Curious Incident Podcast Episode #1 - Understanding the Neuropsychological Evaluation
You can listen to our discussion on your favorite podcast player or watch the video. Below is a summary of the podcast along with the entire podcast transcript.
The Curious Incident Podcast: Episode #1 - Understanding the Neuropsychological Evaluation
Listen to the episode here;
About this episode:
Dr. Jennifer Oratio is a neuro-psychologist who has had her own private clinical practice since 2010 and has been working with special needs students since 2002. She has evaluated and helped hundreds of special needs students over the span of her career. Here, she demystifies the neuropsychological evaluation process and discusses the role of the neuropsychological report in identifying appropriate interventions for a special needs child.
If you have questions that were not covered in the podcast or need guidance about how you should move forward, please contact the Law Office of Adam Dayan at 646-866-7157 to discuss your particular circumstances.
About the Law Offices of Adam Dayan
Adam Dayan Esq. is a New York special needs attorney. Established in 2009, the Law Offices of Adam Dayan has had the primary purpose of making sure children with special needs receive a quality education and long-term financial security.
Curious Incident Transcript - Episode #1 Understanding the Neuropsychological Evaluation
Speaker 1: This is Curious Incident, a podcast for special needs families, your window into the world of special education. If you have a child with special needs, wherever you are on your journey, look out for those curious incidents, those tell tale signs, those moments, so you can find guidance and take advantage of the resources available to you. Here's your host, Adam Dayan.
Adam Dayan: Here we go. I am thrilled to present my first ever guest on this podcast. Today I am speaking with Dr. Jennifer Oratio. Jennifer is a neuropsychologist whom I have known for a long time, maybe 10 years at this point. Jennifer has had her own practice since 2010 and has been working with special needs students since 2002. She has evaluated and helped hundreds of special needs students over the span of her illustrious career. Jennifer, it's great to have you on the show. Thank you for joining us today.
Jennifer Oratio: Adam, thank you so much for having me. I'm so excited to be here.
Adam Dayan: I'm excited too, it's great to see you.
Jennifer Oratio: Yes, same here.
Adam Dayan: So if I were a parent who is new to this process, I might be wondering, what's the difference between a psychologist and a neuropsychologist.
Jennifer Oratio: Sure.
Adam Dayan: Can you speak about that?
Jennifer Oratio: Absolutely. Yeah, that's a great question. So I think it's important to talk about the level training that the neuropsychologist has. So while both individuals have advanced degrees, the neuropsychologist has achieved a doctorate and this is in psychology and then they've gone on to do specific training in neuropsychology. So this is the study of brain behavior relationships. It's specific training in assessment and testing and interventions. And past the doctoral level education there's an internship that the neuropsychologist has to do that is at an APA accredited institution.
Adam Dayan: So let me just jump in and ask, why does this brain functioning matter, right? From a neuropsychology standpoint, for the parent who's looking to have his or her child evaluated, why does this brain functioning matter?
Jennifer Oratio: So it matters because we're looking at central nervous system development, we're looking at normal versus abnormal functioning, and we're looking to see how that plays out in a student's behavior and functioning in their everyday life. So that's really important when we're looking at a student and looking at his or her presentation and looking at what that student needs to be successful. So to have that background and to have that extra training of the internship and then a two year postdoctoral fellowship, which affords additional training in these areas is really, really important to make sure that the individual who is doing this assessment is fully experienced in these areas.
Adam Dayan: Okay. Is there anything else that parents should understand in terms of the difference between a psychologist and a neuropsychologist?
Jennifer Oratio: So another thing I think to point out is that the neuropsychologist could administer many more different types of tests. So they have more experience in different measures that look at areas beyond, say just cognitive or IQ testing and functioning and academic functioning. So these are areas that will look more deeply into language and motor skills and sensory functioning, memory and attention and executive functioning, social, emotional, behavioral, and adaptive functioning. So we're looking at all different areas of development and these brain behavior relationships.
Adam Dayan: So let's break some of those down. You mentioned executive functioning. What is that exactly and how does it relate to a child with special needs?
Jennifer Oratio: Sure. It's a big term that many people have not heard of. So essentially it's broken down into sort of two to three domains. I like to break it down into two, because I think it's more digestible. So one is called metacognitive function. And what that really looks at is one's ability to plan and organize and focus and concentrate. It looks at working memory, being able to mentally manipulate information, it looks at your ability to self initiate and self monitor.
