Episode 40: Missed Diagnosis and Overlapping Symptoms with APD – Dr. Elizabeth Geringer

Jill Stowell: When it comes to your child’s struggles in school, do you feel like you’re constantly putting out fires? You do tutoring here. You use that accommodation there. You’ve tried a number of therapies but your child still feels dumb and not getting more independent.

 

If you’re not addressing the real cause of the problem, you’re spinning your wheels and losing precious time. Today, we are going to talk with clinical psychologist Elizabeth Geringer about how to evaluate the whole child in order to point parents in the right direction for treatment and we will talk about what real solutions look like. This is LD Expert Live.

 

[Intro music]

 

Welcome to LD Expert Live, your place for answers and solutions for learning differences, dyslexia and attention challenges. I’m your host Jill Stowell and founder of Stowell Learning Centers and author of At Wit’s End: A Parent’s Guide to Ending the Struggle, Tears and Turmoil of Learning Disabilities.

 

This book will help you understand why some bright children and teens struggle in school and what can be done to change that permanently. To get a free copy, go to parentsatwitsend.com.

 

Our guest today is Dr. Elizabeth Geringer. Dr. Geringer is a licensed clinical psychologist specializing in neurodevelopmental, neuropsychological and independent educational evaluations for children, adolescents and adults.

 

She helps clients better understand how their brain works and provides a personal plan for clients to follow in order to thrive and live a happier, healthier life.

 

I’m going to ask her more about that in just a minute. But let’s welcome Dr. Geringer.

 

Dr. Elizabeth Geringer: Good morning.

 

Jill Stowell: Good morning. It’s so nice to have you.

 

Dr. Elizabeth Geringer: Thank you for having me.

 

Jill Stowell: So you have a practice in Camarillo and Westlake, California right near our Thousand Oaks center. In fact I think our center is right in between your two offices.

 

Dr. Elizabeth Geringer: Yeah.

 

Jill Stowell: We were so excited to meet you because your philosophy is completely in line with ours when it comes to understanding and finding solutions for struggling students. I would love for you to tell us about all the different kinds of testing you do and your goal for students and families who come to you.

 

Dr. Elizabeth Geringer: OK. Well, let me just tell you about like three kind of general categories of testing that I do and a little bit about the differences and why that’s important. So starting with, the first one would be neuropsychological and that’s really looking at cognitive functioning. So we’re looking at memory, attention, executive functioning, visual processing versus verbal processing and really looking at intelligence levels.

 

Then we add in all the psychological factors that could be influencing any of those things. So we’re looking at anxiety or compulsions or a little bit of lower self-esteem or things like that. That could show up and influence all of those things I just mentioned as well.

 

The second category is going to be psychoeducational or those independent educational evaluations and I will talk a little bit more about what the difference is for that later. But basically what that is, is combining that cognitive functioning piece with psychological but adding academics.

 

So OK, where is the child struggling to achieve? Is it in reading or writing or math or things like that? So the psychoeducational or independent educational evaluation, it adds that academic piece. 

 

Then lastly the third category is neurodevelopmental and basically it just adds one more component. This is more of the all-encompassing type of evaluation and that adds in things that we would typically see problems that occur in the early developmental period so things like autism or ADHD or intellectual disabilities.

 

Also common speech or language disorders will present early and also getting into very specific learning disorders as well. So the neurodevelopmental just kind of goes through an entire individual whereas the neuropsychological as just doing the cognitive and psychological, psychoeducational as the academic piece and neurodevelopmental adds the developmental on top of that.

 

So those are kind of just the general three broad categories of testing that I do.

 

Jill Stowell: So that is really helpful. Now if a parent were thinking that they know there’s something going on, they want to get testing for their child, do you kind of guide them which type of testing they need? Because I feel like that would be difficult for parents to know.

 

Dr. Elizabeth Geringer: For sure. So I often have parents call in and they’re really unsure. They said, you know, that something is wrong. My son is behind. He’s acting out and all of sudden, they’re listing all these kinds of different symptoms.

 

So I usually just introduce them with the question of tell me what’s going on. So I just listen to the parent and I jot down notes of like what areas of those categories are they talking about. Is there attention problem? Are they struggling, don’t want to go to school in the morning? Are they hating the learning process? 

 

Then I’m thinking, OK, is it really attention or is it anxiety or is it – do they feel unsafe because possibly there could be some bullying or problems with social interaction? There could be so many different things going on so I really make it a point to just listen to what the parent is describing the problems are.

