Dr. Sharp: Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.
This podcast is brought to you by PAR.
PAR offers the SPECTRA: Indices of Psychopathology, a hierarchical-dimensional look at adult psychopathology. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com\spectra. For a limited time, you can get one free administration and score report for the SPECTRA on PARiConnect by calling PAR at 8558564266, just mention promo code SPEC.
Okay, everybody. Welcome back. Glad to have you here for another episode of The Testing Psychologist. Hey, today’s episode is a replay of a really good episode from way back in the beginning. This was episode 19 with Dr. Aimee Yermish, all about gifted and twice-exceptional individuals. Aimee is clearly an expert in this area.
I’m not going to do a lengthy introduction here because this was back in the days when I was doing an introduction of the guest during the podcast interview itself, so you will hear that once I transition to the interview audio. Suffice it to say that if you have questions about assessment with gifted and twice exceptional individuals, the likelihood is that we’ll cover those things during the podcast today.
Aimee has made a career out of working with these individuals and we talk about a number of things. We talk about how giftedness can be viewed as a cultural experience and she frames it in the way that it’s important for practitioners to be “culturally” competent with that population if you’re going to work with them. We talk about how we might tailor the feedback session and report a little bit differently for parents of gifted kids and we talk about countertransference or the potential for countertransference as far as our own feelings and thoughts around intelligence and perhaps giftedness and how that comes into the room in more of a therapeutic or interpersonal context.
So fascinating episode. Like I said, Aimee is fantastic and many of you have probably seen her in the Facebook group. So I hope you stay tuned and enjoy this one.
All right, without further ado, let’s transition to my conversation with Dr. Aimee Yermish.
Hey everybody. Welcome to another episode of The Testing Psychologist podcast. My guest today is Dr. Aimee Yermish. I’m excited about our conversation today. We’re going to talk all about giftedness, twice exceptionality and how Aimee built her practice around assessment with those kids and their families.
Aimee and I first made contact on the Minnesota Pediatric Neuropsychology Listserv, which some of you might be aware of, if not, it can be a really nice resource for conversation and discussion around neuropsychological assessment. I noticed that Aimee was pretty active on the listserv and she had so much good information to share, particularly with kids who were on the gifted spectrum or twice exceptional spectrum. And that caught my eye, so I reached out to Aimee to see if she’d be willing to come and talk with us about this kind of assessment practice. Luckily, she’d agreed.
So let me do a little introduction, Aimee, and then we can jump into our interview. Sound good?
Dr. Aimee: Sounds good. Thanks for inviting me.
Dr. Sharp: Yeah, of course. Dr. Aimee Yermish is a clinical psychologist and educational therapist practicing in Stow, Massachusetts. She provides consultation, therapy, and assessment for clients who manifest giftedness or multiple exceptionality. Drawing on her analytical background as a scientist and practical background as a teacher, she focuses on building self-understanding, self-regulation, and range of choice in life. Her book on executive functioning coaching for smart people, If You’re So Smart, is in progress with Great Potential Press.
Aimee, welcome to the show.
Dr. Aimee: Hi, thanks so much.
Dr. Sharp: Welcome. I’m so glad to have you. I’ve been thinking about trying to talk with you for a long time, so I’m glad we could get it together and have you here.
Dr. Aimee: That sounds great.
Dr. Sharp: Yeah. I think based on our previous conversations, that we have a lot that we could dive into, so I’m just going to jump right to it. Let’s talk a little bit about giftedness and maybe talk about how [00:03:00] you would define giftedness. We can start there.
Dr. Aimee: It’s funny because that’s where everybody always starts. I did my dissertation research on the experiences gifted clients have in psychotherapy and every single one, what are you doing your work on? Oh, I’m doing the experiences of gifted clients. Oh, really, how are going to define giftedness? That was always the question.
The entire field of giftedness research has been going around and around in circles on the definition thing forever. I think it’s a waste of time. At one point during one of these conversations, I said, okay, look, how about you define African American for me and I’ll define gifted for you.
I was being a little cheeky about it because I was like, come on, not everything can be defined. The more I thought about it, the more I realized it’s true. We can do good research and have good clinical practice on a group, even when it has fuzzy and sometimes internally contradictory boundaries. [00:04:00] Lots of clinically important groups are like that.
Both in my dissertation and in my clinical practice, if someone wants to come to my office, I’m not going to tell them that they’re not smart enough to hire me. People tend to self-select, but they also do typically have very good reasons to think that they or their children, I work with adults as well as children, they have good reasons to think that they’re gifted or twice exceptional and they’ve often had trouble with other practitioners or they’ve been frustrated in school or in work or in the social world in ways that are pretty typical for gifted folks.
I have two clients who are pretty average in intelligence. They came to me because they were referred by another very happy client who said, you should work with Aimee. She’s great. I have turned down referrals for kids who are on the intellectually [00:05:00] disabled side of it because that’s an area of clinical competence I don’t have.
The thing that it helps is, what I found in my research was it makes sense to think of giftedness more as a cultural group. Yes, you have people who are very smart, they catch on to things quickly, they learn things quickly, they learn things well. They may learn things younger or better than other people might be able to but a lot of what we’re looking at is the cultural experience of it. And so then we think about it in terms of cultural competence, just as you would with veterans or Latinos or whatever.
Dr. Sharp: Okay, that’s fascinating. Is that a widespread belief in the field? I haven’t run across that. Are there standards of competence for working with gifted kids or anything like that?
Dr. Aimee: Part of what came out of my dissertation work was I came up with a set of provisional clinical guidelines for clinicians who want to work with the gifted folks. Interestingly enough, I was able to base them very heavily on the, I was like, I don’t know how to write clinical guidelines, let me look at some. I looked at the guidelines for GLBTQ clients and I said, oh, this is a lot of the same issues. A lot of times, it functions culturally as a closeted minority or semi-closeted minority status.
This goes more towards questions of therapy than assessment but when I’m thinking about why am I good at this and why is this a good niche for me, a lot of it has to do with that notion of thinking of it in terms of culture.
Dr. Sharp: Okay. Just to maybe backtrack a little bit, that reminds me, it’d be important to probably talk about how you even became interested in this population and why this is so meaningful for you.
Dr. Aimee: Sure. I walked backwards into it. I’m a multiple time career changer. [00:07:00] I am a grown up gifted kid myself. I’d like to say there’s two kinds of gifted families; those who are shocked to find out that their kids are gifted and those who are shocked to find out that anyone could be shocked to find out that their kids are gifted.
I grew up in the latter kind of family where I was pretty socially isolated in a small school but my family not strongly valued education and there was a lot of support, everybody in the family is smart, there wasn’t a sense of surprise, I got a lot of support at home.
And then when I went to a very large public high school in a good district and then eventually to MIT, I was like, oh, well, here I’m totally normal and this is great. And that’s where most of my friends and also my husband we met, when I was an undergraduate. So there’s a community.
I trained originally to be a molecular biologist but in graduate school realized that I really [00:08:00] loved teaching far more than I loved research. I stepped back and said, you know what, I want to know why my undergraduate students don’t understand science. And so then I went into K-12 teaching. I taught biology, I taught physics, math. I started in high school and then I moved to middle school, picked up a teaching credential along the way.
One of the schools I taught at specialized in kids with learning disabilities and ADHD. A lot of them had ADHD. I found that I really enjoyed the shared puzzle solving, how do I help this particular kid wrap their mind around this particular concept? How do I get them on board with me to try? So that was like, oh, this is cool.
And then I taught at a school that specialized in gifted kids. And that brought up a whole new set of challenges. I had a lot of opportunity to be creative as a teacher and to enjoy middle schoolers. People always go, oh, you [00:09:00] poor dear, you taught middle school, what happened? Did you get last choice?
I’m like, no, middle schoolers are great. It’s all about niches. And for me, those young adolescents are, they have energy, they’re a little nutsy. So much is happening for them psychologically. There’s a lot of leverage. They’re trying to figure out who am I and developmentally, they start to want grownup help who aren’t their parents. So being able as both a teacher and a clinician, to do the object relations work of being an attachment figure outside the family who can say, hey, I can help you here, let’s walk together, that’s rewarding for me.
