Dr. Jeremy Sharp (00:00.568)
Hello everyone and welcome to the Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.
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Available on pari connect is an online library of popular mental health checklists that you can use as a personal inventory Stop searching the web and make check at your one-stop shop learn more at pari NC calm backslash ch ECK IT Hey folks, welcome back to the testing psychologist Glad to have you I’ve a return guest today as you will hear my guest is dr. Liz Angoff Liz is
a licensed educational psychologist with a diplomat in school neuropsychology. She provides assessment and consultation services to children and their families in Bay area in California. is the author of the brain building books, which we use frequently in our own practice, as well as a branded book called Our Brains created specifically for parents. So you will hear us talk about that a bit at the end of the podcast. It sounds like another fantastic resource.
More info about her and her work is available at explainingbrains.com. We also have 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’ve done an episode on feedback sessions. And yeah, Liz and I dive deep into the feedback process and what that looks like for her. She talks about this concept that feedback
Dr. Jeremy Sharp (02:02.638)
starts at intake and discusses how she’s delivering sort of ongoing feedback throughout the assessment process. We also dig into the logistics of how she conducts her literal feedback sessions, how she structures them and what she shares and what she does not do. There 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 just high quality, no matter what we’re talking about. So I hope you enjoy this episode talking about feedback with parents with Dr. Liz Enghoff.
Dr. Jeremy Sharp (02:58.53)
Liz Hey, welcome back to the podcast.
It is great to be here, Jeremy.
Yeah, yeah, good to have you back. Good to have you back. It seems like you’re always up to something fun and interesting and useful to the testing community. So I’m always grateful I can grab some of your time because I know you’ve got a lot going on.
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.
That’s what people keep calling for. Yeah, 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, three plus time guests. So just another call to build some jackets, make some jackets. Well, seriously, thanks for being here. I do know you got a lot going on and we were just on a webinar last week about AI and all kinds of things.
Dr. Jeremy Sharp (03:56.75)
I’m going to try to steer clear of that today, even though that’s super interesting, because we’re going to be talking about feedback sessions, which is also super important.
Wow. Digging into the intelligence component of our job.
Yeah, yeah, that’s a good way to put it. There’s a lot of talk about the artificial intelligence, but we still have to be humans. We still have to be psychologists and delivering feedback is a big part of that, right? So I’ll ask you the question that I ask everybody to start. And this is, you know, especially pertinent for folks like yourself where you’re doing a lot of different things, but yeah, why, why this? Why now? Why spend your time and energy on feedback sessions in particular?
So I’ve been really 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 really fascinating is that as I get better and more aware of what’s helpful to kids, I feel like that’s 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 really walk away
understanding. I am kind of, you know, fascinated by this idea that our ethical obligation, as it’s, you know, stated in our code is not to explain results, but to make sure they’re understood. And I feel like there’s two different things going on there. Just us, you know, at the feedback session, going through the report and explaining everything, or in an IEP meeting or whatever our
Dr. Liz Angoff (05:38.888)
know, 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 like confident and empowered by the testing result, which is what we want. I mean, I keep talking about we want to empower kids to really understand their brains. And I realized we want to do the same thing with families and empower them. So how do we…
Do that.
Yeah, it’s such a legit problem, I think, and an easy one to forget about. It’s funny, you’re so well known, I think, for how to deliver feedback to kids, and that’s been a cornerstone as far as your materials and what people, I think, know you for, which is great, because I, I don’t know, just speaking personally, came at it from the opposite direction where we were taught
more in grad school about like how to deliver feedback to parents, you know, and kind of forget about the kids in some sense. And we got a lot, you know, you’ve been shining light on that for a long time and now kind of going back into the, the parental aspect of it. Right. Super important. But it reminds me of some of the things that, you know, 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. Like they just nod enthusiastically and kind of fake their way through it and then walk away having no idea what we actually told them or what it means.
Dr. Liz Angoff (07:25.044)
Right, right. Because 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’s two things that have really stuck out to me and have formed my practice and the way that I approach feedback. And one of them, I’ll tell you a story about when this went completely wrong. This family sticks out of my mind and
and still like catches my heart to this day in thinking about, you know, 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 other, like their other child. And we had a really, really good rapport and I did the assessment and realized like this child’s 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 and I reveal this diagnosis to them. And there was this complete rejection. This is not true. We disagree with you.
this is there’s no way that that’s possible. And I did such a thorough evaluation. I am proving my case. My report is like fail proof. and, and there, was just kind of a dead stop. And I, I really spent a lot of time reflecting, you know, like, what did I do wrong? And I think that, you know, one of the things I talked to you about with kids is that.