And then the other area really is self-regulation, being able to inhibit your impulses, being able to control your behaviors and your emotions, especially under stressful situations and in order to be a good problem solver and to carry out all of those areas that I had mentioned before like planning and organization, you really have to be under good emotional and behavioral control to carry those things out.
Adam Dayan: Okay. And you mentioned a few other areas, motor, memory, attention, break that down for me. If I'm a parent, what does that tell me about how my child is functioning?
Jennifer Oratio: Yeah. I mean, I think the major purpose of a neuropsych evaluation is to find patterns of strength and weakness. So we're looking into all of these areas to see where are the strengths and where are the areas where there are gaps or vulnerabilities, and to be able to boost the areas that are more vulnerable and reinforce the areas that are strong.
So depending on what a student's presentation looks like and what a family's concern is for their child, it's really important to look at all of these areas in tandem and certain areas may be affecting other areas too. So if there's a weakness say in language that might be affecting a student's ability to access their curriculum at school. So it's really, really important to look at every individual area of functioning and how they overlap and affect each other.
Adam Dayan: Looking at the whole picture and seeing how different areas interact with each other.
Jennifer Oratio: Exactly.
Adam Dayan: In your experience, what is a private evaluation with a professional like yourself offer that a school district evaluation usually cannot?
Jennifer Oratio: That's a really good question. It's a question that I get a lot too. So let's talk about the district evaluation first. So the individual who is carrying out the evaluation is a school psychologist usually and their level of training is not as extensive as what a neuropsychologist has gone through. So you might have a school psychologist who is not even at the doctoral level maybe at a master's level, and really what that means is that they don't have that extensive experience with the clinical populations that I had mentioned. And also that extensive experience with brain behavior relationships and as well as the testing experience that's necessary in order to comprehensively evaluate a child.
So usually the district evaluation is either a psychoeducational or a psychological. So I can explain the differences with those two. With the psychological, it's usually just IQ testing or cognitive testing, and maybe there is an adaptive measure or a social emotional screening measure that's thrown in. With a psychoeducational, it's the IQ testing and maybe the social emotional and or adaptive and then there's also some academic testing that's included in that.
So it really kind of stops there and it doesn't look as comprehensively into those other areas that I had mentioned like language and motor and memory and attention and executive functioning. So depending on a student's needs, sometimes the psychoeducational is sufficient, particularly if it's just something that is like slight learning difficulties, but if there are any other concerns like attention, or maybe a question of ADHD or social function or behavioral functioning that's more extreme, then the neuropsychological evaluation which would be sought privately would be warranted.
Adam Dayan: So I know from my own experience, sometimes parents might look at a school district evaluation and say, that's not my kid. It doesn't resemble my child in the slightest, but there are some parents who might not know any better, maybe because they're very early on trying to figure out what's going on. So in the latter example, how would a parent know this is not adequate, I need to explore this further and get a more comprehensive evaluation?
Jennifer Oratio: Sure. Well, I think when they're looking at the reports the school district does, then they have to first look how comprehensively it's done, what's included and if it really answers that referral question. So if it doesn't seem to answer what the concerns are, it doesn't seem to match up and sometimes it doesn't. I mean, another difference is that the school district has tons of evaluations that they have to do, and they're usually time limited.
So they may have one session that's a couple of hours and they don't have the flexibility to add more sessions to do more specific testing, even if it is just at the psychoeducational level. And maybe they are not really focused on redirecting behavior if attention is something that's interfering with the testing so you're getting these really, really low scores when you're looking at the results.
So I think that it's important to look at some of those factors when reviewing the report and see if that's something that makes sense in which case then the neuropsychological evaluation, especially when you're seeking that with a private provider and maybe one that has a private practice, a more flexibility in their schedule to add sessions if need be. So say if a student is having an off day, they're really distractible or they didn't sleep the night before, or they're just feeling upset or anxious, which definitely the testing can even just provoke in and of itself, there's a lot more flexibility with a private evaluation.
Adam Dayan: Right. It's good that you mentioned the multiple sessions, we'll come back to that soon. And I just wanted you to emphasize from our firm's perspective how important the neuropsych evaluation is from a legal standpoint. And it's really good to have you on the program to talk about it because I think it's so important for parents to know. I mean, in so many of our client's cases, having that neuropsychological evaluation has made the difference in the case, has made the difference in the child's ability to secure those services and has made the difference in having an expert, an objective expert in the parent's corner to communicate what that child needs.