I eventually got tired of politics in school and so I went into private practice as a tutor. I could teach AP Biology and AP Calculus [00:10:00] and do it for kids with LDs. So that was a little specialized niche all by itself.
I got interested in testing and I took this certificate in educational therapy. It was not represented accurately to me when I took it. It was basically Boston Process Approach Neuropsychological Evaluation and Remediation specific to learning disabilities. So that’s how I got into testing.
And then over time, my clients got more and more unusual, more kids with psychological disorders, more kids with autism spectrum disorders, with trauma and kids who needed official diagnoses, which I couldn’t make. They needed a big doctor person to come in for their special education advocacy.
What was happening was, I was finding that I had to turn away more and more kids where I’d say, I can’t do what you need and at the same time, I had nobody to turn them [00:11:00] towards. So that’s what got me back into graduate school. I became a psychologist.
Part of what I liked about graduate school was that I was able to, I went to a professional school, which’s now called William James college, Massachusetts School of Professional Psychology was name at the time. They allowed me to tailor my clinical work to what I wanted to learn and also to do my dissertation work on, as I said, the topic that I was interested in.
My dissertation is free on my website. People read it. I will talk more about marketing later, but I have to tell you, having paid the extra $40 to ProQuest for the right to put my own dissertation up on my own website has paid off enormously because people read it and they go, oh, you get it.
Dr. Sharp: She gets it.
Dr. Aimee: And that’s [00:12:00] the thing, is that in the clinical where the gifted clients often say, well, we have to find therapists who get it, and most of them don’t.
Dr. Sharp: I was going to say, it sounds like that’s particularly important for this population because you have folks who actually would read a dissertation before coming to see you, right?
Dr. Aimee: Yes. It’s a qualitative dissertation. It’s very conversational. And the thing is that within the gifted community, people say, oh, you have to find a therapist who gets it and a lot of them don’t. A lot of people have had very bad experiences. A lot of people have a wonderful experience too, but they’ve had very bad experiences.
The problem is when I would explain this to clinicians, so often the response I would get was, well, there’s nothing to get. They’re all a bunch of narcissists who think they’re all so special.
Dr. Sharp: Oh, goodness.
Dr. Aimee: And the harshness of that. I was like, oh, little [00:13:00] unprocessed countertransference match. That was part of the thing, was realizing that, because a lot of the people who would say this were obviously themselves very intelligent, but it was like, this is part of that sense of you have to be comfortable with yourself. So yeah, people read it and they go, oh, this person gets it. I want to work with her.
Dr. Sharp: It’s funny, you had to think of that as an aspect of marketing in your practice, but I could totally see that. It’s an extended version of your biography that people […].
Dr. Aimee: And it’s also a service in and of itself. Sometimes I get thank you notes from people who write and they go, thank you so much for putting that. It was validating to know that I wasn’t the only person who had experienced these things. They don’t need therapy, they don’t need anything, they’re just [00:14:00] sending me a note.
Sometimes, at the urging of a friend, I put a tip jar there and occasionally somebody puts money in the tip jar. It’s because she said, I can’t believe you’re putting it out there for free, and I’m like, because I want to offer it, I want people to hear that they’re not alone. That their experiences are not, they’re not the only one. So there is this.
And part of this, there is this sense of mission for me. This isn’t just like, oh yeah, gifted people, they’re cash cows. No, this is actually much more a sense of purpose for me as a clinician.
Dr. Sharp: Oh, sure. It seems clear this is your life. This is what you’ve experienced personally and have managed to wrap it around in a professional way too. I think that is so important. I’ve talked on this podcast a fair bit about how testing a lot of people, I get these [00:15:00] questions of like, oh, how do I start testing my practice? What are the codes? How do I bill?
You got to walk that back and say, what do you really like to do and what are you passionate about? Because otherwise, it’s going to get real tough when you’re sitting down to write those 10, 15, 20-page reports and you don’t have that motivation to do it.
Dr. Aimee: Oh, yeah. I think every neuropsychologist I’ve ever talked to, we all go, oh God, the reports.
Dr. Sharp: Sure. Oh gosh.
Dr. Aimee: I’m sure we’ll get to this later in the hour about report writing for different clients, its own ball of wax, but if you’re going to be doing that work, you’ve got to. I think most people I know who have a niche area have some personal connection with it. You have to have metabolized that. You can’t be like, okay, I have to do this and I have to fix this.
If you’ve got too much of a drivenness, then [00:16:00] you’re working out your personal needs with the clients. I think you need to have done your own work so that that’s not what, you’re doing it for the clients, not for yourself, but to have it be this very authentic outgrowth of this is a population that I love to work with and a kind of work that I love to do. People can tell, and it’s easier for them then to hear you when you have to say things that are hard for them to know that there’s trust.
Dr. Sharp: Oh, that’s so important. I think you nailed it. Trust is the word. So let me maybe use that and transition a bit, did you go straight into private practice doing assessment and testing after graduate school then?
Dr. Aimee: Yeah, what had happened was I had had my educational therapy practice [00:17:00] where I was mostly doing, let’s say, glorified tutoring, special education consultation and advocacy with that. I did some intelligence testing. I did some LD testing, fairly limited in that because I needed to stay on the right side of the law. So I had been doing that.
And then over the course of my training, while I was in graduate school, I still maintained that practice. From a time perspective, I had to prioritize graduate school, but I continued to see clients as much as I could squeeze them in and to stay involved with the community and to continue doing all of the things that I had been doing that had built the educational therapy work. I continued to do those things.
And then as I became progressively more legal, as I [00:18:00] became more able to do the things that I wanted to do and that I was now competent to do, during my postdoc phase, I had an agreement with one of my former internship sites where I was then on staff as an employee. What happened was that people would come and they would come to me and I’d say, well, I can’t legally do this assessment, but I can have you go over to the clinic with me and I will be your assessor.
So the clinic was making money and I was making money and they were getting me to do their assessment and I was getting appropriate supervision. It was a win-win all the way around. It was a great experience for me. And then once I was independently licensed, then I started working independently.
It took a little bit to grow but it [00:19:00] grew quite quickly because it already existed and because of the, I don’t know what it would have been like had I not had the previous experience. I think it would have taken a little longer to establish myself.
Dr. Sharp: That makes sense. That is a natural extension of the work that you were already doing. It sounds like you were getting some of those calls beforehand in the tutoring practice but you rightfully said, no, I can’t do this but once you had your degree, it’s like, okay, yeah, the market is open.
I know we had some conversations earlier about insurance and cash pay and that sort of thing, have you ever taken insurance with these assessments?
Dr. Aimee: No.
Dr. Sharp: No. Okay.
Dr. Aimee: No. It was funny because one of my motivations was, oh, I would love to go and be a licensed professional and then I’ll be able to take insurance and then more people will be able to afford my services. And then I saw the dark underbelly of [00:20:00] the insurance system and I saw how little they pay for assessments and I went, I can’t feed my family on that.
I am basically a cash only practice. I do offer some pro bono work. There are times where somebody will call up and I’m like, all right, I can. If I choose to slide my scale or to offer pro bono stuff, I will do that but basically, it’s cash only. What I’ve done instead is I offer a range of services and that includes free information that is high quality, useful, take it to the bank, use it. You don’t need to pay me for it.
Information on my website and the blog that I don’t know… if I write up, oh, here’s the things that I usually recommend for people as far as how to help your middle schooler or your high schooler organize their stuff and get their homework done. [00:21:00] Well, that stuff’s for free on my blog. People call me and I say, you can do that for free.
And then I have a range of other services so that it’s not just the multi-thousand dollar assessments. There’s a range. I’m very clear with people around let’s find a service that works for you.
Dr. Sharp: So let’s say that someone calls and they want to go forward with an assessment and you’ve deemed that to be appropriate, how do you structure the pricing for that?
Dr. Aimee: What I do is I usually have them fill out a developmental history first. A lot of my clients have been assessed before, some of them many times. They’re often a lot of single discipline assessments or the schools have done, there’s a lot of little things and everybody’s like the blind men seeing the elephant that they’ve got, everybody’s got a little piece of the [00:22:00] picture.
