Producer: Good morning and welcome back to Full PreFrontal where we are exposing the mysteries of executive function. I am here with our host as always, Sucheta Kamath.

Sucheta, this is going to be a pretty intriguing conversation. Well, frankly, all of our conversations are quite intriguing, but I’m looking forward to this one, but lead us off, help us understand, I mean, we all have these educational experiences and those all feed ultimately how we go through life forms our strengths and weaknesses. Talk us through that a bit.

Sucheta Kamath: Well, thank you, Todd, it’s great to be with you today, and yes, you bring up such a great point that we have educational experiences and Kind of shape our own understanding of our strengths and weaknesses, and not everything is rosy as you know. We may have more weaknesses and strengths, and we need education and learning to shape that, and it can be the other way: we can have lots of strengths but learning and formally participating in education and create a lot of challenges and then turns out to be a weakness. So, anyway, when my kids were – you know, I have two boys and they are now young adults – but when they were little, my husband always teased them and say, “Why are you guys studying? You should know this already,” and I used to remind my husband that he had this somewhat inflated memory of his own skills and abilities. When I met my husband, we were 19 and he was in medical school, and in fact, my family has this vivid memory of all of us getting together and there was an India-Pakistan game, cricket match, going on television. It was televised and all of us were facing the television and shouting and screaming, and my husband was facing against the television and he was sitting at the dining table with completed full concentration and he was preparing for a big exam he had coming up. So, I think he has a sense that he never had needed to study and all he is learning has been natural and that he has just breathed into his consciousness.

So, I always admired this about my husband, but that’s not me. I’m a different kind of learner. I’m in fact very good at coming up with strategies and tricks for myself because things never stick to my brain like a Velcro. What has really carried me through is my deep desire for learning and passion for learning, and I enjoy challenges that learning brings up, and I do take a lot of initiative to invent tricks for myself because of my curious mindset. I think learning has never been a natural process. In my lifetime, I have met some friends who actually would browse through their Grey’s Anatomy, for example, when they were in medical school and they would memorize every single paragraph on every single page and be able to locate in their brain using the visual images. That is just not me.

So, what I’m trying to get to is there are people who take their strengths for granted and they may end up in a place where they hate their weaknesses, but I find that since I have entered in this arena as a professional, I spend all my time helping youngsters and adults overcome their weaknesses and learn more about their weaknesses to become more proficient, and I in fact, I have spent all my life helping them develop a better relationship with their weaknesses, and how do people really get to know what is in their profile of learning? That is what I’m going to talk about today, and that’s the expert we have who’s going to shed some light on it. So, let me quickly share a story of a student who came to me in 10th grade. Let’s call this kid James, and I received a report from his educational psychologist who described that when James was born, he was born of a full-term without any complications during pregnancy. There were a few issues related to sleep, but other than that, he had a great skill set as he was hitting every early development milestone and all of them were attained within normal limits. When James entered kindergarten, he was playful but distractible and always last to start and last to finish, and by the time he was eight, this last to start, last to finish business became a little bit of a barrier, so the parents took him to a psychologist and he was eventually diagnosed with attention deficit hyperactivity disorder which is ADHD, and was taken to a pediatrician who eventually prescribed Adderall, and that medicine had its ups and downs and eventually, it was discontinued because of the side effects, and at this point when James came to me, he wasn’t taking any medication.

So, as I began to take the history, conversation came up about when did the challenges in learning become a roadblock in academic and personal success, and I found out that the second week of ninth grade, James withdrew from local private school and enrolled into online Academy, and he began to receive failing grades last year, but he was passing everything except honors biology, and the reasons for withdrawal were personal. There were a lot of personal crises – parents going through divorce, having a very massive custody battle, the son was moved with a caretaker, the father had an international traveling job – he was hardly in the country, but the mother had significant psychiatric breakdowns and she was in and out of psychiatric hospital – she had substance abuse problems, on and on, so James, in this shuffle, got lost, and of course, his learning problems which were diagnosed since third grade became a bigger barrier, but he was never prepared for it, and that is what brought him in front of the psychologist and the results of the psychological testing brought James to me.

So, what I’m trying to get to today, Todd, is the journey of childhood educational path may be very treacherous, not easy, or bumpy, or smooth, but sometimes, we need that external information, external guide, we need some formal information regarding the profile of our inner capacities and that is why I have this expert today. Her name is Dr. Judy Wolman. She is a psychologist in my neck of the woods which is Sandy Springs. She in fact is in the building over. I’ve known her for the last 17 years ever since I moved to Atlanta from Boston. She specializes in psychoeducational evaluations, family therapy regarding child related issues, and psychotherapy for children and adolescents. She received her PhD in developmental school psychology at Georgia State University in December 1984 and prior to that, she received a Masters in learning disability in 1976, and a Bachelor of Science in special education and elementary education from University of Maryland in 1974.

