Frequently Asked Questions

Dr. Hale is committed to an evaluation process that includes timely feedback, both verbally and in writing.  Feedback sessions to discuss findings are typically scheduled within a week of final assessment sessions, and a written report is mailed within approximately two weeks of the feedback. 

Some psychological and neuropsychological practices use someone called a psychometrist, testing assistant or neurocognitive assistant.  This person is usually a bachelors-level, unlicensed employee who works directly with you or your child to administer and score tests that the psychologist later interprets.  

Dr. Hale performs all of her own testing and conducts each assessment personally.  She does not have any employees, supervisees, interns, psychometrists, testing assistants, techs, associates or students taking part in any aspect of the evaluation process.  

Dr. Hale believes that a meaningful evaluation is dependent on taking the time to get to know you and/or your child, on directly observing the unique process and approach that lies behind a test score and on accurate, first-hand interpretation of assessment results.

The evaluations conducted by a clinical psychologist in private practice are very different from the evaluations conducted by a school psychological service provider or school psychologist specialist in a child’s school.  These differences also apply to evaluations completed by a private school student’s local school district (the district within which the private school, not the student, resides).  Some differences that parents are most interested in understanding are:

Confidentiality:  School-based evaluations are a permanent part of a child’s educational record and automatically shared with a child’s school team.  Similarly, all results from a CDS evaluation are shared with the team determining eligibility for services and with a child’s public school when transitioning to kindergarten.   

Evaluations conducted by a psychologist in private practice are only shared with others when parents give explicit permission to do so. 

Person conducting the evaluation:  Often, a referral for special education or early intervention services includes evaluations by two or more evaluators (e.g., school psychologist, special education teacher, speech and language clinician, instructional strategist, occupational therapist, physical therapist, behavior strategist), all of whom are employed by or under contract with the school department or CDS.  

For the psychological portion, most evaluators working for public school districts have a master’s degree in school psychology and are trained to work with children and adolescents in a K-12 school setting.  Their training emphasizes assessing students in order to gain information that guides educational decisions made by your child’s school team and supporting students within their school environment.

A clinical psychologist in private practice is not employed by your child’s school or by CDS and practices independently of any school regulations, policies or requirements.  He or she has a doctoral degree in clinical psychology.  Clinical psychology is a psychological specialty that emphasizes continuing and comprehensive mental and behavioral health care for individuals and families across all ages and across diverse settings.  These settings may include schools (spanning early childcare settings and preschools to graduate universities), hospitals, outpatient clinics, community organizations, workplaces and research institutions.  

In contrast to the separate, domain-specific evaluations completed by several different evaluators as part of the special education or early intervention process, a clinical psychologist conducting a comprehensive evaluation in private practice will often include and integrate assessment measures shared by other disciplines (e.g., academic, language, fine motor, behavior, adaptive development).  

Purpose of the evaluation:  The purpose of most school-based evaluations is to inform whether a student has a disability as defined by the Individuals with Disabilities Education Act (IDEA).  Evaluations for younger children that are conducted by CDS – which, like school districts, falls under the supervision of the Maine Department of Education – are also for the purposes of identifying a disability in accordance with IDEA.  

The purpose of a private practice evaluation with a clinical psychologist is to address the unique set of questions and concerns that parents and children have about any number of issues related to learning, attention and other executive function skills, processing, memory, problem solving, language, social communication, social skills, friendships and interpersonal relationships, resiliency, levels of independence, family dynamics, behavior, anxiety, depression, anger, self esteem, overall mental health and coping capacity for various types of stressors and transitions (e.g., relocation, birth of a sibling, parent separation, new school, death of a loved one, traumatic events).

Scope of the evaluation:  There are thirteen possible disabilities under which children ages 6-20 may be evaluated and identified for special education by their public school district.  That number increases to fourteen for children ages 3-5.  Children under age 3 are identified as either having developmental delay or as having a condition with a high probability of resulting in developmental delay, as defined by state and federal regulations.  