I know, a lot of those kids are on the autism spectrum. That’s the most common when I see the giant pile of stuff. I know here’s where we’re going but I’m looking at the complexity of the case, I’m looking at what do we already know? What can I figure out so that I can try to create?
I don’t use the same testing plan for every kid so I plan out an approximate testing plan. I think, okay, how much time am I going to need for this? And then I quote people a flat fee up front. I’ll give them options. I’ll say, if you’d like me to include testing for dyslexia, then that’s how much it is. I’ll let them pick and choose.
I’m very collaborative with the client around defining what are the referral question? What do you already know? What do you suspect? Who’s the audience? If you need me to make this clear so that you can advocate for an IEP, [00:23:00] that’s a different set of clarity than if I’m working with a homeschooler who says, I need to know the answer but I don’t need to be able to prove it to anybody else.
And also what was in the range of services is needed, sometimes it’s just a consultation. They just come in for two hours. There’s no testing. I play with the kid. We talk, we have fun. I talk with the parent at the same time and I can give them a lot of the same advice for a lot less money. So I give them their options.
Obviously, there’s richer information when I test and more certainty. I frequently with consultations, I don’t make a diagnosis but some people don’t want the evaluation in part because they don’t want the diagnosis. I try to lay out their options but I quote them a flat fee and the reason I do that is because I know some people like to work hourly; the problem is with gifted kids, some of them go [00:24:00] for a really long time into those tests. And with the WISC, you can’t adjust the start points. It takes forever.
I’m very nice because I’m like, I’m really sorry, I have to give you these really easy questions first, just bear with me, it’ll get more interesting soon. They’ll keep going and a lot of gifted folks are perfectionists and persistent and they will work really hard.
I used to do it hourly and I would tell people, okay, this testing, it’s typically four hours of testing and then I had this one mom where I told her it was going to be four hours of testing and the kid took six. I felt horrible because people need to be able to budget. And so I said, I don’t want this to ever feel like a bait and switch. There’s a flat [00:25:00] fee that includes everything I’m going to do, that includes feedback, the report, more conversations. I am extremely generous with my time because I want them to feel that they’ve gotten their questions answered.
Dr. Sharp: Got you.
Dr. Aimee: And so I just sit there and I go, all right, I set up, I say, this is what, this is going to be for this. I tell them, I don’t want to be in a position of having to come back to you in the middle of the testing to say, oh, actually, I want to do something else.
Dr. Sharp: So how do you structure that just from a business perspective? How does that flat fee correspond or not correspond to your hourly rate and how do you come up with that budgeting for all these factors?
Dr. Aimee: Some of it is related to my hourly rate. There is no way I could charge for the hourly time I spend writing reports, I just can’t. And that’s my perfectionism and I don’t believe in punishing other people for my perfectionism.
[00:26:00] A lot of it is based on what’s the going rate around here. I do charge a bit more than the going rate around here, but not ridiculously much more. In any time you’re setting prices for any service, it doesn’t matter what industry you’re in, it comes down to a question of what value do I provide and what do I feel comfortable being paid for this? Is it so much that I can’t look at myself in the mirror? Is it so little that I resent it?
I end up with an approximate that most of them come out and around the same point, but it really is this sense of, I know how much work this is going to involve and here’s what I think is a fair price. If somebody says, I can’t afford that, then I go, okay, let’s talk about a different service that you could afford. [00:27:00] In some cases, for some services, I’ll say, well, then I think you should go to somebody else because it’ll be less good service but it’ll answer your question. I am enthusiastic about recommending my colleagues.
Dr. Sharp: Got you. Just a nuts and bolts question, are you doing all of this during, you call it a consultation, but is that like an intake interview? Do people fill out that developmental questionnaire ahead of time and then you talk with them on the phone before they even come in or how does that work when you’re deciding with them what’s the best?
Dr. Aimee: I started doing the consultations as almost a diversionary service. The thing is that I’m only one person and I’m a perfectionist writer myself, the limiting reagent was how many reports can I write? And that’s a piece of business decision around, is [00:28:00] there a way I can hire an assistant of some kind who could help me, who would still do the quality work? I haven’t figured that out yet. That’s not something I’ve solved right now but I would get way more people asking for testing than I could possibly test.
And very often what I would see is, I know what I’m going to tell them. I would look at the history and I go, I already know what this is going to probably be. I know what to tell them, maybe not in as much detail, maybe not as perfect as I could do it if I actually had all the testing data. But if I know that a kid is clearly struggling with social cognition, then I actually already know what I’m going to recommend for them for a lot of things. And once I meet the kid, I get a lot more information just from meeting them.
So it was partially because I don’t have the bandwidth and partially because it lets [00:29:00] me serve more people and save them money and stuff. If somebody comes in and they say, I know that I want to do an assessment, then what I do is I have them fill out the developmental history and send me all of that pile of paperwork, every previous test, current special education records if you’ve got them, current school records if you’ve got them. And then I usually say, anything else you think would help orient me.
I do say all prior evaluations even if you think they weren’t very good or you disagree with them because people will try to edit what they give me. I’ve seen that. I’ve been on both sides of that coin where people have edited or wanted to suppress or edit my report and then give it to somebody else. I’m like, I’m not going to edit my reports in any case.
So I’m getting this pile of paper on the person. [00:30:00] Usually within that, I can say, okay, if they know they want an assessment, I will be able to figure out from that what I want to do. And so I’ll be able to give them a quote, we can schedule the assessment directly. They’ll come in and I orient the kid and I do an assessment and then we do feedback pretty typically.
I can tell you a little bit more about that process but it’s more when I’m trying to do the consultation to head off the need for assessment. There’s a lot of mythology in the gifted community around, well, you’re a bad parent if you haven’t had your kid tested. And I’m like, no, you don’t need to get your kids tested, you test when you have a question that testing will answer and when you have an audience that’s interested in the answer.
A lot of what I’m doing is educating them about, you don’t have to do testing if you don’t want to or if you don’t need to. Sometimes the consult is as a [00:31:00] prelude to maybe doing testing. So then that’s part of the question that we’re doing in the consultation is figuring out whether they now know what to do or whether they do want to have an evaluation. What’ll happen is they filled out all the paper beforehand.
I always tell people it’s not strictly required, but I do find that it lets people give me a lot of information quickly so that we can make best use of our time together. I read faster than they talk so it’s better if I already know that stuff.
I do do consults over video chat also and there’s obviously, I’m not going to play with the kid. But for testing, I’ll be playing with the kid and I’m taking notes on how they do playing board games or what they’re doing in the sand tray or whatever, that ends up getting rolled into the evaluation report [00:32:00] if they go forward with it.
I’m trying to help them. I’m trying to answer their questions. They’re getting a chance to scope me out. I’m getting a chance to scope them out. There’s definitely trying to get a sense of personal fit. Sometimes I will get a really strong sense that this family is not ready to hear the news.
Dr. Sharp: Interesting. What might give you that impression?
Dr. Aimee: They’ll be very explicit about it. Oh, we don’t really believe in diagnosis or we don’t want our child to be labeled. We don’t want that. And I have answers for those things. I believe them. I talk about it. I believe that self-knowledge is always better than not. Once you know something about yourself, you can then decide what to do with it.
Dr. Sharp: I would agree.
Dr. Aimee: These are the same answers I would give, these are not gifted specific answers. Although gifted clients can often do really well with that self-knowledge. [00:33:00] It becomes then part of the grist for your problem solving. Oh, well, here’s what I’m really good at and here’s what’s harder for me, I’m going to approach this difficult task.
The labeling thing, I say that the issue is that everybody’s always being labeled. What we’re working for is labels that are accurate and compassionate. When a kid is rude or thoughtless or a jerk or what, I’d much rather be able to explain why this kid is having trouble managing the expectations of the social world or whatever.
I try to work with them around that but sometimes it’s very clear that they’re not comfortable with that or what they really want is a much more limited assessment that is not designed to be diagnostic. They want something that’s more aimed for advocacy [00:34:00] purposes and it’s more focused on identifying strengths.
