Written by Charles Galyon, Ph.D. & Carolyn Blondin, Ph.D.
Following a psychoeducational evaluation, you should have a results session with your examiner to discuss the results and the meaning of the results. However, even an extended results session may leave you with unanswered questions. The time to discuss results is limited, your examiner will not be able to anticipate all of your questions, the amount of information you receive may feel overwhelming, and you likely will have many other questions come up after the results session. The information provided below is here to help you figure out what to do next after your results session and how you can get additional help and information when you need it.
What does a diagnosis mean?
First, remember that a diagnosis is only a “functional label.” By itself, a diagnosis is not helpful. The reason you might seek out a diagnosis is to get better ideas about what you can do to improve the problem. With a diagnosis, then you can get an idea of what may happen in the future, and what kinds of accommodations or treatments may be helpful. For example, when you know your child has a cold, then you can expect it will be unpleasant for a period of time, but that your child will get better without need for medical intervention. On the other hand, if your child has a severe case of the flu, then you can expect the child may need medical assistance, and that a pediatrician will have an idea of what treatment will prove most helpful.
How reliable and permanent is a diagnosis?
When making a diagnosis, the examiner is looking for a combination of symptoms and characteristics that tend to occur together, which may indicate some underlying condition (for example, a learning disability, an Autism Spectrum Disorder, or a developmental delay). The examiner is well-trained in a variety of disorders, their symptoms, and how to test for other characteristics that would be consistent with a disorder. However, it is ultimately “clinical judgment,” and some individuals simply do not show symptoms in the same way. Also, the examiner only sees you or your child for a limited period of time and typically only in one setting (such as a clinic). While the examiner is aware of these limitations and tries to take them into account, you may have important information that would affect the diagnosis. For that reason, be sure to share all information you believe may be important with your examiner.
Keep in mind that as you or your child grows, learns, and develops new skills, things may change with respect to the diagnosis. Many diagnoses are considered “permanent” (such as Autism Spectrum Disorder), meaning that if the diagnosis is received earlier in one's life, then it stays the same regardless of changes in the symptoms. However, the degree of impairment can change considerably, which is ultimately the goal of receiving a diagnosis and treatment.
Is there a cure?
Generally speaking, there are no “cures” for disorders; however, many disorders are better understood now and can be greatly helped with different treatments. For psychoeducational disorders, many of the treatments are called, “interventions.” Interventions may include skill training, behavior modification, or therapy. Medical treatment is also often used in conjunction with interventions to improve the effectiveness of interventions and reduce potentially more severe symptoms (which may interfere with the ability to benefit from interventions). Though your examiner may be able to discuss medical treatment to a limited degree, remember that they are not trained in medical practice. To gain more information regarding options for medical treatments, you should speak with your family physician.
What is involved with “training skills, modifying behavior, or receiving therapy”?
Skill training. Training skills is used for academic difficulties (improving math, reading, or writing skills), adaptive behavior (day-to-day activities), and to teach compensatory strategies (such as for problems with organization, memory, communication, or social skills). Skill training usually occurs periodically (such as once per week), involves assessing the current skill level, using a scientifically-validated training program, and measuring improvement in the skill to make sure the training is working. Skills training can be an invaluable approach to addressing disorders and may reduce problems associated with the disorder. It generally provides significant improvement, but does not completely eliminate the problem.
Behavior modification. Behaviors may become a regular habit over time, and often occur without thinking. Most behaviors are appropriate and desirable, but sometimes behaviors are not desirable (misbehavior) and need to be changed. Many problems may be effectively addressed by modifying behavior or replacing an undesirable behavior (for example, throwing toys), with a new desirable one (such as, expressing anger verbally). Behavior modification requires several steps, including identifying the “antecedent”, “target behavior”, and “consequences”. This process is known as “Functional Behavior Analysis” and is done before behavior modification begins. The “antecedent” is what occurs before the behavior and may act as a trigger. A simple example would be: when a traffic light turns green, the driver applies his/her foot to the gas pedal of the car. The “target behavior” is the behavior to be changed. The “consequences” are what occur after the behavior that increase or maintain the behavior. This is easy to understand if you consider how you might respond if you got $50 each time you said, “Hello” to someone (you would probably say, “Hello” a lot!). A major goal of behavior modification is promoting “successful behaviors” (behaviors that we desire and that result in good things) and making them more enjoyable than the previous, undesirable behavior (typically by using rewards for the good behavior).
Therapy can take many forms, but when applied to psychoeducational disorders, it often focuses on desensitization, counter-conditioning, restructuring thoughts, and other anxiety reduction strategies. Therapy should be “solution-focused”, meaning it identifies a specific problem, creates a plan to reduce the problem, and evaluates progress throughout therapy. Therapy in this context is typically relatively short (for example, 7 to 12 sessions over a period of 2 to 3 months).
Now I've got a diagnosis, what should I do next?
There are a variety of steps that you may take next. Some disorders may benefit from medical treatment, such as Attention Deficit/Hyperactivity Disorder or severe Anxiety Disorders. In such cases you should meet with your physician to discuss your concerns and bring your evaluation report with you. You may want to request a letter for your physician from your psychoeducational examiner. The letter is a helpful way for the examiner to briefly state the evaluation procedure, results, and provide contact information for the physician.
It is also appropriate to begin treatment planning following the diagnosis. Treatment planning can include a variety of steps, such as those mentioned above, as well as identifying additional resources that may be helpful (such as local support groups, clinics, or material resources). If the disorder has an educational impact, then it is appropriate to begin the process of requesting accommodations from the school. An educational impact generally means the disorder interferes with the ability to succeed in academic work, or that the disorder produces behaviors or stressors that interfere with the ability to function in an academic setting (which may include social difficulties).