So, Dr. Wolman has been practicing in Sandy Springs area for almost 30 years and she previously was with the Dekalb County School System for 10 years as a school psychologist as part of preschool assessment team and as a learning disabilities resource room teacher. So, she brings a very special perspective from private, public school and her number of years of expertise in serving as a diagnostician as well as advisor for kids and families in private school.

So, Judy speaks to many schools and community groups on topics such as behavior management of preschool and elementary age children, living happily with preadolescent and building self-esteem, identifying attention deficit hyperactivity disorder and learning disabilities, and all kinds of other topics related to successful parenting. She is actively involved member of many professional associations including American psychological Association, Georgia branch of the international dyslexia Association, etc., and a personal note, she is married, and she has two grown up children, and she says that they have made it through the child and adolescent stages that she addresses in her practice and lectures unscathed, I think, and she is now a proud grandmother as well. I personally have a deep friendship with Judy and that’s one of the reasons that I thought she and I have a deep connection and going back and forth with, me referring to her, she referring to me, and we together helping these kids and adolescent, and adults live a better life with greater insight into self. So, that’s who we have today, Todd.

Producer: Well, goodness, Sucheta. It seems like every guest you have, you have a deep relationship with. I suspect that means that today’s conversation is going to be really, really great, so I’m very much looking forward to it. So, let’s just get right to it then. So, here is Sucheta’s conversation with Dr. Judy Woman.

Sucheta: Welcome to the podcast, Judy, I’m so delighted to have you. You are my first educational psychologist and you and I go long ways, and I’m so honored that you decided to come on board and give us some insights into what you do.

So, welcome.

Dr. Judy Wolman: I’m delighted to be here, thank you, Sucheta.

Sucheta: So, let me start by asking you, what is an educational psychologist or what does an educational psychologist do, and can you tell our listeners a little bit about your job and your background, so we can kind of set up the stage so that they understand how your services can be utilized or why you are an essential part of educational planning.

Dr. Wolman: Absolutely, absolutely, and there are certainly a lot of terms out there and I’m always explaining to parents to kind of clarify when they are told that they need to get testing by a school psychologist, by an educational psychologist, or by a neuropsychologist. What’s the difference? And, there’s a lot of crossover with everyone. Actually, technically, educational psychologists are people who are doing a lot of statistical work regarding testing in PhD programs and in school systems, and really, it’s school psychologists that are trained to do assessments and clinical psychologists who focused on testing as one of their areas of expertise. There is also this category of neuropsychologist, and what I explained to parents when they call is that if a child has some sort of brain injury and there isn’t a need to figure out where that injury is and what it is impacting, or the child’s got seizures, or something that is very brain-related that has been an injury, that is usually for a neuropsychologist, whereas school psychologists, clinical psychologist sort of shift our focus, is a little more geared towards what’s happening in the classroom in terms of reading and math, and spelling, and writing. We all look at processing, we all look at intellect, we all look at socio-emotional functioning, and we are all looking at attention concentration, but I’d say the slight difference between a neuropsychologist and a school and clinical people is that school clinical psychologists are really looking very intensely at the academic process, a lot more testing in those areas, and the neuropsychologist is really looking more at what’s happening in terms of brain functioning to see if there is something that one of those injuries that occurr is causing to occur.

Sucheta: So, is it fair to say that generally, whatever type of psychologist who does assessment is looking at brain behavior relationships, and in educational context, the psychologist is looking at how is that learning or how learning is impacting academic progress? Is that a good way to think about it?

Dr. Wolman: Yes, yes, and so if we are really wondering what do the teachers need to be doing and if there is any type of program or special school that a child needs to attend, or even if it is a youngster who we are looking at for some types of accommodations in the schools or even for standardized testing. It’s really the clinical and the school people who are doing the kind of assessment that is needed in those settings.

Sucheta: Got it. So, why doesn’t every child receive a psycho educational or neuropsychological, or clinical psychological evaluation?

Dr. Wolman: I always tell parents that it would be a lovely thing to do for every single learner. If the issue is the amount of time it takes to do what. Each child gets somewhere between 5 to 6 hours of assessment, and so it becomes cost prohibitive, and so I worked in the public school for 10 years and I wish we could’ve done it for every child, but we don’t get that opportunity because of the amount of cost that goes into getting it.

Sucheta: So, cost sounds like the biggest barrier. So, what does a psychologist or a educational psychologist finds that a teacher cannot detect?