The thing that goes wrong is when it’s a surprise. there’s a, actually a podcast, I went back into the archives to find your podcast with Karen Postel and she and Kira Armstrong wrote this book, Feedback That Sticks. And 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.
Dr. Liz Angoff (09:51.118)
to families because that surprise, it puts us all into really like a fight or flight kind of place where it is very hard to process information and engage in any kind of dialogue. And so it was a really stark example for me and really transformative of, 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, it was what the emotional response of the family was to that, hearing that information, that they, 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 really understand. And so this idea of feedback, it’s not a single session, it’s really a journey with
with families. You mentioned Stephanie Nelson and the other piece that’s been transformative is her questions that she asks at the intake session that really 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?
would be, what are you most concerned about? What could I tell you that would be the best outcome or the worst outcome? And understanding these things like helps us really get at the bottom of what are parents really looking for from this assessment beyond a diagnosis? And what are the tricky pieces going to be that we might stumble over that we really want to help families process along the way?
if they have fears, if they have, you know, like past trauma that they’re bringing into our assessments, so that we can have, bring parents through a real therapeutic process as part of this assessment, not just relaying information like it were, I don’t know, something that’s not so emotionally laden.
Dr. Jeremy Sharp (12:09.61)
my gosh. Yeah. Yeah. Yeah. It just makes me think this is sort of an amplification of this whole dynamic, but you know, being in a meeting with a physician probably, this was maybe three years ago, right? Where we, you know, we’re giving this news that like my mom had bladder cancer, right? And I mean, this is serious. This is like, like I said, dramatic sort of example, but it’s the process of that was so,
Sterile might be the right word. And, you know, I don’t know that we as psychologists go into feedback in that same manner. I mean, this was like a 15 minute appointment and like, hey, you have cancer and then boom, boom, boom, here’s the treatment options. you know, we’re trying to like do this emotional processing along with, like you said, formulate questions to sound coherent and like actually make an informed decision. you know, it was just like so much going on in a very short period of time.
And we have, I think, the luxury maybe that, or 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, you know, to this.
And it sounds, you know, as I’m saying it, I’m kind of thinking like, maybe I’m the only person who’s made this mistake and I didn’t get it or didn’t get the memo. you know, one of the things that Karen Postle said is that feedback is therapeutic by nature and that we really have to shift our hat or we have to be fluid in the hats that we wear from assessor to therapist.
to parent coach. really, we need this wide skill set to be able to hold families through this process because it’s really emotional.
Dr. Jeremy Sharp (14:07.99)
Yeah, yeah, I agree. I feel like feedback is probably the most, closest that we get to therapy in this process. I’m thankful for that. I don’t know. I think it’d be hard to just stick to the data and the numbers and the kind of rote process of testing. Yeah. I was going to ask you though, you know, around this whole process. I mean, it’s like you said, feedback starts at the beginning and I’m curious how that actually looks.
for you in practice.
so the, that concept feedback starts at intake has just really driven the way that I think about the assessment process. And there was one other 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. And 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, you know, things like really scaffolding families to ask questions, really helping them to formulate their questions, being very transparent about what questions we’re formulating in our head and what diagnoses we’re pursuing.
Dr. Liz Angoff (16:09.56)
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 gonna 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 really a black box to parents.
As a parent myself, now I’m part of a lot of, you know, like 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 kind of mind-blowing. using all those types of accommodations we would give to kids who have trouble processing information or who need help with executive functioning kind of
preempting that with families, I think, is really, 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. 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 really 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, I really…
In addition to the general questions like, do you want to know? Or are you curious about a specific diagnosis? 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?
Dr. Liz Angoff (18:29.408)
Asking those questions become really, really important for getting things out on the table that aren’t part of our standard interview and really understanding how I’m going to need to support this family throughout the process.
really does elicit those emotional components of the process for families.