 

Then I guide them because a lot of times parents will call in and just say, you know, my teacher said he – Johnny has an attention problem. So I need testing for ADHD. Well, to be honest, you can go to a pediatrician and they will have you fill out a survey and decide he has ADHD and prescribe you medications. So that’s not what we’re looking at because there are so many different things that can affect attention.

 

So that’s why I need to hear from the parents all the things that are going on both in the school and at home to really understand and point them in the right direction for what type of testing they actually need.

 

Jill Stowell: And I love that because you’re really looking – you’re just looking at a much bigger picture than a diagnosis and it’s not that you don’t want a diagnosis. You do. That’s helpful but I like that you’re looking at a bigger picture.

 

Dr. Elizabeth Geringer: Right, and that’s what the difference is between like – a lot of parents will get testing done at the school, which is fine. That’s a start. But to be honest, the school has a very narrow focus, right? They’re looking at the child’s behaviors or symptoms that are only affecting the academic process.

 

Are they able to learn reading, writing, arithmetic? So they’re really only – that’s the narrow focus which is not a bad thing. That’s all that they’ve been testing or trained in. However there are so many other things that are affecting a child that could result in slower reading development or something like that.

 

Jill Stowell: Right, right, and actually I want to talk about that a little bit more later. I want to talk a little bit about autism. You mentioned when we spoke earlier that there are many things that look like autism that aren’t. What are some of those things and how do you tell the difference?

 

Dr. Elizabeth Geringer: OK. So we typically – I see this all the time. Parents come in where they – somebody might have said, OK, your child needs testing for autism and they’re really unsure and so there are things that are very typical for autism. So immediately you think of communication problems. A lot of kids on the spectrum have speech delays. They didn’t speak until maybe age three. So that’s one of the obvious symptoms.

 

The second is one that people don’t know as much about but they know that there’s a problem with social reciprocity. When I say that, I mean can they build on your conversations? Autistic kids typically have like one-track mind. They focus on one thing that they’re interested in and don’t really pay attention to the conversation. They don’t have that volley back and forth of social interactions.

 

So there’s that social component as well and then the third area is repetitive behaviors and I see parents unsure of this all the time as well because you think of the typical autistic behaviors as like the hand shaking or the rocking motions, big motions like that. But repetitive behaviors include things like repeating verbal things.

Like if a child says the same thing over and over and has like a verbal ritual or likes to talk their way through or explain what’s going on while they’re doing things and no one is watching or have verbal or just physical rituals before bedtime or how they do something that you cannot break.

 

Those are the repetitive behaviors. So those are the things that are core and central to autism. But there are other things. OK. So the next option that kind of looks like autism is social communication disorder and the key item here that’s lacking are those repetitive behaviors.

So social communication disorder has no repetitive behaviors and it’s very important to note that that’s historical and current because if you are getting testing for autism a little bit later, say maybe you have an eight-year-old or a twelve-year-old that has never been diagnosed and you say, “Well, they’re not doing any of those repetitive behaviors now.”

 

Well, did they ever? Because an autism diagnosis means that if they at one point did in like their early preschool years, they would still be considered to have those repetitive behaviors. Often children learn to not do those repetitive behaviors. Parents tell them to stop or not do them. But if there was no repetitive behaviors ever, then it falls into a social communication disorder.

 

Another option would be something like a nonverbal learning disorder and often kids on the spectrum have additional problems with visual, spatial processing and motor development. So we will see problems with math and spatial relationships. We will also see problems with coordination, balance and fine motor.

 

A lot of these kids with non-verbal learning disorder can’t ride a bike, never learned how to ride a bike even into adulthood, have difficulty learning how to tie their shoelaces. They have like visual problems that are like poor memory of visual details but they also have those social problems, difficulty understanding, nonverbal communication like gestures, body language, things like that. So you can be autistic and also have nonverbal learning disorder.

 

But not necessarily – it doesn’t go the other way because you don’t have those repetitive behaviors again. So it’s a little bit different than social communication but both are lacking those repetitive behaviors. 

 

Then the third option would be like social anxiety and a lot of times people think when their kids have very high anxiety, don’t want to socialize, don’t want to interact with kids, that they might be on the spectrum.

 

When in reality if they’re evaluating themselves constantly and feel like they will be embarrassed and humiliated, that’s anxiety. That’s not autism because autistic kids usually don’t care. If they’re not feeling like they’re being evaluated, they usually just go off on their own and play with bugs or whatever. They’re not really understanding that social interaction as something that they’re lacking whereas a child with social anxiety is very aware that they’re lacking that social interaction. So those are just like three other options of what autism could look like.