Dr. Wolman: It’s interesting because I was a learning disabilities teacher before I became a school psychologist, and they are both important parts of looking at the way the child learns. It’s just that there is a very intensive approach that comes through with the testing. You got that one child sitting with you for this concentrated period of time, and you are putting them through so many different tests that you find a huge amount of information in a small amount of time, whereas I think it takes a teacher a little bit longer in working with that student, and sometimes, in the classroom, you’re not sure what you should be expecting from a child. You might have a child who is an average youngster performing on grade level, and that is absolutely perfect performance, but sometimes, with the testing, you find out that you’ve got a very gifted youngster who is managing to scrape by with average reading and math, and that is sometimes an indication that there is an issue, that there may be something like dyslexia is going on, but until you do the testing, you don’t realize what you should of been expecting from that child.

Sucheta: And also, I think another benefit that you have is you have standardized measures that give you a perspective on what the norms look like, right? Can you tell us a little bit about what that means? What do you compare a child’s performance to?

Dr. Wolman: So, all of the tests are based on the Bell curve, and on that bell curve, a 100 is at the 50th percentile and that is right on average, and the scores on all these tests range from very low to very high, but that you are able to compare that child with beautiful norms that there are people that have spent a great deal of time researching and testing students to get a large normative sample, you are able to test that child to see that in fact, they are not performing at the potential that we would expect for them, that particular individual, so if you start with intellectual functioning and they are an average child, you are then able to test them in reading and math, and spelling, and writing to see if they are performing in those areas consistent with their ability.

Sucheta: So, is it possible for a child to have the capacity because this child is answering questions well, he is at home talking about dinosaurs or all types of dinosaurs in kindergarten, so we know he has got great memory, but then when it comes to learning letters and sounds, and composing words, he is not doing, so is that something that the psychological report will capture all that?

Dr. Wolman: Absolutely, and it’s a very common thing that happens, is that parents are thrilled, they know they’ve got this bright verbal young child, and then that child suddenly hits school and they start teaching code, and code is just a very different thing, learning names of letters, learning sounds that go with those matters, learning to blend those sounds, and that sometimes doesn’t happen until mid kindergarten, and the people are sort of blindsided to hear that their child is having difficulty when in fact, my goodness, and got this really bright child with a well coordinated sociable, it’s kind of like, where did this come from? But, it’s a very different skill and really not one that gets Fully until somewhere in the kindergarten range. That said, there are some things that we can look forward with younger children to alert us to the fact that maybe, there’s going to be some difficulty with code. Some of these kids when they were younger had a little difficulty remembering names of colors or shapes because those are symbolic things that aren’t very meaningful, or they had difficulty remembering the first letters of [0:17:22] introduced, or they didn’t sort of get the rhymes in all the nursery rhymes – they just didn’t kind of play with those sounds – a man, can, pan, or enjoyed the fact that there are lots of things that start with the same sound, like potato and pancake, and popcorn, and those kids that are not playing with some of that symbolic information and that auditory information, sometimes, we will start to see that in the kindergarten setting, they are starting to do some of the advantage that they seem to have before the code started to be introduced.

Sucheta: Got it. So, it sounds like that there are certain aspects of formal learning which doesn’t excuse whether you are interested or not, you have to learn. These children start running into problems, and then it becomes a barrier to their success. What are the common reasons that you see children who are in elementary school, and I don’t know if I want to break it down like that, but I was hoping maybe you can explain to our listeners that people can reach out to a clinical or educational, or neuropsychological expert at different junctures of the child’s academic journey, so I was hoping that you can distinguish that in elementary years, what might be the reasons? What might be in the middle school reason pages, and high school, or college? Do you mind sharing that?

