Welcome to Dr. Appelgren's Blog

Michael Appelgren, PsyD

Introduction

Supporting LGBTQIA+ students in schools is essential for creating a safe and inclusive learning environment for all students. There are several ways schools can support LGBTQIA+ students, including providing inclusive curriculum, creating a safe and supportive school culture, and offering resources and support for students and families.

5 Ways to Support LGBTQIA+ Students

  1. Create a Safe and Inclusive Environment: One way to support LGBTQIA+ students in schools is to create a safe and inclusive environment where they feel accepted and valued. This can be achieved through policies and practices that explicitly prohibit discrimination and harassment based on sexual orientation and gender identity, as well as through education and training for staff and students on LGBTQIA+ issues.
  2. Provide LGBTQIA+-inclusive Curriculum: Another way to support LGBTQIA+ students in schools is to provide an LGBTQIA+-inclusive curriculum. This can include teaching about the history and contributions of LGBTQIA+ people, as well as incorporating literature and other materials that reflect the diversity of LGBTQIA+ experiences.
  3. Establish Support Groups: Establishing support groups for LGBTQIA+ students can provide a safe space for them to connect with others who share similar experiences and to receive support and guidance. These individuals do not have to feel alone. These groups can be run by school staff, teachers or counselor, or by student leaders with the support of adults in the school community. Schools should have gay-straight alliance groups (GSAs).
  4. Provide Professional Development for Staff: Providing professional development for staff on LGBTQIA+ issues can help ensure they are equipped to support and affirm LGBTQIA+ students. This can include training on how to create a safe and inclusive environment, how to respond to discrimination and harassment, and how to support students who may be questioning their sexuality or gender identity.
  5. Partner with LGBTQIA+ Organizations: Partnering with LGBTQIA+ organizations can provide additional resources and support for LGBTQIA+ students. These organizations can provide training and education for staff and students, as well as support groups and other resources for LGBTQIA+ students and their families.
 In Conclusion….
In conclusion, supporting LGBTQIA+ students in schools is crucial for their well-being and academic success. By creating a safe and inclusive environment, providing an LGBTQIA+-inclusive curriculum, establishing support groups, providing professional development for staff, and partnering with LGBTQIA+ organizations, schools can work to support and affirm LGBTQIA+ students. It’s important that the education system and society as a whole, to recognize the importance of providing a safe and inclusive environment for all students, regardless of their sexual orientation or gender identity. It’s important to understand that every child deserves to feel loved, respected and safe, and that is a basic human right.
 

Michael Appelgren, PsyD

Introduction

In the realm of psychological assessments, two common types stand out: neuropsychological evaluations and psychoeducational evaluations. While both aim to provide insights into an individual’s cognitive functioning, they serve different purposes and are conducted in distinct contexts. Understanding the differences between these evaluations is crucial for individuals seeking clarity about their cognitive abilities or those advocating for someone else’s needs. In this blog, we delve into the disparities between neuropsychological and psychoeducational evaluations, exploring their respective scopes, methodologies, and when one might be preferred over the other.

Neuropsychological Evaluation

A neuropsychological evaluation is a comprehensive assessment that focuses on understanding an individual’s cognitive strengths and weaknesses, particularly in relation to brain function and structure. This evaluation is typically conducted by a neuropsychologist—a specialist trained in both psychology and neurology—who utilizes various standardized tests and measures to assess different domains of cognitive functioning.

Scope and Purpose
– Neuropsychological evaluations assess a broad range of cognitive functions, including attention, memory, language, executive functioning, visuospatial skills, and motor abilities.
– The primary goal of a neuropsychological evaluation is to identify any neurological or brain-related deficits that may be affecting an individual’s cognitive functioning and behavior.
– These evaluations are often sought in cases of suspected brain injury or neurological disorders such as traumatic brain injury, stroke, dementia, epilepsy, multiple sclerosis, and developmental disorders like ADHD or autism spectrum disorder (ASD).
– Neuropsychological evaluations also help in treatment planning, rehabilitation, and monitoring of cognitive changes over time.