Yeah, I use a couple tools. I have a little intake packet that I give families. And one of the things is I have a 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 and one box is strengths, one box is challenges, one box is
you know, possible diagnoses that we’re looking for and the other is next steps. So things you’re going to do while we’re, you know, but what this process is going to look like. And what I try and do is just mark down a couple of things from the interview that 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. And so those are the things we’re going to investigate. I have a couple different kind of diagnoses kind of help us drive treatment and help us understand if your child’s profile reflects
Dr. Liz Angoff (20:14.734)
common profiles. And so some of the things I’m thinking about are autism, our ADHD. I also want to really 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, you know, I had a child who’s, you know, has really big emotions and a lot of just
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 like, want to just answer, like, I wonder, since you’ve mentioned this history, if you have questions, you know, if your child might be showing 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 had been really scared to ask that.
It just kind of 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 actually download it from my website, so on explainingbrains.com. There’s a little journey that just shows kind of some little circles and the, you know, kind of
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 and kind of X marks the spot, here’s where we are on the journey, just really, really helpful. And 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. Jeremy Sharp (22:22.882)
Yeah, yeah, that makes sense to me. Do you ever run into situations, actually I’m gonna back up, I have two questions. Fux and I, I’m super concrete with this stuff. So when you are sharing these visuals and the boxes and 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?
I ask parents to come in if they can. Oh, okay. I’ll give them a physical packet in a bright yellow folder that they can keep. If we do it over Zoom, then I’m screen sharing and then I send them their intake packet with all those visuals. If you use TextExpander or Blaze, you can
put together your intake packet and it’s very easy to just send. But that four box handout, which again, 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 you know.
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 a couple of things that here are some things that I’m going to be looking at when I do the testing. Cause they don’t know what happens in that session. And if they’re anxious, if they go home anxious about it, the kid’s going to come in anxious about it. So I’m gonna feel like really, really confident. And then they, again, this is all, I don’t want to get sidetracked into feedback with.
It’s our testing sessions. What this is doing is it’s planting seeds so that they know exactly what to expect when they come in for the feedback session.
Dr. Jeremy Sharp (24:17.486)
Fantastic. Yeah. 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 like crushing their dream right at the beginning or do you wait to do that somehow? How do you navigate that?
so I think I’m aware of a couple of 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 session. So just cause I’m not hearing anything, it,
It doesn’t mean that it’s not there. It just means that I have some work to do. And I might say something like, you know, it’s interesting. I’m not hearing a lot of, I’m thinking of things I have really said before. you know, like as we’re thinking about 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 and we might circle back.
to this interview after I meet your child. And I think that saying something like that, like I’m not hearing it, but I wanna look at it further, of plants a seed of it might not be there, but also leaves me open and helps me be humble that I’m not, I think.
You know, you’ve had other guests who have talked about our bias going into things. And if I go into the assessment with my decision already made, I just want to be very aware of that. but I might 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, you know, some things that really map onto anxiety. So I want to go into that.
Dr. Liz Angoff (26:21.646)
Or, know, 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. And 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? Like what would be success out of this? And even to the point of if you learn that your child is autistic, what would that mean to you? And 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. And so we got to talk about like, what are you really looking for? And she said, you know, I need a way to describe why I’m different. Like I need.
shortcut for telling people like this is why I’m not doing things the way you expect me to do them. And so you know I said if I could tell you that at the feedback session if we could get at that like how do you explain your experience, that be helpful whether you’re autistic or not and she said yes that would be helpful. So we kind of had a little 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.
Right, right. Yeah, I know we’re spending a lot of time here, but I think it’s really important just this whole idea of, you know, feedback starts at intake and using that as a time to seed some of these thoughts that you may be having, some of the possibilities, some of the outcomes. Yeah, we talk about them.
Dr. Liz Angoff (28:28.184)
Karen told me that I pulled over to the side of the road and I rode it down. Just wondering, know, like, are people listening to this? like, hope those light bulbs are going off, like it did for me, because I just feel like it was such a transformative moment. And I remember the parking lot I pulled over into, like, I have, I have stuff to learn.
Nice, nice.
Dr. Jeremy Sharp (28:51.306)
For sure. Right. Right. Yeah. That was such a good interview. My gosh. And I think, you know, getting back to something that we mentioned in the beginning, I don’t know if this is true for you, but for me personally, you know, there are, 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, you know, make me
seem like I had more to offer or something. Like it was this like grand surprise or like gift or something that I was presenting at the end. And over time, of course, kind of figured out that that’s not the case, but just thinking about like why we might do that as clinicians, know, why we might hold back, not offer some initial thoughts or impressions in the intake. I’m curious, you know, if you thought about that for yourself.