 

Jill Stowell: That’s really helpful. You know, once in a while we get a student who comes to us with a diagnosis of high functioning autism and then when we test them or we start working with them, we think, hmm, this looks more like dyslexia. Both autism and dyslexia generally have some degree of auditory challenge and when auditory processing, when the auditory issue keeps the student from processing a full range of sound frequencies, they get an incomplete message.

 

So a dyslexic student might look lost or unengaged or like they don’t comprehend just as we see sometimes with our autistic students. Other dyslexic students experience a great deal of disorientation when looking at print and that can create sensory overload and confused behaviors that someone might associate with autism. But the source of the challenge is different and sometimes our dyslexic learners are so creative that they just tend to live in their imagination, which can look like a gifted child on the spectrum who’s living in his own thoughts and areas of expertise.

 

So understanding the root of the symptoms is really critical to creating the right cognitive learning plan.

 

Dr. Elizabeth Geringer: Absolutely.

 

Jill Stowell: So where are some other places Dr. Geringer where you see overlapping symptoms or even misdiagnosis?

 

Dr. Elizabeth Geringer: Well, I love that you brought up the dyslexia and the creativity because there are so many things like that where you’re seeing overlapping symptoms and a lot of times I would say attentional difficulties are a big one. I think that for a big period of time, kids that were more active or distracted or had trouble sitting still were just automatically labeled as attention problems. But in reality, there can be so many other things that are affecting that.

 

I mean from psychological where is there anxiety or depression or things going on, that makes it so they have difficulty concentrating or is there something like a problem with learning. So they don’t want to sit down or concentrate on something because it’s too hard for them to learn. So is there something different like that that’s causing the behavioral reactivity to something that is a deeper concern?

 

So I would say attentional problems I think were just kind of all lumped together. When you say a child that was not concentrating or was more hyperactive, they just immediately labeled it as an attention problem when it really could be a really broad spectrum of something going on.

 

Another thing I think I often see is the gifted individuals that get misdiagnosed. A lot of times what happens with gifted whether they’re autism or not is that they fly under the radar because people do not – if you’re meeting expectations at school and things like that, then they tend to leave you alone.

 

Well the problem is with that is that we have a lot of these kids that are highly intelligent that may be bored in school. They’re not stimulated. So all of a sudden they’re hyperactive or they’re acting out or – and so now we’re labeling a gifted child as ADHD or oppositional defiant in the classroom and things like that.

 

So a lot of those get misdiagnosed as well and I would say the learning disabilities as well get often overlooked and misdiagnosed all the time because there are so many other things like auditory processing that you mentioned. You know, a lot of times when – for us, there are so many other noises going on all the time that we can just tune out. You know, the lights, the air conditioning, things going on outside. We just don’t pay attention to them and we’re able to tune in and focus to the important information.

 

But a lot of times kids with specific type of learning disabilities, that auditory processing phase [0:18:06] [Phonetic] and it can be visual as well. But specifically, they cannot tune all those things out and focus in and learning and it makes it for long-term learning to become very difficult for that individual.

 

Jill Stowell: Absolutely and of course in a classroom, the first thing a teacher is probably going to see when a child is struggling is they’re going to see a lack of attention or a reactive kind of behavior. 

 

Dr. Elizabeth Geringer: Right.

 

Jill Stowell: So it’s easy to mistake that for an attention deficit when there are so many other things that it could actually be.

 

Dr. Elizabeth Geringer: Absolutely. 

 

Jill Stowell: Yeah. And you were mentioning the really gifted kids. I mean really truly so many of our students with learning challenges are really bright.

 

Dr. Elizabeth Geringer: I know.

 

Jill Stowell: And sometimes they go – a lot of times our kids, they start to show up about third grade as having difficulties. But sometimes kids get all the way to high school or college before their challenges catch up to them to the point that they just can’t do it anymore.

 

I think you see some of those kids, right?

 

Dr. Elizabeth Geringer: Yeah. I often have people come in that are high school or even college age where they have gotten by just fine and usually these are children that have a lot of support. They have parents that are involved. They have parents that are working with them after school, checking in on their homework, getting them tutors. Whatever they need, they have a very supportive environment.

 

So they do well in the lower grades. But what happens is when you get to high school or college, their gap becomes unbridgeable for the parents. So you start very young. It’s just a small gap and it gets bigger and bigger.

 

With parent support it’s narrowing the gap but still they get to a point where parents can’t help anymore. There’s too much or too difficult to bridge that gap and what happens is you have students that break down. They lose interest in their education. They give up. They feel like a failure when in reality they could be very bright and very capable but they haven’t learned the tools to learn, to really study because they haven’t had to.

