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Why do some families pay for private evaluations when the ones at school are free? What is a neuropsychologist? And can this person do things that a school psychologist can’t? Listen to this episode of Understood Explains to learn the answer, which involves making diagnoses.
Host Dr. Andy Kahn is a psychologist who has spent nearly 20 years evaluating kids for public and private schools. His first guest on this episode is Dr. Ellen Braaten. She teaches psychology at Harvard Medical School. She also runs the Learning and Emotional Assessment Program at Massachusetts General Hospital. Andy and Ellen will explain:
How private evaluations compare to school-based evaluations
Why families may want to seek out one or the other — or both
What to look for in a private evaluator
Ways to help cover the cost, like asking the school to pay for an independent educational evaluation
Andy’s second guest is parenting expert Amanda Morin. They’ll share tips about a tricky topic: what to say if your child is getting private testing after being evaluated by the school.
Jennifer: Hi, my name is Jennifer from Atlanta. When you have your child take these standardized assessments, these tests, they can't retake it five months later. So what happens when you go through the school first and you've had the school do theirs, if they use the good test, then when you go get your private evaluation, the person you're paying now a lot of money to do the evaluation can't do the test themselves. So in hindsight, I wished I would have done a full neuro psych evaluation right from the beginning and just paid the money up-front privately and gotten the big picture of what was happening, and then taken that to the school and asked for an eligibility meeting. And then they could have performed whatever they wanted to do. So I feel like I got it backwards.
Andy: From the Understood Podcast Network, this is "Understood Explains." You're listening to Season 1, where we explain evaluations for special education. Over 10 episodes, we cover the ins and outs of the process that school districts use to evaluate children for special education services. My name is Andy Kahn, and I'm a licensed psychologist, and an in-house expert at Understood.org. I've spent nearly 20 years evaluating kids for both public and private schools. I'll be your host.
Today's episode is all about private versus public school evaluations. We're going to cover a few key things: how private evaluations are similar to and different from evaluations that are done through public school districts, why families may want to seek out one or the other or both, what to look for in a private evaluator, and ways to help pay for a private evaluation. We're also going to give you some ideas on what to say to your child about different types of evaluations, and what not to say. First, let's hear from another parent.
Michele: My name is Michele and I live in the Bronx, New York. I paid for a private evaluation. And we were there from 9:00 in the morning to 5:00. And this was last year during the pandemic. And I was sort of excited because it was all day and I felt that they were going to be very thorough with the evaluation, and it was going to be helpful. So the evaluation report that I received was very generic, and it was incomplete. And it totally did not really discuss my son's strengths, his weaknesses, what services he would need. I paid out of pocket $350. And they billed my insurance company $6,800.
Andy: It's very common for families to think about getting an evaluation through a private clinic rather than their school district. Different families may do this for a variety of reasons. For some families, their child may have already gotten an evaluation through the school district, and they want a second opinion. Some families may prefer the control they have with the private evaluation. For example, they may not decide to share those pieces of information with their school.
There are a lot of pros and cons to consider. For starters, private evaluations are really expensive. They can be very time consuming to get into. And school evaluations are free. So how do families go about deciding about these needs?
My first guest today is going to help me unpack all this. Ellen Braaten is an associate professor of psychology at Harvard Medical School, and is the executive director of the Learning and Emotional Assessment Program at Massachusetts General Hospital. She's the co-author of "Straight Talk About Psychological Testing for Kids." Ellen is also a mom of two and a longtime Understood Expert, and we're so thrilled to have her here today. Ellen, welcome.
Ellen: I'm really happy to be here.
Andy: So Ellen, let's talk a little bit about the program you run at Mass General. I understand it specializes in evaluating kids for learning and thinking differences. And you also help to train psychologists as part of the Harvard Medical School program. And — so I understand you do a whole variety of different assessment types there, correct?
Ellen: We do. We do neuropsychological assessments, which I think we'll get to in a little while. We do educational evaluations, intelligence testing. We even do school observations, as well. And we assess children for various kinds of learning differences, dyslexia, ADHD, autism spectrum, and developmental issues as well.
Andy: So you just mentioned several types of evaluations. Can you tell me a little bit about each one and how they're different from one another?
Ellen: So let me give you a few big-picture definitions. A neuropsychological evaluation typically implies that there are a number of different tests that measure different types of brain functioning. And by that I mean attention, memory, language, learning kinds of functioning. So that's sort like the granddaddy of all assessment batteries.
