Season 1, Episode 5: Dr. Nick Gelbar on What's the Difference Between a Psychological, Psycho-educational and Neuropsychological Evaluation?

Speaker 1: 0:03

Welcome to the podcast. Let's talk sped law, a podcast dedicated to discussing special education rights of children with disabilities. I'm your host and special education attorney, Jeff forte. Now let's talk sped law.

Speaker 2: 0:19

Hi everyone. This is attorney Jeff forte from let's talk sped law. We're here with another episode, um, to speak about the differences between psycho educational, psychological and neuropsychological evaluations here with us today as our guest speaker. I'm very honored to have him on the phone with us. Today is dr Nick Gelbar. Dr Gelbar, can you please, um, share a little bit about yourself and your background please?

Speaker 3: 0:51

Perfect. Well, first of all, Jeff, thank you for having me on. I'm really excited to talk about this. Um, I am a certified school psychologist in Connecticut. I'm also a licensed psychologist in Connecticut. I received my PhD in school psychology from the university of Connecticut. I went on and did a postdoctoral fellowship where I got training on autism and intellectual disabilities. Um, and in for six years I was a practicing psychologist as well as serving as the research director of the center for excellence in developmental disabilities at Yukon. And, uh, currently I have my own private practice educational testing and consulting in Connecticut, uh, and do a little bit of work at the university of Connecticut as a researcher as well.

Speaker 2: 1:42

That's great doctor. Well first, welcome to the show. Welcome to the podcast. Um, it's really a real pleasure to have you and thank you for all the work that you do for children with disabilities to help move their education forward. Um, so for the benefit of our listeners, um, I want to share with our listeners that I've often as an attorney wanted to know the clinical differences cause I'm not a clinician. Uh, I've walked in, wanted to know what are the differences between a psychoeducational evaluation versus a psychological evaluation versus a neuropsychological evaluation. And, um, you know, there's not much out there on the internet that really puts it into a perspective as to what are the differences both clinically and assessment wise. But I radically, um, I just came across an article by dr Gelbar that was just published yesterday, um, April 6th, and it really hits to the exact merits of the things that I've been looking for. So I wanted to have dr Gelbar on today so he can really go through for the benefit of us and for parents to understand what are the differences. So dr Gelbar, can you, can you kind of go through and explain to us what are the key differences between the three types of evaluations?

Speaker 3: 3:16

Yeah, definitely. Um, and as psychologists we don't make it easy for parents and infer people cause we all have different titles and we call our reports different things. Um, the, the easiest one to start with is a psychoeducational evaluation. Those evaluations are traditionally done by school psychologists working in schools and they've been referred to as psychoeducational cause it's supposed to kind of indicate that this wasn't a psychological evaluation done in an outpatient setting. That it was really focused primarily on answering questions about how to best educate this child and how this child is functioning in the school environment. Um, so it's really normally a school based sort of evaluation

Speaker 2: 4:09

and that, and that would make sense because the term psychoeducational implies that there's some type of educational component to it. So that, yeah, that makes sense. Yeah.

Speaker 3: 4:20

Right. And that what often happens in to talk for a second about sort of what a school based evaluation typically looks like. Normally the school psychologist is doing some cognitive assessment and doing some behavior rating scales. Um, recently they've more and more started to do things like testing and executive function or learning and memory. But that's their piece of the puzzle. And then a special education teacher sometimes is the one who does the academic achievement. Sometimes it's the school psychologist that does the academic achievement testing.

Speaker 2: 4:58

So, so for the go, go ahead. Go ahead.

Speaker 3: 5:01

Well th and then the speech language person does their assessment and the occupational therapist does their assessment. So it's sort of the psychoeducational if you put into all of those together, that would create a psychological assessment. Um, but the psychoeducational that the school psychologist doing is narrower and doesn't always have all those things, all those other people's reports that are done separately. Not all that information is brought together and integrated. It's sort of parents get all these separate reports.

