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Six hours for full eval? Is this typical?


popmom
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Today I received a breakdown of the fees associated with the evaluations that were recommended by whomever went over the 27 pages of forms I filled out. The evaluation process consists of 1.5-2 hours of initial clinical interview (parents only, child not present), 6 hours of diagnostic evaluation with write up, and 1 hour feedback session. It will be conducted by a multidisciplinary team including a psychologist (board certified behavior analyst-doctorate.) I'm curious how this compares with others' experiences.

 

I feel pretty good about this place. I guess maybe my only concern is that their eval process seems a little "one size fits all". Like I feel like everyone that fills out the forms probably gets the same email.

 

And I'll add that my husband and I are slightly concerned that a BCBA-D is a "hammer looking for a nail". Autism is their specialty. I know it sounds crazy that I would have a problem with that. Please be merciful. lol  I was initially hoping to find a pediatric neuropsych, but these people are "in network" for my insurance.

 

I will call tomorrow to get specifics--as in exactly what testing dd will receive-- I.Q.?, ctopp, etc. She has several things going on that need to be addressed.

Edited by stephensgirls
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I've had two kids get neuropsych testing done as well as my husband. One son was 5 when he was tested and I think his tests were a total of six hours broken up over several days. 2nd DS was 10 when he was tested. His testing was 8 hours. DH testing was 8 hours. So 6 hours seems reasonable.

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I really appreciate this community for all the input. I've tried posting a question on a local forum, but it doesn't seem to get any "traffic", so I got no response. I haven't told anyone I'm close to that I'm going through this process--for various reasons. So, anyway...I appreciate y'all.

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It sounds similar to what we did.

 

In that first parent-only interview, they are going to decide what tests to use in the rest of the process.

 

So it may be cookie cutter now, but at the parent-only interview part, I think that is when it will get more specialized.

 

Or, they may decide on specific test to run based on the 17 pages of intake forms you filled out (if they seem like they are about your child).

 

Where I went was a place to get diagnosed with autism, too.

 

However ------- for us personally, we had a physician referral made with the physician thinking we needed to go to an autism clinic.

 

Then ----- we had intake forms.

 

Then ----- we had an intake phone interview going over the intake forms.

 

So if those forms were not flagging us as "yes this is appropriate for the autism clinic," then we would have gotten changed to a child development clinic.

 

And the autism clinic is not only for autism, but when they think that group of professionals is going to be the best to see a child, which could also be for some things not autism but with one similarity.

 

I am not positive but I think we had part of the parent interview with the phone intake interview.

 

We had a long (45 minute) parent interview also in person with a lovely, lovely speech therapist.

 

But we had to drive in and stay at a hotel the night before, and I think they do a little more

on the phone for people driving in so we don't have to have such a long day. I think we were 4 hours total, but we also didn't do a section that they do with older kids, so I think if we were going now it would be 5-6 hours instead.

 

We had a positive experience.

 

But I had that feeling too, before, like "are we deciding he has autism by just getting the referral?" Like -- once we had that referral, then I was filling out forms, then I was doing a phone interview.... it seemed like from the time I got the referral, I was on this inexorable path leading to autism, just because I got the referral. And who am I to ask for a referral? I am not a doctor, shouldn't it be more of a doctor thing and seem less like I asked for a referral?

 

But I didn't feel like that at or after the evaluation.

 

But then, at the parent part at the end, when they did say the diagnosis, I was just going "yeah." They said I was one of the parents who really already knows before they come in, and it is just confirmation. I think that is true.

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I am just going to add something I wouldn't be surprised by on the CTOPP/

 

I wouldn't be surprised if they don't waste their $$$$$ time on it.

 

And instead -- if they refer you for speech, then the speech therapist runs it.

 

I could be completely off on that, and it could be that this is a very "here is how our insurance works" thing.

 

Our insurance has good coverage in a lot of ways, but then is very nit-picky in other ways.

 

So it is not so much I think this would happen, more just that I would not be surprised.

 

(I just mean -- I don't think my insurance would pay a BCBA-D billing $500/hour to do something a speech therapist could do if we got referred for speech, or that I could possibly get if I pursued a referral for speech therapy from the primary care doctor. I don't see it happening.)

 

(And then a speech therapist at the clinic you go to might run more specialized tests than a CTOPP too, even if they are a speech therapist and could do it. So I just would not be surprised for them to be like "oh you can get that anywhere, we can refer you for speech." Bc if you get referred for speech anyway then they are going to do their own initial testing which could include the CTOPP.)

 

Anyway -- you might not get so much done as you think in 5-6 hours, of which maybe 3-4 are spent with your daughter (and not you).