I think there is this idea and thank you for saying that because maybe I’m not the only one who thought like I, you know, it’s my job to take all this information in and kind of do my black box thing and then spit it out at the end. And that’s what being a professional means.
Oh, you’re definitely not the only one. feel like that’s how like 97 % of people do it, you know, or did it.
I think we’re taught that. I’ll just speak from personal experience because I was a school psychologist at the beginning of my career and worked in schools and sharing that information upfront with parents was thought to be predetermination.
Dr. Liz Angoff (30:40.202)
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, you know, or I think we have fear that if we shared something that parents were not okay with or that they didn’t like in some way that we’re inviting confrontation.
And that’s such a misunderstood concept. mean, I think drawing from a lot of the therapeutic assessment and collaborative assessment kind of 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 really help in our analysis and how we interpret the numbers. And their insight into what it means for real-world experience is going to make us better at our diagnostic process, not interrupt our diagnostic process. So I think that there’s something
really, really important to having ongoing communication and taking that collaborative stance, having that humility as an assessor that my tools are not the end all be all and that kind of bringing them into the real world is 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 or in the intake than it is at that feedback session when it feels like everything’s done.
Dr. Jeremy Sharp (32:43.256)
Sure. That reminds me of a question around the testing process. Are you also offering additional thoughts or impressions after testing, like kind of in between intake and feedback?
Yeah, you know, feedback starts at intake and then I think the next piece for it for me is that feedback is ongoing. throughout the assessment process, there’s a couple informal and informal ways that I check in with families. One of them is, I, you know, 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 kind of check-in points along the way is to say, you know, this is what we learned about your child’s strengths, and these are the construction zones that we found today. Or here’s something your child said about their experience. Or I noticed, and we talked about how, you know, he was using this strategy that I thought was really cool.
And then parents have a chance to kind of, you know, like comment on that, or they get a little bit of insight. And again, it eases that anxiety of like, what’s going on in that room? Like, what am learning? So they’re getting pieces of information. And that’s been really, really helpful because they’re getting it in the child’s
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 tasks that your child was using? It turns out that it applies this way and now we can kind of relate it to the actual testing results. The other thing that I do is if
Dr. Liz Angoff (34:51.873)
we have 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 really set on an autism diagnosis, like your example, and I start seeing that I really don’t think that this is autism, I think there’s something else going on, I will have a mid-evaluation check-in, like an informal, let me share, 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’s what I’m seeing. Here’s a couple of things I’m seeing. Usually in that, I’ll share one or two strengths that have come out, so they see that. 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 really seemed like there was this initial anxiety that really made it hard for your child to interact. But once they warmed up, I saw a very different kind of interaction from them. And I’m wondering if you’ve seen that as well, like that initial transition, but then things changed, you see those two sides of your child, and I can hear from them and then start to float the idea like I don’t.
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 kind of 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.
When there are 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 and any new information that’s going to be surprising, I will definitely do that 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?
Dr. Liz Angoff (37:11.768)
So, 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 kind of what my thinking is.
That’s great. That’s great. Yeah, we had a situation like that just come up on our practice the last couple of weeks, you know, we’re testing someone and there are very few signs of autism throughout the testing. And, you know, we had a conversation with the parents about that because they were pretty set, invested in that outcome. And that gave them an opportunity to share more feelings around that. And, you know, their concerns and their thoughts and, you know, we were able to kind of pivot in the moment.
add on some additional things and you know it just just reinforcing everything you’re saying you know there’s nobody really likes surprises yeah so anything
Including us, it helps us to, I don’t know, 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 really helpful for me to have more of an informal check-in so that I can know what the reaction is, how they write, process that information so that I can put supports in place to help with that conversation. And I can kind of preempt what they might need in the actual feedback session to really walk them through.
and help them understand if it’s gonna be at odds with their current conceptualization. In the therapeutic assessment community, they talk about level one information, level two information, level three information. Level one information is really consistent with how I see or think about myself. The kind of like, yep, that’s me, that makes sense. Those are the best feedback sessions. They’re easy, they flow, we feel good.
Dr. Liz Angoff (39:00.728)
Families feel very empowered. There’s level two information, which is kind of the, 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. Like, so that does explain the things I was concerned about. I just didn’t think about it that way before.