And then you'll also see evaluations that have the label of behavioral or emotional functioning or psychological functioning. And that typically means just what you think it is: that the evaluator has looked at someone's behavioral functioning, or their psychological functioning. Things like anxiety, depression, worries.
And so you would think that there were clear definitions for each one of these assessments, but there really isn't. Depending on where you live, what area of the country, these are sort of used interchangeably. I would say the only exceptions to that is the term neuropsychological assessment. And you'll also see one other assessment, which is called a core evaluation. It's a battery of tests that are used to determine whether a child is eligible for services in school.
Andy: Yeah, and what you just described as a core evaluation, parents in some places might hear it referred to as a psychoeducational evaluation. So there's a lot of jargon for parents to wrap their heads around. I also want to add that when psychologists like Ellen and me use the word "battery," what we're referring to is a group of tests.
So let me give a quick example. A psychoeducational battery commonly includes an IQ test, academic achievement testing, and sometimes subject-specific tests that look at reading, writing, or math. So with this kind of battery, I might use these tests to answer the question of does a child have a learning disability, or slow processing speed, or trouble with working memory? And the results may point to some kids as having one or the other. Some kids might have all of the above.
OK, so we've been talking about different kinds of evaluations. What about the people who do these evaluations? Is there one type of evaluator for each type of evaluation? Or do some providers offer like a menu of choices? Tell us a little bit about who typically does what,
Ellen: Typically these evaluations are done by psychologists, but even psychologists aren't all the same. You might hear the term "neuropsychologist." That's the kind of psychologist that typically does neuropsychological batteries. School psychologists typically do evaluations through the school system. And then you'll also hear the term "educational psychologists," "clinical psychologists" — it's all different sorts of psychologists who are licensed to do different sorts of testing,
Andy: You just use the word "licensed," which reminds me — I want to mention yet another type of evaluator that parents may hear about, and that's a licensed psychologist. That's what I am. Unlike a school psychologist, a licensed psychologist can diagnose mental health and other conditions. And this next detail I'm going to share can be a bit confusing, but it's helpful to know: Some schools hire licensed psychologists like me to do their school-based evaluations. So not all psychologists who do school-based evaluations are school psychologists. Kind of confusing, I know.
Ellen: And then also, there's the term "psychiatrist," which a lot of people think is the same as psychologist, and it's not. Psychiatrists are medical doctors who specialize in the treatment of psychiatric issues like ADHD that they would treat medically, typically, and sometimes with therapy. But psychiatrists do not do the kinds of evaluations that we're talking about today.
Andy: Good to know. And Ellen, there's one other jargony term I want us to cover. And it's a real mouthful. It's called the "independent educational evaluation," or an IEE. This is basically a private evaluation, but the school district pays for it. So it's free to families. We're going to dig more into IEEs in a minute. But first, I want to ask Ellen a big-picture question. Ellen, talk to me about the pros and cons of private versus school-based assessments.
Ellen: It's not like private evaluations are better than public school evaluations. It really depends on what your child needs. And you've got to weigh the pros and cons yourself. So one of the big pros of going public is that you pay nothing for the evaluation. The other pro about a public school evaluation is the people who are doing the evaluation are ones who are really invested in your child. And sometimes those people will be actually the ones to implement the services that come out of the evaluation. That can be really nice.
You also, as you mentioned before, thinking about the independent evaluation, you do have the right to seek that independent evaluation if you're unhappy with the school's evaluation, if you're not satisfied, or you feel like they just didn't capture your child's strengths and weaknesses and where you need to go from there. And you do have the right to seek amendments to that report. So those are all pros of going publicly.
If we talk about the pros of going privately, I think the biggest pro is that you can have more confidence that the recommendations that are being made are not being made with regard to how the services are implemented, or whether or not they're available. The other positives are that you get to choose the evaluator, you control who sees the report, you can usually get a more comprehensive evaluation. That's not always true, but sometimes from a private evaluator, you get a more comprehensive evaluation.
And the other thing that really is a big difference, and it's a difference between these two kinds of evaluations, but that's a pro with a private evaluation, is that it usually results in a diagnosis. And sometimes the diagnosis is very important for a parent. They really want to know, is it ADHD? And the school district is not — they're not in the business of providing diagnoses. That's not what they do. Their purpose — their evaluations decide whether or not this child meets eligibility for services. Where in a private evaluation, the evaluator's thinking, does this child meet criteria for a diagnosis? And would having that diagnosis associated with their profile be helpful?
