When to pursue a second opinion

[Doodlebug]

Deleted for privacy issues...

[Lecka]

Non-compliant can have different connotations.  

 

When it is used with my son, it really does not have any negative connotations.  It really just means -- he did not do the requested behavior, or he didn't do the expected behavior.

 

It is used in a way that does not have all the negative implications, judgments, and connotations, etc.  

 

Now -- I don't know if it will come out the right way with your son's report, but I do think -- there is no need to read too much into a psychology student using the term "non-compliant," b/c it is not a word they use in the same way as everybody else (or this has been my experience with it).

 

And -- my son has non-compliant behavior at various times for various reasons (often b/c he does not have a needed skill) and it is not viewed as some bad thing -- it is just useful information to help plan what he needs to learn and how he needs to learn it.  It can be a sign that he is stressed out.  It can be a sign that there is a lot of noise.  It can be a sign that he needs some change to his environment so that he can have an easier time.  It is NEVER said like "oh, this bad child," and, no one thinks he has ODD.  No one even thinks he has ADHD (I have asked, lol).  

 

But with that said -- if the results do not seem good, then they may not be good.  

 

If you see what they are saying, and it is just not him, then the results are just not good.  

 

I hope you can get a good result, but if it is not good, maybe you can talk to this student's supervisor or something.  

 

Did they already verbally say ODD?  If they have, and you know that is not right, I think you should follow up with your concerns, send a copy of your concerns to the director and the supervisor or whoever you can send a copy to.  

 

But honestly, if you are just guessing that, I do not think that is necessarily what they are thinking of, from asking the questions.  Especially with my experience of the neutral use of "non-compliant."  It does not make me think "heading for an ODD diagnosis" at all.  But -- I do not know, either, just saying, I do not think they are angling that way from those questions, necessarily.  

[Lecka]

I just glanced at the diagnostic criteria (by googling) for ODD, and it looks to me like the behavior is supposed to occur across settings.  So -- if you filled out a parent form, and you did not check any blocks about him doing similar things, then I do not see how it could be across settings.  I would at least ask this question -- maybe they have an answer that makes sense.  Or, maybe they do not.

[Jennifer-72]

Did she specifically mention ODD or are you just drawing that conclusion from the non compliant comment? I her defense I am not sure what else she could really say about not answering his name or age. I think that is a reasonable comment for her to make. Of course, you know your son and what was probably going on in his mind and his response makes perfect sense. But she is looking at it from the point of view of what most children would do in that situation. I also don't think non compliant means she is going to go with a dx of ODD, it really could point to any number of things. If she was telling you already she is going with ODD and that was her strongest evidence of such, I would be concerned.

 

I think most people are completely shocked by what they walk out of testing learning about their child. I do think you have to sit down with a full report and a debriefing session with the psych and give yourself a chance to see if any of it fits or not.

[Lecka]

A lot of my son's non-compliant behavior is non-responding (not answering) and a lot of the time -- the solution is to give him a visual.  He can very often respond great when he can see what is being talked about.  

 

It is really a very neutral thing in practice, and helpful.  It is a good reminder for me to make sure to give him a chance to see a visual!  

 

They are not going "didn't answer, non-compliant" and then going from there to painting some weird picture of him.  

 

But it is really hard to get used to some of this terminology.  

 

In real life -- what is "didn't answer when we asked if he wanted milk, but when we got out the milk carton, then he said he wanted to have some milk," put into technical terms could be "non-compliant to verbal request." Even though it is SO not non-compliant in the way it might be used in general conversation.  

 

Just trying to share how this word is used so neutrally by some professionals.  The professionals we see, would see "non-compliant to verbal request," and not draw any weird conclusions, too -- they are using it how they use it, it is really not more or less than what it is.  

 

Edit ----- what is ironic, they think that they are being non-judgmental, by not saying "it was bad, it was good, it was manipulative, it was deceitful, it was innocent" or those kinds of words that they think are implying a value judgment.  They think some of their words do not have the value judgments or implication of what the intent of the behavior was -------- but really, it sounds very judgmental to me, except I am used to it now.  It is one of those irritating things, for sure, though.  Behavior is also meant to be neutral and value-free, too, and it is another word that is not used that way by the rest of the world.  

 

[OneStepAtATime]

Here is my suggestion.

1.  Try not to stress while you wait for the report (easier said than done, I know.).

2.  Confirm when you get the report that you will be allowed to ask questions later.

3.  When you get the report there will be a lot that will not sink in right away or that you will probably misinterpret.  Just expect this to happen and don't overreact.

4.  Read the report in the privacy of your home and let it percolate.  Don't let whatever is in there get to you.  Don't call up family and friends freaking out or questioning the validity or whatever.  Try to just take it at face value and let it sink in.

5.  Re-read the report a few times, in pieces and as a whole.

6.  Get a piece of paper and as you read it yet again jot down questions, concerns and things you think are spot on.

7.  Re-read the report and your notes.  See if any of your questions are still valid or if things make more sense now.

8.  After you have let things percolate for a while (I'm talking several days at least), then call and ask your questions if they will let you.