Speaker 2: 5:33

Right, right. So dr Gelbar, you mentioned the term cognitive assessment. So to the lay parent, you know, who may have a child that's emerging out of preschool, pre, pre K let's say, and entering kindergarten and they may be noticing some cognitive, um, it delays. What, what are some examples of, um, you know, cognitive assessments that would be commonly included in a school-based psychoeducational evaluation that a parent should be looking for or even asking for as part of the evaluation process?

Speaker 3: 6:14

Right. Um, so the traditionally, um, the measures that are used and referred to as cognitive assessments are though the Woodcock Johnson tests of cognitive abilities though Wechsler scales that are, there's one that's for preschool aged children and then there's one for, uh, children until they're, they're like six and a half until they're 16 and a half roughly. Um, and uh, there's also the Stanford Benet, um, the, those are like the three big ones. There's some other less popular measures that are used and kind of the lay term of people often think of this as like IQ testing, but it's not, you don't just get an IQ, you get a bunch of other scores as well to interpret. So it's not, you know, you get sort of a picture of how this title thinks and how we think they should be doing in school. Like what's their potential to do in school.

Speaker 2: 7:07

So what type of, uh, background or, um, degrees does a, uh, psychologist that works for a school have versus a, um, versus a clinical psychologist that has their own private practice like, like you do?

Speaker 3: 7:26

Yeah, so the, the school psychologists that work in schools either have, um, in Connecticut we call it a six year degree, but an ne nationwide is sometimes referred to as a certificate of advanced graduate studies or an educational specialist degree. That's a complicated way of saying a school psychologist working in schools has done everything but write a dissertation. They've done all this advanced coursework and they've done all this training to work in schools. They've had to do an internship where they worked in schools and they've tested children and they've done other things, you know, like counseling and other things with children. Uh, and so that allows them to be certified. There are some people who have written a dissertation and have, so they have a PhD or a psy D. there's not really a big difference between those things. Um, and they also may work in schools and be certified. Um, but it, it's just sort of, there's a base level of training that happens. It's usually at least 60 graduate credits. Um, sometimes it's often much many more credits than that. Um, and then they've completed what they need to do to be certified to work in schools. Generally that's the only place they can work. There are, if there are some exceptions in some States there are, some people are school psychologists who can operate privately without, um, doing that. But predominantly school psychologists tend to work in schools. Okay.

Speaker 2: 9:00

Okay. So, so moving on to, um, the difference between then a psycho educational versus a psychological evaluation, what, what are the main differences between the two?

Speaker 3: 9:15

So the, the main difference is that the psychological is generally brogger in terms of the assessments that are used. So it's, it's always going to have a cognitive, some sort of behavior scales and academic achievement at sort of the bare minimum. Um, so it, it, but it also may have tasks of learning and memory, executive function, other things depending on the child. Um, it also is going to lead to medical diagnoses. So the main differences are psychoeducational. We'll say this is what the child's strengths, his weaknesses are. A team needs to come together to discuss these strengths and weaknesses to determine special education eligibility and all of those things. Um, uh, psychological, this data all comes together and it's gonna lead to a medical diagnosis or series of diagnoses for a child. So based on this data psychologist putting all of that information together, um, all psychologists, clinical and neuro psychologists have PhDs or side DS. So they're, they're all doctors. And in addition to the training that happens before you're done with the doctorate, they also have to do some work after their doctorate where they're supervised before they're allowed to independently practice.

Speaker 2: 10:47

Okay. So one of the questions that attorneys is parents, special education education attorneys often get asked from parents is, well, if I want to get a private evaluation done for my child, for the betterment of their education, um, I'm going to contact my insurance company to see what's covered. And it's my understanding that oftentimes these types of educational based private evaluations are the types of evaluations that are covered by insurance. Can you, can you kinda break that down a bit for parents?