 

So we have a lot of things that – you know, self-esteem, anxiety, feelings of hopelessness and failure that come out in high school and adulthood because they haven’t received any diagnosis to kind of get them in the right direction and I would say that goes along in most cases for high functioning autism spectrum.

 

I have people that are getting diagnosed in their 20s or even later because they’re intelligent. They have very supportive families. But then they reach adulthood and really cannot make that transition to adulthood. It becomes too difficult to socialize and act in the college environment or work environment.

 

Live independently, make all those appointments, pay bills and things like that. So that transition is very hard and you have a lot of young adults who are in that older adolescent age that are failing and then they really struggle to really understand who they are, how they fit in and how to be successful and a lot of them just lose motivation to the point of giving up, which is really a shame because they have so much to offer and beginning of adulthood. But we just need to kind of give them an understanding of why this is happening and understand that they’re OK and that get them on the right path and get them the support to move forward. Maybe they just need a little extra time on their exams in college.

 

Maybe they need some time with their supervisor at work to kind of understand. Maybe they need time to go to their desk alone or things like that. So there’s just slight accommodations that can be made, that can make a world of difference for these individuals.

 

Jill Stowell: So I want to talk about this whole area of diagnosis a little bit because it sounds like, you know, even just helping a student like that, an older student who doesn’t get diagnosed until they’re in high school or college but then helping them to understand what that really means in terms of how their brain works and how they need to learn.

 

You know, sometimes parents feel that a diagnosis will help them understand their child and sometimes parents are afraid that a diagnosis will limit them. I’m sure you’ve run into both of those things as well. What are your thoughts around this?

 

Dr. Elizabeth Geringer: Yeah. I understand from a parent myself. I have five of my own children. It’s kind of scary to receive a diagnosis whether it’s psychological or medical or any of the above, right? So just say, OK, is this – you know, the label that’s going to stand with them forever? However, diagnosis provides resources. It provides options. It provides understanding. I would say 100 percent of the time, when I work with even a child or a young adult or a parent, when I’m going through the feedback session and going over the accurate diagnosis, there’s a sense of relief.

 

It's like, OK, I understand this. This is my reason why and parents always say, “Well, what do I tell Johnny who’s eight years old?” and I said I guarantee he knows something is wrong. He knows he’s different and you got to give him – you know, according to the age. What’s age-appropriate? Some understanding. You can go in there and say, “Hey Johnny. Guess what. We found out you’re really good at this. But you’re struggling in this area. So we’re going to help get you some help in this area.”

 

I guarantee you they’re going to be like, “Oh, OK. That makes sense. I understand.” It’s a feeling of all of a sudden, they have hope again. So I really do actually believe in diagnosis as really important and I have – like the young adults, a lot of them are coming to me because they do need that support within not only their family that they’ve had indirectly their whole life but then in the community or in their work environment or in the classroom.

 

So all of a sudden, they’re getting just a few little accommodations that are making the world a difference and that occurs because they have an accurate diagnosis.

 

Now I am stressing the accurate diagnosis because that’s what’s really important because your treatment plan is based on the unique individual. Everybody processes things differently. I mean those of us who have multiple children know that from one child to the next, they’re completely different, right?

 

So when we’re doing testing, we need to find out the unique ways that that child processes their world. So then when you have an accurate diagnosis, I really do think it opens up so many options and understanding for the whole family.

 

Jill Stowell: Absolutely. I’ve had kids that have left our testing session. I mean they haven’t done any therapy or anything and the parent will say, “Wow, it’s like he’s starting to do better.” I think, you know, just sometimes there is a relief in knowing there’s a reason why this is harder for me than the next guy. So …

 

Dr. Elizabeth Geringer: Exactly.

 

Jill Stowell: And I do think that a diagnosis can be important for getting your child support services and for gaining a better understanding of the thinking style. But I also would say that a diagnosis alone is not enough for us to create a targeted cognitive learning plan for the individual child because functionally it looks different for each person.

 

Dr. Elizabeth Geringer: Absolutely, yeah. And that’s why basically what I do and what you do kind of go hand in hand, right? Because I’m giving – starting from a very broad view and finetuning it to very detailed. Like does this child have difficulty putting things into long-term memory or do they have problems with retrieving things from memory? Is it auditory versus visual? It is attention versus executive functioning?

 

There are so many things and then we finetune it and you go in and design a very specific plan to help that individual with their symptoms but even just their characteristics of learning, to better improve whatever they’re struggling with.

 

Jill Stowell: Right. And we are actually going to talk about that a little bit more. This is LD Expert Live. I’m Jill Stowell, founder of Stowell Learning Centers and today my guest is clinical psychologist Dr. Elizabeth Geringer. We are talking about testing and understanding the whole child so that we can find real solutions.