Dr. Wolman: Not at all. I think some of the kids that get picked up earlier even aged two and three are kids with some developmental issues with their language, it’s not coming along at the expected speed, certainly kids whose motor coordination is a little bit more obvious as they are not playing on the playground the same way other children are playing, those things certainly showed up, and then I start to hear parents aware that the sensory system isn’t working; they’ve got a child that is annoyed by the feel of the clothing and the feel of the straps in the car seat, and so they are thinking is behavioral but sometimes, it turns out that it’s really sensory, and I always try to get those little people into speech and language were into occupational therapy, to begin to address some of those issues. The sooner we get kids in, the better. The brain is very, very responsive to intervention, so we certainly want to jump on that opportunity as quickly as we can. I always say to folks, “If your mother gut or your father gut says something is off, don’t delay. Even if somebody says, ‘Oh, they will grow out of it,’ “I believe that the worst – so the biggest mistake we might make on one of those kids is that we got them overly stimulated to really strengthen that area of weakness. It’s nothing invasive. I just don’t like waiting and seeing. I just know that we can make a difference if we get going early. So, those are the preschool things that show up. Starting in kindergarten, first grade, we will start to see things with code. A lot of parents get very anxious when they see their child make reversals of letters, like backwards B’s and D’s, and they think, oh, that is dyslexia, and I have to educate them that no, that’s actually pretty typical and developmental. We don’t get very nervous about that, and I explained that dyslexia is actually the cracking of the code of reading and putting it back into code, the decoding and encoding so that when the child is looking at the word cat and they are having to remember the sounds of c-a-t to blend it for ‘cat,’ or they want to spell the word ‘cat’ and they are having to search their memory to remember the formation for those letters to get that word back on paper, that is actually what is dyslexia, and that is going to start to appear somewhere in kindergarten and first. As the later grades go on, some bright children, by the way, can actually get by for a very long time with no one picking up dyslexia. We have seen it many times where we go to test a youngster were they just don’t like to read, they might be in fifth, sixth, seventh, eighth grade, and then we do the assessment and we are sort of shocked that oh my gosh, this child that has gotten by all this time is dyslexic. People go, “Well, they weren’t a great speller. They didn’t like to read. They read slowly,” or some bright children, we sometimes even call it ‘stealth dyslexia,’ can stay under the radar for a long time. I even read an article once about a young student. She was heading off to – I think she was heading off to Harvard, and she just knew something was wrong and ended up getting tested, and found out that she was dyslexic, but she covered it all those years with her persistence, and some of these kids can struggle to read the words and yet somehow, they set the meeting out of the passage because they are so bright. So, that dyslexia piece stands out early, but it can also hide for a long time. The comprehension difficulty sometimes is a little later to raise its head, so you’ve got kids in first and second grade who might be spectacular at cracking the code of reading, but they are developing that picture in their mind to match what they are reading, and some of those kids won’t show up until second, third, fourth grade. Math reasoning, sometimes, kids are very focused on adding, subtracting. The lower grades, and it’s the thinking about mass and the retrieval of what formula do I need to use? And once you get to fourth grade, you have to remember, okay, which process do I use? And that renaming it addition, renaming and subtraction, so many steps, that those issues can start to appear a little later, and I would say written language, when kids are young, we expect them to write a sentence, but as they get up into the upper middle grades and middle school, we are going to want them to organize an idea, and then try to get that idea onto their paper, and then they have to think about all of the grammatical pieces in the punctuation, capitalization, and then the spelling. Written language is probably one of the toughest things for kids, so sometimes, because they are developing that scale, we may not really see the significance of their difficulty until they get into the late elementary, middle school grades.

Sucheta: Yeah, and it’s interesting that you are talking about, as you are talking about these difficulties that the kids are experiencing, a lot of driving force is the academic needs and academic relevance, and many times as you and I have talked about this from our work together for over the last 15 years, that the executive processes are more invisible and intangible compared to the academic, specific reading, specific math, specific writing skills. Can you talk a little bit about just the way you described stealth dyslexia? I feel there is still executive dysfunction. Can you draw a parallel as to what are the reasons when somebody who is academically learning find in a way, but they are not regulating themselves that might get referred to you?

Dr. Wolman: Yes, well, I always say to folks that what I see executive function often being is the way that we see the impact of sometimes, tension difficulty or learning how it actually plays out for a child, and it’s interesting when I have parents assess their own children with executive functioning at kindergarten, first grade, they often say, “Well, I can’t really tell because I pack their bag, and I put all of their things into their lunchbox, and I unpack everything and clean it out, and send it back up, so I don’t know if they can or can’t,” and so I think sometimes, it gets hidden for a number of years because people are finding that it’s just so easy to sometimes do it themselves for their child that they don’t realize, wow, my child is struggling. I do think sometimes parents are aware with their child is good at it because I think those kids taken away from their parents early. I think they go, “I’ve got it, mom,” with taking care of the shower and the process that you have to go through, and running their own homework and taking care of keeping their own rooms neat, and their bags neat, and their desk is neat, and so we don’t realize sometimes that those children that aren’t fighting to take it over, maybe there is going to be a little issue coming down the pike as teachers begin to expect more and more independence. I think that’s when the executive function key starts to raise its head a little more and especially when kids are no longer just with the one teacher and one classroom, and they are doing some switching of classes, and they have to coordinate expectations into different rooms are three different groups at school, I really think things can start to fall apart at a rapid speed.

