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Hey, folks. Welcome back to The Testing Psychologist. [00:01:00] Glad to have you. I have a return guest today, as you will hear. My guest is Dr. Liz Angoff.
Liz is a Licensed Educational Psychologist with a Diplomate in School Neuropsychology. She provides assessment and consultation services to children and their families in the Bay Area in California. Liz is the author of the Brain Building Books, which we frequently use in our own practice, as well as a brand new book called Our Brains, created specifically for parents.
So you’ll hear us talk about that a bit at the end of the podcast. It sounds like another fantastic resource. More information about her and her work is available at explainingbrains.com. We also have a lot of links in the show notes for Liz’s resources, but as you can tell from the title, we are talking about feedback sessions today.
It’s been a while since I have done an episode on feedback sessions. Liz and I dive deep into the feedback process and what that looks like for her. She talks [00:02:00] about this concept that feedback starts at intake
and discusses how she’s delivering ongoing feedback throughout the assessment process. We also dig into the logistics of how she conducts her literal feedback sessions; how she structures them, what she shares, and what she does not do. There are some interesting points to consider there.
So, lots to take away from this episode. As usual, I try to anchor us in some pretty concrete strategies, and Liz has been doing this for a long time and doing it really well. So the information is high quality, no matter what we’re talking about. So I hope you enjoy this episode talking about feedback with parents, with Dr. Liz Angoff.
Liz, hey, welcome back to the podcast.
[00:03:00] Dr. Liz: Hey, it is great to be here, Jeremy.Dr. Sharp: Good to have you back. It seems like you’re always up to something fun, interesting, and useful to the testing community, so I’m always grateful that I can grab some of your time because I know you’ve got a lot going on.
Dr. Liz: Well, thank you so much. I think this is time number three. I feel like there should be some kind of Letterman jacket that goes with that or something.
Dr. Sharp: That’s what people keep calling for. I think I need to hit the internet and design some jackets and get them shipped out. I’ve got a few folks, there’s maybe three or four of y’all who are three-plus-time guests.
So, just another call to make some jackets.
Well, seriously, thanks for being here. I do know you’ve got a lot going on. We were on a webinar last week about AI and all kinds of things, and I’m going to try to steer clear of that today, even though that’s [00:04:00] super interesting because we’re going to be talking about feedback sessions, which is also super important.
Dr. Liz: Digging into the human intelligence component of our job.
Dr. Sharp: Yeah, that’s a good way to put it. There is a lot of talk about artificial intelligence, but we still have to be humans. We still have to be psychologists, and delivering feedback is a big part of that.
So I’ll ask you the question that I ask everybody to start, especially pertinent for folks like yourself, where you’re doing a lot of different things, but why this? Why now? Why spend your time and energy on feedback sessions in particular?
Dr. Liz: I’ve been passionate for the better part of my career about how we talk to kids about their testing results and how we explain a diagnosis to kids. And what’s been fascinating is that as I get better and more aware of what’s helpful to kids, I feel like that’s [00:05:00] shifting the way that I talk to parents in a big way, and helping me understand at such a deeper level what parents need to walk away understanding.
I’m fascinated by this idea that our ethical obligation, as it’s stated in our code, is not to explain results, but to make sure they’re understood. I feel like there’s two different things going on there, just us at the feedback session, going through the report and explaining everything, or in an IEP meeting or whatever our mode of communication is, doesn’t necessarily mean that parents are walking away understanding the testing results, knowing what to do with the testing results, or feeling confident and empowered by the testing result, which is what we want.
I keep talking about we [00:06:00] want to empower our kids to really understand their brains, and I realize we want to do the same thing with families and empower them. So, how do we do that?
Dr. Sharp: It’s a legit problem, and an easy one to forget about. You’re so well-known for how to deliver feedback to kids, and that’s been a cornerstone as far as your materials and what people know you for, which is great because just speaking personally, I came at it from the opposite direction where we were taught more in graduate school about how to deliver feedback to parents, and forget about the kids in some sense. You’ve been shining light on that for a long time, and now going back into the parental aspect of it is super important.
It reminds me of some of the [00:07:00] things that Stephanie Nelson has said, others have said on the podcast around research around people not understanding a lot of what we say in feedback sessions, and the double whammy of not telling us that they don’t understand what we say in the feedback session. They just nod enthusiastically, fake their way through it, and then walk away, having no idea what we actually told them or what it means.
Dr. Liz: Right. I think that there’s something about not only understanding what we’re talking about, but also being able to formulate a question in the moment. I think there are two things that have stuck out to me and have formed my practice in the way that I approach feedback.
In one of them, I’ll tell you a story about when this went completely wrong. This family sticks out in my mind and still catches my heart to this day in thinking about [00:08:00] doing this assessment for their child and being so excited that I felt like I figured it out.
And this is a family I had a good relationship with. I had evaluated their other child. We had a really good rapport. I did the assessment and realized this child is autistic. It was a subtle profile. I felt like I had picked up on it, and I was so excited to share these results because I felt like, as this child was entering adolescence, it was going to be so important for her development.