 

In the end, give it time.  After some time has passed, your questions have been answered, etc. if you feel strongly that they missed the boat, yes consider a second opinion.  I wouldn't probably leap into another eval right away, though.  I would take the parts that make sense and run with those while still carefully considering the things I disagree with, not dismissing them out of hand.  A second opinion may very well be a good idea.  I just wouldn't leap into it right away.

 

:grouphug:  :grouphug:  :grouphug:

[Doodlebug]

Thank you, Lecka...

 

It helps to understand how the terminology is used professionally. I wish that would've been explained prior to my conversation. I'm probably reading into her "concerned" facial expression a bit much.

 

I suppose waiting on the report is the best thing at this point. I need to be open, but discerning. Waiting is not my strength. ;)

[Doodlebug]

Deleted for privacy...

[OneStepAtATime]

Yes, she did say ODD. I'm probably reading into things a bit too much, but she definitely referred to ODD in my son's case.

 

Stella

I know this is stressful.  I think most if not all of us here can relate.  Hugs and best wishes.  Hopefully, the report will be clear and you will be allowed to ask questions.

[Doodlebug]

Here is my suggestion.

1. Try not to stress while you wait for the report (easier said than done, I know.).

2. Confirm when you get the report that you will be allowed to ask questions later.

3. When you get the report there will be a lot that will not sink in right away or that you will probably misinterpret. Just expect this to happen and don't overreact.

4. Read the report in the privacy of your home and let it percolate. Don't let whatever is in there get to you. Don't call up family and friends freaking out or questioning the validity or whatever. Try to just take it at face value and let it sink in.

5. Re-read the report a few times, in pieces and as a whole.

6. Get a piece of paper and as you read it yet again jot down questions, concerns and things you think are spot on.

7. Re-read the report and your notes. See if any of your questions are still valid or if things make more sense now.

8. After you have let things percolate for a while (I'm talking several days at least), then call and ask your questions if they will let you.

 

In the end, give it time. After some time has passed, your questions have been answered, etc. if you feel strongly that they missed the boat, yes consider a second opinion. I wouldn't probably leap into another eval right away, though. I would take the parts that make sense and run with those while still carefully considering the things I disagree with, not dismissing them out of hand. A second opinion may very well be a good idea. I just wouldn't leap into it right away.

 

:grouphug: :grouphug: :grouphug:

 

Thank you...

 

Seriously! Thank you so much.

 

This in between time is the worst. Trying to chill... Argh!

 

 

[OneStepAtATime]

Thank you...

 

Seriously! Thank you so much.

 

This in between time is the worst. Trying to chill... Argh!

 

Stella

Totally understand.  BTDT.   :grouphug:  :grouphug:  :grouphug:

[Lecka]

They do not even seem to understand that they are not communicating clearly.  They have forgotten.  They are just so used to using some of these words in certain ways, they do not realize it.  

 

I have this with people who are really lovely, too.  

 

It does come across like they have horrible things coming out of their mouths while their bearing and voice seem nice -- I have had it happen to me!!!!!!!!!!

 

Good luck, I hope it is not too long to wait, and I hope you get some useful information :)

[geodob]

Though a crucial skill for any Psych evaluator, is to be able to put a child at ease. As they participate in the evaluation.

If they don't do this, and make a child feel anxious?

Then this totally skews the results.

 

His response to being asked his name and age, etc.

Raises more of a question about the manner of the Psych student?

Where these questions should be presented in a relaxed getting to know each other process.

But his reply, suggests that she presenting them as 'demands'?

Which continued with the tests.

[Doodlebug]

Though a crucial skill for any Psych evaluator, is to be able to put a child at ease. As they participate in the evaluation.

If they don't do this, and make a child feel anxious?

Then this totally skews the results.

 

His response to being asked his name and age, etc.

Raises more of a question about the manner of the Psych student?

Where these questions should be presented in a relaxed getting to know each other process.

But his reply, suggests that she presenting them as 'demands'?

Which continued with the tests.

Thank you for presenting this aspect of testing. I was tested as a child and I remember the kindness of my evaluator, the snacks, and her warm demeanor. My son's experience was nothing like that.

 

Your response hits at the heart of my concern. Though kind, this student evaluator was very reserved and scripted in her presentation skills. Not what I would call warm, or comfortable in her role. Though well spoken, English is not her first language, which may've been a contributing factor.

 

Anyway, to my gregarious DS, who interprets reservation as disapproval... this is all a big deal. Just the way the obligatory info, "I won't share anything unless someone is being hurt," was done in a slightly awkward way -- within the first two minutes of meeting him! It's outside my DSs realm of experience (of course it will be private/ why would someone be hurt?). It was off putting. DS requested I stay in the room at that point, which I knew wouldn't be optimal... So I told him I'd be right outside the door. Evaluator told me they would come out and visit during breaks, but they never did.

 

The name/ age questions were asked of DS as soon as I left the room. He was definitely not on comfortable terms with her at that point.

 

Well, off to take a walk with my boy. Thanks for the help... Will hopefully hear something to his week.