Speaker 3: 11:27

So it depends. It depends a lot on different, um, having spent six years working with insurance companies, um, and using the term working loosely. Um, it depends on the plan that you have and it depends on what the specific referral questions are. So some plans will cover testing that to determine if the child has autism or we'll cover testing to determine what sort of mental health challenges that a child faces. Some insurance companies won't cover testing that, um, leads to the potential diagnosis of a learning disability, for example. Um, sometimes I've seen that be rejected. So when I first was practicing in a private clinic, we gave academic achievement tests to all, all of the children who were in that clinic. And the insurance companies basically told us, we're no longer covering that cause that's something that can be done in the schools. We pay you to do autism testing, just stick with autism testing.

Speaker 2: 12:39

Interesting. Right. Right. So if so, so, so my understanding is then if there's parts of the evaluation that a parent's asking for that might include, for example, reviewing school district evaluations or reviewing IEP[inaudible], that's the part that's most likely not going to be covered by a insurance claim.

Speaker 3: 13:00

Right, right. And that those things are sometimes, and um, those are things that often that psychologists, if parents want those things to be done are going to happen. They're going to say they're going to be additional fees for those things often or they're just not going to offer those services. Um, you know, that they'll do sort of the basics that are covered by insurance, but they're not going to sort of necessarily rapid together to put it into that package of this is then what would translate into schools.

Speaker 2: 13:29

Right, right. So when would the best time, um, I guess to, to be requesting or seeking from the parent's perspective, a psycho educational evaluation versus a psychological evaluation from a private accredited providers such as yourself?

Speaker 3: 13:53

I think there's a lot of many factors that go into that. Um, I think it really, the main factor to me though is the complexity of the child. If, if the, you know, the more, and this is sometimes tough for parents to know how, how complicated is my child, but, um, if the, it's often that you get the psychoeducational done by the school and there's an, there's a weird pattern of those results and, or those results are aligning with the way the child's performing in school. But we sort of haven't answered all of the questions that then doing that. Um, I also think if there's some type of specific, you know, some sort of, um, looking for autism, looking for the potential for some sort of processing difficulties, looking for, um, mental health challenges that may be arising across settings. Um, and as well as, um, you know, just generally that this is a complex child and we're seeing that the child isn't functioning well in school, but the data says they should be and there's not really a good answer as to why

Speaker 2: 15:11

and psychological evaluation typically. Um, we'll, we'll cover things beyond just the educational components. Right,

Speaker 3: 15:19

right, right. So then you're also going to get, um, recommendations that are for things that you can do within the home as a parent to how to better parent this child as well as these are the types of services that this child needs. Um, I think it's also important. Um, and this may be sort of foreshadowing a question you were about to ask, but um, it's important to remember though, if that parent gets a private evaluation and they show up with that private evaluation at that PPT meeting, the PPT meeting has their IEP meeting to talk in more national terms. Um, that IEP meeting only has to consider those results. They don't have to.

Speaker 2: 16:10

Okay.

Speaker 3: 16:10

You'll have to, they don't have to accept them. They just have to consider them. They have to be sort of noted. Um, and I think that's a really important thing so that inside the psychological evaluation is going to give you a much broader look at the child in a broader look at recommendations, but it may not have the teeth behind it to help in terms of making changes in schools. Also, that person may not have as much knowledge about the way that schools work and with and how special education law works. Um, in terms of diagnosing a learning disability, you know, you can look at data and diagnose a learning disability, but there's a process schools have to go through to show that they've done everything they can do, instruct this child well before they can say they have a learning disability. So there's sort of two standards going on that sometimes don't get, um, that don't sort of talk to each other. We have these educational standards that we have these medical standards and the two don't align all the ways.

Speaker 2: 17:12

Right, right. You know, one question that often comes up between, um, parents sometimes and evaluators is the importance of regardless if it's a psychological psychoeducational or neuro psych, which we haven't gotten to yet. Um, is the importance of having a student observation, um, component to the evaluation? Uh, can you talk about that a bit?