Methodology
– Neuropsychological assessments involve a battery of standardized tests tailored to the individual’s age, developmental level, and specific concerns.
– Tests may include measures of intelligence (e.g., Wechsler Adult Intelligence Scale), memory (e.g., California Verbal Learning Test), attention (e.g., Trail Making Test), executive functioning (e.g., Wisconsin Card Sorting Test), and emotional functioning (e.g., Beck Depression Inventory).
– The evaluation process often includes interviews with the individual and collateral information from family members or caregivers to gain a comprehensive understanding of the person’s cognitive functioning and everyday behavior.

When to Seek a Neuropsychological Evaluation
– Suspected brain injury or trauma: Individuals who have experienced head injuries or trauma may benefit from a neuropsychological evaluation to assess the extent of cognitive impairments and guide rehabilitation efforts.
– Neurological disorders: People diagnosed with neurological conditions such as Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis may undergo neuropsychological evaluations to monitor cognitive decline, assist in differential diagnosis, and develop personalized treatment plans.
– Developmental concerns: Children or adults with developmental disorders like ADHD or ASD may undergo neuropsychological assessments to identify cognitive strengths and weaknesses, guide educational accommodations, and provide recommendations for behavioral interventions.

Psychoeducational Evaluation

A psychoeducational evaluation focuses on assessing an individual’s academic abilities, learning styles, and emotional functioning within an educational context. This evaluation is typically conducted by school psychologists or educational diagnosticians and aims to identify any barriers to learning and academic success.

Scope and Purpose
– Psychoeducational evaluations primarily assess academic skills, including reading, writing, mathematics, and academic achievement.
– The main goal of a psychoeducational evaluation is to identify specific learning disabilities, developmental delays, or other educational challenges that may be hindering a student’s academic progress.
– These evaluations are commonly conducted in school settings as part of the special education eligibility process or to inform the development of individualized education plans (IEPs) or accommodation plans (504 plans).

Methodology
– Psychoeducational assessments involve standardized tests and measures designed to assess academic skills, cognitive abilities, and emotional functioning.
– Tests may include measures of intellectual functioning (e.g., Wechsler Intelligence Scale for Children), academic achievement (e.g., Woodcock-Johnson Tests of Achievement), processing speed, and attention.
– The evaluation process may also include observations of the student in the classroom, interviews with teachers and parents, and a review of educational records and previous assessments.

When to Seek a Psychoeducational Evaluation
– Academic struggles: Students who are experiencing persistent difficulties in reading, writing, math, or other academic areas may benefit from a psychoeducational evaluation to identify underlying learning disabilities or cognitive weaknesses.
– Suspected learning disabilities: Parents or educators who suspect a child may have a learning disability such as dyslexia, dyscalculia, or specific learning disorder may request a psychoeducational evaluation to determine eligibility for special education services and accommodations.
– Behavior or emotional concerns: Students exhibiting behavioral or emotional challenges that impact their learning may undergo a psychoeducational evaluation to assess emotional functioning, identify underlying issues, and develop appropriate interventions or support services.

Choosing Between Neuropsychological and Psychoeducational Evaluations

While both neuropsychological and psychoeducational evaluations provide valuable information about an individual’s cognitive functioning, the choice between the two assessments depends on the specific concerns and goals of the evaluation:

– If there are suspected neurological or brain-related issues impacting cognitive functioning (e.g., following a head injury, stroke, or diagnosis of a neurological disorder), a neuropsychological evaluation is typically warranted.
– If the primary concerns revolve around academic performance, learning difficulties, or eligibility for educational services and accommodations, a psychoeducational evaluation is more appropriate.
– In some cases, individuals may benefit from both types of evaluations, especially if there are overlapping concerns about cognitive functioning and academic performance.

In Conclusion….

Neuropsychological and psychoeducational evaluations serve distinct purposes but are both invaluable tools for assessing cognitive functioning and addressing individual needs. By understanding the differences between these evaluations and their respective scopes, methodologies, and purposes, individuals can make informed decisions about which assessment is most suitable for their circumstances. Whether seeking to understand neurological deficits, learning challenges, or academic barriers, these evaluations provide valuable insights that can guide intervention, support, and educational planning, ultimately promoting better outcomes and quality of life for individuals across the lifespan.

Extended Time Testing

How do I find out if I require accommodations for standardized tests?