 

Dr. Geringer, we talked about how important it is to not only get an accurate diagnosis but to get a picture of the whole child in order to put together the right treatment plan. I want to dig into that a little bit more and take a look at what you see or would be looking for in testing and what the treatment that we do at Stowell Learning Center might look like.

 

Dr. Elizabeth Geringer: OK.

 

Jill Stowell: So let’s take the case of a child who is behind in reading. What are some of the things that you would want to explore in order to find the reason behind the struggle?

 

Dr. Elizabeth Geringer: OK. So I would say probably my first thing that I would do is I would look at their intellectual functioning. Is there a delay? Because a lot of times kids will come in and most kids are going to be in the average range of intellectual functioning. But I just had probably three or four months ago a boy that came in and he was I want to say in the third or fourth grade range and he was coming in because he was struggling with reading. Well, I immediately did an IQ test and found that he was in a very low intellectual functioning range and borderline intellectual functioning, which changed everything.

 

So I need to look at intellectual functioning first. Make sure there’s no delays. Then the next thing I need to look at is what type of reading is difficult for the child. Is it phonetics? Because if it’s phonetics, there could be an auditory processing problem and then we do auditory processing testing.

 

Is it the sight words? If it’s sight words, then there could be a problem with learning or memory or encoding that information into long-term memory. Retrieving that information. So a lot of different from phonetics to sight words. Is it comprehension? Because then there could be problems with language development.

 

So then we’re looking at very specific types of problems with reading and then lastly I would say very important is to get into the psychological piece. Is the child anxious at school? Is he constantly worried about reading in front of the group? Is he clamming up and feeling unsafe and just really stressed out at all times? So are there other psychological influences as well?

 

So that’s where I would start and try to really tease out what the very specific problems are that are leading to what the school sees as a delay in reading. There’s a lot of underlying problems that would occur to cause that reading problem.

 

Jill Stowell: So often there is an auditory issue when a student struggles with reading. So a part of the solution in that case has to be to stimulate and improve the auditory processing so that the student’s brain can then make sense out of phonics and reading instruction. Of course if you’re smart and you’re not able to perform as well as you know you should or you’re feeling confused and disoriented when you look at the page, you’re going to feel stressed and anxious.

 

So the solution to a reading problem isn’t as simple as just providing a good reading program. The anxiety, the visual disorientation, spatial confusion, auditory processing have to be addressed first in order for that good reading instruction to really take hold and work.

 

Dr. Elizabeth Geringer: Absolutely. It’s very key because like I said, the school is going to look at he’s behind in reading a grad level or however they’re going to count it, right? They’re not looking at the underlying problem and again I’m not saying – these are not bad things about the school. It’s just what their focus is, right?

 

Jill Stowell: Right.

 

Dr. Elizabeth Geringer: So like you said, we’re putting a Band-Aid on the problem when you’re getting services at the school whereas in going to a center like yours, they’re getting really at the underlying problem and working to improve those skills so that the reading naturally improves.

 

So it’s a compound effect in all areas.

 

Jill Stowell: So many parents come to us concerned about attention, which we talked about a little bit and executive function. That’s really a big, big concern coming up these days. What would you want to explore for these kinds of challenges?

 

Dr. Elizabeth Geringer: OK. So with attention and executive functioning, I’m first going to try to tease out the difference between auditory and visual attention. So I do test for both. So one of the things that is inadequate is just by filling out parent surveys or teacher surveys and observing behaviors. What you really need to do is a computerized test that actually measures their auditory attention and another one separately measures their visual attention and see how they compare on both and see if one is stronger than the other.

 

Then again there’s always going to be psychological factors or other intellectual differences and things like that, the way they’re processing things. But really for attention and executive functioning, I’m always testing for both and there’s a whole bunch of tests that I can do for auditory, executive functioning versus visual executive functioning.

 

One thing that I found when I do testing that way, I also have some tests that combine both auditory and visual. That way I can see is if they have a deficit in one area, when they combine the two, do they improve? Most often those scores that combine both are somewhere in the middle.

 

So if someone is better at auditory attention and the executive function versus visual, when I combine the two, their scores will improve a little bit and that helps really understand because if that doesn’t occur, then we can’t use the strength to help the weakness. But most of the time, whichever area they’re stronger in, when you combine the two, the child is going to perform better.

 

Jill Stowell: So when you talk about auditory executive function and visual executive function, just help us understand the difference a little bit. I mean I realized auditory and visual. But kind of what does that look like?