Andy: Yeah, and as I mentioned earlier, most school psychologists legally aren't able to diagnose something like ADHD. You need a special kind of licensing for that. So it's pretty unusual for a school-based evaluation to result in an actual diagnosis. A school-based evaluation is much more focused on determining if you qualify for services because of whatever you're struggling with.
OK, so Ellen, we've been talking about the upsides of private evaluations. But there are also some downsides. One is how much it costs. And the other is how long you have to wait. With a school-based evaluation, the school has to follow a very specific set of rules about how quickly they have to complete the assessment. But those rules don't apply to a private evaluation. In our area here in Maine, the waiting lists for neuropsychological assessments is over a year, and in many cases, close to two years.
Ellen: Yes, and you bring up one of the biggest cons, and after money, it's time, which is one of the biggest cons for private evaluators is that they're expensive and there's usually a very long waiting list to get an evaluation. And so — and the school does have to do it, depending on your your state or even your school system, within a certain amount of time. Oftentimes, it's 30 days, usually no more than 60 days. So it can be very anxiety-provoking for parents who have to wait a year to have an assessment done.
Andy: So we've talked about some pros and cons, but to help parents who are trying to make a decision, Ellen, can you summarize some of the biggest differences between public and private evaluations?
Ellen: So the biggest difference that I mentioned before, other than money, is that the whole point of a school evaluation is to make a determination whether or not a child is eligible for services. So that is their, you know, their whole point is to see, OK, we're going to evaluate what the child is struggling with in school. Whereas in a private evaluation, the evaluator is really looking at whether or not the child meets criteria for specific diagnosis, in addition to looking at what would be most helpful in terms of treatment, and often looks beyond that very specific referral question that needs to be addressed at school.
Andy: Super helpful. So one of the things I think that may be important for parents to understand is that you could get a diagnosis as part of a private assessment. That doesn't necessarily mean that that diagnosis is going to lead to a plan at school. So Ellen, let's talk a little bit about cost. How expensive can these assessments get where you live? Now you're in the Boston area.
Ellen: They can be very expensive. And it really depends on the evaluator, how lengthy the evaluation is, the age of the child — the younger the child, more typically the cheaper the evaluation and the shorter the evaluation. The older the child, the more expensive the evaluation and longer. Right now in our area, if you're having a full neuropsychological evaluation, and I think this is fairly true, even outside of Boston, it's going to be at least $4,000. And in places like New York City can range to eight or $10,000.
Andy: Where I live, those kinds of assessments may cost in the neighborhood of between two and $4,000. And again, depending upon, I'll pull Ellen's word out, again, the size of the battery, and how complex the testing question is. Ellen, what advice do you have for families trying to decide whether their child needs a private evaluation?
Ellen: Well, one of the things is to sort of — I always say this: Trust your gut instinct. If you are thinking like, "Oh, I wish we knew more," and you're sitting, you know, awake at night, wondering "Is there something we could do?" Trust that instinct, because I've never yet had a parent come to me and say, "Oh, I wish we hadn't done this yet. This was too soon." But I have almost every week either a case that I'm seeing or supervising, where the parent says, "I wish we'd done this sooner."
Andy: For families who want to get a private evaluation, what questions do you recommend that they ask to make sure the evaluator may be a good fit for them?
Ellen: Well, before they even ask the evaluator, I recommend that parents ask around. I think that word of mouth is a great way to find an evaluator. So ask around: "Who would you see if your child was being evaluated?" is a great question to ask your pediatrician, or school psychologist, or a teacher. So you want to make sure that you've talked to other people who have either been through what you've been through or who have insight into who is good in your area.
Once you've gotten a name or two or more, you want to make sure that you know what license that provider carries. Are you a licensed psychologist? A licensed school psychologist? What does that mean? What kind of training do you have? You want to ask the evaluator "What kind of kids do you typically see? How long have you been practicing? What is the procedure after the evaluation is done? Can I talk to you afterwards? Is there follow-through that happens? What happens if we don't agree with the findings? What do you do?"
Andy: Those are really great questions for all parents to ask. Ellen, let's talk a little bit about any tips for different groups of families who'd be seeking a private evaluation — for example, families who are getting their first evaluation.