Sucheta: I love your incidental definition of executive function, the need to coordinate expectations – I love that. Do you mind taking a minute and telling us a little bit about how you define executive function from the point of view with the brain behavior relationships can be deciphered and separated from or integrated with academic demands, how do you define it for parents or an educator?

Dr. Wolman: So, I see executive function has different pieces and some of those pieces are a little more with the behavioral regulation, and I think those are the ones that we see earlier read I think even the preschoolers, we start to see that they are really struggling to self regulate behaviorally and they are a little bit impulsive, and of course, it definitely totally overlaps with usually in attention deficit hyperactivity disorder case. Very rare in my opinion, and maybe you would say something different, but if there’s usually some attentional component also interacting with the executive functioning, and these are kids that are not able to be flexible and to shift, so behaviorally, I think we see it first along with some of the emotional – difficulty with emotional control, kids are a little rigid and not as flexible. I think the last piece that comes to our awareness are more of the cognitive executive pieces and part of that is because again, I don’t think our expectations are there when they are little, and then as the expectations begin to increase academically, we want to see a little more of that cognitive regulation starting to come into play, and that when they have to organize and when they have to task monitor, and when they have to finish things, and when they have to organize materials, I just, I think that it starts to appear probably into the elementary grades, and if a child has got to learn with a disability, it is really exacerbating. They dance together.

Sucheta: Yeah, that makes perfect sense to me. In fact, that is how I see it as well, that’s behavioral dysregulation then comes that cognitive dysregulation, and that self-dysregulation where you are not aware of your own self, you are not aware of your thoughts, you are not aware of your reasons or lack of reasons, so for not performing well for those kinds of insight-based deficits. Now, can you explain to us a little bit about measuring, so a typical psycho educational evaluation include something like Wechsler Adult Intelligence or – I mean, not adults – but intelligence scale, for children, can you talk a little bit about what actually goes into assessing a child’s performance when we say a psycho educational battery?

Dr. Wolman: Sure, sure, sure, sure. So, first of all, the initial piece is that a parent is giving us a lot of background history and whether that is in the form of a written background questionnaire for some people might do an interview, but we’ve got to start with that and know what’s this child exposure has been, what have been some of the developmental issues, and are there any medical issues or emotional issues? We’ve got to put the child in the context of everything that has occurred in their life as of this point and we also want teacher input. So, very critical to have teachers complete forms and rating scales regarding the way they see that child. It’s very interesting sometimes when the teacher fills in the rating scale and the background history form. It sort of gets dumped to stop and think about that student in a different way than when they are filling out a report card, and sometimes, I get a lot of information, and very honest information that they may not have at that point sort of express in their report cards. Report cards tend to be these happy positive things sometimes and they aren’t giving all of the real data as to what is happening. So, I get a lot of background information first. Once I’ve got the youngster in with me, I always start with the intellectual assessment because that sets the stage for what the child’s strengths and weaknesses are, how do they learn, and the intellectual assessment is not just one number because of course, our thinking is not one number, but we are looking at verbal ability, we are looking at visual spatial ability, being able to put together blocks and puzzles, and looking at their problem-solving abilities, things like matrix patterns, and other kind of problem solving tasks, and then we are looking at an area called work memory and we are looking for both of their auditory working memory and their digital working memory and that is one of the places that be will start to see attention difficulty impact a child’s performance and also being able to organize and executively together [0:31:01] those kind of tasks.

Sucheta: Can you give us an example of how to measure working memory, whether it’s auditory or visual working memory?

Dr. Wolman: So, the Wechsler Scale, for example, ask children to repeat digits forward, and then to repeat digits backwards, and then to repeat digits in ascending order, and that is a task that is not intellectual, but it does require be present, and if a child slips in and out of focus, they are going to lose some of those digits. I always say to parents when they see a low score and they go, “Where would I see this at home?” and it would be the child, they say, “Okay, I want you to please go upstairs, but these shoes in your closet, get your belt or Boy Scout and I want you to be in the car,” and that the child, the parent goes upstairs in the child is sitting on the stairs picking lint because they just lost the whole thing that they were sent to do. Sometimes, parents will say, “Oh, no, if I give an example like, ‘Go upstairs, brush your teeth, but on pajamas, get in bed,’ oh, they are great at it,” and I go, “But, wait a minute,” sometimes, all we have to say on that direction is, wah-wah, wah-wah, wah-wah, and the kids know it’s getting dark, they’ve had dinner, the that their path, they note that there is the process, and they aren’t really using working memory; they are just using the fact that it’s predictable.

Sucheta: Context.