I write in the report that this was not designed as a diagnostic assessment and can’t answer a diagnostic question. That’s fine. I try to be clear with them that if you come in for a multi-day full neuropsychological assessment, the usual practice in that is that in that report, I am either going to make a diagnosis and explain why I’ve made it or I’m going to explain very clearly why I think no diagnosis is warranted.
Usually if you’re in a situation where you’re thinking about a full assessment, that’s a large investment of time and money, usually there’s a problem so there’s usually going to be something diagnosable. So sometimes what it is, is that they’re able to get the help that they need. They’re able to take in the idea of, for instance, the kids with the autism spectrum disorders are probably the hardest in terms of getting [00:35:00] families on board. I could spend a whole hour talking about that.
Dr. Sharp: Can I jump in there real quick? Because I would imagine some people might be saying, and I’m thinking, is there truly any relevant or documented comorbidity between giftedness and autism spectrum?
Dr. Aimee: The issue is that the autism spectrum is very broad. It’s not even a single spectrum, it’s a large multi-dimensional space. I don’t think there’s any support for the idea that giftedness causes autism. Sometimes what you’ll see is that kids who are quite bright when they’re very young and they’re autistic, and they learn to read early, and they read and they score, so they gather lots of [00:36:00] information, and they score very high on measures of crystallized intelligence because they’re five and most of the kids in the norming sample don’t have access to the sources of information they do.
As soon as you’ll get these very high scores on IQ tests at quite young ages with autistic kids where it’ll tail off if you see the same kid come back. Remember, I’m often seeing reports where I’m seeing, oh, here’s the report from when they were five, here’s the report from when they were 10, here now they’re 15, now it’s your turn and I’ll see changes over time. Sometimes those scores hold up, sometimes they don’t.
One of the common experiences that a lot of gifted folks have is social isolation and social mismatch. You’re the normal kid, you’re going to school, school’s not built for you. Most kids have the experience of going to school and [00:37:00] having lots of kids around who are basically like them and having most of the things the teachers ask you to do to be reasonably challenging but doable. That’s what schools is for most people.
For a lot of gifted kids, there’s nobody around who’s like you and of course, schools often systematically isolate them. They parcel them out as thinly as possible across all classrooms. Research suggests putting them together in clusters, it’s actually better for all the kids and it gives them friends. It gives them a group that’s easier to make friends with, gives the teacher a constituency, so it’s not just like the one kid.
That’s again, topic for another podcast, but so a lot of gifted kids have limited access to the peer groups and the peer experiences that allow them to develop social skills. So a lot of times people think that a kid [00:38:00] who’s really smart must be on the spectrum because they’re a little bit geeky and they have deep passionate interests that are not necessarily typical for children their age or they’re extremely articulate. They have very big vocabularies and they are more comfortable working with older people or even with adults. And so these are features of giftedness that can masquerade as autistic stuff.
There are also sometimes features of autism and so I don’t think that it is true that gifted people are more likely to be autistic or autistic people are more likely to be gifted. But it’s certainly of the things I see, when people come into my office with a lot of distress, the main things I see are autism spectrum disorders, ADHD, learning disabilities, anxiety disorders, mood disorders.
Everything else in its normal thing, I’ve worked [00:39:00] with kids who are developing psychosis and things like that, but those are rare because that’s rare. It’s mostly the more common stuff.
Dr. Sharp: Got you. Okay. I want to get into the nuances of testing with gifted kids but I do want to ask one question about, it seems clear that you have a really busy practice to the point that you’re using your intake as a diversion, which is funny.
Dr. Aimee: I know. I have to find some way to find an associate, but there’s so much around, I need to find somebody who would be able to do what I do.
Dr. Sharp: Sure. Oh gosh, I know that challenge. Let me ask you then about marketing or whatever you might call marketing. How did you build such a busy practice?
Let’s take a quick break to hear from our featured partner.
The SPECTRA: Indices of Psychopathology provides a hierarchical-dimensional look at adult psychopathology.
Decades of research into psychiatric disorders have shown that most diagnoses can be integrated into a few broad dimensions. The SPECTRA measures 12 clinically important constructs of depression, anxiety, social anxiety, post-traumatic stress, alcohol problems, severe aggression, antisocial behavior, drug problems, psychosis, paranoid ideation, manic activation, and grandiose ideation, and organizes them into the three higher-order psychopathological SPECTRA of Internalizing, Externalizing, and Reality Impairing.
These scores provide a quick assessment of the overall burden of an individual’s psychiatric illness, also known as the P-factor. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect, PAR’s online assessment platform. Learn more at parinc.com\spectra.
And for a limited time, get one free administration and score report for the SPECTRA on PARiConnect by calling PAR at 8558564266 and mention promo code SPEC.
All right, let’s get back to the podcast.
Dr. Aimee: It’s funny, I don’t market per se. I’m very much part of the online gifted community. There used to be a number of mailing lists, they’re less active now in the day of Facebook. There’s now very active stuff on Facebook. It doesn’t have the same intimacy as it used to be but I am very much part of the community.
I’m a participant observer. I present at conferences that are aimed at parents of gifted kids as well as for my professional colleagues. I answer questions. Honestly, the way I built my practice first was just by hanging out in mailing lists, this was before social media and being knowledgeable and helpful in answering people’s questions and doing it out in public.
And the people would be like, oh is it okay if I ask you to, I’d like to pay you for some of your time, are you willing to do that? I’m like, yes, [00:41:00] that’s what I do for a living. The vibe when I’m doing it is not, oh, but if you come in for a consult with me, then I’ll answer your question. I don’t do that.
If I’m going to answer somebody’s question in public, I’m answering somebody’s question in public with the full knowledge that I’m giving something away. What it’s doing is it’s letting people see how I think. So people who see how I think, then say, oh, I’d like to work with her.
The most useful thing I do is I do public speaking. I always joke, I used to do public speaking six times a day for hostile audiences because I taught middle school. They will let you know if you’re boring. So what I learned how to do and I make funny PowerPoints. I’m good at that.
I found that by giving talks in places where [00:42:00] parents, I include adult work too, but places where people who might be interested in hiring me might hang out. For instance, at MIT, there is a weekend once a year where high school students come from literally all over. They get like 2,500 kids coming from all over the place. And like anybody in the community teaches anything for free, if it’s $40 for the whole weekend for the kid, it’s ridiculously cheap.
So the kids are in this giant learning playground. There’s no rules about who can come, but it attracts curious smart people. And so now we have all their parents who are now hanging around with nothing to do. So the organizers set up a little parent program. I always speak at that parent program.
Dr. Sharp: Oh, okay. That’s perfect.
Dr. Aimee: It’s perfect. I always tell us, put me before lunch because what’s going to happen is that I’m going to give my talk and then people are not going to stop [00:43:00] asking me questions. And so put me before the lunch break so that then we have time.
And then I usually end up just sitting out in the parent lounge area for hours afterward. People are continuing to ask me questions. I am so essentially doing what I do in public and letting people see how I think, letting people see how I approach cases and they’re getting to see me as a person.
Dr. Sharp: Absolutely.
Dr. Aimee: It’s great because it’s always been, by being part of the community, that has also really helped me that I can tell you when I was in dissertation how:
a) I had no trouble getting subjects.
b) I had people chilling for me. I provided posts to Facebook, oh my God, another 3000 words. They’d be like, hey, go, go.
It’s like the kid from the small rural village who goes off to college to become a doctor and then comes back and sets [00:44:00] up a medical clinic for the community. It’s been part of why it works. So I think that marketing is very much being out there, being helpful and knowledgeable, letting people see how I do it, how I think.
I am a member of the appropriate professional and parent organizations and so for instance, my state association for gifted education, I talked to them and I said, you guys should have a professional membership. They said, really? I said, yes, I would happily pay you more money every year for the right to have a listing on your website as a professional member. They’re not endorsing me, they’re just saying I’m a member and I’m a professional and I’m on their website. I have the same thing with [00:45:00] SENG.