And so we sit down at the feedback meeting. I revealed this diagnosis to them, and there was this complete rejection. This is not true. We disagree with you. There’s no way that’s possible. And I thought, “I did such a thorough [00:09:00] evaluation. I am proving my case. My report is foolproof.” It was just a dead stop. I spent a lot of time reflecting what did I do wrong?
One of the things I talked to you about with kids is that the thing that goes wrong is when it’s a surprise. I went back into the archives to find your podcast with Karen Postal. She and Kira Armstrong wrote this book, Feedback That Sticks. They talk about that feedback starts at intake.
And that’s when I really internalize that idea that we can’t get to the feedback session and present things that are new to families because that surprise, it puts us all into a fight or flight [00:10:00] place where it is very hard to process information and engage in any kind of dialogue.
And so it was a stark example for me, and transformative of, oh, I made some big mistakes here. I did not bring the family along with me on my journey. I didn’t understand that while autism had been ruled out when this child was very young, what the emotional response of the family was to that hearing that information at that time, that they were relieved that they had gone through this whole journey around it, that they had emotions around it, that I didn’t do my due diligence to understand. And so this idea of feedback, it’s not a single session. It’s a journey with families.
You mentioned Stephanie Nelson, and the other piece that’s been [00:11:00] transformative is her questions that she asks at the intake session that help us support families. She says things like, not just what are the diagnoses that we’re trying to assess, but what would you like to know from this assessment? What are you most concerned about? What could I tell you that would be the best outcome or the worst outcome?
Understanding these things helps us get at the bottom of what are parents looking for from this assessment beyond a diagnosis and what are the tricky pieces going to be that we might stumble over, that we want to help families process along the way if they have fears, if they have past trauma that they’re bringing in to our assessments so that we can bring parents through a real therapeutic process as [00:12:00] part of this assessment, not just relaying information like it were something that’s not so emotionally related.
Dr. Sharp: Oh my gosh, yeah. It makes me think this is an amplification of this whole dynamic, but being in a meeting with a physician, probably this was maybe three years ago, where we’re given this news that my mom had bladder cancer. This is serious. This is, like I said, a dramatic example, but the process of that was so sterile, might be the right word.
I don’t know that we as psychologists go into feedback in that same manner. This was a 15-minute appointment, and like, hey, you have cancer, and then boom, boom, boom. Here are the treatment options.
We’re trying to do this emotional processing along with, like you said, formulate [00:13:00] questions to
sound coherent and make an informed decision. It was so much going on in a very short period of time. We can create the luxury of building that story all along the way, rather than shocking people in the last minute and then demanding a coherent response to this news.
Dr. Liz: As I’m saying it, I’m thinking maybe I’m the only person who’s made this mistake. How come I didn’t get it, or didn’t get the memo? But one of the things that Karen Postal said is that feedback is therapeutic by nature, and that we have to be fluid in the hats that we wear from assessor to therapist to parent, coach. We need [00:14:00] this wide skillset to be able to hold families through this process because it’s really emotional.
Dr. Sharp: I agree. I feel like feedback is probably the closest that we get to therapy in this process. I’m thankful for that. I think it’d be hard to just stick to the data, the numbers, and the rote process of testing.
I was going to ask you, though, around this whole process, like you said, feedback starts at the beginning, and I’m curious how that actually looks for you in practice.
Dr. Liz: That concept, “feedback starts at intake,” has driven the way that I think about the assessment process. There was one other [00:15:00] piece I want to layer onto this that has helped me figure out what the logistics of that look like, and it’s that a lot of the stuff that we work with is highly genetic, and many of the parents are related to their children, and so when we think about the supports and accommodations that we put in place for kids to help them understand information, the same things apply to parents.
I don’t think that we need to even know what the parent’s specific profile is because whenever we’re dealing with something vulnerable and emotional, we need those supports regardless to process information. And so things like scaffolding families to ask questions, helping them to formulate their questions, being [00:16:00] very transparent about what questions we’re formulating in our head and what diagnoses we’re pursuing so that there’s no surprises at the end, outlining what our process looks like so that they know what to expect, and even using visuals to show them what our journey’s going to look like together because it helps us process information.
And we do this all the time. It’s so old hat. It’s very logical to us, but it’s a black box to parents. As a parent myself now, I’m part of a lot of Facebook groups or listservs that have parents who are exploring these processes, and the amount of things that are just challenging to understand or are misunderstood about the assessment process is mind blowing.
So, using all those types of accommodations we would give to kids who have [00:17:00] trouble processing information or who need help with executive functioning, preempting that with families is really helpful. So what does that look like in an intake session?
One of the things that I do is I start the intake session with my standard interview. I have people fill out their paperwork beforehand. I think we all do this. And then we go through our standard interview, but towards the end, what I tell parents is I want to hone in on our assessment questions, and I want to develop those together. And this is part of the transparency and part of supporting them in developing that language so that they have a chance to correct my language or build on the questions.
And so as I mentioned, [00:18:00] in addition to the general questions like what do you want to know or are you curious about a specific diagnosis, I’m asking those Stephanie Nelson questions: What would you like to know? What were you most concerned about?