The scope of evaluations conducted by school districts and CDS is limited to the information that school/early intervention teams consider relevant to a suspected disability within those 13-14 choices.  Generally, school-based evaluations do not yield a diagnosis, and recommendations for services outside of school are not suggested.  Moreover, special education is a deficit model whereby school and CDS teams are tasked with measuring whether a child’s skills are below a pre-determined level of impairment that would qualify them for services.  

The breadth and depth of evaluations conducted by a clinical psychologist in private practice are collaboratively determined in response to the questions and concerns shared by parents, children, teachers, pediatricians, psychiatrists, therapists, counselors, case managers, tutors and/or other providers.  

When diagnostic clarification is a question of concern, a clinical psychologist in private practice is able to confirm or rule out a diagnosis based on the diagnostic system used by providers across multiple disciplines (psychologists, pediatricians, family physicians, neurologists, social workers, psychiatrists).  This diagnostic system classifies over 200 mental health and neurodevelopmental conditions and is distinct from the 13-14 disability categories identified by CDS and schools. 

The scope of a private practice evaluation may also extend to include a comprehensive understanding of a child’s strengths and recommendations across many avenues of support (home, school, community settings and multi-disciplinary providers).  It is important for parents to understand that CDS and school districts are not required to implement the recommendations made by an outside provider (see FAQ titled:  We had an evaluation done by another psychologist or neuropsychologist.  Why won’t our school district accept it?).

Feedback:  Parents receive feedback about CDS or school-based evaluations in the form of a written report.  Special education regulations dictate the components and the purpose of the report.  Special education regulations additionally dictate that reports cannot speak to eligibility or placement, as these are determined by the school or CDS team and not individual evaluators.  After final reports are written, results are verbally reported out on at a meeting with other members of a child’s early intervention or school team (e.g., teachers, school administrator, other evaluators, school counselor, therapists).  

Clinical psychologists conducting evaluations in private practice provide feedback in a multitude of ways.  All psychologists are required to keep a written, confidential record of an evaluation.  However, the content, format, length and style of written evaluation reports are variable and informed by the psychologist’s areas of expertise and the potential uses of the evaluation report.  

Many clinical psychologists also review findings through a face-to-face feedback with parents.  In Dr. Hale’s practice, this is a private, collaborative discussion that occurs before the completion of the final written report.  In many cases, Dr. Hale also conducts follow-up consultation sessions with children and adolescents in order to provide psychoeducation and to de-mystify their learning and other challenges they may be experiencing.  

School districts are not required to accept evaluations by evaluators who are not employed by the school and who are conducting evaluations outside of the formal special education or 504 referral process.  Special education regulations only require that school districts “consider” outside evaluations.  Some of the most common reasons why an evaluation may not be considered or may be only partially considered by a school district are: 

• In the case of consideration by an IEP team:  The evaluation did not assess for or clearly document results that align with IDEA’s disability definitions (e.g., a pattern of inattention and/or hyperactivity-impulsivity for Other Health Impairment; measures of adverse effect for Other Health Impairment, Autism and Emotional Disturbance; confusion between a diagnosis of Specific Learning Disorder and eligibility criteria for Specific Learning Disability; confusion between a mental health diagnosis and eligibility criteria for Emotional Disturbance).

• In the case of consideration by a 504 Accommodation team:  The evaluation did not provide findings or clear documentation of a mental or physical impairment and/or did not address what major life activity or activities may be limited.

• The evaluation did not address how the disability is demonstrated in the school setting by including school-based input and assessment data (e.g., review of school records, teacher and school staff interviews, standardized teacher rating scales, classroom observation).  

• The conclusions and/or recommendations were not based on or derived from evaluation results (e.g., a diagnosis of Autism Spectrum Disorder when there were no measures of autism spectrum symptoms, a recommendation for speech and language therapy when no aspects of language or communication were assessed).  

• Diagnostic clarity was not provided, limiting the degree to which results could inform educational planning.

• Recommendations were not evidenced-based practice.  

• The evaluation relied on outdated, unstandardized and/or invalid assessment measures.  

• The evaluation relied on only one test, measurement or data source.

