Dear Therapist:

I appreciate your weekly column and have learned a lot from it. I had a question regarding what type of evaluation you would recommend for a child who has shown a significant reduction in grades from one year to the next. This is for a child coming out of 3^rd grade who has no major other history of issues. Someone suggested a speech therapist for a language eval, others are saying a neuropsych eval, and yet others are recommending a kriah specialist. There seem to be so many different specialties and areas that it is kind of hard to figure out what the right path is. There also doesn't seem to be a consensus among the morahs as to what the issue is (and even IF there is an issue). Which is the best "first eval" that can help narrow down what the issue is and give us direction. 

Response:

As you mention, when the ostensible problem is so vague it can be difficult to determine where to begin. It doesn’t sound like your child has been diagnosed with a disorder (like ADHD) or a learning disability. However, these are only two of the many factors that could lead to deteriorating grades.

Occam's razor posits that the simplest possible explanation is the one that should first be considered. This makes sense, since the simplest explanation generally requires the fewest assumptions. Bullying can lead to declining performance in school. So can depression, anxiety, ADHD, OCD, specific stressors, and many other issues. Obviously, a learning disability can lead to declining grades. Although these are all possibilities, they all require certain assumptions.

The brilliance of Occam’s razor lies in its simplicity. We tend to overanalyze situations, often leading us to complicated “solutions” to simple problems. For instance, is it possible that your child needs glasses (or a stronger prescription)? Might they simply be unmotivated, and happy to coast along? Explanations like these—if accurate—might be easily corrected.

Assuming that all low-level explanations have been discarded, without any further information I might be tempted to point toward a learning disability as the option with the smallest number of assumptions. However, that—in and of itself—incorporates certain assumptions on my part. I don’t know your child. Therefore, I don’t know their personality, social proficiency, or level of emotional intelligence. I don’t know how they interact with their peers or with authority figures. I don’t know if they feel sad or if they have fears that affect their performance.

While there are numerous possibilities, these are some factors that you might be able to easily identify or dismiss. Naturally, if there are other factors of which you are aware, or which present themselves at some point, they would change the equation.

Even if there are no overt signs of any sort of problem, there may be issues that are affecting your child on a less obvious level. A psychoeducational assessment by a psychologist is a tool that can be very useful in a situation like yours. It essentially focuses on a broad spectrum of possible causes. This should be done by a psychologist who specializes in childhood issues, and who is experienced in this form of evaluation.

Psychoeducational assessments strive to cast a wide net, consisting of multiple consultations, testing, assessments, and a comprehensive report with recommendations. While this may not be necessary, it can be helpful in identifying a number of possible issues, and can help bring you some peace of mind.

Another tool is a neuropsychological evaluation. These are also administered by psychologists. They are often recommended when there is some indication of a psychological problem and more specific information and diagnosis is difficult to otherwise obtain. Or when the information is somewhat nebulous. Although this can be a very useful measure, it typically digs deeper and relies on more standardized testing. It takes significantly more time, and may not be indicated for your child.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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