The Results III

The most painful part of the report was to learn that I was part of the problem, perhaps the biggest.

According to the report there were two problems. 1) a problem with "sustaining attention" and 2) an ongoing conflict with me. He was feeling that there was "something wrong with him" and that I was putting on him a big "pressure to perform" that he could't meet. Understandably, this was bringing a great deal of anxiety, uncertainty, frustration, feelings of rejection, feeling of not being understood, poor self image, loneliness and emptiness.

I was totally devastated and for days I felt misserable, depressed and terribly guilty.

Why did I run the tests?

I wonder why one of my earliest reactions to the report was to reasearch about the tests and to run them to myself.

First, I think it was a reaction I typically have when I am dealing with "Black Boxes": I want to know what's inside, I'm driven by curiosity and by my self indulgency of believing that I can do it myself, better. Second, I think I was driven by the need of convincing myself that there was some scientific value in this evaluation that justified its cost and that I haven't been ripped-off. Third, I thought that it would fair to my son to go through some of the monkey-lab-like experience I have push him through, probably against his will, to share with him part of the experience of being the object of a psychological experiment as opposed to being just an outside observer. Lastly, and perhaps and most importantly, I was reluctant to accept that these tests could reveal anything truthfull and provide a believable clue. I was trying to refute them. I was looking for a proof of their worthness, their flaws. It was probably a way to avoid accepting the diagnosis, to avoid moving forward to the next, painful, step, the treatment.

Eventually, I realized that it was pointless to pursue this test investigation further and I decided to move on.

Wisconsin Card sorting test

I also tried the Wisconsing Card Sorting test myself. 

This is test with cards. The cards can have three different attributes: Color, Shape, Number. For each attribute, there are four different possibilities:

• Red, Green, yellow, Blue for Color
• Triangle, Star, Cross, Circle for Shape
• One, Two, Three, Four for Number.

The test starts with four cards with all three attributes with different values:

Then, one by one, new cards are presented. The objective is to add each new card to one of the four decks according to a "matching criterion". This criterion (Color, Shape or Number) is unknow in advance so you have to guess. The software tells you if you are correct or incorrect. It takes very few trials to learn that the matching criterion doesn't change randomly and that you doesn't need to gamble on each trial. For example, the matching criteria would be color, then they would maintain the same criteria for about 20 consequtive trials, until you get an "incorrect". If you pay attention, then you would try for any of the other two criteria until you get a "correct". Then you can adopt the new criterion for the next 20 or so trials. 

Test of Variables of Attention

I tried the Test of Variables of Attention (TOVA) myself. This test is alienating and irritating, even for an adult, no wonder for a kid.

You have to stare at the black screen for 20 minues nonstop. During the test a white square with a small black square inside flashes on the black background. On some trials (some flashes) the small inner black square is nearer the top of the white square:

On other trials it will be near the bottom:

In the first case (first stimulus) you have to respond by pressing any key. If you fail you made a "comission" error. In the second case you have to respond by NOT pressing any key. If you fail you mad an "omission" error. The software records how many responses are right and wrong and your velocity of response. Half of the test you get mostly the square in the bottom and very few times the square in the top. So you have to press the key very few times. The other half you star to get mostly the square in the top, so you have to press the key very often.

The white flashes on top of the black background made me sort of sick. The white square would persist in my retina and would interfere with the following flash. I did a few errors, but I had to push myself hard to keep myself focused during 20 minutes looking at these anoying flushing squares.

I can certainly understand why my son has struggled with this test. It is boring, irritating, alienating and sickening. 

The results II

One of my first reactions after I got the report was to google about some of the tests. I was still trying to convince myself that there was something scientific and deep about them that justifies the big bucks I payed to this woman.

I run accross this webpage, http://pebl.sourceforge.net/index.html. This is a sort of computer language and software to create and conduct "Psychological experiments". The software comes with a number of preprogrammed standarized psychological tests, among others, the "Wisconsin Card Sorting Test" (which they call the "Berg's Card Sorting test") and the "Test of Variables of Attention" or T.O.V.A. The software is open source and free.

I downloaded the software and run these two tests to myself. I'll talk about this in the next posts.

I also came across this  http://pearsonassess.com/NR/rdonlyres/BDF4BB70-D3BD-44CA-B46D-3C1505989D24/0/CVLTC_SA_Wrtr_SR.pdf. This is a sample report for the "California Verbal Learning Test Children Edition" or "CVLTC". I guess that this is another computarized test and that the software creates this kind of reports automatically after the kid is done and the software finishes collecting the data.

As I read across this sample report, I learned that the moderfucker psychologist had copied verbatim paragraphs of the computer generated report into the report she prepared. This was actually quite a disappointment, because for the bucks I payed I was certainly expecting some personal interpretation of the results rather than a cut an paste composition.

Yes, the computer generated report gives some background information about the test that was usefull to have it "quoted" in her report, but I would have felt less disappointed if she at least would have acknowledged the source instead of copying it verbatim. 