A comprehensive evaluation, usually neuropsychological testing, can help identify required accommodations for standardized tests needed to meet criteria for testing boards. If you have a confirmed or suspected diagnosis of anxiety, depression, Autism, ADHD, or learning disorder and demonstrate significant difficulty causing a disability, the testing board should provide accommodations. The initial step to seek accommodations is to receive comprehensive testing.

We have shown to be successful in helping individuals obtain the required accommodations for standardized tests. We understand what the testing boards require as documentation for accommodations. We offer testing on weekends and can have a report within 2 weeks. We offer expedited services if needed.

What are accommodations at school?

This is not an exhaustive list, but provides examples of accommodations:

    • Shorter assignments
    • Additional time to complete assignments
    • Seating close to instruction
    • Use of visual schedules
    • Advanced copy of class notes
    • Use of assistive technology
    • Redirection and prompting

Need extra time in school or on standardized tests?

Do you or a loved one need accommodations on standardized tests? Would extra time or multiple breaks help you demonstrate all your knowledge? Standardized tests are our way of life now and are present in elementary schools through high school and even in post-secondary education. Standardized testing can be nerve-racking and intimidating. We can see if you require accommodations through the Americans with Disabilities Act (ADA).

What are accommodations for standardized testing (e.g., SAT, GRE, LSAT, MCAT, GMAT)?

Examples of accommodations include:

  • Extra time (50% or 100%)
  • Use of assistive technology
  • Extra or extended breaks
  • Changes in the testing environment (e.g., testing in a separate room)
  • Changes in the timing of testing (e.g., stop time during breaks)

What are accommodations?

Accommodations are a change in teaching or testing procedures to provide an individual with an equal opportunity to demonstrate their knowledge and skills.

Consider the following as an example of an accommodation. Two individuals are required to copy notes from the classroom board, one individual has 20/20 vision (good eyesight); however the second individual cannot see far objects and, therefore, has difficulty copying objects from the board. The person with poor vision would be accommodated with the use of prescription eyeglasses. That is, the individual requires an accommodation (e.g., use of eyeglasses) because they would not be able to accomplish the task  (e.g., copying from the board). Accommodations are not meant to provide an advantage for an individual, but they are meant to allow the individual the same opportunity to be successful as their peers.

Documentation Needed for Accommodations

It will be important to maintain school records, such as report cards, Individualized Education Program (IEP), accommodations plan, previous evaluations (e.g., psychoeducational), and teacher reports about what they observe in the classroom and the need for more time in the classroom to complete tests and/or tasks. These are essential to include in the evaluation to demonstrate a history of challenges. Additionally, it will be important to provide any medical reports or letters from a primary physician, neurologist, or psychiatrist indicating a diagnosis, including ADHD, learning disorder, Autism, anxiety, depression, communication disorder, or intellectual disorder. Providing documentation of accommodations provided in the past (formal or informally) on standardized tests will demonstrate the challenges with working quickly are long-standing and unremitting.

It will be important for you to understand and be able to explain how your disorder and/or symptoms lead you to not being able to complete a task, causing a disability, which leads to the need for accommodations (e.g., extra time). This, in turn, will help you advocate for yourself, and understand your strengths and weaknesses.

Important Links

Click on the name of the test you are taking/planning on taking for more information on how to apply for accommodations on standardized tests:

INDEPENDENT EDUCATIONAL EVALUATION (IEE)

What is an IEE?

An independent educational evaluation a.k.a. an IEE is an evaluation conducted by a qualified person who is not employed by the school district the student attends at the public’s expense. This request can be made by a child’s parent. Families may seek an IEE to have an objective perspective of the child’s needs. The testing procedures for the IEE are the same as those followed by the school district.

Possible reasons for requesting an IEE

  • There is no qualified person to perform the evaluation
  • You believe the school/evaluator is using insufficient or outdated information to make individualized education program (IEP) decisions
  • If the evaluator did not assess all areas of suspected disability
  • Disagreement between the results and actual performance day-to-day
  • Evaluation not done in child’s home language and/or was not culturally appropriate

How do I request an IEE?