 

Dr. Elizabeth Geringer: So if you’re looking at like auditory attention or executive functioning, can the child take in information that they receive auditorily and manipulate it and be able to respond with that information? Can they hold it, categorize it and speak back out more information?

 

The same would be true visually. If they’re given a whole bunch of things visually, are they able to look at, pick out the right information and again respond or select the right answers and how quickly can they find visual differences and things like that?

 

So it’s working with information and being able to manipulate it in short term memory, working memory, so things that are happening very quickly and being able to use that information effectively.

 

Jill Stowell: And that whole idea of being able to manipulate the information is really important because that’s how we kind of problem solve and see different perspectives, being able to mentally manipulate the information.

 

Dr. Elizabeth Geringer: Well, and a lot of times what happens with kids that cannot do that is they lose the next step, right? They lose where they are like of keeping track and in an order or a sequence of events that need to occur. So they’re hearing the information but if they can’t manipulate and work with that information, then they don’t know how to move forward, move to the next step and respond appropriately and make sense of that information.

 

So we need to help them in that area so that they can maybe direct their attention to the right things and explore how to use this information to your benefit.

 

Jill Stowell: Right, right. And, you know, again, just really truly exploring and getting a big picture of all of the skills involved, the supporting skills involved is really important. I remember an 11th grade student who came to the learning center because he was failing and his mom was very concerned about his poor attention and his organization and executive function skills.

 

He avoided his homework and whenever he would finally get started, he would find all kinds of things to distract himself and she was also concerned that he didn’t really seem to have friends. Well, it turned out that Rich’s attention was really solid on the [0:37:24] [Indiscernible] which I think might be the test you work with currently, a continuous performance test.

 

Dr. Elizabeth Geringer: Right.

 

Jill Stowell: That looks at different aspects of attention. But he had many areas of processing skills that were lagging, working memory, auditory processing, visualization, processing speed and over the summer, he did a processing skills program with us, which doesn’t look anything like academics or school work but it uses many different kinds of games and drills to improve memory and auditory and visual processing and attention and reasoning skills.

 

It uses a metronome with many of the activities which improves speed and regulation. When he finished, all of his test scores including reading and comprehension improved. We had thought that we were going to need to do some specific work with higher level reading and comprehension. But really once that base of solid processing skills was there to support him, his reading and comprehension came right up with it.

 

The other thing his mom noticed was that he seemed more mature and we do see that often. When kids are able to take in and think about information quickly and accurately, they respond better in the world. So Rich’s mom called me at the end of the next semester and said that he had made friends, held down a job and was achieving As and Bs.

 

So here we had this really smart, motivated student who actually had good attention and executive function abilities but his lagging processing skills were getting in his way of execution.

 

Dr. Elizabeth Geringer: That’s really amazing because those are real live examples of exactly what I’m talking about, how testing goes hand in hand to moving the child to the next step, to getting the skills, the underlying skills that are really going to improve all areas of functioning.

 

So not just – like you said, not just improving the reading or not just improving the organizational skills all of a sudden because we got at the root cause. We’re able to see the child really thrive in all areas.

 

Jill Stowell: Right, right. This is LD Expert Live. I’m Jill Stowell, founder of Stowell Learning Centers, and my guest today is clinical psychologist Dr. Elizabeth Geringer.

 

So Dr. Geringer, speaking of back to school, you were just mentioning just before we got on that you’re finding you’re doing a lot more counseling with children, adolescents, with going back to school. Is there anything that you would kind of want parents to be aware of or just what’s happening with that?

 

Dr. Elizabeth Geringer: Yeah. So what has kind of happened with the pandemic and parents being – having the children at home, doing home learning and Zoom for a long period of time, what we’ve seen is like the natural progression of social development has kind of stagnated, right? A lot of kids have not been able to have that reciprocal information, feedback, right, that they get from interacting with peers on a regular basis in school, on the playground, in sports and all those things where they’re constantly checking their behaviors and the way they interact with people whether they know it or not because they’re receiving feedback of what’s appropriate and what’s not.

 

So you have a lot of children that have not continued to develop these skills because they just weren’t exposed to it, right? So now they’re getting back in the schools and they’re interacting. They’re having a hard time sitting again for long periods of times, learning in-person and interacting instead of the independent learning, having a parent help and the social part of it is becoming overwhelming. I have a lot of kids that are coming in with problems with social anxieties, self-esteem, comparing themselves to other people that I didn’t see just a couple of years ago and it’s getting younger and younger.

 

I’m seeing kids in first grade that are coming in for therapy that I wouldn’t have seen before this pandemic.

 

Jill Stowell: Well, I’m glad that you’re there as a resource for them and I just think it’s something we need to be aware of so that …

 

Dr. Elizabeth Geringer: Sure.