Jennifer Oratio: Right. And just to touch upon what you just said. I think the objective piece is really important. So having a fresh set of eyes look at the child and look at the child across different contexts really can help to provide the most accurate picture.
Adam Dayan: Sure. So without getting too technical and we may have covered this a little bit already. Can you tell parents what areas of functioning you typically look at when you're conducting the evaluation. Is there anything else that you didn't mention before that you think is worth mentioning to parents now?
Jennifer Oratio: Yeah. I mean, in terms of the actual testing, I had mentioned the areas that are important. So language, motor, cognitive skills, sensory processing, attention, executive functioning, memory, social, emotional, behavioral and adaptive functioning, all of those areas are included in the neuropsych evaluation through different testing measures, one to one quantitative testing with the student, there are also specific rating scales that are given to the parents or caregivers and the teachers, as well as the student themselves if they're old enough and able to complete these types of rating scales and questionnaires.
But I think also what's important as part of the neuropsych process are observations. So there in the session themselves clinical observations that I'm making throughout the entire testing. So if there are certain behaviors that may be interfering during the testing or that are having an impact on a certain performance, I think it's important to note that in the report so that you get a very clear picture of what's going on.
Adam Dayan: What kind of behaviors do you mean?
Jennifer Oratio: If a student is distracted. So if they seem to be distracted by items in the room or noise that they hear maybe in the waiting room or if they are internally distracted. So perhaps they're thinking about a TV show that they just watched and you could tell that they're tuning out, but I think also signs of impulsivity. So maybe rising from their seat, touching items on the desk, again leading to distractibility, frustration, signs of anxiety, foot tapping, maybe they're getting tearful if something is very hard or challenging for them, I think it's really important to include all of this information in the testing report as well. But in addition to the observations during the testing, I think it's also important for-
Adam Dayan: So hang on, let me just interrupt you one second.
Jennifer Oratio: Yeah.
Adam Dayan: I'm making a note of observations. You had mentioned the term before adaptive functioning. Can you explain what that means?
Jennifer Oratio: Yes. So adaptive skills really were looking at activities of daily living and I like to look at this across different contexts as well. So within the home environment, the community environment, the school environment. So how a child communicates and using language skills, their social skills, their ability to just participate in everyday activities, such as zippering and buttoning things and brushing their teeth and following routines. So looking at all of those different areas.
Adam Dayan: Is that something that's specific to students with autism or especially important in cases of students with autism?
Jennifer Oratio: I think it's important in a lot of cases, but I think especially when we're looking at students who are on the autism spectrum, it's very, very important because even just some of the areas that I had mentioned such as social skills or language and communication, they tend to be more challenging for these students. And we need to evaluate those to look at appropriate services, but maybe also to look at appropriate school placements too and those emphasize reinforcing those skills and strengthening those skills.
Adam Dayan: Absolutely. Okay. So before I interrupted you, you were talking about clinical observations.
Jennifer Oratio: Yes. So in addition to the clinical observations during the testing sessions, clinical observations via a school observation or a classroom observation, I think is also extremely important. So I like to do these first before the child meets me. So one, they're not distracted by me if they see me in the school environment. And two, they don't feel self-conscious or anxious if they're aware that I'm there to observe them. So typically this lasts about an hour and I like to see kind of a blend of things within the classroom.
So usually I tell teachers, is there a point during the day where there's maybe an activity that's more structured and then a transition to something that's less structured or unstructured so that I could see the student in different type of context. And I think this is also really important because in the testing sessions, I get a lot of valuable information, but this is not what the student is doing every day.
They're in this school placement for a majority of their day, every day and it's an opportunity for me to see how they're responding to the placement it's self, to the interventions that might be mandated on their IEPs and see if they're happening and if they are, is the student responding well to that? So I can get a lot of rich valuable information from seeing the student in the classroom and then it could help guide recommendations in the report too.
Adam Dayan: It's so important. I mean, anytime we're speaking with clients about the importance of getting an evaluation, we talk about a need for a classroom observation, right? Because you could have a student functioning perfectly okay in the one-to-one testing situation, but put that same student in a classroom with other students, with ambient noise, with lots of distractions and it could be a totally different person.
Jennifer Oratio: Exactly. And we do try to have the testing situation very controlled. So minimal distractions, if any at all, and it is one to one, so there's plenty of opportunities for repetition or reminders of instructions or redirection or breaks and that doesn't always happen if at all in the classroom on a normal everyday basis.