Speaker 3: 17:41

Well, I think it's so important if I'm going to make recommendations for a child, I to see them in as many settings as I can see them. So actually seeing them in school allows me to be better able to see what's working, what, what does this, what are they actually trying with this child? Because, uh, pieces of paper like[inaudible] are wonderful. They don't actually tell you what the living, breathing program that the child is experiencing on a day to day basis looks like. Um, and so I think it's really important to do observations. That's not something that's covered by insurance usually. Um, but I'm parts of, uh, groups of, of people who do this type of testing and everyone says if there's ever anything having to do with schools that they try to get in, at least to see them. Um, sometimes it's not important to give a diagnosis, but it can be really valuable in terms of making sure that the recommendations you are providing are the most useful to the school and to the family and child at the end of the day.

Speaker 2: 18:50

Right, right. So moving on to a neuro psychological evaluation, um, you know, oftentimes parents will call and they'll say, well, we only want to get a neuro psych. We want, we don't want to get a psychological or a psychoeducational evaluation. Um, what, what are the main differences between the neuro psych versus the other two evaluations that we just addressed?

Speaker 3: 19:17

So the, the main difference is there's a couple, but the main difference is a neuropsychologist is looking at this data from the lens of what is this potentially tell me about brain, just function or function. Um, so they're looking at data and they can often provide information about, well, we expect that there may have been some damage to this part of the brain. Um, they also tend to write reports that are more integrated. Um, and they tend historically they've tended to use a broader range of assessment tools than psycho and, or psychological. I would say that sort of, you know, in the past five years has shifted. I'd say most people are using pretty Y batteries or that people, it's not just the neuropsychologist. I'd say psychologists and neuropsychologists are using the same in terms of not just cognitive behavior rating scales and academic achievement that there ma many more psychologists are also using learning and memory tasks, tests of language, test of visual motor integration, et cetera. They're kind of doing these bigger batteries. Um, the integrated nature of the neuropsych report is also a little different. A lot of psycho ed reports are, I gave this test, here are the results I gave test. Here are the results that gave this test. Here are the results. There's then a summary and then recommendations. The neuro psych report often provides a narrative, so it's almost like a much longer summary of the child. So it's all of these things go to about this child and then there's recommendations and then there's usually the tables with all the data that sort of at the ends. Um, again, if you, when you see enough of these, you start to see that there's a lot of blending of this and many schools that ecologists and even psychologists, clinical psychologists are also writing more integrated reports. Um, there are pros and cons to both styles of reports. Sometimes parents kind of like just that quick summary that happens and that they can see the data in tables or graphs. Um, other people really like that, the how it sort of the narrative that's pulled together of their child and that, that four-page description of what's going on. Um,

Speaker 2: 21:52

so that, that's, that's very useful. Um, if, so to put, kind of put it into context, right? If, if a parent has, um, a child with a disability and if we were to try to start to think about, you know, eligibility components on an IEP in which, um, the, the school district may or may not have done a more comprehensive, fully informed evaluation. Are there certain types of eligibility categories or disability categories where a psychological, a psychoeducational or a neuro psych are more appropriate than others?