 

Jill Stowell: So that we spend time just hanging with our kids and listening about their day and providing feedback. An interesting time we live in.

 

Dr. Elizabeth Geringer: Yeah.

 

Jill Stowell: So if parents are looking for neuropsychological or psychoeducational assessment in their area and they’re not in our area here, I know we touched on this a little bit, but what kinds of questions should they be asking to find someone like you?

 

Dr. Elizabeth Geringer: So they need to ask what type of testing is being done. OK? And what they’re going to receive from the testing. So that’s where I was – you know, mentioned they need to have a comprehensive report that is included with the testing, that is going to cover all areas of testing, list the tests that were provided and then provide options, roadmap for intervention. So I’m talking about referrals and recommendations in all areas.

 

So they need to ask what type of training the psychologist has, what type of testing is going to be done, what they are looking for and what they’re going to receive at the end of testing.

 

Jill Stowell: And then you mentioned to specifically look for someone who has a specialization or a lot of experience with testing children or adolescents if they …

 

Dr. Elizabeth Geringer: Very – yes. Very specifically because that’s not common. I mean most people who are doing testing out there do not have extensive – like once I finished my doctorate, I did a year internship and three years of a fellowship very specific to child and adolescent testing. So it’s not common to find someone that has very specific training in this type of neurodevelopmental tests. So that’s very important. Yes, for sure.

 

Jill Stowell: Great. Well, thank you for that insight. What last thoughts do you have for us today?

 

Dr. Elizabeth Geringer: I would say that – well, I would stress that every child is unique. Everybody has their strengths and weaknesses and testing is really going to get at the underlying problems with the child but it’s also going to reveal all the great things. I love asking parents what are the best things about this child because a lot of times we can use those strengths to really buoy the child up, get them moving forward and progressing again. 

 

So accurate testing and diagnosing is really going to understand the whole child, the unique way they perceive their world and that’s when you will be able to really start moving forward with accurate interventions and treatments.

 

Jill Stowell: Great. Well, Dr. Geringer, thank you for being with us today and for the work that you’re doing for kids and families. I love your focus on the whole child and the time that you take to give families clarity and a sense of direction. It’s really helpful.

 

Dr. Elizabeth Geringer: Thank you. Thank you for having me.

 

Jill Stowell: Well, it has been great. Here is Dr. Geringer’s contact information. She is a fantastic resource for you if you are in Southern California and a good model of who you should be looking for in your area, if you’re searching out a diagnosis or a better understanding of your child’s strengths and needs.

 

This is LD Expert Live, your place for answers and solutions for learning differences, dyslexia and attention challenges.

[00:00:00.390] - Lauren Ma

We have some questions from parents or actually, Wayne is a grandparent. He has an eight year old grandson. Parents are divorcing this year. Teachers encourage ADHD testing. Unfortunately, health insurance does not provide. They're in the Sacramento area, and he says he's willing to pay out of pocket for an assessment and a way forward. And so any advice for that situation?

 

[00:00:25.690] - Dr. Geringer

Yeah, I would say a couple of things because first of all, if you can pay out of pocket, I would definitely look for a neuropsychologist or a psychologist that specialize in child and adolescent testing. Someone who has been really trained in that area. But the other thing he can do is request an IEP. They can go to their school and say the teacher is noting attentional problems.

 

[00:00:53.710] - Dr. Geringer

But I feel like there's a lot more going on because if parents are divorcing, there's a lot of psychological issues that could be happening. The school could start testing. I mean, this is a lot longer process, but if you disagree with their testing results or you want something further, that's when you have the right to request an independent educational evaluation.

 

[00:01:17.160] - Dr. Geringer

Now, again, you have to have reasons why and moving forward. And then a lot of times you can get the school district to pay for someone like me who does private evaluations, but it's a whole legal process and it takes a really long time. But yeah, someone who is saying there's attentional problems. But given just that fact that the parents are divorcing, I would say that there could be a lot of other things going on with this child.

 

[00:01:43.390] - Dr. Geringer

And I would highly recommend doing some outside testing.

 

[00:01:49.540] - Lauren Ma

Makes sense. And then we have Amber, I believe she lives in the Tulsa area. And it kind of leads to the question of do you have any recommendations? We have a national audience, and I know you practice in California. Do you have any recommendations for our parents who would like to get testing or services outside of California?

 

[00:02:09.410] - Dr. Geringer

Yeah, I would say the first thing I would do is just check your local networks and see start with your pediatrician. Go to the pediatrician and say some pediatric offices will have a psychologist on staff, and so you need to find out if they do and if they have testing, and it's the testing related to neurodevelopment mental. So I would start with pediatrician, but then you can do Google search online and you can literally just start typing in child neuropsychologist who does testing.