• The evaluation contained errors in scoring, documentation or interpretation.

Dr. Hale appreciates that delaying an evaluation based on a wait-and-see approach takes into account the varying paces at which young children develop, the wide range of what may be considered typical for meeting developmental milestones and the possibility for catching up to peers before trying to assess for any measurable delays.  

Dr. Hale also recognizes that this wait-and-see approach has the potential to miss areas that would benefit from early intervention.  The benefits of early intervention are one of the most well-researched findings in the field of child development.  Numerous studies attest to powerful short- and long-term impacts of identifying and addressing early differences, delays and challenges for young children.  This is true across a range of potential concerns (e.g., language delays, social and autism spectrum-related challenges, mental health, learning disabilities, behavioral difficulties). 

Some practitioners and educators believe that children under age 6 are too young to test and that the results will not be valid.  This is a myth.  There are research-based assessment instruments for infants, toddlers and preschoolers.  When integrated into a comprehensive evaluation conducted by an evaluator who has specific expertise with these age groups, these instruments provide meaningful and valid information about social, language, cognitive, motor, adaptive, emotional and neuropsychological development.  

Through partnerships between parents, educators, pediatricians, therapists and other providers, this information is used to guide intervention planning and educational decision making.  In Dr. Hale’s practice, parents often use findings from their young child’s evaluation to guide their parenting and day-to-day approaches to supporting their child within home and other family settings.  

The process of asking for and receiving accommodations in college and graduate school is different than in high school.  Each college and university has its own requirements for documenting the presence of a disability and the related need for accommodations.  

In Dr. Hale’s experience ensuring that her evaluations align with the specific requirements of the colleges and universities attended by older students in her practice, a prior 504 Accommodation Plan or Individualized Education Program is not always necessary.  It is important to also recognize that having a plan in place during high school is often insufficient for obtaining continued accommodations in college.  Particularly for students with learning and attention-deficit disabilities, required documentation usually includes a recent evaluation.   

A psychiatrist is a physician with specialized training in the biological aspects and medical treatment of mental illnesses.  Psychiatrists prescribe medications that impact mood, anxiety, attention, thinking and/or behavior.  Some psychiatrists also provide therapy.  Typically lasting anywhere from forty-five minutes to two hours, psychiatric evaluations rely heavily on interviews and are geared toward arriving at accurate diagnoses and treatment.  These diagnoses are distinct from the disabilities under which children are identified for special education services by CDS or a school team.

A psychologist is not a medical doctor.  In most cases, psychologists cannot prescribe medication. There are a few states that grant prescription privileges to psychologists who undergo added training.  Maine is not one of these states.  Psychologists have a doctoral degree (PhD, PsyD, EdD) and advanced training in biopsychosocial assessment, treatment, prevention and research across the lifespan.  

Comprehensive psychological evaluations typically last several hours and occur over multiple appointments or sessions.  They rely on a range of assessment procedures, including interviews, observations and standardized testing instruments that measure different domains of functioning and development.  The outcomes and uses of a psychological evaluation are diverse and dependent on the unique questions and concerns for the individual being evaluated (e.g., provide diagnostic clarification; inform educational, vocational and/or intervention planning; highlight learning style and profile; understand areas of resiliency; measure progress and responses to intervention).  

The impression that children and adolescents need to be evaluated a second, third or fourth time partly stems from the requirement that public schools evaluate students receiving special education services every three years.  There are also some hospital-based and community-based assessment clinics that automatically recommend reevaluation on a one-, two- or three-year schedule.  

Dr. Hale does not subscribe to a fixed recommendation that all children or young adults need to be reevaluated at a certain time.  Rather, she believes that the decision to have your child come back to see her for another evaluation is highly individualized.  She also believes that for some children a reevaluation may not be indicated or needed.   

Dr. Hale’s practice does include reevaluations for children and young adults who would benefit from another comprehensive evaluation later on in their development.  The timing of these reevaluations is often determined by major school transitions (e.g., the start to preschool, elementary school, middle school, high school or college), the emergence of new concerns, questions about progress and/or questions about the appropriateness of interventions given progression through various developmental stages.  