The Results I

Ok. I have to acknowledge that there was actually some science behind some of these tests, and that they might be actually worth more than 50 bucks. Not sure yet if they are worth four figures, but I don't regret having them done and I do understand better why it took this psychologist so long to run them.

She gave us a written "report". It was very "impersonal" and cold. It felt like a research report about an experimient with monkeys or something like that.  Half of the report are just results, measured in percentiles and numerical scores.

The Evaluation IV

Ok. Let me present you the facts and give you and idea of what the magic evaluation was about:

This is the name of the "tests". You can google to learn about them and the underlying theory and research that support them:

1. "Hand Dynamometer" test, "Finger Tapping" test and "Grooved Pegboard" test. These tests are to measure "different aspects of handedness such as strength, speed and dexterity". (I didn't know what "dexterity" means so I had to look in the dictionary)
   
2. "Wechsler Intelligence Scale for Children 4th edition". This is an inteligence test, the result of this test is the well known "IQ".
   
3. "Wechsler individual achievement Test second edition". These tests "measure oral expression, listenting comprehension, reading, spelling, arithmetic and writing".
   
4. "Children's memory scale".
   
5. "California Verbal Learning Test Children Version". This is a memory test. In this test he is read a list of items in a "shopping list". There are 3 kinds of items, "foods", "cloth" and "drinks" or something like that (basically 3 categories). The items are not listed by categhory but randomly. The designers of this tests claim that the brain remembers more effectively if you try to remember by category (semantic clustering) as opposed to remember in the order in which the words are presented (serial clustering). The list is recited five times and each time he is asked to recall the items. Each time he is supposed to remember more items (if his memory works as it "supposed to work"). Each one of these repetitions is called by the psychologist a "trial". I guess they like to create this pseudo scientific jargon to make you believe that they are doing something deeper than what they are actually doing, a way to justify the money they charge. Then he is given a second list to see if there is interference with the previous learned list. After 20 minutes they ask him to recall the first list, to measure his "retention".
6. Rey Complex Figure Test. I think this is another memory test, but this one is visual, as opposed to the previous two that are more verbal. He was shown a figure and he had to reproduce it from memory, immediately and after a few minutes.
   
7. "Test of variables of attention". This is a test in front of the computer. He has to "press a button in response to a stimulus and not press a button in response to another stimulus. The computer alternates between both stimuli at varying rates during 22 minutes". This test is certain NOT a diagnostic tool for ADHD for which there is no conclussive diagnostic test that I (or the psychologists and doctors I consulted) know of. I talk about this tets in my next post.
8. "Wisconsin card sorting test". This one is interesting. See my next post to learn about it.
   
9. "Sensory fields".
10. Youth self report.
11. "House-Tree-Person test". Draw a picture of a house, tree, person in that order.
12. "Family drawing test". Draw a picture of the family doing something together.

The Black Box

During a month my son attended many evaluation sessions. Every session would be like a "Black Box" for me. I would take my son to her office. She would take him in. I would go to a coffee to spare some time, she would call me when she was done for the day, I would pick my son up and we would schedule the next appointment. All she would say would be "he worked very hard" or "he is adorable". But no hint of what the heck she was doing with him.

It took her about five or six sessions and a month to complete the battery of magic tests. Finally she decided that she had "collected enough data" and she was "ready to analyze the data".

We waited for days, until she called informing she was done. We scheduled an appointment.

Waiting for her to finish and for the appointment day to come was horrible. I felt miserable, desperate, like if I was waiting for the diagnosis of a brain tumor or something like that. I kept telling myself that it couldn't be that bad and that she would find something easy to fix like a problem with his vision. But deep inside me I knew already what she was going to say.

I knew that she would say he has ADHD and that the "easiest" way to fix this problem is medication. 

The Evaluation III

After a few days of struggling with the decision, I called the woman to negotiate the price. I told her that I wanted to do the "psychoeducational evaluation" with her but that it was too expensive for me. I asked if it could be less. She answered "yes, sure, what figure did you have in mind"?. Honestly, the fair number I had in my mind was about 50 bucks, but I assumed that she woudn't give me a 99% discount, so I tried for a more realistic number. I offered 20% less of her initial price and I asked if I can pay in two payments, half before and half when the evaluation was done.

To my surprise, she accepted with no hesitation, which left me with mixed feeelings. First I regretted not asking for 30% or 40% or 50% less because perhaps she was expecting for a much aggressive number and I came too shy. Second, I thought that perhaphs she was desperate for customers because I might have been her first one in years and she couldn't afford to loose me, which would means that she was not as good as I expected.

Nevertheless I decided that none of these thoughts was helping me so I convinced myself to feel happy with the 20% discount (with represented a three figure number).

Despite of all my doubts, frustration and feelings of being ripped-off, I accepted the fee and scheduled the first appointment for the evaluation process.

The Evaluation II

First session with the psychologist was with the two of us (without my son).