Speaker 3: 22:37

So I'm going to start by saying what's, for some eligibility questions. Like if you went to a neuropsychologist, you might to a clinical psychologist, you went to the school and had them do a psycho ad, they're going to look the same. So if the referral question has to do with a learning disability, a lot of the data is going to look the same. You're going to do tax that are, if we think the child is having difficulty reading, you're going to do reading tests, whether you're a neuropsychologist, a psychologist or a school psychologists. And that's one of the things that as much as we talk about all these differences, they often, we're often all in using the same test and we're just looking at the kid sometimes from slightly different angles. Um, I think when children are more medically complex, whether that's because of sort of, they have some genetic predispositions or um, intellectually or, um, they've experienced, um, a traumatic brain injury or if they've had a stroke or they have seizures that's really kind of the bread and butter of neuroscience, neuro psych testing. Um, they also do all kinds of other testing and they'll test children with learning disabilities and other things. Um, but they're also really good for children who are just complex. These really complex kids, especially, um, when we need to really integrate and look across different areas so that this may be a child who at first, um, was eligible to receive special education services under speech language, but then later on has some reading issues and then also has some social emotional issues and they're sort of gonna look at the whole child and put all of that together. Um, really good school teams can do that, but they can't give you the medical diagnosis that sometimes required to then get outside services for that child. Um, and so the thing that makes her neuro psychologist or is that they can hypothesize about the way the brain is developing or that this is tasked to do with specific areas of the brain. And you can think about it if a child has epilepsy or there's something going on with the brain that makes a lot of sense. Um, they're integrated perspective also can be really useful. Um, that's the big bang for your buck with our psychological is you're going to get those medical diagnoses and sometimes those medical diagnoses are the only way that you can get certain services. Right. Um, so if you need the medical diagnosis of autism to receive certain services outside, you know, from that insurance is provide, um, in a psychoeducational is going to give you really tailored school-based recommendations. Um, what I sometimes do is a neuro psychologist will have seen a child in a school team brings me in to be the translator. The person[inaudible] says, how do we actually make these recommendations work in a school environment? And that's where I reviewed my training as a school psychologist to be able to do that. Um, but again, sometimes these reports will look the same and it doesn't matter where you go, but it's uh, I think someone, people want the neuro side cause they want like the best thing and it's sort of viewed as the Cadillac. And sometimes it is and sometimes it's really useful. And then sometimes the school looks at that and says, well we have no idea actually what we should do. And the attorney and, and, or advocates are looking at them and looking at that record going, but I can't do anything with this. Cause it's not, it doesn't reflect the nature of special ed law in those things. So I would say there's not like a best fit. It's just sort of more complex cases probably in neuro psych is going to be worth it. Otherwise. Um, there are psychologists who focus on autism or intellectual disabilities regardless of if they're a neuropsychologist or a regular psychologist, if that's the issue, you should go to someone with expertise in that. Um, and it's some of that's just shopping and figuring out what is the expertise of the person who's going to evaluate and what are they sort of know and how can they be helpful and is, is that what I need right now? Um, cause you're a child who was in third grade, got diagnosed with a learning disability. We're now in seventh grade and the grades start to tank and there's, they're starting to be moody. And irritable at home, we may need to look at the bigger picture and our other things other than this learning disability going on.

Speaker 2: 27:14

Right, right. So, so, so to recap, um, it sounds to me that a psychoeducational avow is typically one that would be initially at least done by, uh, by a school based psychologist. Um, and school-based psychologists don't have to necessarily, um, achieve a dissertation versus a psychological, a vowel is going to really look at more of a robust, um, uh, kind of view of the child beyond the educational setting. And a neuro psych is, is really more geared toward towards a child that may have a, you know, some very significant disabilities that may evolve over the lifetime or the age of the child where you, they kind of have to put everything together, um, for the benefit of, of the child's life. Um, education, social and emotional.

Speaker 3: 28:10

Yup. That's exactly right.

Speaker 2: 28:12

Right. Okay. Um, well doctor, I really wanna thank you for your time tonight. Um, for the benefit of the, let's talk sped law audience. Um, now if people want to reach you, where are you located and what's your contact information? Dr Gelbar.

Speaker 3: 28:30

Great. So, uh, my website is educational testing and consulting.com. Um, they can, uh, I don't know if you have show notes where I can give you my contact information in terms of Chanel. It's like my email and everything where people can contact me.

Speaker 2: 28:45

Great. Well, thank you so much for your time, dr Gelbar

Speaker 1: 28:49

and, um, to our audience. Thank you for listening. Stay tuned for the next step or so, once we, uh, once we go into another program and podcast. Thank you.