Until the start of the COVID-19 pandemic, the use of neuropsychological and psychological assessments via telehealth was relatively rare.  In an attempt to quickly adapt to meeting evaluation needs under new public health guidelines, some psychologists are administering assessments remotely through a telehealth platform from their office to a client’s home.  

There is considerable disagreement about the appropriateness of conducting evaluations over telehealth.  Moreover, some related service providers, school districts and state-funded agencies have reservations about the findings from telehealth evaluations.  What follows is an overview of some of the arguments against and for telehealth assessment and evaluation.  Please note that this overview is based on an initial inquiry into this topic as of July 2020 and is not an exhaustive summary.  

Arguments Against Telehealth Evaluations

Professional competency:  Competence is the knowledge, skills and judgment needed to adequately fulfill a professional role.  Psychologists are ethically required to practice only within their areas of competency.  This competency is determined by their education, training and experience.  For many psychologists, the onset of the pandemic is the first time they have conducted or considered conducting evaluations over telehealth.  

Critics of tele-evaluations question how it is possible to claim competency in an area of practice for which most psychologists have not received any formal graduate education, systematic sequence of training, supervised clinical experience or ongoing application to their own practice beyond the last few months.  

Limited research:  There are very few studies that have been conducted on the delivery of psychological and neuropsychological assessments over telehealth.  In the small number of studies that have been completed, tests given over telehealth resulted in scores that were roughly the same as when those same tests were given in person.  

The majority of this research supporting tele-assessment has been conducted with adult populations and with the implementation of a remote-site, proctored protocol (e.g., you or your child go to a clinic, school office or hospital setting and a trained proctor facilitates the remote testing process).  The equivalency of in-person neuropsychological or psychological testing with testing occurring over a telehealth platform into your home is unknown. 

Validity:  Changes to how a standardized test is administered, such as adapting an in-person test to remote administration, can impact the validity or meaningfulness of the test results.  While several test publishers have recently provided guidelines for how to best adapt their tests to telehealth, the limited research base for tele-assessment and tele-evaluation, particularly with pediatric populations, calls into question whether the test scores obtained over telehealth are really reflective of what the test was intended to measure.  This then limits what a psychologist is able to confidently conclude and recommend. 

In a survey of over 2000 psychologists conducted by Multi-Health Systems this spring, 78% of neuropsychologists and 80% of school psychologists rated lack of validated tools for use in tele-assessment as very or extremely challenging.  That said, 46% reported that they planned on administering tests remotely within the next 1-3 months.  Loss of service capacity as a result of the pandemic (e.g., neuropsychologists in private practice reported an 82% loss) is a potential factor contributing to the anticipated shift to tele-assessment despite the lack of validated tools.

Usefulness of results: Many parents and young adult students seeking an evaluation are wanting to use the results to advocate for accommodations and/or services from their public school districts, private schools, colleges, employers or state-funded agencies.  Because of the potential limitations to what can be accurately and meaningfully measured over telehealth, those making eligibility decisions may question the conclusions and recommendations from a tele-evaluation and/or decline to consider the evaluation at all.  

As an example, the Department of Education in Pennsylvania stated that standardized tests may not be administered virtually and that remote evaluations conducted while students are in their homes are not considered standard conditions.  The New Jersey Department of Education similarly placed barriers to telepractice service delivery for students.  

Several school psychologist associations have also voiced opposition to telehealth evaluations in position statements and letters to their state departments of education (e.g., California, New Jersey, Florida, Montana, Connecticut, Alabama, Arizona, Delaware, Illinois, Louisiana, Michigan, Pennsylvania, South Carolina, Texas, Washington Associations of School Psychologists).  

In Maine, it is unclear how, whether and to what degree public and private schools will consider evaluation findings and recommendations when the evaluation was conducted over telehealth and not in accordance with standardized administration procedures.  