Level two 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 three information is that no way that’s not me and can be kind of unraveling for families. I was kind of going under this assumption and now you’re telling me it’s something totally different. Those are the feedback sessions that feel
That’s my example, that feedback session that taught me so much, unfortunately, that this family that I thought I knew the answer and came at them with, like, have this insight about your child that I think is going to change your world in a really positive way. And they said, no, absolutely not. That is not true. We disagree. And that’s level three information.
identifying that level three information early on so that we can really move it to level two or level one information by the time we get to the feedback session becomes really important. And it is a process and 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.
So maybe we pivot and talk about the actual feedback session. think people have a lot of questions around how others 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? And we’ll see where we go from there.
Dr. Jeremy Sharp (41:13.582)
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Well, you know, in private projects, 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 other questions. So I’ll start with, understand that’s a luxury. I do allow a lot of time for that feedback session. I start with agenda setting. So I let folks know
Yeah, yeah, it’s important.
Dr. Liz Angoff (43:30.19)
or if you’re to answer them. actually, first of all, because I know that you’re very practical, I will say that 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 said everybody around the testing table because it allows me to actually reference different.
resources and pull things up on my computer. It allows me to write things down in real time as we’re kind of 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. I always, 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 and I got this from Rita. I can sign. She puts out little pads of paper for families where they can just like write notes. so it just like, you’re creating this environment where we’re sitting at the table as equals and you have tools to, you know, to
kind of take notes, feel relaxed, and kind of creating that environment. So little things. I start with agenda 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? And families often will then tell me, I just really want to get to your recommendations.
or I’m just really excited to hear what you learned about the processing question that we had. And so you kind of know where 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 getting to them for considering a certain diagnosis. So it sounds something like, we had questions about why
Dr. Liz Angoff (45:49.856)
Joey is having such a hard time with self-regulation and some of these really big feelings that he’s been experiencing, the prolonged tantrums that you were talking about. And one of our questions was autism. And today I really, I do think that his profile really matches the autistic profile. And 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. 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 the questions that you came in.
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 for a minute about the testing results, they’re just waiting to hear and they’re not processing anything until they hear that information. And then I do not, I have the, usually have a draft report available.
But I don’t reference it except for emphasis if we need to like 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 and construction crew. I use that language. It makes it a little more accessible and less clinical. And I think that’s really helpful. But it’s all on one page. And what I’ve done is I’ve taken the summary of the strengths and challenges that I found and just put them in bullet points on this one pager.
Dr. Liz Angoff (48:15.712)
and 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 is…
a one-pager, it’s very visual and it’s really easy to process because it’s bullet points. It’s very small bullet points. They’re just like little reminders for me of what I want to talk about. want to talk about Amy’s verbal abilities. I want to talk about how awesome her auditory memory was. I want to talk about her enthusiasm and creativity and how that showed up in assessment. Then for challenges, I have
you know, phonological processing and orthographic processing. And so I can talk about while her verbal skills are so strong, that phonological, that very specific type of processing is really hard for her. And this, these things together is kind of what means dyslexia and 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 together, so I’m, you know, writing in there.
Right, right. I love that. Yeah. I’ve always wrestled with, mean, I don’t think maybe back in grad school at some point, I gave people an actual document to flip through like a word document, but it’s been a long, long time. just, I feel like people get lost in the text and jump around to items or information that we aren’t really.
talking about or focused on or, you know, they’re like, they start to try to figure out the scores and the tables and it’s just, it’s, it’s messy. So.
Dr. Liz Angoff (50:12.814)
to go through the report. But to present, and 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 those, you know, the auditory memory and the phonological processing. And I just want to show you that, you know, that there’s a big difference in these numbers, but we’ve already understood the concept.
yeah, yeah
Dr. Liz Angoff (50:42.186)
And so, and so the numbers are just kind of putting a point on, you know, or like a little exclamation point on that. you know, but it’s really rare that I do that or I might have the report available because I want to read them what their child’s, you know, or reference it to make sure I’m really explaining their child’s responses on the Roberts or something like that. So I have it, there’s 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, it just like viewing the comprehension questions or reading an abstract before going into a paper like makes it easier to comprehend, we’re doing that for parents. giving them, 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.
Right, right. So there’s an element in here of communicating in a way that parents can understand and adapting, I think, to different, well, different levels of understanding, different levels of education, different levels of resistance. So this is more of a observation than a question, but I imagine you run into some of this stuff as well. Like we have to be adaptable with
with our feedback sessions or are you experiencing that?