Submit a written letter to the special education coordinator,
case manager, or principal at your child’s school. You can also send the letter
by email or certified mail (dependents on the district’s policies). Include the
following:

  • Child’s name, school, date of birth, and identification (ID) number
  • State you are requesting an IEE at the Department of Education’s (DOE) expense
  • Briefly state the reasons why you are requesting an IEE
  • Ask that the school respond about the next steps to get the IEE

Important Links

Neuropyschological Evaluation

Are you or your child struggling academically? Do you suspect an intellectual disorder, learning disorder, ADHD, or Autism? A comprehensive neuropsychological evaluation can help clarify one’s functioning and guide appropriate treatments and interventions.

What is a neuropsychological evaluation?

A neuropsychological evaluation consists of a series of formal and structured psychological and academic/achievement tests, as well as clinical interviews to help identify one’s emotional, behavioral, learning, and cognitive profile. Neuropsychological assessments may be administered in writing or verbally, or conducted in-person or via the computer. A neuropsychological evaluation is used to assess brain-based disorders by examining cognitive and academic skills on brain function.

Benefits of receiving a neuropsychological evaluation

  • Receiving a comprehensive neuropsychological evaluation will provide an in-depth and holistic examination of one’s strengths and weaknesses.
  • A neuropsychological evaluation provides additional information that might not be assessed if a psychoeducational evaluation was previously administered.
  • Neuropsychological evaluations can provide answers to why an individual continues to struggle or does not make adequate progress despite receiving specialized and intensive supports.
  • Individuals who are seeking accommodations for standardized testing (e.g., SAT, GRE) are required to undergo a neuropsychological evaluation.

What is included in the neuropsychological evaluation?

A neuropsychological evaluation can include multiple components such as:

  • Structured and Unstructured Clinical Interviews
  • Review of Records (e.g., educational, family, medical, psychiatric)
  • Mental Status Exam
  • Clinical Observations
  • Administration of Various Measures
    • Cognitive Measures (e.g., WISC-V and WAIS-IV)
    • Academic/Achievement Measures (e.g., WIAT-IV and KTEA-3)
    • Language Measures
    • Direct Measure of Executive Functioning (e.g., D-KEFS)
    • Learning and Memory Measures (e.g., WRAML-3)
    • Sensorimotor and Visuospatial Measures
  • Formal Rating Scales/Survey (e.g., BASC-3)

What is the neuropsychological evaluation process?

Similar to the Mental Health EvaluationPsychological Evaluation, and Psychoeducational Evaluation the process begins with an initial consultation. Afterward, an evaluation appointment is scheduled with our staff. On the day of the evaluation, a clinical interview will be completed to clarify any information in the intake paperwork, and gain insight into the client’s symptoms (e.g., mood, anxiety, executive functioning) and impairment in functioning. Norm-reference psychological, academic, language, memory, and executive functioning tests will be administered. Once all of the information is gathered, your clinician will conceptualize the underlying symptoms based on extensive professional knowledge, prior experience, and up-to-date research. The results will then be communicated to you outlining the most appropriate next steps and interventions.

Psychoeducational Evaluation

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What is a psychoeducational evaluation?

A psychoeducational evaluation consists of a series of formal and structured psychological and academic/achievement tests, as well as clinical interviews to help identify one’s emotional, behavioral, learning, and cognitive profile. Psychoeducational assessments may be administered in writing or verbally, or conducted in-person or via the computer. This evaluation can be used to determine eligibility for special education services, 504 accommodations plan, or accommodations on standardized tests (e.g., SAT, ACT, Bar Exam).

 

What is included in the psychoeducational evaluation?

A psychoeducational evaluation can include multiple components such as:

  • Structured and Unstructured Clinical Interviews
  • Review of Records (e.g., educational, family, medical, psychiatric)
  • Mental Status Exam
  • Clinical Observations
  • Administration of Cognitive Measures (e.g., WISC-V and WAIS-IV)
  • Administration of Academic/Achievement Measures (e.g., WIAT-IV and KTEA-3)
  • Formal Rating Scales/Survey

What does the cognitive test measure?

There are different types of cognitive measures (e.g., verbal and nonverbal). Cognitive measures assess one’s potential and examine the following areas:

  • Verbal Reasoning
  • Nonverbal Reasoning
  • Visual Processing
  • Cognitive Proficiency (i.e., working memory and processing speed)

What does the academic and achievement test measure?