I love this one; when you think about your child five years from now, what do you hope for them? And then the best and worst outcome; is there anything you’re afraid of? Asking those questions become important for getting things out on the table that aren’t part of our standard interview and understanding how I am going to need to support this family throughout the process.
Dr. Sharp: It does elicit those emotional components of the process for families.
Dr. Liz: Yeah. I use two tools. I have a little intake packet that I give families, and one of the things is I have a [00:19:00] four-part one-page summary that I’ll give at the end, but I actually started presenting it at the beginning with just our notes.
And so it has four boxes on a single page. One box is strengths, one box is challenges, one box is possible diagnoses that we’re looking for, and the other is next steps. So things you’re going to do, what this process is going to look like.
What I try and do is mark down two things from the interview as a way to summarize everything at the end. Like you’ve talked about how your child is very enthusiastic and creative. They’re very deeply feeling kid. These are some of the strengths that I’m going to be looking into more as part of the assessment.
We’re also going to be trying to understand these challenges, and you mentioned that attention, self-regulation, you’re concerned about these big tantrums that seem to go on for a really long time, [00:20:00] and so those are the things we’re going to investigate.
I have two different diagnoses help us drive treatment and help us understand if your child’s profile reflects common profiles. And so some of the things I’m thinking about are autism or ADHD. I also want to do a deep dive into anxiety because I think I’m hearing some of that. Does that make sense to you? And I’m writing these things down.
I’ll tell you that recently, I had a child who has really big emotions and a lot of, I won’t go into detail, but there was a family history of bipolar. And so putting that out on the table at the beginning to say that, I want to just answer, I wonder, since you’ve mentioned this history, if you have questions?
If your child might be showing [00:21:00] early signs of bipolar, is that something? And the relief on parents’ faces of yes, we do want to ask that question, but seeing that they have been really scared to ask that, it helps bring that out to just see it on a piece of paper. This is what we’re looking at, and now I can add things to it. And it makes things really transparent.
I also made a little slide just in Canva, and you can download it from my website, so on explainingbrains.com. There’s a little journey that just shows some little circles and the 10 steps of the assessment process.
So we’re here at intake, and then the next thing we’re going to do is the observations and interviews, and then your child comes in for testing. Then we’ll do parent feedback so they can visually see it, and I’ve explained it 10 million times, but visually seeing it X marks the spot, here’s where we are on the journey is [00:22:00] helpful.
These things might not feel related to feedback, but what they’re doing is they’re anchoring families in these concepts so that the feedback session won’t be a surprise because we’re coming back to all these things later on and we’re laying the foundation for this is what we’re going to be discussing at the end.
Dr. Sharp: That makes sense to me. Do you ever run into situations, I’m going to back up, I have two questions. Folks know I’m super concrete with this stuff. So when you are sharing these visuals, the boxes, the map, and those kinds of things, I assume this is happening over a screen share, is that right? Are you doing virtual intakes or is this happening in person?
Dr. Liz: I have parents to come in, if they can. I’ll give them a physical packet in a bright yellow folder that they can keep. If we do it over [00:23:00] Zoom, then I am screen sharing, and then I send them their intake packet with all those visuals.
I just have a little text. If you use Text Expander or Blaze, you can put together your intake packet, and it’s very easy to just send. But that four-box handout, which you can absolutely download from the website, I put it up on the screen and as families are talking, I’ll put little notes in there so they can see how I’m conceptualizing and make sure that we’re summarizing things.
And it doesn’t have to be a lot. It’s not the whole intake interview. It’s just two things that, here are things that I’m going to be looking at when I do the testing, because they don’t know what happens in that session. If they go home anxious about it, the kids going to come in anxious about it.
Dr. Sharp: Oh, so true.
Dr. Liz: So we want them to feel [00:24:00] confident. I don’t want to get sidetracked into feedback with the kids or the testing sessions. What this is doing is it’s planting seeds so that they know exactly what to expect when come in for the feedback session.
Dr. Sharp: Fantastic. My second question with that is, how do you handle it in the intake if they come in with a specific referral question, let’s say, we get this a lot, does my kid have autism? And you’re just not hearing anything that points in that direction, are you crushing their dream right at the beginning, or do you wait to do that somehow? How do you navigate that?
Dr. Liz: I am aware of two things at the intake session. One is that it’s really hard to summarize your child’s experience or your experience with your child in that [00:25:00] session. So just because I’m not hearing anything, it doesn’t mean that it’s not there, it just means that I have some work to do.
I might say something like, it’s interesting, I’m not hearing a lot of, I’m thinking of things I have said before. As we’re thinking about the autism, I’m not hearing a ton of things that would be a really clear autistic profile, but I do want to look into some of the more subtle things. We might circle back to this interview after I meet your child.
I think that saying something like that, I’m not hearing it, but I want to look at it further, plants a seed of it might not be there, but also leaves me open and helps me be humble that I’m not … You’ve had other guests who have talked about our bias going into things, and if I go [00:26:00] into the assessment with my decision already made, I want to be very aware of that.
In the interest of knowing what to expect for parents, I might say something like, it’s interesting, I’m not hearing a lot of those things. What I am hearing is some things that map onto anxiety. So I want to go into that, or I want to learn more about your child’s processing abilities, because I’m wondering if there might be some clues in there about why these things are so challenging.