Absolutely. And so there’s a couple of things that I use to be able to adapt. I 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 really great comics that just share.
Dr. Liz Angoff (52:42.572)
There, you can download some of them for a really small fee on Teachers Pay Teachers to show different concepts around executive functioning or emotional regulation, how stimming can be beneficial, just what it means to be autistic. And I think it’s really, really helpful. There’s…
Matt Lowry is an autistic practitioner who has some different memes on his website. Or Danny Donovan does comics around ADHD. So she’s ADHDDD.com. And 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 just really hones in on this kid’s profile. they’re just so great.
I also often just use a really simple Venn diagram. And when kids have complex profiles, so you have the…
don’t know, a lot of times there’s a trifecta of anxiety, ADHD and autism altogether. Kind of understanding how those overlap. Having just a basic Venn diagram can be really, really helpful. And again, just a word or two in each one is really helpful. So the more visual I can make things, the easier. And I have…
Dr. Liz Angoff (54:26.318)
I’m trying to think like some other, the other thing that I have is just having some really simple resources that they can reference that go into that feedback packet. So again, like physical things that I can hand to them. That just like a one pager on what autism means. And there’s actually…
I know we weren’t gonna talk about artificial intelligence, but I do have an app on, if you go to explainingbrains.com slash AI, 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. And I’ll send you the link for the show notes, but.
that just explains things really simply for parents and what the common strengths and challenges are, what they can do to help. And you can also create it for coaches or teachers just so that parents have tools that they can use to explain it to other people. Like again, we’re looking for parents to leave this meeting feeling really empowered by the information they have.
And too often they leave feeling overwhelmed. So the more we can make things, you know, and I wouldn’t give all of these things at once to a family, but kind of choosing what your question was around, like there’s parents who come in with different levels of understanding or education or experience. so kind of choosing what’s going to be most impactful from these kinds of resources for a family and sending them home with something that.
And I think what’s going to empower this family? That’s what I want to include in my feedback packet.
Dr. Jeremy Sharp (56:21.772)
Right. Yeah. I love that. 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? Like how much time are you taking to prep for a feedback session and make Venn diagrams and download handouts and write stuff into things? You know, how, what’s, what does that process look like?
takes like, it doesn’t take that long. think I have a folder in my Google Docs, it’s just feedback packet. And for every family, I think the thing that takes the longest is putting together that four part summary. because I’ve written my report and done my conceptualization, I think
it becomes easier just to think like, are the most important strengths I want this family to walk away with? What are the most important challenges? What do want them to know about the diagnosis? And what are three to five recommendations? It’s not everything. It’s just what’s the most important. And it’s really just putting that thing together, which I just did one before we got on this call. So I’ll tell you, it took me 10 minutes to put it together. And it really 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 like drive this point home. And then I’ve 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 and it doesn’t take very long to put that together. And I think it’s made me, because I’m going through that process, it makes me much more organized in my feedback session.
Dr. Jeremy Sharp (58:24.95)
Yeah, yeah, yeah. Well, that’s good to hear. I think people hear these ideas and think, that sounds great. I just don’t know what I’m going to do. It’s actually not that like once you have the.
Hopefully we made it easy with some of these tools and again, I’ll send you the link, but they’re all available on ExplainingBrain.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.
Yeah, yeah, that sounds 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 or parent questions or are there any themes that you’re seeing emerging as far as what takes the most time?
Yeah, I think depending on what parents say at the beginning, like when I get a sense of we’re most concerned about recommendations or we most want to understand, you know, what you found. I think I end up spending the most time on like what I found and sharing like my personal experiences with the kid, with parents. I found that parents really like stories, just like we’re looking for stories from them in the intake session. I’ve found that parents
it’s really effective to tell them stories about like, is a task that I did with your kid and this is how they responded and this is what they said. And having some of those like illustrative moments that really stood out to me of what this looked 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 like have those stories to tell.
Dr. Liz Angoff (01:00:18.926)
That’s probably where I spend the most of my time. I try and make sure that, you know, I have ample time to go through the recommendations, at least those first three to five recommendations that I really want to fill out. Here’s what’s most important. And 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, know, like find an occupational therapist. Here’s a list for you. But make sure that they know what’s my first step with the recommendation.
