PSYCHOLOGICAL EVALUATION AND ASSESSMENT SERVICES
Here For You
I believe that a psychological evaluation should do far more than simply give you and/or your child a diagnosis with a few treatment recommendations. I take pride in conducting some of the most comprehensive psychological evaluations in the Chattanooga area, with a focus on conducting tests that help me describe in full detail your child's strengths and weaknesses and what these mean for how he or she is functioning in daily life. My evaluation services consist of three tiers. Each tier includes several similar components: 1) a comprehensive diagnostic intake interview, 2) administration and interpretation of tests, and 3) a 1-hour feedback session with parents or the client. Each tier differs only in part 2 - which assessments are given and the length of time required to give them.
Tier I is the lowest cost and least time consuming evaluation. Tier I evaluations usually consist of 1-2 appointments, coupled with completion of a number of questionnaires. These evaluations are most often valuable when other testing may have already been completed (e.g. by the child's school) or when the referral question can be addressed through a relatively brief evaluation. Tier I evaluations are currently priced at $500, which covers all parts described above. Insurance can be billed when appropriate.
Tier II evaluations are more common than Tier III evals, and most often consist of psychoeducational evaluations conducted to determine a child's appropriateness for special education services (i.e. an Individualized education plan or a 504 plan) at school. Tier II testing is usually designed to assess if your child has a learning disability, is gifted, and/or to differentiate between symptoms of ADHD versus other causes of apparent inattention. Tier II evals usually consist of 2-3 face-to-face appointments, totaling approximately 6-8 hours of professional time. They currently cost $900, which covers all appointments. Insurance may cover some Tier II evaluations.
Tier III evaluations are comprehensive developmental and psychodiagnostic assessments. The most common referral for Tier III evals is to diagnose autism spectrum disorder, which I can test for at any age (even in adults), though I prefer the child be at least 3 years old for a more confident assessment. Other reasons for a Tier III assessment may be to provide a differential diagnosis for children with complex and extensive medical and/or psychiatric histories, or children who present with rare symptoms that other clinicians have not been able to diagnose. Tier III evaluations typically consist of 2-4 testing appointments and 7-10 professional hours. These evaluations cost $1150. Insurance may also provide some coverage for Tier III evals.
HOW SHOULD I PREPARE FOR TESTS?
Don't try to "study" for them. The tests I give are not tests that you "pass" or "fail." There's no such thing. Instead, my tests are kind of like measuring your brain just to see how it works.
The best way to prepare is to get a good night's sleep the night before and to eat a good breakfast the morning of testing. You should also bring or wear glasses, contacts, or assistive hearing devices if you wear them for any reason.
SHOULD MY CHILD TAKE HIS OR HER MEDICATION ON THE DAY OF TESTING?
In most cases, you should come to the testing just as you would come to school most days. Most likely, that means it's fine to take your medication. In some cases, I may want to see your child "off" medication, but that's rare, and I'll let you know if that is the case beforehand.
HOW DO YOU TEST FOR AUTISM?
I use a combination of tests, but, importantly, I am trained and competent in all 4 modules of the Autism Diagnostic Observation Schedule - 2nd edition (ADOS-2), and I will use this for all autism testing referrals, in addition to any other tests I give. The ADOS-2 is the gold standard instrument for autism assessments, and I don't recommend seeking any kind of autism consultation from someone who does not use the ADOS-2 routinely. When taking the ADOS-2, your child isn't likely to even know he or she is taking a test. To most children, the ADOS feels like playing, talking, and reading stories. It's actually one of the more fun tests to give.
In addition to the ADOS-2, I also usually perform neurocognitive testing to help rule out other cognitive reasons a person may show autism-like symptoms. I also usually include several tests of socio-emotional cognition.
HOW DO YOU SELECT YOUR TEST BATTERY?
I individualize my test battery for all patients, depending on their unique needs and particular referral question. Having said that, though, I don't have the funds to purchase every test in the world, and so I do have to limit myself to what I have available in my current repertoire.
Still, I don't see the purpose of testing to be simply to see what score someone gets on a test. Tests are specific measuring tools that each have specific uses for specific purposes. Like a lab test ordered by a physician, I'll only order what tests are necessary to explore all the possible reasons to explain the reason you're coming to see me. If the first set of tests I order aren't enough, I'll order more. For me, the end goal is to get you the answers you seek, while also making sure I'm giving you the highest quality professional service possible and doing so through a lens that's focused on understanding as much about the client as possible. My job is to serve you, and I work hard to fulfill my duties as a psychologist.