Just as I’m talking, I’m realizing that’s why that question, what do you want to know, or what’s your biggest concern, is so important in helping families expand their questions from is this autism to what do you actually really want to know? What would be the success out of this? And even to the point [00:27:00] of if you learned that your child is autistic, what would that mean to you? If you learned that they were not autistic, what would that mean to you?
When somebody comes in and they’re very attached to an assessment, and this happened recently, I was so glad with a young adult that I asked that question because she said upfront, I would be very disappointed if I found out I was not autistic. So we got to talk about what are you really looking for? She said, “I need a way to describe why I’m different. I need a shortcut for telling people this is why I am not doing things the way you expect me to do them.”
And so I said, if I could tell you that at the feedback session, if we could get at that, how do you explain your experience? Would that be helpful whether you’re autistic or not? And she said yes, that would be helpful. So we brought a little [00:28:00] agreement so that when we got to the feedback session, I knew how to share with her the results in a way that would resonate.
Dr. Sharp: Right. I know we’re spending a lot of time here, but I think it’s important. This whole idea of feedback starts at intake and using that as time to seed some of these thoughts that you may be having, some of the possibilities, some of the outcomes. We talk about amongst some team lot.
Dr. Liz: Karen Postal said that. I pulled over to the side of the road, and I wrote it down.
Dr. Sharp: Nice.
Dr. Liz: Just wondering, are people listening to this, and I hope those light bulbs are going off like it did for me, because I feel like it was such a transformative moment. I remember the parking lot I pulled over into, I’m like, I have lots to learn.
Dr. Sharp: Oh, for sure. That was such a good interview. My gosh. Getting back to something that we mentioned in the beginning, I don’t know if this is true for you, but [00:29:00] for me personally, for a long time I held this belief that I had to hold back that diagnostic information so that it would make the feedback session more meaningful, or make me seem like I had more to offer or something.
It was this grand surprise, gift or something that I was presenting at the end, and over time figured out that that’s not the case, but just thinking about why we might do that as clinicians, why we might hold back, not offer some initial thoughts or impressions in the intake. I’m curious if you’ve thought about that for yourself.
Dr. Liz: I think there is this idea. Thank you for saying that, because maybe I’m not the only one who thought it’s my job to take all this information in and do my black box thing, and then spit it out at the end. And that’s what being a [00:30:00] professional means.
Dr. Sharp: Oh, you’re definitely not the only one. I feel like that’s how 97% of people do it, or did it.
Dr. Liz: I think maybe we’re taught that. So I’ll just speak from personal experience because I was a school psychologist at the beginning of my career and worked in schools. Sharing that information upfront with parents was thought to be predetermination. It basically means that you’re telling them whether their child qualifies or not before the IEP meeting, and it’s supposed to be a team decision.
And so there’s this ethos around not sharing anything. I think we have fear that if we shared something that parents were not okay with, or that they didn’t like in [00:31:00] some way, that we’re inviting confrontation. And that’s such a misunderstood concept.
I think drawing from a lot of the therapeutic assessment and collaborative assessment principles, we are experts in our tools, but we’re not experts in the parent’s experience or the child’s experience, and we need collaboration in order to not only develop a relationship but actually do our jobs well.
There’s information that families have that is going to help in our analysis and how we interpret the numbers. Their insight into what it means for real-world experience is going to make us better at our diagnostic process, not interrupt our diagnostic [00:32:00] process.
So I think there’s something really important to having ongoing communication and taking that collaborative stance, having that humility as an assessor that my tools are not the-end be-all. And that brings them into the real world, the way we do that is through collaboration with families, and not to be afraid.
And if we present something and we get pushback, it’s going to be a lot less and a lot easier to work with mid-assessment in the intake than it is at that feedback session when it feels like everything’s done.
Dr. Sharp: Sure. That reminds me of a question around the testing process. Are you also offering additional thoughts or impressions after testing in between intake and feedback?
Dr. Liz: Feedback starts at intake, and then the next piece for it for me is that feedback is [00:33:00] ongoing. And throughout the assessment process, there’s two informal and then formal ways that I check in with families. One of them is I will bring in parents for the last five minutes maybe of the session just to share with them what we learned.
And so if you’ve heard me talk before, you know that I’m talking to the child about what we learned and one of the ways that I give parents check-in points along the way is to say, this is what we learned about your child’s strengths and these are the construction zones that we found today. Here’s something your child said about their experience, or I noticed. We talked about how he was using this strategy, that I thought was really cool.
And then parents have a chance to comment on that, or they get a little bit [00:34:00] of insight. It eases that anxiety of what’s going on in that room. What are they running? So they’re getting pieces of information, and that’s been really helpful because they’re getting it in the child’s language, and it’s really easy to understand.
And then at the feedback session, I can pull on that. Remember how we talked about that strategy of talking himself through the task that your child was using. It turns out that it applies this way, and now we can relate it the actual testing results.