That means that people who are looking for an evaluator, and they go, oh, gifted, Massachusetts, let me see what I find, they find me. I also have nice relationships with, there are a few schools around here that require IQ testing for admissions. That’s very easy testing. And so I’m on their web pages too. But mostly it’s word of mouth being part of the community, that’s where it goes.
Dr. Sharp: Just thinking about specifics, are there any particular conferences or websites or groups that you would recommend for anybody else who is interested in getting into this community?
Dr. Aimee: What I would recommend is if you go to the blog that I never have a chance to update, part is because I’ve been working on writing the book, I write long blog posts and it’s too much. It was like I’d write something, I go, [00:46:00] oh, I should put this out where people can see it. So that’s what the blog is. I had two sticky posts there. One of them is called, oh no, my kid might be gifted, where do I start?
Dr. Sharp: Oh, perfect. Okay.
Dr. Aimee: I update the post rather than posting new things. I just go, oh, there’s a new edition of this. I’ll put that up there. And that gives good stuff.
I don’t know if the misdiagnosis book saying is called Supporting the Emotional Needs of the Gifted. That’s a really good organization. It’s primarily for families and gifted people themselves, but there are professionals in it. Again, you can be a professional member. I think you do have to establish that you’re not just some carpetbagger. I have to say, people are often very suspicious around that; [00:47:00] Who are you?
I go to the SENG conference. There’s a New England Conference on Gifted and Talented, whenever it occurs, I present at it. Locally, we have a little tiny thing happening this weekend called Beyond IQ. It’s mostly like a family reunion more than anything else.
Essentially, I’m a member of the National Association for Gifted Children. You identify with the things. I’m also connected with the Davidson Institute for Talent Development. They serve kids who are at 3 standard deviations above the mean. I’ve done seminars for them. I’ve presented at their annual conference.
They’re actually going again this summer. They have an annual gathering and they’ve invited me as a speaker. It’s a win-win. They get a great talk for their people and I get to be in front of people who don’t know me yet.
Dr. Sharp: Sure. That’s [00:48:00] fantastic. Thanks for those resources. We’ll put all of those into the show notes so that folks can check those out when they are ready. So let’s transition, you’ve been so generous with your time. I really want to …
Dr. Aimee: I talk too much, but yeah.
Dr. Sharp: well, this is all good. You have a lot of valuable things to say, so this works well. Let’s transition into the actual assessment process. I would imagine people are really curious. Does assessment with gifted kids differ from other kids in terms of measures you might choose, the process of testing, how do you approach that?
Dr. Aimee: Sure. Some of it has to do with managing anxiety because sometimes they’re coming in because I want to get my kid into the following school. So there’s often a lot of parental anxiety. I have had to warn parents, do not go looking for how do I [00:49:00] do test preparation. I tell the parents, the only preparation you’re allowed to do, and I want you to do this, a kid has to have a good night’s sleep and a good breakfast the morning of and the parent needs to relax as well because the kids can read the parental anxiety and then the kid’s going to get anxious. So there’s a lot of stuff around that.
Sometimes, a lot of parents will say, oh, let’s go to take the kid to my friend and we’ll play some games with them. The gifted kids usually can tell that you’re lying to them. Why are you so anxious that I have a good night’s sleep before we go play with your friend? I don’t get it. They’re not dumb.
It’s funny, I remember one particular case where the parent insisted I was not allowed to use the Word test.
[00:50:00] And you know what, it was a mistake because the kid was more anxious because she didn’t know what was going on. Why is this so serious if we’re playing games? Why can’t we agree to change the rules of the game, if it’s a game?
I think the problem is they also start worrying what’s wrong with me. No matter what’s going on, these are kids who crave knowing and it’s a different experience. So I am very honest with them. I say, I am a psychologist.
If it’s a little kid and they don’t know what a psychologist is, I say, I’m a thoughts and feelings doctor. I help people who are frustrated in school. I think about what’s the kid’s reason for referral. I help people who are really bored in school, or I help people who are trying to have more friends. Whatever it is that the kid would identify as their reason for referral.
I try to solicit that when I’m talking [00:51:00] with kids. What would you like to know about yourself? Recently, I was sitting with a parent and the parent had pretty typical, we’re pretty sure we know what the diagnosis is, but we need updated testing and we’re trying to get guidance on where to put the kid in school.
And the kid says to me, I want the following career. I’m not going to say it because I don’t want to be mad, but here’s the career I want. It’s a little bit impractical but not totally. I said, this career, I can tell you, I want to be a race car driver.
Dr. Sharp: No.
Dr. Aimee: I said, okay, well, being the actual driver might be unrealistic because very few people can have that and he understood me. But then I said, but we can think together and we absolutely can use the testing to help you think about what you can do now in school that might help you get a job in the larger field of race car stuff. Maybe you’re going to end up [00:52:00] as an engineer, maybe as a broadcaster, maybe as a mechanic, there’s lots of things and the testing will help us figure out how to help direct you now that might help you.
I said, that’s actually a really good reason for referral. It can really help. And that also helps bring the kid into the process because if you don’t get them in on the game, oppositional kids don’t test or you don’t validate it, and that’s true for everybody. So I do that.
The other thing I have to really do is I have to normalize for kids the experience of what testing is going to be like, because a lot of these kids, first I explain, we’re going to do lots and lots of different things. I talk with them. If they play sports or music or something, I’ll say, oh, how is this sport different from that in terms of what you have to be good at. You have to run fast or jump high or if you’re really strong, or you can go all day. [00:53:00] Sports are different.
Different kids have different strengths and weaknesses so I’m going to normalize that we’re going to do lots of different testing and some things are going to be really easy for you, and some things are going to be really hard for you. And that’s okay. These are kids who normally don’t get anything wrong in school very commonly.
The other thing I have to explain to them that the tests work on the Goldilocks Principle. It’s going to start really easy and then it’s going to get harder and harder and then it’s going to get too hard. And it’s okay that it’s going to get too hard. It’s okay that you’re going to get things wrong. That’s my job, is to find the things you can’t do.
And I tell them, I say, these tests are normed all the way up for big kids or adults or whatever. I say that I guarantee you there are going to be things that I ask you to do that you don’t know how to do. And that’s okay and that’s good.
I give them a little bit of a quiz, as long as I keep asking you to do things, you’re probably [00:54:00] doing better than you think you are. One mistake doesn’t end it so I want you to stay in there with me. I don’t know silly answers when it’s too easy. Give me good effort when it’s hard and that’s okay but I need to give them that normalized thing.
Sometimes when the kid is particularly anxious, I’ll use that consultation beforehand so they can meet me, that’s why we’re doing a consultation ahead of time, it lets them play with me. It lets them be okay. She’s not from the black lagoon or something like that. It lets me do some play-based evaluation.
I don’t find that most gifted kids do not do well on do I get to earn stickers by doing subtest. Some of them do, it’s not particularly motivating. The thing that tends to motivate them is the idea that we’re going to learn something about you and I’m going to include them [00:55:00] in the process. I often do create a checklist so that they can, okay, I’ll write the things I’m going to do that day and then we’ll check them off so they can see where we’re going.
Sometimes gifted kids have trouble accepting the the role of the authority, like I’m setting the rules here now and you’re not. I will tell them, I have to follow the rules of the test too, because I can’t … Sometimes they’ll try to control the book, try to try to turn the pages and things like that. Sometimes they don’t, they want to look at my side of the easel.
I think a lot of kids do that and it’s anxiety. I want to see the answers. Maybe you’ll tell me the answers. I try to give the kids as much autonomy as I can. Every once in a while, I’ll get a kid who wants to make a test for me and I let them do that. That’s fine.
I [00:56:00] want them to understand what we’re doing and to understand that the failures that they’re going to experience are totally fine and normal. It’s information. It’s not like at school where you generally know everything.
Dr. Sharp: I think that’s so important yet to normalize that because I think most people come into it thinking, oh, this is a test, I can maybe get 100%. I’m going to be graded. And just to say like, hey, this isn’t
how it works.