Totally agree. I totally agree. Yeah. Yeah. I’ll circle back at the end of feedback sessions and check in with families and just do something around like, what are you taking away from this? Or what did you hear? Like what felt most important from this session just to do a reality check. you know, it’s, I don’t know, 50 50. Like if, you know, their answers like match what I was hoping it would be. And
Sometimes it’s right on, but it’s a nice opportunity to then go back and say, okay, I’m glad to hear that and 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.
I love that. I’m thinking of recently when I asked that question and 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, so let’s put all our perspectives together. But yeah, 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. Jeremy Sharp (01:02:24.878)
Yeah, yeah, exactly. It’s illuminating to let me know if I’m sharing what I thought I was sharing, right? So that reminds me, just maybe one or two more questions around this. What do do when parents disagree or there’s conflict or they’re like really pushing back against, you know, what you’re saying? Some of those more dicey, difficult situations and feedback.
Well, I will tell you that this doesn’t happen often anymore because of all that work of really starting things at the intake and being able to anticipate when we need a little check-in. And I’ve been really 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, you know, this wasn’t what I was expecting. I’m still processing, but I get it, I think is what I hear. And when it does happen that there’s resistance, you know, for example, one parent’s on board and the other parent is saying no, I don’t agree. I think my first thought is,
is just I haven’t brought this parent along with me on the journey and I might have some work to do. And so I will really listen. mean, this is not new to anybody in the audience. We listen, we empathize. I’m asking myself like very seriously, is there something that I missed or something that I didn’t understand 100 %?
And being very like really humble, I guess, in that meeting in the vein of collaboration to say, you know, like, I’m hearing you have a different perspective and I’m wondering if I could hear a little bit more. And 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 that disagreed with part of my assessment and that’s
Dr. Liz Angoff (01:04:44.578)
They, I came back with, I don’t think this is autism. This is on our, this is a lot of our cases these days. And they disagreed a lot. so I listened, we got more information and you know what had happened is that we referenced this at the beginning. It’s really hard. We’re asking a lot of parents to summarize their child’s history.
in that meeting, it’s hard to put things together. It’s hard to ask the right questions. It’s hard to think of the quote unquote right stories or right details. And the parents said, you know, 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 really open to like, it’s, 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 needed 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 and a chance to get used to the assessment and what we’re looking for so that they can add that. And it doesn’t always change our ultimate diagnosis, but the
point is is that they leave feeling empowered and understood, not that we’re right.
That’s such a good point. That’s such a good point. Yeah, just reflecting on that for a second. Yeah, I think we do get wrapped up in wanting to be helpful or right or any number of things. Sometimes those get convoluted. But yeah, I like what you said about, you know, 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.
Dr. Jeremy Sharp (01:06:46.478)
There’s always feelings. Just understand the feeling.
Yeah, I got feelings too. That happens to Sure. I very often have feelings in that moment.
Yeah
Uh-huh. Yeah. Yeah. Seriously. my gosh. Well, we’ve talked about a lot of things as usual. think this is super helpful. I appreciate you indulging my need for logical, concrete examples. And you’ve been working on a book, right? Tell us about the book.
Yes, so you know in the interest of or kind 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 really help their kids understand their diagnosis and empower them to be a strong self-advocate. And the way that the book is created is that it’s a
Dr. Liz Angoff (01:07:43.502)
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 and it is amazing because the parents are, you know, kind of 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’s under construction and parents, you know, are
kind of 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, you know, and there’s a checklist, there’s, you know, all these different activities in the book, including places to draw or write checklists. And, you know, I have kids who are like, you know, dad, this is this, this one’s one of your construction zones, you got, 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 really help their child understand their diagnosis. 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 and or you can share it as one of the resources that you give with your feedback to really help parents feel empowered with that question of what do I tell my kid?
Dr. Jeremy Sharp (01:09:51.116)
Yeah, I get that question all the time. How do you share this with the kid? How should I talk to my kid about this?
Well, here’s a book that will help you do that and you can share that. And yeah, you can go to explainingbrains.com slash our brains. 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.
Yeah, that sounds awesome. I’m gonna check it out. I’m gonna check it out more. I got a sneak preview, but yeah, I’m gonna check it out. It’s super cool. Yeah, love to hear what you’re up to. And you always got fresh thoughts. All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life.
Ew, same same.
Dr. Jeremy Sharp (01:10:42.828)
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We have homework, have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, can check out the details at the testingpsychologist.com slash consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
Dr. Jeremy Sharp (01:11:55.618)
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