 

Some will be that you get pointed in the direction to go in next for 1-2 hours of speech/language testing if you get referred for that, or 1-2 hours o OT testing if you get referred for OT.

 

That is how it goes more for me I think.

 

Partly bc probably 1-2 solid hours need to be spent on autism evaluation, and that is legitimate I think. I mean, it will depend, but for some things at this place you are getting the things done you can't get done at other places (or without the same expertise you are hoping for at this place).

 

But I really don't know!

Edited by Lecka
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Similar to our experience but with DDs first evaluation the evaluator actually blocked out three hours for review afterwards and we needed every single bit of it to go through everything. All 6 hours were done in one day, but DD was given frequent breaks to run around, play in the garden, look at the pond, etc.

 

With the second evaluation several years later the neuropsych blocked off an hour for end review officially but unofficially had not scheduled anything for the half hour after that in case we needed the extra time for questions.  We didn't but it was nice to know we could have had that time if we needed it.  The estimated 6 hours for evaluations were done over the course of 3 days, 2 hours each day, and a 4th day was tentatively scheduled in case more tests needed to be run than originally anticipated.  We ended up not needing the 4th day.

 

That parent only interview, along with the paperwork you submit, will be crucial for them tweaking out exactly what tests they will run.

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It sounds similar to what we did.

 

In that first parent-only interview, they are going to decide what tests to use in the rest of the process.

 

So it may be cookie cutter now, but at the parent-only interview part, I think that is when it will get more specialized.

 

Or, they may decide on specific test to run based on the 17 pages of intake forms you filled out (if they seem like they are about your child).

 

Where I went was a place to get diagnosed with autism, too.

 

However ------- for us personally, we had a physician referral made with the physician thinking we needed to go to an autism clinic.

 

Then ----- we had intake forms.

 

Then ----- we had an intake phone interview going over the intake forms.

 

So if those forms were not flagging us as "yes this is appropriate for the autism clinic," then we would have gotten changed to a child development clinic.

 

And the autism clinic is not only for autism, but when they think that group of professionals is going to be the best to see a child, which could also be for some things not autism but with one similarity.

 

I am not positive but I think we had part of the parent interview with the phone intake interview.

 

We had a long (45 minute) parent interview also in person with a lovely, lovely speech therapist.

 

But we had to drive in and stay at a hotel the night before, and I think they do a little more

on the phone for people driving in so we don't have to have such a long day. I think we were 4 hours total, but we also didn't do a section that they do with older kids, so I think if we were going now it would be 5-6 hours instead.

 

We had a positive experience.

 

But I had that feeling too, before, like "are we deciding he has autism by just getting the referral?" Like -- once we had that referral, then I was filling out forms, then I was doing a phone interview.... it seemed like from the time I got the referral, I was on this inexorable path leading to autism, just because I got the referral. And who am I to ask for a referral? I am not a doctor, shouldn't it be more of a doctor thing and seem less like I asked for a referral?

 

But I didn't feel like that at or after the evaluation.

 

But then, at the parent part at the end, when they did say the diagnosis, I was just going "yeah." They said I was one of the parents who really already knows before they come in, and it is just confirmation. I think that is true.

 

Thanks for sharing your experience. It's very reassuring.

 

 

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I am just going to add something I wouldn't be surprised by on the CTOPP/

 

I wouldn't be surprised if they don't waste their $$$$$ time on it.

 

And instead -- if they refer you for speech, then the speech therapist runs it.

 

I could be completely off on that, and it could be that this is a very "here is how our insurance works" thing.

 

Our insurance has good coverage in a lot of ways, but then is very nit-picky in other ways.

 

So it is not so much I think this would happen, more just that I would not be surprised.

 

(I just mean -- I don't think my insurance would pay a BCBA-D billing $500/hour to do something a speech therapist could do if we got referred for speech, or that I could possibly get if I pursued a referral for speech therapy from the primary care doctor. I don't see it happening.)

 

(And then a speech therapist at the clinic you go to might run more specialized tests than a CTOPP too, even if they are a speech therapist and could do it. So I just would not be surprised for them to be like "oh you can get that anywhere, we can refer you for speech." Bc if you get referred for speech anyway then they are going to do their own initial testing which could include the CTOPP.)

 

Anyway -- you might not get so much done as you think in 5-6 hours, of which maybe 3-4 are spent with your daughter (and not you).

 

Some will be that you get pointed in the direction to go in next for 1-2 hours of speech/language testing if you get referred for that, or 1-2 hours o OT testing if you get referred for OT.

 

That is how it goes more for me I think.