The other thing that I do at that intake session, if I know that there is a lot of anxiety around what the diagnosis might be, if the parents come in set on an autism diagnosis, like your example, and I [00:35:00] start seeing that I don’t think that this is autism. I think there’s something else going on. I will have a mid-evaluation check-in; this is not a formal feedback, but let’s just do a half-hour check-in because I want to run some things by you, some initial thoughts that I have. Here are two things I’m seeing.
And usually, in that, I’ll share one or two strengths that have come out. So they see that. And then I’ll share one thing that I want to run by them to say that when I did some of the specific autism testing and talking with teachers, it seemed like there was this initial anxiety that made it hard for your child to interact, but once they warmed up, I saw a very different kind of interaction from them. [00:36:00] I’m wondering if you’ve seen that as well; that initial transition, but then things changed. You see those two sides of your child.
I can hear from them and then start to float the idea I’m starting to lean more towards that this might be an anxiety profile, and this is why, and I’m wondering if that makes sense. I haven’t put all the data together yet, but this is what I’m thinking and giving them the opportunity to get some feedback.
I don’t always have time for that, but when I know this is going to be hard information to process, I try and make time for it. Or when the times that I always make time for it, if there is a new diagnosis that comes on the table that wasn’t part of our intake, any new information that’s going to be surprising, I will do that [00:37:00] pre-check-in to let them know at some point to say, I’m starting to think that ADHD might be a factor, and I’d like to look into it a little more. Does that make sense to you, too?
So I’ll do an additional survey, or I already have the information I need, but just before I do that, I just want to make sure that you know what my thinking is.
Dr. Sharp: That’s great. We had a situation like that come up in our practice the last two weeks, where we’re testing someone, and there are very few signs of autism throughout the testing. We had a conversation with the parents about that because they were pretty set and invested in that outcome, and that gave them an opportunity to share more feelings around that, their concerns, their thoughts, and we were able to pivot in the moment and add on some additional things. Just reinforcing everything you’re saying. Nobody likes [00:38:00] surprises. So anything we can do.
Dr. Liz: Yeah, including this. It helps me know when I can float things by families that I’m not sure how they’re going to react to, it’s helpful for me to have more of an informal check-in so that I can know what the reaction is, how they might process that information so that I can put supports in place to help with that conversation. It can preempt what might need in the actual feedback session to walk through and help them understand if it’s going to be at odds with their current conceptualization.
In the therapeutic assessment community, they talk about Level 1 information, Level 2 information, and Level 3 information. Level 1 information is consistent with how I see or think about myself. They’re like, yes, that’s me. That makes sense. Those are the best feedback sessions. They’re easy. They flow. We feel [00:39:00] good. Families feel good. They’re empowered.
There’s Level 2 information, which is the, I didn’t think about it that way before. So these are the families, I’ll just go back to the situation we’re talking about. They come in thinking, I think my child’s autistic. It turns out that this is an anxiety profile. Let’s talk about what anxiety means and how that influences your processing. Oh, so that does explain the things I was concerned about. I just didn’t think about it that way before.
Level 2 information, we want to be a little more prepared for those kind of feedback sessions. Make sure we really understand the underlying questions so that we can get at those and make sure that those underlying, or what Stephanie Nelson calls secret questions are being answered.
Level 3 information is the no way, that’s not me, and can be unraveling for families. I was going under this assumption, and now you’re telling me it’s something totally different. That’s my [00:40:00] example of that feedback session that taught me so much, unfortunately, that this family that I thought I knew the answer, and came at them with, I have this insight about your child that I think is going to change your world in a positive way, and they said, no, absolutely not. That is not true. We disagree. And that’s level 3 information.
And identifying that Level 3 information early on, so that we can really move it to Level 2 or Level 1 information by the time we get to the feedback session becomes really important. It is a process. It does take time. And finding ways to integrate that into our testing process, especially in cases where things might be different than what families thought, is really important.
Dr. Sharp: Of course. Maybe we pivot and talk about the actual feedback session. I think people have a lot of questions around how others [00:41:00] do feedback. So I’ll start with that question. How do you do feedback? How long is it? What’s the structure? What do you focus on? Mostly where we go from there.
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[00:43:00] Dr. Liz: In private practice, I have a lot of luxury, and so I’ll recognize that I do longer feedback sessions. I aim for an hour and a half. I schedule two hours just in case there are other questions. I’ll start with, I understand that’s a luxury.Dr. Sharp: Yeah, it’s important.
Dr. Liz: I do allow a lot of time for that feedback session. I start with agenda setting. First of all, because I know that you’re very practical, I will say that in my intake session, my office has a couch and my chair that we do that session at. I do the feedback at the testing table.
I sit everybody around the testing table because it allows me to reference different resources and pull things up on my computer. It allows me to write things [00:44:00] down in real time as we’re changing and adjusting during the conversation, and it feels like we’re equals. When we’re all sitting at the table, there’s something to that.
When I set up the table, I have water heated. When they come in, I offer a cup of tea or water. We all sit down at the table together. I got this from Rita Eichenstein that she puts out little pads of paper for families where they can write notes. And so it’s like you’re creating this environment where we’re sitting at the table as equals, and you have tools to take notes, feel relaxed, and creating that environment. So little things.