 

[00:02:45.640] - Dr. Geringer

There's a lot of listservs like Psychology Today that lists different psychologists in areas all over the country. And a lot of times people like I can reach out to my colleagues and say, is anyone in this area? And sometimes I can get referrals and recommendations. And believe it or not, I have people that fly in all the time and will spend the night in the hotel and do all day testing in one day and then fly home. I had someone that flew in from Chile to get testing. And so it's not unusual for people to fly in and do testing. I have people that have come from out of state several times that will come in if that's something that they can do and have an opportunity to do that.

 

[00:03:34.680] - Dr. Geringer

But I would start, probably the easiest way to start with your pediatrician, start asking questions.

 

[00:03:40.540] - Lauren Ma

We have some questions again from parents regards to testing. Veronica is asking, once the child is diagnosed with a pediatrician, what's the next step?

 

[00:03:51.490] - Dr. Geringer

Okay, so getting a diagnosis, I guess it's really going to under like see what the diagnosis is. Pediatricians are going to be kind of limited in what they can diagnose, right? So I assume with a pediatrician it would be something like ADHD. Or they might say, well, it looks like they have anxiety, but they wouldn't give any other real formal diagnosis. They would probably refer out. But then the next step should be involved in the whole diagnostic process.

 

[00:04:23.100] - Dr. Geringer

This is what I'm a huge stickler about, is you should have recommendations and referrals immediately for services. I'm not just talking about in school. I mean, there could be speech therapy, there could be occupational therapy, physical therapy, there could be educational therapist, there could be so learning center, there could be all kinds of different referrals and recommendations. And when I do reports, I have sections and there is a section just for the parent of what they can do in their house. And like with an ADHD diagnosis, I always say screen time is balanced with green time. Okay?

 

[00:05:01.590] - Dr. Geringer

So I always tell their parents, if your child is getting 2 hours of video games, they are spending 2 hours outside in your backyard and parents are going: What? I can't, that's too much. And I said it has to be because ADHD brain is very different. It needs that outdoor stimulation. So that would be just one example of a parent recommendation.

 

[00:05:24.010] - Dr. Geringer

So parents can do a lot of things. If their child is on the spectrum, they can get them involved in some social skills groups. And so we could do group therapy or even just finding an interest. Maybe your child is really interested in robotics or chess or music. Find a club in your area and get them there. Even if you are working with them every week and holding their hand and walking them in there, that's going to develop their social skills.

 

[00:05:54.570] - Dr. Geringer

There's a lot of recommendations and referrals that will be for the parent home environment, school environment, and then therapeutic type of interventions, which could include therapy, group therapy and or medications. So you're going to COVID all areas. That would be the next step.

 

[00:06:16.690] - Lauren Ma

Great. And then kind of piggybacking off of Jill's story a little bit. Lisa is asking, we had my daughter tested just before the pandemic by a pediatric neuropsychologist we were told she is a slow processor. Do you have any suggestions? Sounds familiar.

 

[00:06:40.010] - Jill Stowell

Well, and certainly I would want to look at the bigger picture to see what else is around that. But certainly the processing speed response time issue is something that we look at. We look at it both with training in terms of our processing skills. Work has a lot of work with the metronome and timing as well as our core learning skills.

 

[00:07:19.320] - Jill Stowell

Sometimes the challenges are really going down into a much lower level of reflexes and motor skills. And so we work with rhythm and timing there to work on processing speed. Sometimes response time, slow processing could also be connected with diet, which is not my area of expertise, but I have a colleague who did a lot of research there with dairy and sugar and the impact on processing speed and in particular response time. There's a lot to explore there to see where that's coming from in order to make the right recommendations.

 

[00:08:07.590] - Dr. Geringer

I would also add that processing slower processing speed is not unusual. It's very common for kids to be better at verbal comprehension or visual spatial relationships and then all of a sudden have slower processing speed. So there's things that you can do to speed up that processing speed. But maybe it just means that your child needs a little bit more time to process things. But there's lots of gains and things that you can do that have timers and like you were talking about the metronome to kind of quicken that speed that with practice will improve processing speed. However, a lot of those type of things are pretty much stay the same. We can get improvement in the general functioning, but if it's lower than other areas, that's not a severe problem. You're just saying that, okay, I need a little bit more time to figure this out so we can work on speeding things up in the processing. But it just means that, you know, maybe they're higher, more complex cognitive areas are stronger, which is great.