Adam Dayan: Right. Exactly. (Music) How will parents know when it's time to contact a neuropsychologist about an evaluation for their child? Because some families are just struggling for so long, or not knowing for so long that there's a problem. And so what signs should parents be looking for? What are those signals that will help them know I need to reach out to a neuropsychologist now.
Jennifer Oratio: Right. Well, I would start by saying that parents really know best when there's something that is "Off" or "Wrong" with their child or they see them struggling in some way. I would say the sooner, the better, and only because we can assess what's going on and provide recommendations as soon as possible so that we can get appropriate interventions if they're necessary, but usually I see sort of-
Adam Dayan: I'm sorry, I'm just going to interrupt you again.
Jennifer Oratio: Yeah.
Adam Dayan: You mentioned off, something is a little off, what does that mean to you? Right. And do you limit that to academics? Are you thinking of that more broadly? What are some examples of what a parent might notice if something is kind of off?
Jennifer Oratio: Yeah. Well, this actually goes into what I was going to say too, is that, I mean, there's sort of two camps of families that come to me especially first time evaluations. And one is the family that seems to be looking at their child and noticing or sensing that they're not developing appropriately or it's not typical of what they've seen in other children their age. So maybe that's difficulties with language, perhaps it's a delay or difficulties with socially relating to other children. Maybe it's certain behaviors such as difficulties with focus and attention, but also perhaps behaviors that may seem unusual like lining up things, or sensory related behaviors that are not typical or typically seen in other peers their age.
So I think that families will usually bring this up to their pediatrician first, but sometimes the pediatrician, they don't really have the answer or they tell the family to wait and it's something I think that they're not fully equipped to do a comprehensive evaluation and diagnosis of certain conditions. And I'm thinking more specifically, if you could guess already in autism spectrum disorder.
So there's usually a screening form that they'll give at around 18 months and there could be follow up and maybe a referral to developmental pediatrician, but the neuropsych will really look into this very, very comprehensively through specific measures. And from this then we can make appropriate recommendations for different services. So maybe ABA or specific speech services and what needs to happen in those speech services and occupational therapy.
Adam Dayan: And I'm glad you're mentioning these services and therapies. I mean, there's so many components to it. And you mentioned behavior and sensory issues. And I think it's so important for parents to know that educational development is not limited to academics, and when we're in impartial hearings, we're always making this point clear that, there's academics, sure, but you could have a child who's struggling socially. You could have a child who's struggling behaviorally and those are very important components of education as well.
Jennifer Oratio: Absolutely.And sometimes those components can affect how a child can achieve academically too, or access their curriculum and they need it delivered in a specific way. So it's definitely not just academically related, there are other components that go into school progress.
Adam Dayan: Sure. So walk us through the process, for our listeners. Tell them about the process of contacting a neuropsychologist, having an evaluation conducted, getting feedback, and any other steps that you think are important to mention in terms of the evaluation process from your perspective.
Jennifer Oratio: Sure. So I think when contacting a neuropsychologist one is, to ask if the neuropsychologist has experience and expertise working with a child like yours. So that's going to be really important because even in the field of neuropsychology, certain people specialize in different areas. So I think that's going to be the first question to ask. And if you've been referred by somebody who's trusted, then hopefully they know that there may be a certain level of experience in that area, but it's always good to first off ask that. Then I think based on if there's a timeline that's very specific to your child's case to see what their availability is.
And also keeping in mind that there may be multiple sessions that are needed. So I would say usually it's between two and three sessions that are several hours each, but sometimes we need to break that down. So in total it could be six to eight hours of testing, maybe more. There's sometimes where we have to break it up into four, five or six testing sessions because the child loses focus or attention or can't tolerate that much all at once.
So it's really important to see what the availability is, what the flexibility is, if we do need to add more sessions and also from start to finish, from the time of say the initial consultation where you would discuss all of the history and background and reason for coming in and your concerns and the classroom observation and the testing sessions all the way from to the feedback session and then the report that follows. So when you have the report in hand, how long is that from start to finish that's going to take.
Adam Dayan: The feedback session that you mentioned, what happens at that feedback session?
Jennifer Oratio: So this is a really important part of the evaluation. This is the time where we discuss all of the results from the testing and from the observations where we put everything together, where we talk about strengths and weaknesses within the student's profile, we talk about diagnoses if they're appropriate, what that means, and we talk about recommendations going forward. So it's essentially a verbal version of this comprehensive written report, but it's a time most importantly for us to get on the same page. So to make sure that all questions are answered, that the parents are completely clear with the findings.