I start with agenda [00:45:00] setting. So we’re here to answer the questions. Here are the questions that you had. I can even bring them out from our initial meeting, that these are the questions that we’re answering. I’m going to be going through them. Is there anything else that you’d like to add to the agenda?
Families often will then tell me, I just want to get to your recommendations, or I’m really excited to hear what you learned about the processing question that we had. And so you were to put your emphasis. So starting it out with that collaborative sentiment.
I tend to lead with the punchline, I don’t walk parents through everything before considering a certain diagnosis. So it sounds something like, we had questions about why Joey is having such a hard time with self-regulation and some of these big feelings that he’s been experiencing, the [00:46:00] prolonged tantrums that you were talking about. And one of our questions was autism. Today, I do think that his profile matches the autistic profile. I’m going to walk you through today how I got there.
Or it turns out Amy, we’ve been talking about reading and how much she’s been struggling with reading and writing. We were asking a question about dyslexia. It turns out her profile is consistent with dyslexia, and I want to walk you through how I got there.
You were asking questions about this. I don’t see that his profile totally lines up with ADHD, but I’m going to walk you through what I’m thinking and what we’re going to do to help with that you came in with. So we get it right out the gate.
There’s been some research saying that parents don’t hear anything before that line anyway, so if we talk from myth about the testing results, they’re just waiting to hear. [00:47:00] And they’re not processing anything until they hear that information.
I usually have a draft report available, but I don’t reference it except for emphasis. If we need to find a specific score, I use that same one-page four-box sheet that has strengths in one box, challenges in another box, diagnosis in the third box, and recommendations in the fourth box. I use my metaphor of a brain under construction, and usually it says highways, construction zones, helpful words, which is the diagnosis, and then tools in construction group.
I use that language. It makes it a little more accessible and less [00:48:00] clinical, and I think that’s really helpful. It’s all on one page. And what I’ve done is I’ve taken the summary of the strengths and challenges that I have found, and just put them in bullet points on this one-pager. I use it as a reference to walk through what we learned.
If through our conversation, other things come up, like a different way of saying it or a different strength that I just didn’t include in my short list, then I have a pen ready and I’m annotating this thing as we’re talking through it.
But it’s a one-pager. It’s very visual, and it’s easy to process because it’s very small bullet points. And they’re little reminders for me of what I want to talk about. I want to talk about Amy’s verbal abilities. I want to talk about how [00:49:00] awesome her auditory memory was. I want to talk about her enthusiasm and creativity, and how that showed up in assessment.
And then for challenges, I have phonological processing and orthographic processing. And so I can talk about while her verbal skills are so strong, that very specific type of processing is really hard for her. And these things together is what means dyslexia. I’m explaining things, but it’s not all written out in large paragraphs. It’s just small things that parents can reference. And as I said, we’re all sitting together, so I’m writing in there.
Dr. Sharp: Right. I love that. Maybe back in graduate school at some point, I gave people an actual document to flip through; a Word document, but it’s been a long time. I feel like people get lost in the text and jump around [00:50:00] to items or information that we aren’t talking about or focused on. They start to try to figure out the scores in the tables, and it’s messy.
Dr. Liz: They start to go through the report that I thought to present. So this was a big change for me to not reference the report at all. And the only time I might reference scores is if I want to make a point, like let’s look at the difference between the auditory memory and the phonological processing. I just want to show you that there’s a big difference in these numbers, but we’ve already understood the concept, and so the numbers are just putting a little exclamation point on that, but it’s rare that I do that.
Or I might have the report available because I want to [00:51:00] reference it to make sure I’m explaining their child’s responses on the Roberts or something like that. So I have it as a tool for me to help me explain, but I’m not going through it.
And when we have that summary and we’ve already talked about it, just like viewing the comprehension questions or reading an abstract before going into a paper, it makes it easier to comprehend. We’re doing that for parents. We’ve already given them all the answers, and then it’s going to make the report easier to understand because they already know the Cliff notes.
Dr. Sharp: Right. So there’s an element in here of communicating in a way that parents can understand and adapting to different levels of understanding, different levels of education, different levels of resistance. So [00:52:00] this is more of an observation than a question, but I imagine you run into some of this stuff as well, we have to be adaptable with our feedback sessions. Are you experiencing that?
Dr. Liz: Absolutely. And so there are two things that I use to be able to adapt. I use visuals whenever possible.
So there’s a number that are easy to reference. When we’re talking about autism, there’s an Instagram influencer, NeuroWild, who has some great comics that just share. You can download some of them for a small fee on Teachers Pay Teachers, to show different concepts around executive functioning or emotional regulation, how stemming can be beneficial, [00:53:00] what it means to be autistic. I think it’s helpful.
Matt Lowry is an autistic practitioner who has some different memes on his website. Dani Donovan does comics around ADHD, so she’s adhddd.com. She’s got these great comics. There’s always one for a kid. In my experience, if that’s part of the profile, there’s always one that hone in on this kid’s profile and they’re just so great.