Dr. Aimee: Not how it works. Sometimes kids will have done a thing in science class where they get a piece of tin foil and they have to make a boat. I used to talk about building balsa wood bridges and then you would find out which bridge was the strongest by seeing how much weight it could hold, but the problem is with that you end up crushing the bridge. And I said, I know that’s not a nice image.
Because I talked about the tinfoil boat and if we wanted to know which boat could hold the most weight, then we’re going to keep putting pennies in all the boats and we’re going to see which one sinks first [00:57:00] and then we know, oh, it can hold that many pennies minus one. It doesn’t mean the boat was a bad boat, it means that that’s how many pennies it could hold before it sank.
Dr. Sharp: That makes sense.
Dr. Aimee: It’s something that kids have often seen something like that. I try to leverage their curiosity.
Dr. Sharp: Good. You have to enroll them in such a lengthy process, I think.
Dr. Aimee: Yeah.
Dr. Sharp: So then once you get into it, what measures are you selecting? We got standard, Wechsler scales, are there different measures that are better for gifted kids or?
Dr. Aimee: It’s an interesting thing. A part of what I’m looking at is who’s the audience. Generally, if it’s school admission stuff, most of the private schools want the Wechsler. So I’ll do that. The Wechsler is a fine test. I like the new edition because the splitting up of fluid reasoning away from visual-spatial, [00:58:00] both fits better with research and also tends to be more relevant.
I’ll often see kids where they’re very strong in fluid reasoning and their visual-spatial is good but nothing fabulous and I like to be able to see those as two separate factors.
Dr. Sharp: Hey, can I ask you? Sorry to interrupt you. I’m just very curious, I like to get people’s perspectives. How do you explain how fluid reasoning is relevant in everyday life to parents?
Dr. Aimee: I usually talk about it in terms, I say intelligence is made up of a lot of different things but one of the biggest splits, this is actually how I usually start my feedback sessions, is between stuff you know, and your ability to figure out new things. Stuff you know and familiar situations for most of the time with the gifted kids, the verbal Comprehension Index is usually functions more as a crystallized intelligence. It’s [00:59:00] measuring their experience in the world.
So fluid reasoning is about coming into a new situation, figuring out what to do when you’re not sure what to do. I also talk about how the two intertwine because one of the best things to have when you’re coming into a novel situation is to have a good pile of existing knowledge about, oh, but other problems similar to this were solved this way, so that’s crystallized intelligence about problem-solving.
And when you’re trying to learn something new, you’re trying to build your crystallized intelligence focusing on how does this fit in with what I already know, how do I connect this, how to make sense, that’s a problem-solving technique. So they tend to intertwine, but I think of it in terms of figuring out what to do when you don’t know what to do.
[01:00:00] Dr. Sharp: Okay. Thanks for indulging me there. I was just curious. That’s something that I think about sometimes, so measure selection.
Dr. Aimee: The other thing I happen to like about the Wechsler, if I think that autism spectrum disorder is on the table as part of the differential, I usually do the whole test minus the reading stuff at the end but the balance between the information and the comprehension subtest, often with the gifted kids on the autism spectrum, we will see 18 on information and nine on comprehension. You see a huge split between those two subtests because it represents the difference between book learning and social learning.
Dr. Sharp: Sure.
Dr. Aimee: It doesn’t prove anything by itself, but a lot of times I’m looking for like, oh, I just need a little, sometimes if I’ve used a different IQ measure, I’ll often just do those two subtests as a [01:01:00] supplemental piece.
I really like the DAS. I like it better than the Wechsler for a lot of things. I like the fact that the fluid reasoning tasks are not confounded with time, with speed.
Dr. Sharp: Oh my gosh.
Dr. Aimee: It gives you time to think. I like the fact that I can put the start point anywhere I want to, I don’t have to do the easy stuff. In fact, you can administer stuff out of level. Some stuff has to be administered, so if I have a four-year-old, there are some five-year-old stuff I can give them and there are still norms for it. If I have a five-year-old or if I have a gifted five-year-old on the Wechsler, they’re on the WPPSI, which means they’re going to ceiling stuff and I’m going to have ceiling effects. It’s a big issue.
Whereas on the DAS, I can give them the school-age battery [01:02:00] which is designed for six and up, but it has norms for five-year-olds. Sometimes the cute things with the little pictures for the little kids is actually confusing and they’re like, why are you telling me this? Whereas the stuff that says Scott Squares and Circles on it, is easier for that. They’re like, oh, okay. I see what you want me to do. You want to figure out the rule. Oh, I can figure out the rule. So I like the DAS a lot.
I don’t care for the Stanford-Binet. I find that it doesn’t have enough granularity because there’s just not enough items at any given level and the instructions are very confusing in some places for the kids. I’m like, I don’t want this to be about, could you understand the instructions?
Dr. Sharp: Oh, of course.
Dr. Aimee: I’ve used other tests, mostly I use the DAS and the WISC. Those are my favorites. And then I use the [01:03:00] Woodcock-Johnson, not as an overall IQ measure, but it is my best source of little diagnostic bits and pieces in the cognitive realm.
And then I use all the same things you would use for a lot of other stuff. If I’m doing dyslexia, I’m going to be using like a CTOPP and a PAT and a GORT and things like that. I’m going to be using stuff that’s aimed at the particular question I’m asking.
The biggest issue that I have is that most tests of social cognition are much too easy for the gifted kids and they just ace them no matter how much trouble they’re having. The thing that I’ve found thus far that has been the most sensitive has been the Social Language Development Test. It has picture items and verbal items, and a lot of times the kids can answer the verbal items reasonably correctly.
Although they might have trouble with the, well, I can know the right thing to [01:04:00] say in a social situation as long as it doesn’t upset me but when you’re actually asking them to look at pictures and say, what’s this person thinking and why, it’s often much harder for them.
Sometimes that also gives me a source of very clear information I can show to a parent. I can show them a picture. There’s one item on SLDT that has this kid who looks furious and he’s got his hand up in the universal stop, get away from me gesture. If I show that to the parent and I say, I want you to know your kid looked at this picture and he said, I’m five years old. It’s vivid.
Dr. Sharp: That’s so big.
Dr. Aimee: They can see that. They go, okay, that kid is not correctly interpreting social signals. There’s two pictures on that test that adults in these scolding [01:05:00] things, like they’re warning you, like it’s the teacher giving you the look. I can show them, I say, if this kid can’t understand what this look means, they’re going to get in trouble a lot because they got the warning, but they didn’t see the warning. So they don’t know why they’re getting in trouble, but the teacher thinks she warned them. I like that test in particular.
I have heard really good things about the RESCA and I haven’t gotten it yet.
Dr. Sharp: Oh yeah, I’ve seen that one going around on the listserv as well.
Dr. Aimee: It’s being discussed. I’m likely to check that out. A lot of what I’m looking for, for the gifted kids in the neuropsychological realm is I’m looking for difficult tasks. I don’t get as much information out of something like Trails and Verbal Fluency. I usually administer them because they’re easy and fast and stuff, but oftentimes, they don’t give me a whole lot. But tests like the Tower of Hanoi or the Tower Test on the D-KEFS, [01:06:00] the tower on the D-KEFS is great because I can watch them try to learn from experience.
Dr. Sharp: Yeah, sure.
Dr. Aimee: It starts with, can they figure things out? How do they approach it? Do they just dive right in and do 100,000,000 moves? It gives me a sense of how they are, similarly, the Sorting Task, what do they do when they run out of easy answers?
A lot of times it’s the qualitative stuff. With gifted kids, it’s often hard to find tasks that are actually hard for them. Frequently, even in their areas of most profound weakness, twice-exceptional kids will give you average scores because nobody told them they’re supposed to do badly on it. So they’re compensating. They’re doing everything they can to try to get the answer and they can muddle through.
Dr. Sharp: So you’re looking at scores that are in the average range or maybe even above [01:07:00] average technically but still are significant weaknesses for these kids and have to be mindful of.