 

Partly bc probably 1-2 solid hours need to be spent on autism evaluation, and that is legitimate I think. I mean, it will depend, but for some things at this place you are getting the things done you can't get done at other places (or without the same expertise you are hoping for at this place).

 

But I really don't know!

 

I agree with what you are saying. They have OT and Speech therapists, too. They have already told me it would be a good idea to go ahead and get my pediatrician to send a script for OT and speech to "eval and treat".

 

Thanks, everyone, for sharing. It helps so much. They tried to call me this morning, but I didn't answer the phone because I wasn't sure I could remember all the questions I have. I made a list, so I'm about to call them back.

 

 

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That makes sense to go ahead and do it all there!

 

For us we did this at a place a 3-hour drive away, so we were much more doing what we couldn't do locally.

 

The next year they started doing what we drove her by Skype at a local place, which would have been great to save the drive, but I did like talking to people in person.

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Didn't read the others' replies, but the place you've found sounds fine. Why would they want to over-diagnose? Their professional reputation is on the line if they do that.

 

That eval set-up is pretty standard and how a lot of places roll. If you're looking at the ASD question, there's more they could do, sure. We had a psych spend many more hours doing really out of the box stuff, like real life stuff, going through the criteria, to see how he responded to things. Sometimes they'll try to sneak those experiences into the sessions. 

 

You just have to start somewhere. 

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Fwiw, when people work with a LOT of autism, they're usually extremely observant on what *isn't* as well. And they notice things that *are* the autism that less experienced people miss. Like our ps uses an SLP as their autism expert (I kid you not), and this (removing nasty words) person misses SO MUCH. Then you take my ds to the autism charter, where they see ASD2/3 all the time (for the record, my ds is currently ASD1) and the director is like of course he is, didn't you see xyz and abc and... They see more, so they notice more. They see more severe expressions of it (that level 3), so they recognize when they're seeing a level 1 expression of it. Novices miss stuff. 

 

So if your dc is on that higher functioning end, it's especially important to go to someone who deals with a LOT of autism, who isn't going to blow you off. Your worst case scenario is missing things and delaying diagnosis and appropriate intervention.

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Fwiw, when people work with a LOT of autism, they're usually extremely observant on what *isn't* as well. And they notice things that *are* the autism that less experienced people miss. Like our ps uses an SLP as their autism expert (I kid you not), and this (removing nasty words) person misses SO MUCH. Then you take my ds to the autism charter, where they see ASD2/3 all the time (for the record, my ds is currently ASD1) and the director is like of course he is, didn't you see xyz and abc and... They see more, so they notice more. They see more severe expressions of it (that level 3), so they recognize when they're seeing a level 1 expression of it. Novices miss stuff. 

 

So if your dc is on that higher functioning end, it's especially important to go to someone who deals with a LOT of autism, who isn't going to blow you off. Your worst case scenario is missing things and delaying diagnosis and appropriate intervention.

 

That is what I'm hoping for--that they would recognize what "isn't". The place we are going actually specializes in Autism, so they have seen a lot. The psychologists there don't only treat autism, so that's good--if there is something else going on.

 

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My daughter was evaluated by a neuropsych who specializes in autism, and came out with only an ADHD diagnosis (after an interview and 5-6 hour eval.) They'll run a full battery, take everything into account and won't diagnose ASD if it's not there.

Mine too. Almost exact scenario. These people don't hand out dx's unwarrented.

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Fwiw, when people work with a LOT of autism, they're usually extremely observant on what *isn't* as well. And they notice things that *are* the autism that less experienced people miss. Like our ps uses an SLP as their autism expert (I kid you not), and this (removing nasty words) person misses SO MUCH.

 

Western Psychological Services offers a 1 day training workshop on the ADOS to SLP's who want to offer ADOS testing. I was not at all expecting to see the ADOS as an option on the SLP training workshop list. Really, it's inappropriate for a SLP to be diagnosing ASD unless she's a BCBA with the specialized training and experience required for that certification.

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There are univ in our state that offer a masters level certificate in autism. You're *supposed* to use it to give you some familiarity so you can work with kids better, etc. The ps uses it to declare them "experts" (I kid you not, they literally say this) so they can pay the SLP instead of the overworked, more expensive psych. 

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Sounds just like what DD had. Initial was just parents and took about 2 hours. DD's test was from 8:30 to 4:00 with a one hour break for lunch when I took her off site. So 6.5 hours with the psych. I spent the time on site but in the hall not with them and was often filling out more forms. Then DH and I returned alone for about an hour for feedback. 

 

The psych DD saw also specialized in autism and shares a building with an autism center and DD did not get an ASD dx. They don't automatically hand out that dx just because they see it a lot. 

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