Ellen: So for a first evaluation, you want to make sure you know exactly what's going to happen that day or over those subsequent days. Go in with a lot of information about what to expect. Are there lunch breaks? Is it straight through? How much time will it be? Because that's going to help you orient yourself to that evaluation process, make the child feel more comfortable. And we've talked about making sure you have an evaluator that you feel confident and comfortable with — that's implied. But I think that first evaluation, you don't really know what to expect, and what the experience will be like. So go in understanding, having asked the questions of the evaluator as to what to expect.
Andy: So what about families who are coming in and getting the kids reevaluated? What tips might you have for them?
Ellen: So I think one of the things you want to really take note of is what has changed or stayed the same since the prior evaluation. I think it's very good, if you can, to go back to the same evaluator. If you liked that evaluator, they already have all of the data on your child — more than what's in the report. They remember the child, the child already has built some rapport with the evaluator. I would recommend, if possible, to do that. If not, that's OK. You still have the evaluation. And be sure you bring that prior evaluation to any further evaluations that you have. And make sure that you have really documented or at least thought about why you're coming back in. What's working, what's not, and why you're seeking the reevaluation.
Andy: All right. So last but not least, any suggestions on what families can do to help pay for this private evaluation process. And I know we've sort of nibbled around the edges of it a little bit. But maybe you can give me some of your, you know, your advice on this.
Ellen: So if you want to get it covered through health insurance, you want to make sure that you go through your health insurance company to get all the information you can before you even make the appointment. Health insurance companies are not very happy when after the fact you submit a bill for $4,000 for something that's already been done.
Any time that you can make a case that it is a medical issue, use anything in your child's background that is honest, of course — we don't want to make up anything. But things like prematurity, memory issues, attention issues, any sort of concussion, head trauma, anything that's happened in your child's recent or past medical history that might indicate a neuropsychological evaluation is something that would be helpful. Use that.
Another thing that you can do is go through teaching hospitals and universities. So for example, lots of universities offer these evaluations at a great, great discount, sometimes $50 for a $5,000 evaluation. Seriously, it's that much. Now you're not going to get a licensed professional who's doing all of the evaluation, but a licensed professional will be overseeing the evaluation.
And the other thing too is to ask your school system to do the IEE that we talked about before. It might be a longshot. I find that schools are oftentimes willing to do it if you can make the case that your child is still struggling and what you're really seeking is a resolution of the problems that you're having with the school providing services. And that's typically what it is.
Andy: Listeners, our show notes have links to more info about IEEs, neuropsychological evaluations, and other resources that can help if you're thinking about getting a private evaluation. Ellen, today has been fantastic. I can't thank you enough for all the info you've given us. Thanks so much for being here.
Ellen: Thanks for having me. It's been great.
Haizel: Hi, my name is Haizel. I finally decided to have Sayeira evaluated outside of the department of education when she was in the eighth grade, I believe. She had the math disability added as part of the private evaluation. The comprehensive testing that was done outside of the DOE was probably the most telling and the most accurate in my opinion. It really explained to me what and why I had seen discrepancies between previous testing and her performance in the classroom and her, you know, her ability to study, her ability to take tests, her report cards, it just did not match. And that and that outside evaluation helped me better understand why.
Andy: So we've been talking about how to help parents and caregivers decide if their child needs a private evaluation. But what can adults say to kids about getting a private evaluation? My next guest is an expert on how to talk to your child. Amanda Morin co-hosts Understood's "In It" podcast about the joys and frustrations of parenting kids who learn and think differently. She worked as a classroom teacher and as an early intervention specialist, and is also a parent advocate. Amanda, welcome.
Amanda: Thank you. It's good to be here.
Andy: So maybe we can talk a little bit about what to say — maybe if it's your child's first evaluation, or how to get us started in that communication with them.
Amanda: If it's your child's first evaluation, it's a really different conversation, because you're really just talking to them about what an evaluation is. You want to talk about, like, who they're going to meet. I've already talked with them, I feel very comfortable with them, I trust them. Those are the kinds of things you want your child to know up-front. If this is an evaluation that has happened after a child has already had a public school evaluation, with a younger child, keep it tight, keep it simple. You know, you're going to meet somebody new. They're going to be asking probably some of the same questions somebody else already asked you, maybe doing some of the same activities, but maybe doing different ones too. And the reason is, because you know what, I know a lot about how your brain works now, but I want to learn more. I want to learn more. And I think that's the key to lean into is, we're just getting more information here. As a parent, you may have feelings about having to do that. And I think keeping those out of the mix matters a lot — to be able to just be matter of fact with your child.