Adam Dayan: So you mean to tell me that the parents have a say in the matter.
Jennifer Oratio: The parents have a say in the matter.
Adam Dayan: Unbelievable.
Jennifer Oratio: They do. And I think that's a huge difference between what you find with the district too, is that often times they're going into these meetings there's not a feedback session when their child is evaluated through the district. The first time a lot of times is during this IEP meeting that you're hearing the results. A lot of families have not gotten reports ahead of time, so it's sort of just dropped on them and then the district has their mind made up in terms of what the recommendations would be going forward, but in a neuropsych evaluation, this feedback session is more of a collaborative approach for sure.
Adam Dayan: Right. Let me ask you, does the child usually participate in that feedback session?
Jennifer Oratio: Not usually in the feedback session with the parents. But I would say if they're old enough and it's developmentally appropriate what I do is I schedule a separate child or adolescent feedback that's usually shorter and much more general in nature where we're not really talking about specific scores and performances, but more of a general overview of, this is what you are really great at, and this is where your strengths are, and you did such a good job in this area, and then these are the areas that we need to work on, and this is how, and giving them sort of a blueprint on what they can do to feel empowered to make progress.
Adam Dayan: And I'm so happy you mentioned blueprint because I was just about to say, they've gone through this whole process. The parents have had to feel feedback session with you, and you've spent all these hours testing the child, and now what do they leave your office with? What does this blueprint look like? What does it mean? How does it help the student?
Jennifer Oratio: Well, I should preface it. Every neuropsychologist is a little different. I don't give the report at feedback just again, because there are certain things that might come up during the feedback session that I want to incorporate in that report. So everything is scored and there's definitely a synopsis that happens. But the report usually comes within a week or two later and that report is about 20 to 25 pages long, and that is the blueprint. It is the roadmap. So it discusses everything that we went through, the history, I've reviewed all of the records that the family has given me.
So there's sometimes 2, 3, 4, 5 pages of just background information that's essential to knowing who this student is from birth. And then I talk about the observations, both during testing and the classroom observation. I then talk about the testing results, which also put additional observations based on certain performances. And then there's this summary section that really just brings everything together. It's something that will discuss again, if there's a diagnosis that's appropriate, what that diagnosis means. And then a full prescriptive 3, 4, 5 pages of recommendations that are individually tailored to the student and his, or her needs and these are recommendations for the school.
So what's appropriate with placement classroom setting, what's appropriate with related services like speech and OT and PT, any sort of behavioral intervention. And then also just interventions for accommodations, extra time, what's necessary in the classroom, multi-sensory important, preferential seating, and then also recommendations for home and community too. So you really receive something that for the next several years is going to be really important in managing the student's progress.
Adam Dayan: That's the roadmap. I mean, those recommendations are truly the roadmap and as legal practitioners, we rely on those recommendations so much. I mean, parents come to us to help them secure what their children need and the way we know what their children need is by reviewing recommendations from professionals like yourself. So can't emphasize enough how important that section of the report is.
Jennifer Oratio: Right. And just piggybacking off of that, I think it's just such a great partnership that I get to work with attorneys like you, because I write these reports and I will advocate for the families as much as I possibly can. I'll participate in the IEP meetings. I'll emphasize what's needed for the students programming and I'll testify in hearings, but it's really the attorney that fights for these recommendations to come to fruition.
Speaker 1: You're listening to Curious Incident, a podcast for special needs families with your host, Adam Dayan.
Adam Dayan: I guess we touched on this a little bit before, we were talking about social and emotional and behavioral as distinguished from academic, what do you say to the parent who believes my child is doing fine academically so there's no need to go get a comprehensive evaluation, especially if it's going to take 10 or 12 hours of testing for my son or daughter. And if you can cross that barrier and get them to come in from testing, is there anything that you do differently if it's more about social, emotional behavioral?
Jennifer Oratio: Yeah. There is. I mean the academic portion is always included in the neuropsych evaluation and that's an essential portion of the whole process. But if the referral question is more social, emotional, or behavioral, then there are specific measures that I can add to the battery to look at those areas more in depth. And I think again, observations are really key too. And classroom observation, because if it's more of a behavioral issue, then it's probably to maybe certainly affecting how the student is performing in school and maybe affecting peer relationships, or if it's something where it's more emotional, maybe yeah. Maybe the child is doing well academically, but it's under a tremendous amount of stress and anxiety.