IS THERE ANY DANGER OR RISK IN TESTING?
Psychological tests are very safe, and there is almost no risk of direct injury occurring as a result of testing. The biggest risk is that tests can be mentally challenging for some, which can cause frustration. In fact, most of the tests I administer are designed to get difficult eventually. I've gotten pretty good, though, over the years of working with kids to minimize frustration and to keep the encouraged even when things get a little hard.
Some patients can experience fatigue from testing too. Working your brain is hard work, after all. I always pay attention to minimize fatigue and can stop testing if fatigue seems to be too great to go on and get good results.
During testing, I'm likely to ask a few potentially uncomfortable questions. For example, I may need to ask questions about trauma, drug use, sexuality, and legal history. You'll ALWAYS have a right to tell me as much or as little as you want in response to these questions, and I will always respect your right to privacy. Like everything I do, your answers stay confidential, except in emergency circumstances when a child or vulnerable adult is being harmed. In such emergencies, I may have to inform some sort of protective service to keep you or someone else safe. So, you should know that with testing, as with any psychological service, there is a small risk that if you tell me something that leads me to believe a child or vulnerable adult is being harmed, I am required by law to report it. I only do this to protect you or protect others though, I only tell the essential information necessary to help the victim be safe again.
HOW ARE YOUR REPORTS DIFFERENT FROM OTHERS?
I have one major philosophy in testing, and that is that the actual test scores are probably the least important part of testing. Anyone can learn to administer and score a psychological test. That is the easy part. The hard parts are 1) taking notice of everything else that happens during administration of a test battery that influences how test scores are interpreted, and 2) thinking deeply about the pattern of the scores, how they influence each other, and understanding why a person scored how they did on that particular test on that particular day and in that particular environment. These are the things that really matter in testing and psychological evaluations. It's also why my reports are so long. In my reports, I will never just give you the scores, followed by a simple assessment of the scores. Instead, I take the time to describe every aspect of the testing environment and how the tests work together to explain what a score means for each particular child. Sure, this is time consuming, but it's important because those are the things that truly matter in a professional psychological evaluation. Of course, you'll also get the scores, and I'll tell you what they mean, but those won't be the "highlight" of the report at all. Rather, the real "meat" will be in the integration of scores with everything else.
Relatedly, when I used to teach Psychological Assessment to doctoral students (future clinical psychologists), I used to make them work so hard to become familiar enough with tests that they could administer them near flawlessly without even thinking about what they were doing. Test administration had to be an automatic, behavior, something that took very little cognitive resources to maintain, because, to me, what mattered most, again, was not the test score itself but everything else happening. So, my students needed to be able to administer a test without thinking about the test. That way, instead, they could use their brains to take notice of all the other subtle things that matter in test administration.
DOES INSURANCE COVER TESTING?
Insurance does cover some, but rarely all of testing. The most frequent thing I am asked to test for is specific learning disability (like dyslexia, for example). It's important to know that insurance considers testing done for school to be an academic service, not a clinical service. Therefore, insurance does not cover psychoeducational testing - that is, testing for which the primary purpose is to give recommendations for school. So, if requesting psychoeducaitonal testing, you will need to pay for this out of pocket. Most frequently, I rate psychoeducational testing at a Tier II rate. In some special, complex situations, I may need to upgrade to Tier III. For example, children with developmental disabilities usually need more thorough evaluation, and so these are Tier III tests. However, in these cases, because I'm also evaluating for a developmental disability, we can bill insurance - diagnosing or evaluating for the effects of a developmental disability is a clinical service.
Still, overall, I'd say that as a general rule, it is best to assume that insurance will NOT cover testing unless they first tell you otherwise. In other words, it's best for us to try to obtain a prior authorization to see how much testing they will cover. I will complete a prior auth for all testing except psychoeducational testing. Again, when the testing is psychoeducational in nature, any prior authorization request will be denied, so I don't submit one in these cases.
When in doubt, the best thing to do is call you insurer and ask them if your plan includes coverage for the following codes. Be sure to specify that I am the doctor too: