by Dr. Vincent J. Nunno
Description of Professionals and Services Performed
Licensed Psychologists
There are three types of psychologist you are likely to encounter at a public school in California. The most common is the "School Psychologist", who most commonly holds an M.A. in psychology and performs basic educational tests, which are called assessments. An M.A. level psychologist cannot give a diagnosis of a psychiatric or psychological condition.
In addition to the school psychologists, you may encounter licensed educational psychologists and licensed clinical psychologists, who will hold Ph.D. or Psy.D. degrees. Licensed clinical psychologists can diagnose psychological conditions, and both can diagnose learning difficulties. They can perform neuro-psychoeducational assessments.
When seeking a psychologist for a school-age child or adolescent, you should consider the following:
Are you looking for a diagnostic evaluation? There are generally three types:
- Psychodiagnostic Evaluation
This is the traditional evaluation done by psychologists and has developed complexity over the last fifty years. In general it consists of intellectual testing, neuropsychological screening and personality testing. The general focus is on psychological diagnosis and treatment planning, usually for individual, group or family therapy, and whether a referral for a medication evaluation by a psychiatrist / behavioral pediatrician is suggested. This evaluation may not be as useful in areas related primarily to educational, attentional or behavioral problems.
- Psychoeducational Evaluation
In addition to some or all of the above procedures, educational testing is also included. This type of evaluation can also be done by a licensed educational psychologist (LEP). The LEP is a separate license in California designed to allow school psychologists, with appropriate supervised experience, to practice educational/school psychology in the private sector on a fee-for-service basis. Many LEPs are master's level clinicians, and generally the areas of psychological/psychiatric diagnoses are beyond the scope of their practice.
- Neuropsychological Evaluation
This is a comprehensive evaluation that includes some, if not all, of the above areas, and in addition, testing and evaluation in the area of neuropsychological functioning. Neuropsychology is based on an understanding of brain-behavior relationships; that is, how certain behaviors of focus (attentional problems, memory problems, planning and organizational problems, learning disabilities in all areas) are understood in terms of underlying problems with neurointegrative functioning. Commonly these are referred to as "process disturbances" or "processing problems" and generally involve problems with cross-modality integration (auditory-visual-motor). Sometimes the roots of these problems are understood as reflecting "high-risk" characteristics, some of which are:
- Premature birth
- Difficult birth with signs of distress
- Adoption with unknown biological parents' history
- A history of blood family members with similar problems, especially in the areas of learning disabilities, attention deficits or the presence of significant mood disorders and/or psychosis/schizophrenia
- Dyslexia of the developmental and uncomplicated type (no real issues of ADHD or Significant emotional problems/behavioral problems), and without evidence from the early history of gestational/birth problems and no significant illnesses or injuries in early childhood, are most commonly related to genetic vulnerability. In most cases there are blood relatives with a history of reading problems.
The purpose of a comprehensive neuropsychological evaluation along with educational testing is an attempt to clarify whether there is some underlying level of integrative disturbance that is likely the root of the child's learning/behavioral/attentional problems.
If you are seeking psychological treatment (sometimes called therapy or counseling- and these are different) in addition to licensed psychologists or licensed educational psychologists, you may encounter other professionals.
- Marriage, Family and Child Therapists (MFTs)
This is a licensed professional (generally with a master's degree in marriage, family, and child counseling, although some practitioners also have doctoral degrees) whose practice focuses on the areas of relationship, family or child therapy. In general, the scope of this license does not include psychodiagnostic testing.
- Licensed Clinical Social Worker (LCSWs)
Individuals licensed to practice as LCSWs generally have a MSW degree ( a few may have DSW degrees ) and are trained to provide therapy. Usually they provide individual and family therapy.
Psychologists are licensed by the Board of Psychology. LEPs (licensed educational psychologists), MFTs and LCSWs are licensed by the Board of Behavioral Sciences.
- Speech and Language Therapists
Individuals certified to diagnose and treat disorders of language and the process of expressive speech.
- Educational Therapists (CETs)
Individuals certified to work with people using therapeutic educational techniques to help with basic processes, remediation, and/or issues of motivation.
Medical Practitioners
- Psychiatrists
These are M.D.s who practice psychiatric medicine and may do psychotherapy in addition to medication evaluations/prescription management. They usually specialize in either adult or child psychiatrists
- Behavioral Pediatricians
These are M.D.s with a specialty in pediatric medicine but who tend to focus their practice on behavioral problems in children. They are frequently the pediatricians who will prescribe medication for ADHD, although psychiatrists and regular pediatricians may also provide these medications.
- Neurologists
These are M.D.s who specialize in the diagnosis and treatment of diseases of the central nervous system. They usually specialize in either adult or pediatric areas. They are the ones most likely to use the following types of procedures:
- EEGs to study the electrical functioning of the brain and to diagnose seizure disorders
- CAT scans a static imaging technique helpful in diagnosing pathological brain tissue
- MRIs more sophisticated imaging technique, most useful for the above
- There are newer radiological techniques (PET scans, SPECT scans and quantitative EEGs) that are still considered somewhat "experimental" and may be used by some practitioners but not others. Until they are fully accepted, getting medical insurance to pay for them is frequently difficult. The advantage of some of these techniques is that they provide a more dynamic picture of brain functioning and may assist in the diagnosis of areas of inadequacy in neurological activity, which may be facilitated by medications.
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Dr. Vincent J. Nunno's "Parents' Guide to Service" was prepared for the Learning Disabilities Network Head-Royce School and reprinted for the COPAA conference 2004.
Its annotated form here is provided so that parents understand the roles of educational professionals. |
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