Adam Dayan: Right. What's the toll, at what cost?
Jennifer Oratio: Right.
Adam Dayan: And we see this all the time that parents are providing a lot of tutoring or homework help at home, or the child is doing well, but having nervous breakdowns in doing so. And so in a lot of cases that may not be sustainable for the student and you have to ask yourself, how much longer can this go on and what supports need to be put in place so that student can continue to thrive and progress socially, emotionally, et cetera.
Jennifer Oratio: Yep.
Adam Dayan: What age groups do you work with? Is your testing the same for all age groups or does it vary depending on what age group you working with?
Jennifer Oratio: So I start working with students as young as three years old through adulthood. I would say the majority of the students that I see are somewhere in the school age area, but the testing, the areas that are being looked at kind of remain the same, but the specific measures may change based on age. So what a three year old is engaging in is not going to be the same testing measure as an 18 year old. Usually they will, well, sometimes it could be the same, but they're developmentally designed based on age. And usually it's to the month as well, or within few months of the student's age.
Adam Dayan: I want to pause to focus on that a minute. Because some parents are told that if their children are three or four years old, they're not able to be tested or can't be tested with certain measures or something along those lines. And so I just want to repeat back that you're saying someone who's three, someone who's four can still be tested comprehensively. The measures might be different and you would use that discretion, but you can still evaluate and get a picture of what's going on with a four year old child.
Jennifer Oratio: 100%.
Adam Dayan: So the last two years or so have been unusual to say the least, what trends have you been seeing since March, 2020 when the COVID 19 pandemic started?
Jennifer Oratio: Wow. Lots of different things. So I think, where to start with this, even just for certain families to access remote learning has been quite difficult. So some families don't even have access to the technology that's needed to engage in that type of virtual learning. I've seen that it's been very difficult for parents to implement what a child and especially when we're talking about a child with special needs is supposed to be getting within their school programming at home in, well, say it's just it's non structured environment, it's not meant to be a classroom setting.
So to be able to implement those things to the student has been quite difficult, but a lot of parents have told me, it was so enlightening for them to see how their student or how their child is learning because they don't get to see what they're learning in school, they don't get to see them in the classroom every day, but parents have essentially become somewhat of the teachers or at least one parent even yesterday said, I was kind of the para because they had to assist their child. So they're seeing firsthand what's difficult for their, or how their child needs to learn and they're learning little tips and things just based on what they're seeing and on their own and having these insights and then seeing how the current classroom setting might not be working for them.
Adam Dayan: So they're getting to know their children's educational functioning better.
Jennifer Oratio: Yes, absolutely.
Adam Dayan: And probably on their strain while doing that, being the teacher and the para and the tutor, but they're getting to know their children's styles more intimately.
Jennifer Oratio: Right. Absolutely. Another trend that I've been seeing is there's been a lot of regression because of some of the factors that I had mentioned not had having access to sometimes the technology to access the virtual learning, or there haven't been the mandated services that have been delivered that were supposed to be delivered during this time, sometimes that just halted in general. And I think there's been a lot of time lost and a lot of IEP meetings, families are really emphasizing this and the school districts are kind of throwing up their hands and saying, yeah, this is kind of everybody right now, we have to accept a certain amount of regression.
And to me that just sounds crazy. It sounds ludicrous. And as a parent myself if my child was going through this, I'd be so angry and frustrated and scared. So I think that they're trying to put together whatever kinds of programs that they can, but it's not going to make up for a lot of that time lost.
Adam Dayan: What are some examples of the regression you've seen in students you've been working with over the last two years or so?
Jennifer Oratio: So I would say academic regression, or just stagnation at the very least, but then I've also seen, especially because I work with a lot of students on the spectrum, a lot of behavioral regression too. So higher amounts of distractibility, I think higher amounts of sometimes frustration which could be aggressive behavior at times. So increased aggression, maybe increased self injury in more of the severe cases of autism. And that's really, I think concerning for families. And sometimes these students were getting certain services at school, but I think parents have realized too that maybe even the services that they were getting in school weren't enough to now what they're seeing at home there's such a decline in their functioning.
Adam Dayan: It's sad.
Jennifer Oratio: Yeah.