Arguments for Telehealth Evaluations

Validity:  Although the research into the efficacy of tele-evaluations is in its infancy, researchers in this field highlight that initial evidence is promising and largely in support of some level of equivalency between face-to-face evaluation results and results obtained over telehealth.  

This research-based conclusion in support of tele-evaluations spans a range of assessment measures and domains of functioning (e.g., language, autism spectrum symptoms, mental status, cognitive problem solving, verbal memory, verbal fluency).  The Society of Personality Assessment further points out, “a great deal of personality and psychopathology assessment is absolutely feasible to be accomplished during the COVID-19 crisis and beyond through tele-assessment procedures and methods.”  

Access to intervention:  Many psychologists see the careful adaptation of traditional, in-person assessments to remote administration via telehealth as crucial to providing timely identification of needs that would benefit from intervention.  Tele-evaluations provide students, parents, schools, physicians and community-based providers with the information needed to guide access to intervention.  

As highlighted by a position statement in favor of remote assessment written by the Massachusetts Psychological Association and the Massachusetts Neuropsychology Society, delays in assessment for students with special needs not only denies access to the special educational eligibility process that they are entitled to but also threatens children’s long-term educational and psychological wellbeing by delaying the provision of services and interventions during developmentally-sensitive periods.    

Parallels to remote learning:  Proponents of tele-evaluations see a direct parallel between remote instruction and remote assessment as viable options during the COVID-19 pandemic.  While there are clear limitations to the meaningfulness (or some would say validity) of remote learning, particularly for students with disabilities and learning differences, those limitations did not stop schools from adapting their delivery of teaching to provide remote instruction and learning opportunities into their students’ homes. 

In addition to the relevant parallel between providing evaluations through telehealth adaptations of assessments and providing instruction through remote adaptations of in-person teaching, tele-evaluations are a crucial method for understanding how students process information, learn and self regulate within the context of a remote education during a pandemic.  As such, tele-evaluations are poised to inform the types of accommodations and supports that are specifically needed for fostering a successful remote learning experience throughout the pandemic.  

Wider range of usefulness for results:  Informing eligibility for accommodations and/or services within a public school system in accordance with federal and state regulations is one potential outcome of a child or adolescent evaluation.  Some opponents to telehealth evaluations consider those regulations as the key rationale for adhering to the highest standard of validity possible and, thus, for denying consideration of any findings obtained over telehealth.  There are, however, a number of other uses that are not as closely tied to federal or state regulations.  

Other uses of evaluation results that fall outside public school regulations include informing private school learning plans, helping parents make decisions about their child’s education or future life plans and guiding tutors, counselors, therapists and other community-based providers in their intervention planning.  Indeed, some potential recipients of telehealth evaluations have indicated an openness to using results in order to provide timely support and care.   

Psychologists evaluate, not tests:  A comprehensive evaluation relies on a psychologist’s clinical expertise to interpret and integrate multiple methods of assessment, well beyond a test and the test’s corresponding score.  This expertise includes careful consideration of potential impacts to the validity of various findings.  Purposeful deviation from standardized administration procedures is one such potential impact to validity.  

Before the pandemic, there were any number of reasons for a psychologist to deviate from standardized procedures and adapt testing in some way based on individual circumstances and the needs of the child being assessed.  Examples include:  a visual checklist to help follow directions, a parent staying in the room to alleviate anxiety, a translator to bridge a language barrier, a pause in the middle of a test that is meant to be delivered continuously because of a needed bathroom break and use of a test outside of a child’s age range in order to provide qualitative information about a specific area of advanced or delayed development. 

During the pandemic, mask wearing, use of a plexiglass shield, social distancing and asking children to manipulate their own testing materials (e.g., turning pages of a test book) are example changes to the in-person evaluation process and test administration that have a potential impact on validity.   

Breaking with standardized administration procedures by changing the delivery of an in-person test to telehealth is no different than the many ways that psychologists already adapt their testing.  Moreover, psychologists base their conclusions on the patterns seen across a range of assessment data well beyond single test scores and within a larger framework of expert understanding for the accuracy and meaningfulness of each data point gathered.