Older kids are a little more tuned in sometimes, and they're gonna be like, wait, why are we doing this? Didn't we just — didn't we just do this? I think it's OK to say, I'm not sure we got all the information that was needed from the school evaluation. And so I want to actually go a little bit further into what we know about you. And so this is one of the reasons we're doing this.
Andy: Are there any things in particular that you would avoid actively saying to your kid, or things that you would steer away from in this conversation?
Amanda: If a private evaluation is being done because you don't agree with the school evaluation, I would definitely steer away from saying that out loud to your child. Kids spend so much time in school, and they need to trust where they are. And so if you say "I don't trust the school's results," that's all they're gonna hear. They're gonna hear "I don't trust the school." They're not going to hear anything that comes after it.
And I also think that I would stay away from making promises about what this evaluation is going to provide. As a parent, we want to fix things, we want to have simple solutions and simple answers. And sometimes there aren't simple answers. It's not a good idea to say to your child, we're going to have this private evaluation to see for example, if you have dyslexia, because we can't guarantee that's the outcome of the evaluation. So I think it's really important to not say, "We will know for sure after this," whatever that you think you'll know for sure after it, because you may not.
Andy: That's a really, really great point. You know, the idea around this is where we really try to be cautious about any of the judgment aspects of this. It's an exploration, we're trying to find out information. And I think that some of it that's probably going to bounce back on kids, especially if they've been evaluated before, is the "why" questions: Why do I have to do more? And perhaps having an idea about what's potentially in it for them. Like what — how are they going to benefit from this? Because your older teens are asking that about just about everything. What's in it for me? Why would I do this? Why, you know, I just did all this already. You know, my gosh, you guys are just always poking and prodding at me and, you know, these are things that when kids enter the room with me for assessments, I usually have to navigate that in my process. So, you know, what would you say, you know, if your child's a little reluctant to be evaluated again? What kind of things might you say to them?
Amanda: I would make sure that you say to your child, I know it feels like we're doing things to you, but we're really doing is something for you, right? And to be able to make that distinction. I know this is tough, I know you're tired. I know this has gone on X amount of time. I am just as anxious as you are to get to the point where we can now understand more, and get to the place where we know how to really support you, and help you feel confident and comfortable and really do well at things that you're not feeling like you're doing well at.
Kids need to buy into this process. They need to be a part of it, whether or not they're making the decisions, they're making the decision to participate, right? So when they sit in that office, instead of having their arms crossed in there and kind of glaring at the evaluator, they need to understand that if they participate, there's something in it for them, right? And what's in it for them is learning more about them so we can make life a little bit easier for them. And I think that's important to really focus in on, that this is for you, and not to you.
Andy: So we've talked about the difference between private and public school evaluations, why some families may want one or the other, how to find a private evaluator and cover the costs. If there's one thing to take away from this discussion is that you can play a crucial role in suggesting what kind of testing your child needs. This is true regardless of whether you decide to seek out a private evaluation, or get one through your child's school. So don't be afraid to share your concerns and ask lots of questions. As always, remember that as a parent, you're the first and best expert on your child.
In our next episode, we'll explain when kids need to get reevaluated and why. We hope you'll join us.
You've been listening to Season 1 of "Understood Explains," from the Understood Podcast Network. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we've mentioned in the episode. And now just a reminder of who we're doing all this for. I'm going to turn it over to Cecilia to read our credits with an assist from her mom. Take it away, Cecilia.
Cecilia: "Understood Explains" is produced by Julie Rawe and Cody Nelson, who also did the sound design for the show. Briana Berry is our production director. Andrew Lee is our editorial lead. Our theme music was written by Justin D. Wright, who also mixed the show. For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. A very special thanks to Amanda Morin and all the other parents and experts who helped us make this show. Thanks for listening and see you next time.
Mom: That was great!
Andy: Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at understood.org/mission.
is a licensed psychologist who focuses on ADHD, learning differences, anxiety, autism spectrum disorder, behavior challenges, executive function, and emotional regulation.
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