These psychologists have this scam that they call the "intake interview". I knew already that I wanted a "Neuro-psycho-educational evaluation" and I told that to her, but she insisted that she needed to meet the parents first for the "intake interview". We sat in the couch and we repeated the story to her. She didn't say anything usefull, she just said that she recommended the fucking "Neuro-psycho-educational evaluation" (which I already knew) and nothing else.

I was expecting some positive closing statement from her, some quote that would let me feel that the intake interview was worth something, that she will be the guide I was looking for and she would shed some light. But she didn't. She didn't say anything new or useful or that could onfort me or give me some new insight, nor she explained any details about the "magic tests" that she would run. 

She just handed in a questionaire (the so called "Achenbach child behavior Checklist") and explained how much the "evaluation" would cost. It was about the same four figures the first psychologist wanted to charge ($100 more expensive). Of course, this figure was on top of the three figures she had already charged for the "intake interview".

The evaluation of the "Evaluator": My second struggle.

My wife didn't like the first psychologist because this guy said that having him repeat third grade might have been actually detrimental and made the problem worst.

He might be right or he might not, I don't know, however, I expect from a psychologist some degree of empathy as opposed to telling me in the first session that I screwed up with a decision I had taken 6 month before.

We didn't like the second one either. He looked like a Hollywood celebrity, wearing ultrafashion glasses, driving a convertible BMW and sounding more like an astrologyst or a preacher than a psychologyst. He did said something that conforted me: He said that having two parents with diametrally different approaches to parenting (as he quickly glanced) was probably beneficial for my son because it would make him more creative and intelligent. 

Nevertheless, we went to a third one, a woman, recommended by somebody else. The difference between this woman and the previous two men is that this woman is "out of network" meaning that I have to pay out of my pocket 4 times what I payed the other two guys (which only charged me the "copayment" which is already expensive because my Health insurance sucks). Furthermore, all the hassle of fighting the Health Insurance company to get some of the expense reimbursed (if any) is now on my shoulders.

The evaluation of the "Evaluation": my first struggle.

What a heck is a "Neuro-psycho-educational evaluation" and why it is so expensive? I'm talking here about a four figure number.

I only learned exactly what this is about after we went through it (and payed for it) and I'm going to talk about it in another post.

But, when this psychologists recommended the "evaluation" I struggled. The "evaluation" felt to me as a kind of "magic black box". They claim that you need special training to run this tests and interpret their results. They claim that they have to spend many hours with the kid (and with the computer) to run the tests and that is why it costs what it costs. So, you pay the money, you give him/her your kid, and after some hours where they run the magic tests, they give you back a written report with their findings and a recommendation.

I was reluctant and frustrated. I questioned then (and today) whether this "black box" test approach actually works for "psychological" or "educational" issues. For example, you can run a lab test to detect an infection. Those tests are conclusive, because, I imagine, there is some substance that reacts chemically with the bacteria or virus that causes the infection, so, by looking for some evidence of this chemical reaction (like a change of color or something like that), you can assess the existence of the infection. However, there in no chemistry in these "psychoeducational" tests that I know, so what the heck they are and how do they work? Are they conclusive and objective? Can you measure attention objectively? Can you measure handwriting skills? Every kid is different, and learns at his/her own pace. How can I know if this is going to be worth and that this stupid psychologist is not trying to squeeze my money and make a profit out of my desperation?

Nevertheless and hesitantly, I agreed to the tests, and to pay the charge.

The Evaluation I.

He did third grade last year. The previous summer the teacher had recommended tutoring. By the end of the year, she recommended to repeat it "to give him more time".

We thought that repeating third grade (and changing school) would solve the problem but a few weeks into the new third grade, we realized the underlying academic problems were still there.

So we went to a first psychologist. After listening our story, he recommended a "Neuro-psycho-Educational evaluation". Then we went to a second psychologist, and after listening to our story, he also recommended the same "Neuro-psycho-educational evaluation".

The bad news is that the "Neuro-psycho-educational evaluation" is not covered by the health insurance, therefore, it has to be payed out of pocket.

Some background

Let me start stating the "symptoms". To make a long stroy short, he has been "behind" in reading and writing almost from kindergarden. He makes a lot of "careless" mistakes in his spelling and math (adding instead of subtracting and thinks like that), his handwriting is rather messy, there is something in his grip and fine motor skills that I can't describe. He is rather forgetful. For example, he forgets his homework in the school very often. Needless to say that he distracts very easily with anything in front of him. He plays with his feet and hands a lot. He needs to hold or play with something in his hands all the time, he needs a lot of breaks, needs a lot of reminders to stay on track in his tasks. He loves watching TV (can spend hours and hours nonstop) and videogames. He loves outdoors activities, particularly basketball, soccer and golf. He is also adorable, cheerful, joyful, fun, sensitive. He is a mensch and we love him with all our heart. 

First Post

Hello. Two months ago (Feb-09) my son was "diagnosed" with ADHD (non otherwise specified).

I'm starting this blog to share my feelings, frustrations, thoughts and actions I'm taking to solve this problem. So far It has been very challenging, and I'm struggling with it.