Just the same as cognitive measures, there are various academic and achievement tests. Academic and achievement tests are designed to measure one’s level of skills and proficiency of knowledge in different domains such as:

  • Language Processing
  • Writing (e.g., spelling skills and essay composition)
  • Reading (e.g., basic reading skills and reading comprehension)
  • Mathematics (e.g., basic calculation and word problem-solving)

What is the psychoeducational evaluation process?

Similar to the Mental Health Evaluation and Psychological Evaluation, the process begins with an initial consultation. Afterward, an evaluation appointment is scheduled with our staff. On the day of the evaluation, a clinical interview will be completed to clarify any information in the intake paperwork, and gain insight into the client’s symptoms (e.g., mood, anxiety, executive functioning) and impairment in functioning. Norm-reference psychological and academic tests will be administered. Once all of the information is gathered, your clinician will conceptualize the underlying symptoms based on extensive professional knowledge, prior experience, and up-to-date research. The results will then be communicated to you outlining the most appropriate next steps and interventions.

Pyschological Evaluation

What is a psychological evaluation?

A psychological evaluation consists of a series of formal and structured psychological tests, as well as clinical interviews to help identify one’s emotional, behavioral, and cognitive profile. Psychological evaluations may be administered in writing or verbally, or conducted in-person or via the computer. Psychological evaluations can be used in the identification of intellectual differences and personality disorders.

What is included in the psychological evaluation?

A psychological evaluation can include multiple components such as:

    • Structured and Unstructured Clinical Interviews
    • Review of Records (e.g., educational, family, medical, psychiatric)
    • Mental Status Exam
    • Clinical Observations
    • Administration of Cognitive Measures (e.g., WISC-V or WAIS-IV)
    • Formal Rating Scales/Survey

What does the cognitive test measure?

There are different types of cognitive measures (e.g., verbal and nonverbal). Cognitive measures assess one’s potential and examines the following areas:

  • Verbal Reasoning
  • Nonverbal Reasoning
  • Visual Processing
  • Cognitive Proficiency (i.e., working memory and processing speed)

What is the psychological evaluation process?

Similar to the Mental Health Evaluation, the process begins with an initial consultation. Afterward, an evaluation appointment is scheduled with our staff. On the day of the evaluation, a clinical interview will be completed to clarify any information in the intake paperwork, and gain insight into the client’s symptoms (e.g., mood, anxiety, executive functioning) and impairment in functioning. Norm-reference psychological tests will be administered. Once all of the information is gathered, your clinician will conceptualize the underlying symptoms based on extensive professional knowledge, prior experience, and up-to-date research. The results will then be communicated to you outlining the most appropriate next steps and interventions.

Gender Affirming Surgery / Pre-Operation

Are you or a loved one undergoing surgery or procedure requiring a mental health evaluation? We provide specialized evaluations to assist in pre-operation procedures. As with most evaluations, it begins with a clinical interview to obtain background information. The evaluation includes a review of records and collateral information. The clinical interview focuses on behavior, psychiatric symptoms, and understanding of the surgery. The information discussed in the clinical interview is critical to assess the appropriateness of surgery and to enhance the client’s success during the post-surgery adjustment. The evaluation may require multiple sessions.

Components of the Evaluation

  • Reasons for Seeking Surgery
  • Informed Consent
  • Understanding of the Surgery and its Associated Lifestyle Changes
  • Social Supports
  • Psychiatric Symptoms (current and past)

Receive your 15-minute free consultation with a knowledgeable clinician.

Mental Health Evaluation

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Assessing with Confidence

What Could I Expect?

Our clinicians have a range of experiences working with diverse populations and assessing different mental health symptoms. We provide thorough and comprehensive mental evaluations for individuals of all ages (children, adolescents, and adults) based on symptomology and provide appropriate recommendations for intervention.

What is the Intake Process?

There will be an initial interview prior to testing, which occurs over the phone. You will consult with a clinician and determine the next steps forward and how we can meet your needs. During this time, our clinicians will provide information about the evaluation process and answer any questions you may have. We share the different services we offer, explain our accepted forms of payment, and schedule an appointment.