Though your examiner has provided a brief description of the diagnosed disorder in the evaluation report, it is usually helpful spend some time learning more about the disorder yourself. Your examiner is one useful source of information and should be consulted if you have additional questions, but there are also a variety of helpful resources that can be located elsewhere, including books, support groups, and internet resources. You should be careful to evaluate the credibility of these sources, though, because not all sources are factually accurate or well-researched. Your examiner may also be able to provide some suggestions for resources that are reader-friendly and scientifically valid related to the diagnosis.
I didn't get the diagnosis I came in for, now what?
Possibly one of the most frustrating experiences is to come in for evaluation due to problems, but not get a diagnosis to confirm or explain the problems. Just like getting a diagnosis does not solve the problem, problems can exist even if a clinical diagnosis is not made. Sometimes problems are “sub-clinical”, meaning that a problem is evident, but the degree of severity of impairment is not enough to warrant a diagnosis. Your examiner may still provide recommendations related to the problems you are experiencing, and these recommended solutions can still be beneficial. It is also possible that a problem may change over time and become more or less severe, which would change the eligibility for diagnosis. If you feel a problem has persisted or becomes worse over time, then consider requesting a re-evaluation.
Why does my child struggle despite not having a diagnosis?
This is a common question and point of frustration for parents, particularly when a child is struggling in school, but there is no apparent explanation. There is not a simple answer, but there are a number of possibilities that may make it easier to understand (though not necessarily easier to deal with). When making a diagnosis, there are two primary questions that must be asked: 1) does the child exhibit the symptoms consistent with a disorder, and 2) is the impairment significant enough that it affects daily functioning? Most often, when a child does not receive a diagnosis, it is the second question that comes back with the answer, “No.”
To help improve the reliability of diagnoses (so that different examiners will reach the same conclusion), certain scores must be reached to indicate significant impairment. A child may struggle, but their scores could be right on the edge, meaning they will not get a diagnosis. However, it is possible that if the problems continue, the child will qualify in the future. Therefore, if you do not receive a diagnosis initially and the problem is still present (or worse), then it is often a good idea to ask for a re-evaluation.
Why won't the school help my child?
Rest assured, the school wants to see your child succeed and is not intending to frustrate you. Similar to the previous question, schools are required to use certain criteria in deciding if a child will receive services. Because schools have limited funds, they often must be cautious with regard to identifying children for services. As a result, there are a limited range of disabilities and disorders for which children may receive services in a school setting.
Unfortunately, if a child struggles academically because of a cognitive processing deficit (for example, poor short-term memory, low processing speed, or difficulty with recalling information), then they may not qualify for services because these are not recognized “disability categories” within education. These difficulties are still very real and can cause a great deal of frustration for the child. In such cases, it is strongly encouraged that you try to work with your child's teachers to see if some reasonable accommodations can be made (such as extra time on assignments or tests or allowing the use of scrap paper for jotting down notes during tests). Keeping communication open with teachers about behavior, progress, and/or concerns can be very helpful. Many teachers are willing to work with students and parents to help the child succeed.
Should I get a re-evaluation? When?
Re-evaluation may be recommended under a few circumstances. If the previous evaluation did not produce a diagnosis, but the problems persist or have gotten worse, then re-evaluation may be helpful after some time has passed. Usually you should allow at least a year to prevent a “practice effect” (when a test scores artificially high because it has been seen before). You should also be sure to inform the examiner of any previous evaluations that were done, when they were done, and (if known) the tests used for evaluation. This helps the examiner select an appropriate test.
Re-evaluation is also necessary periodically to check progress and to figure out if a new plan should be developed. This kind of re-evaluation is typically conducted once every three to five years. Information from these evaluations can help determine if there is improvement, if there is a new need, or if a different approach to treatment would be better.
And finally, an evaluation may be periodically required for progress monitoring. Schools often require recent evaluations when determining if accommodations and services are necessary. Many colleges and universities also require recent evaluations for services. Though “recent” may have different meanings between schools, in general, evaluations should not be older than 3 to 5 years.
Should I get more evaluations from other professionals?
The initial psychoeducational evaluation may only be a starting point in terms of identifying needed services. Psychoeducational evaluations typically assess cognitive, academic, and psychological functioning. This means that other skills, such as motor skills and language skills, are not evaluated in depth. Though the psychoeducational evaluation may provide some information about language skills, it is not intended to be a thorough evaluation of language skill, which is more thoroughly examined by a speech-language pathologist. Motor skills are also not thoroughly evaluated as part of a psychoeducational evaluation, and are usually assessed by an occupational therapist.
Depending on the diagnosis, your examiner may recommend follow-up evaluations by other health professionals, including speech-language pathologists and occupational therapists. If unsure, ask your examiner if it would be appropriate to seek further evaluations.
Should I share this report with anyone?
You may share your report with anyone you desire (it is your report); however, it is typically helpful to share your report with your family physician, any counselors or social workers with whom you visit, and schools. Your family physician may need the information to begin a collaborative treatment plan (as is often the case with Attention-Deficit/Hyperactivity Disorder). Your counselor or social worker may need the information to better understand how to best help you. And schools may need the report to set up a program of services and accommodations for your child. For example, you may require services under an Individualized Education Plan (IEP) or Section 504 Plan. Ask your examiner for a further explanation of these programs and what is involved in them. Similarly, sometimes it is appropriate to share the results of the evaluation with your employer to secure workplace accommodations (as protected by the Americans with Disabilities Act).