Dr. Aimee: Yeah. I care much more about the within-kid differences. And that also is reflected in their grades. That sometimes the kids, they’ll be like, well, but he’s getting B’s in reading, I don’t know what the problem is. The school’s like, well, he’s getting B’s in reading. I’m like, well, yes, but he can barely read. It’s taking an immense amount of effort. This is not fluent, comfortable reading.
Oftentimes, that becomes a thing that’s a little more sensitive because they can do it if you give them time but if you force them to do it immediately, they have a harder time.
Dr. Sharp: That’s tough. Yes. So once you have all of those results, then I am curious, just to wrap the process, how do you structure the feedback session and write the report? Do [01:08:00] those differ with gifted kids versus neurotypical kids?
Dr. Aimee: Yeah, one of the big things where I don’t know that many people do this for more typically average intelligence kids, I virtually always include kids in the feedback process.
Dr. Sharp: Okay, at all ages?
Dr. Aimee: Yeah, I can explain the normal curve to a smart four-year-old. They don’t understand it as well as their parents do. They’re usually curious, they want to know. What I always explain to parents is, it’s like sex, I don’t want them to get their information on the street. I want them to get their information from me because I’m a reliable source.
Sometimes parents don’t want me to give numbers during the feedback session, and I’ll respect that because I don’t want the kid to go to school and go, I got a 137 on my IQ. I will talk with kids [01:09:00] about how do you talk with people about this and how not. It’s like bragging about your income, we don’t do that.
But even pretty young kids, what I usually explain is I say, well, for anything we ask you to do, there’s going to be lots of different things that affect how well you can do on it and some of that is who your parents are and what you had for breakfast that morning and what I had for breakfast that morning. So there’s going to be lots of different things that affect it.
Most of the time, the things that help you about counterbalance the things that hurt you and so you end up in the middle. And sometimes, it’s more unusual, you have more things that help you and other things that hurt you and so then that gives me the hand-wavy explanation of why a normal curve looks like it does.
I draw a normal curve and I put little smiley faces on the normal curve to say, okay, so when we’re in the world of knowing things, you do a lot better than most kids and I draw a little [01:10:00] smiley face up here. And over here, when it comes to keeping track of what you’re thinking about and holding lots of information in your head at once, you’re much more like most kids there, or that’s a lot harder for you and I put the smiley face someplace else. I build up this color-coded thing so that they can see the score splits. When I have that kind of a split, we’ll say, oh, and I try to tie it to their experience.
People who have this often have the feeling of I feel like I have all these ideas and I can’t remember them all. And the kid will go, oh yeah. I’m like, well, that’s where we saw that on that score. So I’m trying to tie it to them.
The language, we’re going to keep it nonjudgmental. You know a lot of stuff, here’s what’s harder for you. It can be hard for you to do easy things quickly without getting bogged down. I go back to the kid’s reason for referral.
A [01:11:00] part of why I want to keep the kids in this is because if we don’t tell them, besides the fact that they’re going to get information off the internet or their friends or whatever, they’re going to get a lot of wisdom, they will tend to assume there’s something deeply wrong with them. There’s a lot of shame.
If there is something that’s diagnosably wrong, I want to be able to frame that in terms of, it’s not a death sentence, it’s this year’s, here’s what are the good aspects of this. Here’s what are the more troublesome aspects of this. Here’s how you can use your strengths to compensate for your weaknesses. Here are some things you can do to help yourself.
I have to get to report writing. The other thing is that I leave a ton of feedback at a time. If it’s just an uncomplicated IQ test, I will allot an hour but if it goes a little over, I won’t get upset. If it’s a full evaluation, [01:12:00] I try to get it done in two hours, but sometimes parents aren’t done. Sometimes they’re not done, especially if there’s a developmental diagnosis on the table.
Gifted kids tend to have gifted parents and they are also used to knowing a lot and understanding a lot. They don’t want me to just say, here’s the answer. They want to know, how’d you get there? What exactly was that test? No, that can’t be right.
Usually, I don’t get outright arguments, but I get a lot of curiosity, a lot of debate. I accept that asking questions, it’s how I learned. I ask a lot of questions when I’m a student too. So I don’t get upset by the lots of questions. I’m like, I need to prove my case. I need to show them the data.
Oftentimes I’ll pull out the rag. I’ll show them, I say, here, this is the Rey complex figure. And they go, that’s a complex figure. I say, yes, that’s a complex figure. And [01:13:00] I say, what do you notice about it? They’ll tell me different things. I’ll say, okay, so now I’m going to show you, first thing I asked you to do was to copy it. And I’ll say, we noticed and they’ll see like, wow, the kid missed a lot of the important details even though it was right in front of them or wow, they’re seeing all the pieces, but they don’t see how it all fits together.
If I had only one traditional neuropsychological test, the Rey would be the thing. I find that it usually gives me a lot of information. I hate to say this in front of a lot of neuropsychologists, but the Rorschach is my favorite of tests. It gives me a ton of useful information. It’s really good. You can hate on me for it if you want, but it’s very helpful. I would never diagnose anything on the basis of the Rorschach alone, but it gives very rich information.
To go back to Rey, I’ll show them, they’ll be able to see, wow, this kid can see all these details, but they don’t see how they [01:14:00] fit together. I can also use that to build empathy. For a lot of folks with autism, it’s like every detail in the world is exactly as important as every other detail in the world. And that makes them really observant, but it also gets them overwhelmed.
It’s hard for them to fit it into a coherent whole, and you can see that here. They can see that on the thing. And then I can show them the recall copies. I say, and here’s what they internalized from it when I asked them to do it from memory. You’ll see details randomly scattered on the page or whatever, or the kid with ADHD where they’ve got the basic idea, but everything’s just missing and it’s very sloppy. The point is I show the parents primary data so that they can see where I’m coming from.
There’s a lot of family therapy [01:15:00] involved. There’s often oh yeah, my brother’s just like that too, or my spouse is just like that, or I’m just like that. I think that’s certainly not specific to gifted kids but doing that family work around acceptance is important.
My number one rule is, I don’t want my reports to be used as fish wrap. If they’re rejecting the report, if they go, I paid all this money and she’s wrong, then I haven’t been able to help this person. So I do try to accept that it’s going to take longer. I want them to feel that they’ve had their questions answered.
Sometimes they’ll send me emails later with other questions. What I do is I take notes during feedback and I make a point of making whatever I told them, I make sure I incorporate those questions into the report as well and make sure that that information goes in. [01:16:00] It’s long but it’s worth it because ultimately, if I’ve gone to all this trouble to do the report and then they don’t believe me, then I’m not helping anybody.
Dr. Sharp: Right. Believing comes through educating and just walking them through. I don’t know about you, Aimee, but I find those feedback sessions fun if somebody is asking nuanced questions like what’s the difference between rote memory and working memory? Why can they do this but not that? That’s fun for me. I’m like, okay, we can talk about this.
Dr. Aimee: I’m trying to tie it to their everyday experience too. What’s always amazing is when I’ll tell them something like, oh, I’ve noticed that you come up with a million ideas but then you struggle to get them all out before you’ve forgotten them. And they go, how did you [01:17:00] know? It was something they hadn’t told me. If they had noticed it and crystallized it, they probably would have told me but they didn’t realize it.
And so I’m able to show them things and then they go, oh yeah, that is like me, or that is like my kid, that explains it. And so I’m helping them build. I always say, I do diagnosis because the universe demands diagnosis, but I care about case formulation. I want to build a coherent understanding; why does this person have the dilemmas and struggles they do? What can we do about it?
The goal is for it to be really empowering. A lot of times, it helps people build compassion for themselves and for their kids and it helps them build a sense of hope that I’m not stupid. Kids tend to globalize because people tend to globalize. [01:18:00] It’s like, you’re not stupid at all. Here are the things that you’re super good at and here are the things that are a lot harder for you. And it is normal to not be good at everything.
Here’s why you like the things you like and here’s why the things that are hard for you are hard for you, and here’s what you can do. Ideally, it’s a joyful process. It’s not always, it can be hard.
Dr. Sharp: Of course.
Dr. Aimee: Is a grieving process often. There’s that sense of the death of the ideal child in mind.
Dr. Sharp: Oh yeah. Of course.