Considerations for Mental Health Conditions Include:

  • Duration of symptoms (e.g., How long have symptoms been present?)
  • Frequency of symptoms (e.g., how often are symptoms occurring or present?)
  • Age of Onset of symptoms
  • Level of Distress (e.g., mild, moderate, severe)
  • Level of Impairment (e.g., lack of employment, academic failure)
  • Due to medical reasons or substance abuse

Feeling overwhelmed by life events? Struggling to maintain meaningful relationships with others? Feeling sad? Constantly worrying about the future or about your career? If you can relate, you might be one of many individuals who are struggling with mental health. We specialize in the assessment of a variety of symptoms, several including depression, autism, anxiety, depression, gender dysphoria, and attention-deficient/hyperactivity disorder.

What are the next steps? Don’t worry, our easy process is described below.

Clinical Interview

You will meet with a clinician to begin the evaluation. We start by building rapport and making you feel comfortable as we know this can be an overwhelming process. The clinical interview includes a discussion about your current unique challenges, early childhood and development, school and/or work, medical, and family histories.  Additional questions are asked about past and present mental health symptoms. There is no simple “test” that can identify a mental health condition, that is why we use multiple evidence-based assessments and best practices to come up with our conceptualization and understanding of the issues.

After the clinical interview, you and/or your child will be asked to complete several scientifically validated rating scales on the computer. These scales may be completed independently or with the assistance of your clinician. Afterward, we generate scores that are compared nationally with thousands of other individuals, with symptoms or without symptoms, to statistically calculate the severity and impairment of your current symptoms.

A brief break is provided to you so your clinician can formulate their thoughts based on the clinical interview, standardized measurements administered, and years of clinical experience working with diverse populations. Your clinician will analyze the information gathered and rule out disorders that may be similar to the current presenting symptoms.

Conclusions

Your clinician will meet to share and discuss the findings with you based on the information gathered and our expertise. Receiving a confirmation of a mental health condition can be confusing or overwhelming. For these reasons, we take the time to answer your questions and provide you with a holistic approach to treatment. Your clinician will provide you with the most appropriate recommendations and interventions, which include psycho-education. Your clinician will discuss various services provided at Dynamic Learning Services should you decide to pursue treatment or provide you with appropriate referrals for additional interventions.

Receiving an accurate diagnosis is the beginning step to welcoming change. Understanding the diagnosis (i.e., what it is and what it is not) may help explain why it is challenging for you to start a task, finish a task, keep yourself organized, or why you might feel sad or anxious. Seeking treatment can help you manage your symptoms.

Psychotherapy Services

CBT - acronym from wooden blocks with letters

Therapy at Dynamic Learning Services

At Dynamic Learning Services, we offer individual, couple, and family therapy. We provide non-judgmental, holistic, collaborative, using primarily evidence-based cognitive-behavioral therapy (CBT) and trauma-focused cognitive-behavioral therapy (TF-CBT) when working with a diverse population. We use gender-affirming language when working with individuals who identify as LGBTQIA+.

Our experience includes treating a variety of symptoms, including anxiety, depression and mood, attention-deficit/hyperactivity disorder (ADHD), specific learning disorder, autism, executive functioning, and posttraumatic stress disorder (PTSD).  Additional therapy modalities include solution-focused therapy, motivational interviewing, and communication/interaction family therapy.

What is Cognitive-Behavioral Therapy (CBT)?

The premise of CBT is that how we perceive situations (i.e., cognitions) affects our feelings and our behaviors.  CBT tries to identify the underlying assumptions and beliefs that are causing impairment or dysfunction and challenge automatic thoughts through cognitive restructuring. CBT is evidence-based and is considered a brief psychotherapy approach.

Step 1: Reflect

The first step in initiating therapy is to reflect on whether you are ready to make changes in your life. Therapy can be challenging and frustrating and can feel like a waste of time if you are not receptive to making different decisions to allow yourself to grow.

Step 2: Evaluation

If you choose to pursue treatment with us, you or you and your child will meet with a clinician so they may learn more about the current symptoms. During this time, the clinician will ask about challenges faced at home and in school.  After the evaluation, the clinician will provide initial diagnostic impressions and recommendations.

Step 3: Treatment Planning

Your clinician and you will collaborate and develop a personalized treatment plan based on the current symptoms and the severity of symptoms. The treatment plan will incorporate the goals you identify for treatment.

Step 4: Reevaluate Your Progress

Periodically, you and your clinician will meet to review what is working in sessions and make adjustments to treatment as needed.