Adam Dayan: It's sad to see the way kids have suffered as a result of not having access or not getting the services, or simply not being able to sit and attend, particularly for kids with autism who don't have those skills. In school they may be used to one-on-one support from somebody who's right beside them and a qualified adult sitting right beside them, but now they're home and they're expected to sit at a desk and focus on a computer and access instruction through a screen perhaps without that one to one adult beside them. And the demands are so great and the expectations are unbelievable and some students are simply not capable to hear those stories, especially when it's coming directly from the parents.
You can talk to your colleagues and you get that feedback, but when you're speaking with the parents and you're getting that raw emotional version of what their kids have suffered over the last two years, it's heartbreaking, especially as professionals. We have this in common that we want to help, we exist to help those kids do better, but to a certain extent some of these aspects have been uncontrollable and you just hear these heartbreaking stories.
Jennifer Oratio: Yeah. It's really sad. And I get that a lot from families and especially when they're talking about the reasons that they're coming for me, I definitely get all of those and it is heartbreaking and it's tough for the whole family, not just the students, tough for the whole family.
Adam Dayan: Absolutely. A lot of strain on the entire family, that's right. Well, I guess we covered this already. I was going to say, since this podcast was inspired by autism, how have students with autism in particular been affected by the pandemic from your perspective? Is there anything else that comes to mind that we haven't covered already in terms of how students with autism have been affected?
Jennifer Oratio: Yeah. I would say in addition to what we just talked about socially, there's been a lot of regression. So even if the student is in a one-to-one type of setting, they're still exposed to other peers and there's opportunities for socialization, but with the pandemic, there hasn't been that opportunity. So in addition to any other behaviors that have been impacted by this social skills have definitely been impacted as well.
Adam Dayan: Right. And in many cases for kids with autism, these are students who are already struggling with social skills to begin with. Right. And so they need those opportunities to practice their social skills with peers.
Jennifer Oratio: Right.
Adam Dayan: What do you see as the long term effects or consequences of kids with autism who have social difficulties not having had those opportunities for socialization?
Jennifer Oratio: I mean, it's really, really difficult for them. I mean, are we talking about just within the pandemic or just in general?
Adam Dayan: I mean, I guess both, these are kids who have been without that socialization for almost two years, who knows when it's going to be fully back to normal for them, they've probably already experienced consequences of it and who knows how those ramifications are going to continue. And so just now within the pandemic and long term beyond the pandemic, how do you see it affecting them?
Jennifer Oratio: Well, it's a lot of time lost and a lot of gains that would have to be made up. So I think when we're thinking about sort of the legal realm and what I try to advocate for in my reports to, is when there has been this loss of service or loss of needs that have been neglected, that I'm advocating for compensatory services, even if it can't be sought specifically within the school outside of school what's necessary, what's appropriate for a student to make progress.
So I try to advocate for those kinds of services so that the student can make up for what they've lost in that amount of time. And it could be hours and hours and hours of certain services, social skills, groups, or training. But I think that without that, there's not this social learning that's taking place. And I think also long term for certain students who have autism is that they may become more socially anxious or lonely and not have the tools to socially communicate with others.
Adam Dayan: Right. Concerning.
Jennifer Oratio: Yeah. (Music).
Adam Dayan: What would you say makes your approach or your services unique?
Jennifer Oratio: Well, I would say that one thing that is unique is that I do a classroom observation for every student that I see. And I would say another thing that is unique is that as part of the evaluation process, I do that kind of advocacy that I had mentioned. So I am participating in IEP meetings and further consultation with other providers within the school and outside of the school. There's not sort of this catch and release, here's the report I'll see you later.
It's something where I'm with the family and that they don't have to stress because they know they will have somebody on their side. I will advocate in hearings too, if it goes to that. So I think that is something that's unique that you don't get everywhere, but think it's something that's really important. And the whole reason I'm writing these reports with these prescriptive recommendations is so that they actually happen. So it's my responsibility to help that happen.
Adam Dayan: Yeah. And you emphasize this point earlier, but I want to reiterate it here. I mean, the advocacy piece is so important and we emphasize this to clients who are considering evaluations, but there are some evaluators who see their role as evaluating, handing over a report and being done. And unfortunately, because the way this process is set up, that doesn't get the parents or the family or the child most importantly to the finish line, because you need someone who's going to advocate for the recommendations in that report, as you said, whether it's at the IEP level or at an impartial hearing, but you need that professional to be available, to speak to an IEP team or an administrative law judge about what the testing showed, what findings were made and what recommendations are appropriate for this student.