I also often use a really simple Venn diagram. When kids have complex profiles, a lot of times there’s a trifecta of anxiety, ADHD and autism altogether, and understanding how those overlap, [00:54:00] having a basic Venn diagram can be really helpful. A word or two in each one is really helpful. So the more visual I can make things, the easier.
The other thing that I have is some really simple resources that they can reference that go into that feedback packet; physical things that I can hand to them, like a one-pager on what autism means. I know we weren’t going to talk about artificial intelligence, but I do have an app on … If you go to explainingbrains.com/ai, [00:55:00] there’s something called the handout generator, and you can put your child’s profile in there. And whether it’s just a simple profile or there’s multiple diagnoses, it will generate a handout for you.
I’ll send you the link for the show notes, but that just explains things simply for parents in what the common strengths and challenges are, what they can do to help. You can also create it for coaches or teachers so that parents have tools that they can use to explain it to other people.
We’re looking for parents to leave this meeting feeling really empowered by the information they have. Too often, they leave feeling overwhelmed. I wouldn’t give all of these things at once to a family, but choosing what your question was around, there’s parents who come in with different [00:56:00] levels of understanding, education, or experience. And so choosing what’s going to be most impactful from these resources for a family and sending them home is something, and I think what’s going to empower this family, that’s what I want to include in my feedback packet.
Dr. Sharp: Right. I love that. I’m guessing people are listening and thinking, when do I do this? So my question is, when do you do this? How much time are you taking to prep for a feedback session, make Venn diagrams, download handouts, and write stuff into things? What does that process look like?
Dr. Liz: Oh, it doesn’t take that long. I have a folder in my Google Docs that is just a feedback packet. For every [00:57:00] family, the thing that takes the longest is putting together that four-part summary, but because I’ve written my report and done my conceptualization, it becomes easier just to think, what are the most important strengths I want this family to walk away with? What are the most important challenges? What do I want them to know about the diagnosis? What are 3 to 5 recommendations? It’s not everything. It’s what’s most important.
It’s just putting that thing together. I just did one before we got on this call. So I’ll tell you, it took me 10 minutes to put it together. It forces me to think through what’s most important for this family to know. Not everything that I said in the report, but what’s the most important thing to empower them to take those next steps?
Then I’m choosing usually one visual and one resource. So it’s not everything, it’s just what’s one visual that’s going to help them drive this point home. And then I’ve [00:58:00] been really excited about these handouts from the handout generator. So usually I’ll create one of those, but that takes 30 seconds.
So it’s helping me prepare. It doesn’t take very long to put that together, and because I’m going through that process, it makes me much more organized in my feedback session.
Dr. Sharp: That’s good to hear. I think people hear these ideas and think, Oh, that sounds great. I just don’t know when I’m going to do it. It’s actually not that labor-intensive once you have the template.
Dr. Liz: Hopefully, we made it easy with some of these tools. I’ll send you the link, but they’re all available on explainingbrains.com. There’s a practitioner tab, and the things that I use when I find something that’s helpful for me, I throw it up there and hope that it’s helpful to other folks.
Dr. Sharp: That sounds [00:59:00] great. So where are you spending the most time in the feedback session? If you’re shooting for about an hour and a half, you’re presenting a diagnostic picture at the beginning, then are you spending the bulk of your time on recommendations, parent questions, or are there any themes that you’re seeing emerging as far as what takes the most time?
Dr. Liz: Depending on what parents say at the beginning, when I get a sense of we’re most concerned about recommendations or we most want to understand what you found, I end up spending the most time on what I found and sharing my personal experiences with the kid, with parents.
I found that parents like stories. Just like we’re looking for stories from them in the intake session, I’ve found that it’s effective to tell them stories about this is a task that I did with your kid, this is how they responded, and this is what they said. [01:00:00] Having some of those illustrative moments that stood out for me of what this looks like.
It doesn’t have to be every moment that the child lost their train of thought and went somewhere else, but just one moment that really illustrates that, and to have those stories to tell. That’s probably where I spend most of my time.
I try and make sure that I have ample time to go through the recommendations, at least those first 3 to 5 recommendations that I want to fill out. Here’s what’s most important. I don’t read through everything. I might say there are more resources in the report, but if you do anything, I want to make sure that you get hooked up with space treatment, which is going to help with the anxiety stuff that we’ve been talking about.
The first thing that I want you to do is call this, find an occupational therapist. Here’s a list for you. But make sure that they [01:01:00] know what my first step is with the recommendation.
Dr. Sharp: I totally agree. I’ll circle back at the end of feedback sessions, check in with families and do something around. What are you taking away from this? What did you hear? What felt most important from this session, just to do a reality check. It’s 50/50. If their answers match what I was hoping for, it would be the end.
Sometimes it’s right on, but it’s a nice opportunity to then go back and say, okay, I’m glad to hear that. I want to make sure there’s this that’s sticking with you. It’s just a nice way to revisit and make sure that we’re leaving on the same page and reinforce or cement.
Dr. Liz: I love that. I’m thinking of recently when I asked that question. [01:02:00] It was a mom and a dad who had two totally different answers to my question, and that was fantastic to get on the table. This is like, okay, let’s put all our perspectives together. I think it gives us a chance to know what they’ve taken away, if we have any follow-up to do, and how well we’ve done with communicating.