Step 5: Termination

Termination in therapy is typically referred to as the period in which the psychotherapy relationship comes to an end. There are several reasons for termination, which includes achieving therapeutic progress (i.e., decrease in symptomology and intact functioning), the client’s lack of commitment to therapy, or symptoms are beyond the scope of available care. Termination can be a stressful time for clients; therefore, your clincian will assist you in processing your thoughts and feelings toward termination, discuss the next steps, and provide appropriate referrals if needed.

Executive Functioning Coaching

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What is Executive Functioning?

There are multiple definitions, explanations, and theories of executive functioning and there is no consensus of a single definition. From our experience and an easy way to think about executive functioning is imagining an orchestra conductor of all other orchestra conductors in the brain. It is the part of the brain that cues and directs how the brain works and processes information. 

Executive functioning is located in the frontal lobe of the brain (the area right behind the forehead), and it takes about 20-something years to develop and fully mature. Our executive functioning helps not only with the organization but also assists in the managing of our emotions and our behaviors.

How do I know if I have difficulty with executive functioning?

If you struggle with daily functioning such as keeping up with assignments and projects, decision-making, difficulty staying focused when required, then you might have vulnerability in your executive functioning. If you think or suspect you have an attentional disorder, such as attention-deficit/hyperactivity disorder (ADHD) then testing can help clarify your skills. Testing for executive functioning weaknesses should be completed as part of a full evaluation that looks at how you learn and think. Licensed psychologists and/or neuropsychologists can conduct the necessary evaluation to assess executive functioning.

How does executive functioning affect my life?

Here are some signs and issues individuals struggle with when executive functioning is impaired:

  • Trouble starting and/or completing tasks
  • Adjusting processing speed (e.g., difficulty completing timed tasks)
  • Prioritizing a task
  • Completing a task but not handing it in
  • Estimating how long a task will take
  • Difficulty following multistep directions
  • Becoming easily frustrated
  • Interrupting others
  • Forgetting appointments

Services Offered

We provide individualized and prescriptive organizational skills training to address an individual’s executive functioning. We start with an initial assessment (e.g., clinical interview and rating scales) to obtain a baseline and pinpoint the areas of need.

Each session consists of direct instruction on the identified executive functioning skill. Individuals will be tasked to practice the skills taught, discussed, and reviewed in sessions from week to week. Reflection and metacognition (awareness and understanding of one’s own thought processes) are important components of the training.

How do you assess executive functioning?

There are measures and tests that look at a wide range of executive skills.

Measures used to assess executive functioning:

  • Intelligence
  • Trail Making
  • Rating Scales (broadband and narrow)
  • Informal (observations, background/developmental history)

Executive skills include:

  • Attention
  • Inhibition
  • Processing Speed
  • Word Retrieval
  • Set Shifting/Cognitive Flexibility
  • Working Memory

Consultation Services

Pre-Evaluation

Have you received previous evaluations and/or have Individualized Education Programs (IEP) and are not sure what should come next? Do not worry, our team will thoroughly review all the past reports and documentation. With permission, we will also contact current and past treatment providers and/or teachers. Once the information has been reviewed, we can discuss the next steps including a personalized evaluation and intervention plan. It is important to obtain an accurate diagnosis to be able to identify the most effective treatment.

Special Education and Individualized Education Program (IEP)

Special Education and the IEP Process can be overwhelming and confusing. You recognize your child is struggling academically or socially and want the best possible plan to ensure academic success. You might ask yourself, “what is the difference between a 504 plan or an IEP?” We have years of experience working in NYC and NJ school systems so we understand the process. We can explain special education law and the IEP process in detail. Initially, we will review background information such as previous evaluations and IEPs. At times an updated evaluation or additional testing may be warranted after a review of records. Afterward, we will work with you to create a meeting strategy to prioritize the most effective classroom placement, supportive services, and accommodations for your child.

Independent Evaluations

Has your child been referred for an evaluation to determine eligibility for special education but you are not in agreement? We offer independent (second opinion) educational evaluations (IEE) when necessary. The initial step is for our dedicated and experienced staff to review background information and previous evaluations. Then we create an individualized testing plan that addresses your concerns. Once testing is complete, we will create a plan to discuss educational placement, supportive services, and accommodations for your child. We also consult with other professionals such as occupational therapists, physical therapists, speech-language pathologists, psychiatrists, and neurologists.