Jennifer Oratio: Yeah. And in addition to that, these people that you mentioned, even an impartial hearing officer or an attorney, they're not qualified to understand and interpret all of the results. So I think especially when we talk about the IEP meeting, you do have a school psychologist who's there, and there have been times where they've taken on the role of interpreting my report and sometimes they're just completely wrong. Sometimes I'm there and they decide they want to try to give the findings and I have to correct them. So it's really, really important that the neuropsychologist is part of that process.
Adam Dayan: Agreed. Absolutely. 100%. Anything else that you think makes your approach unique?
Jennifer Oratio: I don't know. I mean, I'd have to speak to my colleagues a little bit more to see if what I'm doing is any different. But I really do try to of make this as fun as possible for the kids and as stress free as possible for the families. So I tell families, don't use the T word with your kids. Don't mention testing, because that's going to automatically produce some anxiety. So just say it's different brain games and activities, and that to see how smart they are in certain areas and to mention that there's going to be stickers and rewards that they can get as part of this process.
Adam Dayan: That's a great one. I mean, I'm a big believer that the experience is important. I mean, obviously you're delivering a valuable service, but what you just said shows that you're making it a really special experience, it's focused on the child, how to remove some of those barriers, make it less stressful, more playful and I think that's really great. Before we conclude, I have to ask, what fuels your passion? Why do you do what you do? What drives you to get out of bed and go into the office every day?
Jennifer Oratio: That's a great question. I mean, I have been working with students with special needs since 2002, and especially with the autism spectrum population and their families, and I've seen how special each child and each family is and how many gifts each of these students have, even if they're not always completely obvious, but I've also seen the struggles too. And again, the struggle that the whole family experiences and I just have this desire and drive to help and to do my part to make sure that these students can achieve. And so I take it on as a role of trying to level the playing field, so to speak, to make sure that every family, every child has an equal opportunity to be successful.
Adam Dayan: I love that. And I love what you just said about gifts and it just clicked from me. I mean, it's about unlocking those gifts, right? And-
Jennifer Oratio: Absolutely.
Adam Dayan: ... getting children the supports they need so that they can unlock those gift.
Jennifer Oratio: Yes.
Adam Dayan: Love it. Tell me one interesting fact about you.
Jennifer Oratio: Okay. So when I'm not putting on my neuropsychologist hat, I put on my runner's hat and my traveler's hat and sometimes both at the same time. And I run half marathons, other races too, but I've done 25 half marathons across a number of different states and a number of different countries and I've got one on the way. I'll be doing the New York one in March.
Adam Dayan: That's awesome.
Jennifer Oratio: But it's a fun experience for me, but I put in that same intensity towards training and planning trips as I do with my evaluations too.
Adam Dayan: That's awesome. That's really awesome. Great one. So before we wrap up, I'd like to make sure that our listeners can find you later. So how can they get more information about you?
Jennifer Oratio: Yeah. I mean, I'm a little embarrassed to say that I still have not completed my website, it's still in the works, but I do have email and I do have a phone and I have a LinkedIn page too. So there you can see my bio, but definitely via phone or via email would be the way to contact me.
Adam Dayan: Do you want to give out the phone and email?
Jennifer Oratio: Sure. So my email address that's probably the easiest and fastest way is, email@example.com. So that's D-R-J-E-N-N-P-S-Y-D@gmail.com. And by phone it's, (201) 675-0155.
Adam Dayan: I think you mentioned LinkedIn. How can they find you on LinkedIn?
Jennifer Oratio: LinkedIn you could just put in Jennifer Oratio LinkedIn, and that should come up in a Google search.
Adam Dayan: Okay. Great. This has been wonderful. I'm so happy that you came in to be the first guest on this program. It's so great catching up with you. This was really fun, really into enjoyable. You gave so much valuable information for parents out there, and I know that it's going to help them demystify the neuropsychological evaluation process. I hope that it will help them get past some barriers to contacting a neuropsychologist to get the evaluation process started. Congratulations on your professional and personal achievements. And I look forward to speaking with you further.
Jennifer Oratio: Thank you so much, Adam. I'm so honored that I was your first guest and this is definitely a lot of fun. Thank you.
Adam Dayan: Great to have you.
Jennifer Oratio: Thank you.
Adam Dayan: You're welcome.
Speaker 1: If you like what you hear, join us every month for new episodes of Curious Incident, a podcast for special needs families.
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