Dr. Wolman: Yeah. So, in the WISC with the digit repetition, that’s the auditory working memory test the use, and then they actually brought in a new visual working memory where the child looks at a group of pictures, turns the page, and then has to find those pictures in the right sequence from a larger group of pictures, so if we say, “Focus, turn the page, you will be able to do it,” but if you lost focus for this a couple of seconds, you turn the page and go, “Oh, my gosh, I don’t remember what I just saw.” If you are thinking about something else, you’ve lost the focus for it, so those are two ways that they use it on the Wechsler test, different tests probably have different ways. When kids are younger, before they are old enough, before age 6 and it’s the preschool version of the test, they actually don’t to the auditory visual working – they do visual memory but they do not do an auditory memory, and the visual memory that they do doesn’t require the pictures to be retained in sequence because that’s just too tough for a little five year old, but they just require you to remember in any order what you saw, and then the processing speed is a fourth section on a WISC test and that looks at the paper-pencil speed with the idea that either phone a code or finding things that match in a line quickly does also require staying focused, stay persistent on the task, kind of keeping your head on the job instead of being distracted. With little kids, by the way, they don’t expect pencil tasks; they use ink dauber with the same concept of trying to save focus to get a job done.

Sucheta: So, when you save these four components and collectively, they form – give you information about the child’s intellectual ability, so that includes reasoning skills and higher-order thinking skills to, right, or not?

Dr. Wolman: Yes. No, it does come absolutely. It’s also verbal things, the verbal tasks go into abstract concepts. They start concrete, the visual spatial tasks also start with concrete things with blocks and puzzles, but then require a much more abstract mental manipulation.

Sucheta: Is it possible for a child to have a profile where there is a gap between these skills? So, can you explain to us that if these two scores which is verbal and performance scores, if they are matching or at that same level that is showing a whole some brain development and which are – those skill sets are kind of in coordination with each other, is that a good way to think about it?

Dr. Wolman: So, it’s interesting because I’ve been in the [0:34:58] for a very long time, and when I first started, they thought a learning disability was, if there was a 15 point difference between your verbal ability and nonverbal ability, and then we realized, wait a minute, wait a minute, that’s way too simplistic because we are just all such a combination of strengths and weaknesses and that is what makes us unique. So, there are some very brilliant picture engineers who might be a little bit above average in their verbal ability but not at the level of their exceptional visual spatial ability. It’s not a learning disability. It’s just a difference in the way that unique person learns and functions, and it kind of predicts what we are going to see from that person down the road. I would say most of our most talented architects, engineers probably aren’t always as strong vocabulary, but they are not learning disabled, and the same is true – the opposite – that some of our future attorneys and future professors might be okay with blocks and puzzles, but they aren’t necessarily going to take that as their summer vacation activity, they are not going to want that big puzzle that is set up on the dining room table at the contest; they’re going to read a book and that doesn’t mean they are learning disabled either. So, it’s not the differences in our intellectual ability that necessarily mean learning disability. Those differences in our intellectual ability kind of give a sense of what our strengths and weaknesses are. We then look to see, is it causing learning difficulty when we get to the point of reading and math, and spelling, and writing. If it’s not, it’s a non-issue. I remember actually, when I was learning how to give the test and I was on a preschool assessment team that they are very bright speech language pathologists, and when I was practicing the tests with her, her verbal ability was literally off the charts, but her blocks and puzzles were just sort of okay. She wasn’t learning disabled but she sure wasn’t going to change fuel in her car. She was going to pay somebody else to do that. So, we all have these patterns of strengths and weaknesses. It’s an issue if it causes a learning difficulty, if it causes us not to be doing our reading, our math, our spelling, our writing at the level that you would expect.

Sucheta: So, in conclusion, when you see a report and what you are getting ready to discuss with the parents, what concerns you the most for what is it that you want the parents were educators get out of this report that is good and informed them about this child’s potential, child’s current state of affairs, child’s, as you mentioned, the learning difficulty he is enduring? What are a few points you want them to really, really not forget or not lose sight of?

Dr. Wolman: First of all, it’s important to realize to focus on your whole child, so even if we come up with some things that we need to work on, let us not forget that we are supposed to do on the fun things as a family and not get totally focused on what we are trying to strengthen. We want to make sure we are focusing on the child’s strengths, fun things that they do well, great things as a family. In that context, we then want to make sure that if a particular child needs some strengthening in a certain area, we need to talk with the teachers and get them attending to that, we may want to supplement what we’re getting at school with private tutoring using the right method. The testing will kind of direct what seems to be the right method for that particular child. So, we want to use the opportunity when kids are young, and their brains are able to grow so well to give them the right intervention to make those changes, but we also want to make sure we keep an eye on focusing on the strength to.