[OneStepAtATime]

Thank you for presenting this aspect of testing. I was tested as a child and I remember the kindness of my evaluator, the snacks, and her warm demeanor. My son's experience was nothing like that.

 

Your response hits at the heart of my concern. Though kind, this student evaluator was very reserved and scripted in her presentation skills. Not what I would call warm, or comfortable in her role. Though well spoken, English is not her first language, which may've been a contributing factor.

 

Anyway, to my gregarious DS, who interprets reservation as disapproval... this is all a big deal. Just the way the obligatory info, "I won't share anything unless someone is being hurt," was done in a slightly awkward way -- within the first two minutes of meeting him! It's outside my DSs realm of experience (of course it will be private/ why would someone be hurt?). It was off putting. DS requested I stay in the room at that point, which I knew wouldn't be optimal... So I told him I'd be right outside the door. Evaluator told me they would come out and visit during breaks, but they never did.

 

The name/ age questions were asked of DS as soon as I left the room. He was definitely not on comfortable terms with her at that point.

 

Well, off to take a walk with my boy. Thanks for the help... Will hopefully hear something to his week.

 

Stella

That definitely sounds like a bad fit.  I am so sorry your son did not have an evaluator that made more effort to put him at ease.  Ugh!  That may definitely color the results. (We had something similar happen when we went through the school, during their first evaluations.  She was just not a good fit at all and made both kids incredibly self-conscious and uncomfortable.)

 

Although I would definitely wait for the results before saying anything, will there be an opportunity to give feedback on this evaluator/student?  It might benefit her and her supervisor to get some constructive feedback on your concerns.

[Lecka]

That does not sound good. It does not sound professional, either.

 

They are supposed to establish a rapport and have training in establishing a rapport.  It is part of their job.  

 

A lot of people will ask the parents about the child's interests and activities to help them establish a rapport by talking about the child's interests.  

 

I have sympathy on their side, that it can be hard, but they have a burden to make a strong effort and have some skill.

 

I would complain, and not just by making some comment to the evaluator.  I would put it in writing. I do not think it is acceptable.  

 

 

[Doodlebug]

I'm compiling a list of feedback items, and will certainly add these concerns as well.

Thanks for the input!
 

[Crimson Wife]

Ditto to the above comments about there being a difference between "non-compliant" and "oppositional". My little one is very sweet, but she is often non-compliant. Sometimes she'll do what Lecka described her son doing- just not answering at all. Sometimes she'll smile and give a complete non-sequitor. "What's your name?" "I like My Little Pony". It's not angry and oppositional, but it *IS* non-compliance.

 

If the report comes back with something that just strikes your "gut instinct" as being wrong, don't hesitate to get a second opinion. Do be aware, however, that sometimes parents can be in denial and an objective 3rd party can see the child in a more neutral light. I'm not saying that this is the case here, but it seriously took 4 evals all agreeing that my youngest has High-Functioning Autism for me to accept the diagnosis (she later had a 5th eval as part of a research study and that also confirmed the diagnosis). I attributed all the difficulties she was experiencing to the speech delay and thought she was "too social" to have autism. When the developmental pediatrician said HFA, I wondered if it was an "everything looks like a nail when you're holding a hammer" situation. But then the school district psychologist, Regional Center psychologist, and the pediatric neurologist all concurred and I couldn't deny it any longer.

[merry gardens]

Since the testing was done by a graduate student, there is probably a licensed professional supervising and signing off on that student's work.  I don't think it would be a "second opinion" per se if you were to talk over the situation with how the testing went with the licensed professional who has to sign off on the student's work. Before going to another clinic (and paying yet more $$$), I'd talk over the situation with the licensed professional who oversees the student who did the testing.

 

There's a reason why states license the professionals who do this type of testing.  A graduate student is not yet a licensed professional. Talk to someone at that clinic who is.

[mommymonster]

You mentioned that your eval was done by a student. All students are managed by faculty, and their work is reviewed by them.

I would wait for the report, and review it thoroughly. Take some time and think about it as OneStep advised. If it just doesn't ring as accurate, ask for a follow up WITH the student's faculty present. Present your concerns factually and ask that the tests be re-administered with a different student. It will take guts on your part (and I'm sorry, I hate these situations), but it is important that your kiddo gets a good eval and the student evaluator figures out what a good eval looks like.

 

 

 

Edited to clean up wording -- typed originally on phone.

[wapiti]

For certain types of kids, the rapport with the evaluator is immensely important.

[Mrs. Tharp]

When red flags go up just from speaking to the tester, just like yours did. 

 

Read the final report very, very carefully. If anything is suspect, and/or if she cannot clearly and fully answer any questions you might ask, then get the second opinion without hesitation, especially if this is a report that will be used to used by other professionals for information about how to diagnose/treat/educate/recommend treatment for your child. Life is too short to have to deal with flawed information if an evaluation has been done or written poorly, kwim? There are lots of other psychologists out there.

 

I am now reading the other comments and I agree about the difference between "non-compliant" and "oppositional". Oppositional has much stronger connotations in an evaluation--pay more attention to that if it comes up.