a diagnosis that accounts for the difficulties the child is experiencing. A diagnosis can be helpful in identifying the nature of the problem, and suggesting possible helpful interventions, accommodations, or modifications. It can be a quick way of capturing what a child, adolescent, or adult is experiencing. Additionally, a diagnosis is often required for eligibility to certain types of programs and services, such as special education, behavioral/emotional services, or medical interventions. However, diagnostic labels are often limited. They tend to describe conditions and disorders in broad strokes, rather than the specific ways they are affecting a particular individual. They do not identify what cognitive, emotional, behavioral, and environmental factors have contributed to the development or maintenance of the condition. They also do not describe the individual’s unique pattern of strengths and weaknesses. Comprehensive psychoeducational and neuropsychological evaluations are individualized, and help to provide a thorough understanding of the individual being assessed. By understanding why an individual is having difficulties, how to help becomes clearer. Therefore, this in-depth understanding of the individual can help those providing treatment to be more targeted and specific in their interventions, and to choose interventions that are more likely to be effective.
Because they are more comprehensive, individualized, and in-depth, psychoeducational and neuropsychological evaluations can be useful in a number of circumstances. Some examples of situations where an evaluation may be helpful are listed below. This list is not all-inclusive; rather, it is designed to provide some common examples where evaluations may be useful:
- The person is having difficulties in learning, memory, executive functioning, attention, behavior, and/or emotional functioning.
- The person is suspected of having a specific condition (such as an autism spectrum disorder or learning disability), and testing is required to determine whether the disorder is present.
- The person has shown a significant change in mood, behavior, or learning. These changes may suggest the onset of a condition in those without a history of difficulties. They may also suggest the onset of an additional condition, ineffectiveness of interventions, a change in course or severity, or an incorrect initial diagnosis in those who have been previously identified and evaluated.
- The person has not responded to standard treatment or research-based educational interventions.
- The child requires special education or related services.
- An adolescent or adult requires accommodations or modifications in a college or job training program, standardized testing situation, or in an employment setting.
- The person was previously evaluated, but the evaluation was not comprehensive, inadequate, or invalid.
In general, evaluations may be repeated every 2–3 years for children/adolescents in order to assess progress and update treatment recommendations. In some cases, re-evaluations may be unnecessary, especially if the condition has resolved and the person is no longer experiencing any difficulties. However, re-evaluations should be completed in shorter intervals if there is a major change in functioning, if the person has not responded to treatment or treatment has stalled, or if the person has a condition that is known to cause progressive deterioration in functioning.