Sucheta: Yeah, and what I’m hearing you’d say, that those consider this report to be final. It’s not a verdict.

Dr. Wolman: No, absolutely not.

Sucheta: It’s kind of a reference point.

Dr. Wolman: Absolutely not, it’s a direct intervention and it is static; it’s going to move and that’s what usually, somewhere within that 3 to 5-year period, we really do redo it because kids can change so much, especially with some of the things that are recommended or implemented, you can end up seeing a very different profile for a child to 3 to 5 years down the road.

Sucheta: Well, Judy, this was so enlightening and thank you for taking the time to walk us through this, and I can’t wait to have our next conversation about how to kind of incorporate this information and how do you communicate that with the parents, so thank you so much for coming on the podcast and giving us your insights and wisdom, and I again, as I said, let us talk more.

Dr. Wolman: My pleasure! Thanks, Sucheta.

Producer: Well, yup, as I suspected, great conversation with Dr. Judy Wolman. Goodness, Sucheta, I don’t know where to begin. Why don’t you lead us off some initial thoughts? 

Sucheta: Yes, so true, Todd. I’m glad that Judy took the time to explain the professional jargon because it can always great buyer years for people when seeking help or guidance. There are a few fundamental approaches to evaluating brain behavior relationships. There is something called psychoeducational testing, and then there’s a neuropsychological testing, and also, of course, psychologists to other types of testing but we are going to limit, or we have been focused on the educational arena and child’s ability to succeed in spite of the challenges he is facing. So, most professionals have their personal websites that tell parents and educators the services they provide. I personally always recommend parents to interview their educational psychologist for the neuropsychologist. What I mean by that is all these services for these process centric options in life our relationship-based and you are going to work with these psychologists for a while and he or she is going to help you walk on this bridge that takes you across and prepare you for advocacy, and you need to have a sense of comfort and confidence that the psychologist understands where you are coming from, and you completely understand what the psychologist is going to recommend, so this interview process is – getting on the phone in the beginning and just saying, “Can you please tell me what you do and how does this help you know more about my child?” kind of getting those questions out of the way, and other thought that comes to mind that is very important is that these assessments are neither cheap nor quick, so it truly is an investment and I hope people got this from our discussion that it is our kind of consumer obligation to become informed person to understand what we are going to get from this kind of assessment, so I’m glad that she started us off with that.

Producer: Well, clarify something for me. I mean, why would we want to test a child?

Sucheta: Yeah, so I think there’s teachers who after the child goes to school, for example, the most time the child spends is with their teachers or in the classroom with the peers and the teachers, so the parents or even spending less time during the weekday with the child, and so the teachers in a way our experts as they begin to notice a lot of things that are demonstrated through behaviors, but not everything that you see is a problem. It could be a normal variation of what we call our range of being normal, so to speak, and that is why we need some expert opinion to see how does this compare with the national standard? How does this compare with a group of peers and not just one or two, but thousands of them? And that’s what a psychologist can really do, so when a student falls short is managing the class expectations or does not know how to deal with the demands of his learning environment, that’s when the struggles begin, right? And, the learning difficulties of a student can be stressful, and they can impact everyone including the members of the classroom, the teacher or the support teacher, the principal, and also the entire family. Some struggles are avail, but mostly, they are self-evident, but whatever the case may be, it undoubtedly impact the student’s sense of self advocacy and self-confidence. If left unaddressed, it can take a toll on the students of mood, affect, social interpersonal relationships, and eventually, self-esteem. So, the psychoeducational testing focuses on identifying learning processes and even issues such as attention that may be impacting the child’s or adolescence capacity to live an enriched academic life. As part of this process, social emotional and valuation is also often offered. This can address how the social emotional adjustment issues are impacting learning for processing of information and even attention or concentration skills. Eventually, all these abilities collectively impact relationships and classroom relationships, and relationship to learning, so that is why we must assess, and final thought is that a educational psychologists who performs a thorough and comprehensive evaluation has a tremendous training and understanding, and has a deep knowledge of how to interpret the test results, and for meeting and contextualized to the child’s presentations, the report that the teachers and parents provide, as well as a long-standing history from birth. So, that is when a floating picture begins to emerge, so a comprehensive evaluation allows the clinician to rule out other diagnoses and provide the right kind of recommendation plan that actually addresses the child, that is why the testing is essential.

Producer: Yeah, but wow, the process, this testing process seems quite complicated and quite involved, yeah?