Dr. Aimee: I’m a therapist in addition to it. I know that some people who do testing, they’re testers. That’s what they like. I’m a therapist at heart. In some cases for adults, I’ll do a formal therapeutic assessment where the [01:19:00] report writing looks completely different. Are you familiar with Steven Finn’s work?
Dr. Sharp: Yeah, I interviewed a psychologist, Dr. Megan Warner, who’s also over on the East Coast. She’s over near Yale. We did a whole episode on therapeutic assessment, I think it was episode 10.
Dr. Aimee: I think both formal therapeutic assessments where you’re going towards a letter or a personal fable or something like that, I love doing that with people, folks because you can leverage somebody’s imagination, develop a story.
For a lot of the adults who come in, it’s like, I can’t keep a job. What is wrong with me? Or I’m struggling to deal with personal dilemmas. My father is dying or whatever, the things that people deal with and using the testing as an extended therapeutic session. Having them join in the process of interpretation with [01:20:00] you, it’s really good for them. It leverages their strengths.
They’ll often come up with ideas that, oh, I’m not really sure. I might have an idea but I’m not really sure and they’ll go, no, it’s this. I’m like, oh, yes, now I see it. I do share the process as much as I can with them.
Even when I’m going to be writing a formal report because there’s an audience out there or I need to, I still try to keep to the idea of keeping them as a partner in the process.
Dr. Sharp: I think that’s a great perspective just to have with assessment in general. It’s strength based and you’re trying to enroll the person and ultimately they’re the ones who benefit, hopefully. Well, this is great, Aimee. I feel like we have packed so much helpful information.
Dr. Aimee: I talk too much.
Dr. Sharp: No, this is fantastic. You basically walked us through from start to finish how [01:21:00] to develop and run and the structure of practice aimed at gifted and twice-exceptional kids and young adults, of course. This is amazing.
Dr. Aimee: And adults. There are people out there who do a lot of work with adults. I have adults in my therapy case where I have quite a number of adults.
Dr. Sharp: Well, it’s a needed service. It sounds like you’re doing a great job.
Dr. Aimee: Yeah. It’s one of my goals in life is to teach more people. One of the other sticky things on my blog is, I was helped to find a therapist for a gifted client and people write to me, do you know anybody in lower Townsville? And I’m like, no, I don’t. I would love to have a broader network of people who are culturally competent with this group both for therapy and for testing and do a good job.
Dr. Sharp: Just to bring it full [01:22:00] circle, we started talking about how working with gifted individuals is maybe a cultural competence and it helps to view it that way. Do you have any parting words or resources for psychologists who might want to learn more about working with gifted individuals or testing with gifted individuals, anything like that?
Dr. Aimee: I think there’s two things. One is, I mentioned that, oh no, my kid might be gifted. That’ll enter you into a lot of the main resources; go to Hoagies’ website, see what’s going on. There’s part of that you need to educate yourself.
There is a book, they’ve just had a new edition of it called The Misdiagnosis and Dual Diagnosis of Gifted Individuals. It’s a lot of clinical lore, but it’s quite useful in orienting because there are issues with overdiagnosis, underdiagnosis, and misdiagnosis.
There’s a lot of [01:23:00] times where people want to explain away very pathological behavior on the logic that, oh, that must be because they’re so smart. There’s times where we don’t see how much they’re struggling because they’re so smart and they’re working hard at it, and there are times where we misattribute.
So like I got this one little boy. He was adorable. Both of his parents had doctorates in mathematics and he had memorized the entire public transit schedule of the Greater Boston area.
Dr. Sharp: Oh, goodness.
Dr. Aimee: Okay. You’re, the kid must be on the spectrum. I always use memorizing train schedules as the everybody’s idea of what autism is, like, oh yeah, that’s what they do. And I said, most of them don’t do that. This one did.
I tested him and I played with him and I talked to him, no, he was a little boy who lives in the big city and his parents don’t own a car. [01:24:00] It was interesting and it became like this fun family thing and he really does love public transit. It’s really interesting. Maybe he’ll become a civil engineer or something like that or a city planner or something someday.
It was just interesting and fun. It gets him out in the world and it orients him, I feel safe. I know what bus that is that’s coming because it’s this time of day and I’m on this street, so I know what bus that is. Both in how he interacted with me and how he did on the various tests, I was like, no, he is just anxious. It had more of an OCD flavor than autism stuff.
So people will miss, that’s the kind of thing where somebody would take that and go, oh, well, obviously, and you’re like, no. So it’s really important to be aware that you can make mistakes in all those directions. That book’s a good place. It is written for clinicians.
[01:25:00] Steven Feifer has some stuff. The AP does have a book on the psychology of giftedness. Most of the stuff is focused around kids in school with adjustment disorders.
The other piece that I would want to say is most of the psychologists that I know are pretty smart. You have to be pretty smart to get into the field, especially if you like doing testing because to do the coursework to do that, to do the training to do that, so chances are good that you are smart yourself. I think it’s important to work through what that has meant to you and to get comfortable within yourself.
When I think of it in terms of cultural development, we talk about the notion of developing a multicultural self.
To really know, what is this to me? I see myself [01:26:00] as an ambassador between these two cultures. The problem is that what you have, it’s just like anything else, what you haven’t metabolized, what you haven’t processed, you’re going to act out.
When people talk to me about painful experiences that they’ve had, it often has that flare of somebody trying to cut you down a notch, you’re not so smart, you’re trying to stop being so oppositional, you think you know everything or whatever. And so you need to get comfortable with your own intelligence and accept what it means to you, what it’s been.
It may have affected your life, it may not have affected your life. How it feels to know that there are people out there, no matter who you are, I guarantee you there are people who are smarter than you, and there are people who are better than you at everything and what that’s like? Because if you haven’t thought it through, you will act it out with your clients, and that’s not okay. [01:27:00] It’s just like any other countertransference reaction.
Dr. Sharp: Yeah, but one that we don’t talk about. This is literally the first time I’ve heard anyone mention that as an identity to be aware of as you’re working with folks. I think that’s super valuable. My brain is spinning, all these experiences over the year, okay. This is great.
Well, Aimee, I so appreciate all the time that you spent with me this morning and I think that people are going to find this really helpful.
Dr. Aimee: I’m glad. It was great fun.
Dr. Sharp: Good. If folks want to get in touch with you or follow up for any reason; what’s the best way to contact you?
Dr. Aimee: Usually email. My website is www.davincilearning.org. My email is aimee@davincilearning.org. [01:28:00] That’s usually the easiest way to set things up. I do consultations, for quick questions, I often answer them and if people want me to sit down and do a consult with a case with you, we do that hourly. I do that too.
Sometimes people are struggling with that, oh, I’ve got this tricky, not sure what to do with, I’m happy to help out with those because very often it is a pattern that I’ve seen, you may not have seen it a lot because this is who I work with, I probably have seen that pattern before.
Dr. Sharp: Great. That sounds awesome. We’ll put all that information in the show notes too, so that folks can get in touch with you if they want to. Well, thank you again. This is great. I really appreciate your time, Aimee.
Dr. Aimee: Great. Thank you.
Dr. Sharp: Take care. Okay, y’all. Thanks so much for checking out that episode with Aimee Yermish. Lots of links in the show notes. I’m just struck by how this content though it is, gosh, at this point, probably over four years old still holds true. There’s a lot of relevance and I hope that you took a lot away from that episode.
We are headed into the springtime. I hope you are all doing well, getting those vaccines, if you’re choosing to do so and having a little hope there might be a light at the end of the tunnel. I will be back with you, of course, with a business episode next week or this Thursday rather, and invite you to tune in for that.
If you have not subscribed to the podcast, I would invite you to do so. You can do that easily in iTunes, in Spotify, it is follow. So look for that button and the more people that do that, the easier it is to spread the word and that’s always a good thing, to get folks talking about testing and listening about testing if they’re in the field. So thank you so much. Take care. I’ll see you next time.
Information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional psychological psychiatric or medical advice, diagnosis, or treatment.
Please note that no doctor-patient relationship is formed here. Similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.
Click here to listen instead!