Dr. Sharp: Exactly. It’s illuminating to let me know if I’m sharing what I thought I was sharing. That reminds me, just maybe one or two more questions around this. What do you do when parents disagree, there’s conflict, or they’re pushing back against what you’re saying, some of those more dicey, difficult situations in feedback?
Dr. Liz: I will tell you that this doesn’t happen often anymore because of all that work [01:03:00] of starting things at the intake and being able to anticipate when we need a little check-in. I’ve been pleasantly surprised when I think there’s going to be pushback and there’s not, because we’ve done that work. And so it might sound more like, this wasn’t what I was expecting. I’m still processing, but I get it, is what I hear.
And when it does happen that there’s resistance, for example, one parent’s on board and the other parent is saying no, I don’t agree. My first thought is that I haven’t brought this parent along with me on the journey, and I might have some work to do. [01:04:00] This is not new to anybody in the audience; we listen, we empathize.
I’m asking myself very seriously, is there something that I missed or something that I didn’t understand 100%? And being very humble in that meeting in the vein of collaboration to say, I’m hearing you have a different perspective, and I’m wondering if I could hear a little bit more. Today might not be the end of our conversation because it sounds like there might be a piece I’m missing and I want to learn more about that.
I do have a family that recently disagreed with part of my assessment. They came back with; I don’t think this is autism. This is a lot of our cases these days. They disagreed a lot. So I [01:05:00] listened. We got more information. What had happened is that we referenced this at the beginning, we’re asking a lot of parents to summarize their child’s history in that meeting, and it’s hard to put things together. It’s hard to ask the right questions. It’s hard to think of the “right” stories or right details.
And the parents said, “As we’ve been doing this, I’ve been remembering more about my child’s early history. I have some stories I want to share with you.” And it changed things. And so I think it can open to we’re asking a lot from parents, and not every parent is ready with the dissertation on their child to be presented in the exact order and organization that we need to create a comprehensive history.
I think it’s really important that we stay open and give parents a chance to process the way that they do and give them processing time, [01:06:00] and a chance to get used to the assessment and what we’re looking for so that they can add that. It doesn’t always change our ultimate diagnosis, but the point is that they leave feeling empowered and understood, not that we’re right.
Dr. Sharp: That’s such a good point. Just reflecting on that for a second. I think we do get wrapped up in wanting to be helpful, right, or any number of things. Sometimes those get convoluted. I like what you said about if parents are disagreeing with you or with one another, it’s just a great opportunity to dig deeper, learn a little more, see what’s going on for them. There are always feelings. Just got to understand the feelings.
Dr. Liz: I got feelings, too. That happens to me. I often have feelings in that moment.
Dr. Sharp: Yeah. Seriously. Oh my gosh. Well, we’ve [01:07:00] talked about a lot of things as usual. I think this is super helpful. I appreciate you indulging my need for logical, concrete examples. You’ve been working on a book, right? Tell us about the book.
Dr. Liz: Yes. In the interest of building on this idea that parents are related to their children, I have a new book out that’s for parents that they can take off the shelf to help their kids understand their diagnosis and empower them to be a strong self-advocate. The way that the book is created is that it’s a collaborative workbook-style book where parents and kids are exploring their brains together.
And so I’ve been doing this with some kids and their parents. It is amazing because the parents are [01:08:00] thinking about their highways, and how their brain is under construction at the same time as their kid is discovering their highways and how their brain is under construction.
Parents are coming up with so many supportive and amazing things to tell their children. And then the child is like, “Well, mom, one of your highways is making Mac and Cheese.” And there’s a checklist. There’s all these different activities in the book, including places to draw or write checklists.
I have kids who are like, dad, this one’s one of your construction zones, you should check that box. And so it’s creating this really cool conversation. And then there are videos and other resources that are embedded into the book through QR codes so that parents have the tools to help their child understand their diagnosis.
[01:09:00] So it’s on Kickstarter right now. We’re trying to raise enough funds to make sure that it’s possible to print it. And if we’re successful, then it will be printed and everybody will receive a copy of the book.There’s a discount for practitioners if you want to have a number of copies to share with families as part of the assessment process, especially if you don’t have time to do your own feedback session with the child, this is a great resource to either refer parents to because it’s now a parent book that they can buy their own book. That’s not the case for the brain-building books. This one parents can buy their own book, or you can share it as one of the resources that you give with your feedback to help parents feel empowered with the question of, What do I tell my kid?
Dr. Sharp: I get that question all the time: how do you share this with the kid? How should I talk to my kid about this?
Dr. Liz: Well, here’s a book that will help you do that, and you can [01:10:00] share that. You can go to explainingbrains.com/ourbrains. The book is called Our Brains, and check out some sample pages and see if it’s a good fit for the families that you work with.
Dr. Sharp: That sounds awesome. I got a sneak preview, but I’m going to check it out more. It’s super cool. I love to hear what you’re up to. You always got fresh thoughts.
Dr. Liz: Same.
Dr. Sharp: All right, y’all. Thank you so much for tuning in to this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.
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