Sucheta: Yes, absolutely. A starting point of it all is a child who is experiencing issues and that is negatively impacting the child’s ability, so that is the starting point. Educational psychologist, through testing figures out where the issues are and that is what allows the clinician to distinguish whether it’s a true learning disability, is it an adjustment challenge, is it a mini crisis that child is experiencing, and if the child is removed from that challenging environment, he may be able to perform at the expected level, so it’s not a disability. This type of evaluation takes several hours to complete, and it’s usually conducted over several days. It involves around 5 to 6 hours of testing at a time and as I said, it may be broken down over two days. It’s either followed or precedes with in-depth parent interview and lots of forms, case history for, observation 04, that are given to the parents as well as checklists given to teachers. So, this in-depth evaluation leads to an in-depth remediation plan that is designed to address all the concerns or red flags. Finally, the psychologist produces a detailed written report, and this particularly accesses the guiding post that the parents can use as they seek services, or the teachers can use to build academic support in the classroom. So, there are many – psychologists to play many evaluation methods, they use something called WISC which is Weschler Intelligence Scale for Children. They use something called Woodcock-Johnson Test of Achievement that is used to figure out the level of academic achievement. There may be other tests or components that evaluate or discern information processing abilities or personality and emotional functioning as well. There are parts of the test that address perceptual reasoning and nonverbal reasoning abilities, and eventually, the past records, the visits to the psychologist, psychiatrist, ER. So, those kinds of pieces of information together help the educational psychologist formulate a composite picture. [0:47:13] psychological evaluation on the other hand is requested typically went there are concerns about something more complicated than just learning disability that is impacting a child’s overall functioning in the classroom. So, maybe there is a possibility of brain injury, there may be seizure disorder, there may be some inherited brain dysfunction, child has experienced something called the anoxic injury at birth, so those are the kinds of added components make the psychologist used different set of additional set of test material that can address some detailed aspects of cognitive functioning or even executive function aspects. So, for example, the psychologist be used that in addition to the WISC which is the Weschler Intelligence Scale that I was talking about, they may use some test battery to assess memory functions, they may use something called NEPSY, a developmental neuropsychological assessment battery for evaluating functions such as attention, language, sensory, motor, and visual spatial functioning, so there are tests like Wisconsin Car Sorting or Rey-Osterrieth Complex Figure drawing, or Tower of Hanoi. These kinds of tests give additional information of executive function, so what we are looking at is the evaluation process is complex and it takes an expert mind to discern the various forms to identify and hold into the specific of the child’s abilities and disabilities so that a good plan can be formulated.

Producer: Well, that is, Sucheta, I was going to ask you, are there different types of tasks that psychologists can perform? And certainly, there are, and I understand why there are different types and what you would do that. So, all right, well, move us into final thoughts before we wrap up this conversation.

Sucheta: Yes, so the most important message I have for parents out there in teachers out there, that if there are some signs, there are red flags, don’t ignore them. Red flags, all it means that the child’s way of approaching learning is not yielding the best outcome for the child, and that means the child has some specific challenges that he needs to understand for himself, and others need to explain to the child. Going to get the child tested is incredibly important because that will inform everyone involved what to do and how to deliver what will be most effective, and education, just like everything else, one size fits all does not work, and how to tailor the educational aspect only can become more evident after these kinds of test measures are used. The next thing is, find an expert that does it fit your own expectations. I think going into testing, many, many things are available on the website, so everybody needs to take the time to really read and inform themselves, there is a website like understood.com that explains things like how to understand learning disability, there is something like international dyslexia Association website that describes what dyslexia is all about, there is a chat, and I will link all this on our website, but all those websites describe the symptoms, describe how the child presents with problems, and I’m not limiting this to children; there are so many adults that as the parents experience these challenges with their children, that may be their first time to discover that oh, my God, I myself, I’m suffering from this. I always have a thought that was something wrong with me or something that has an idiosyncrasy it means that there is no hope for me to change it, but a lot of times, the parents have gone through these evaluations themselves. So, everybody needs to take a moment to reflect and pause, and not get so scared about challenges and weaknesses, but embrace them, welcome them. Finally, what I feel is information is power. Information is the guiding light that allows us to take good decisions, and including a child in these conversations, don’t leave the child alone, don’t get these complex and comprehensive evaluations done and never share that information with the child. There are lots of psychologists, as I will share with you the future interviews that recommend that compare a separate summary report, and many do, and discuss those report findings with the child so that he or she can be an empowered student and a learner who has great optimism from their learning experience.

Producer: Well, Sucheta, as you said at the very top of the show, upper educational experience can have a lifelong impact as adults, so it’s so, so important.

All right, it’s all the time we have for today. On behalf of our host, Sucheta Kamath and all of us at Cerebral Matters, thank you for tuning in and listening today, and we look forward to seeing you next week with our second conversation with Dr. Judy Wolman.