LGBTQIA+

Does your workplace need training on LGBTQIA+ related topics? Are you in need of a trainer/presenter at your school to discuss how staff can support LGBTQIA+ youth? We have expertise in providing training to different audiences on LGBTQIA+ topics. We have experience providing consulting services to school districts (e.g., administrators and teachers) and mental health practitioners (e.g., social workers). We believe it is important to provide supports in school and in the workplace for LGBTQIA+ individuals.

Read Dr. Michael Appelgren’s dissertation titled:

Emotional Support Animal (ESA)

Young Woman Embracing Dog

Emotional Support Animal vs. Service Animals

Although the terms are frequently used interchangeably, they are different. A service animal (e.g., dog) is trained to assist and guide a person with an identified disability that impairs one’s physical, intellectual, sensory, or mental functioning. Service animals help an individual with a disability perform everyday tasks, such as pressing the elevator button, altering the person to anger, picking up dropped items, and pulling a wheelchair.

An emotional support animal (ESA) provides relief to its owner as a result of having an emotional or mental disability and provides companionship and relieves loneliness. Under the Americans with Disabilities Act (ADA), an ESA encompasses animals from all species. It is important to note that over the years there has been an increase in emotional support animals (ESAs) on airplanes, in community settings, and in homes/apartments. Airlines and landlords beginning to tighten up the way they are coping with the increase of ESAs.

Qualifying Conditions For An ESA

These are some of the common mental health disabilities that qualify an individual for an ESA:

  • Anxiety
  • Depression
  • Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Chronic Stress
  • Post-Traumatic Stress Disorder (PTSD)

Benefits/Risks of ESA

The following are examples of some of the benefits of ESAs:

  • Helps reduce mental health symptoms (e.g., anxiety, depression)
  • Provides unconditional love
  • Works in conjunction with other forms of treatment
  • Provides social support
  • Helps stabilize intense emotions

Possible risk of being granted an ESA would require a letter indicating the presence of a disability that becomes part of the individual’s clinical record. Questions about mental health disability can be asked about as qualifications in certain employment. In some states, the mental health evaluator is required by law to inform the state of a person’s mental health disability. Mental health disabilities can come up when seeking government security clearance and life and disability insurance. A finding of a mental health disability and not reporting it on certain applications may have serious consequences for the individual. Documentation of a mental health disability can become a factor in child custody cases.

Considerations For ESA Evaluation

First and foremost, legal and ethical considerations must be taken when providing an evaluation for ESAs. Regarding this point, mental health professionals must avoid entering into multiple relationships. If a client is already in therapy with a provider, then the clinician must consider their dual role of therapy provider and evaluator. A clinician must be able to identify any biases or other factors that might possibly interfere with the therapeutic relationship.

Second, the individual seeking the accommodation of an ESA must meet the criteria for a psychiatric disorder (e.g., anxiety, PTSD, depression) consistent with the Diagnostic and Statistical Manual- 5th Edition (DSM-5) and be assigned the disorder by a mental health professional. The individual must qualify as disabled based on a mental health condition and the presence of the animal must provide some relief of symptoms to the individual. A disability describes a psychological condition that substantially interferes with the individual’s ability to perform major life activities. It means the person requires the presence of the animal to function or remain psychologically stable, which is more than having a pet.

One of the limitations of the evaluation is the fact the assessment of the animal is beyond the scope of the evaluator’s skill set. Clients may consider assessing the animal’s temperament by obtaining documentation such as the Canine Good Citizen (CGC) test.

Emotional Support Animal Evaluation Process

The evaluation process for an ESA may require multiple sessions.

Clinical Interview- A thorough and comprehensive interview will be conducted with one of our trained professionals in-person or virtually. The interview would include background history and mental health symptoms. Information will be gathered through direct interviews, as well as the use of multiple tools (e.g., surveys and rating scales). A review of previous records and collateral information is also part of this process. The evaluation also assesses the presence of malingering using objective measures (e.g. MCMI-IV, MMPI-2), how does the animal alleviate their owner’s symptoms, and how the animal responds in public settings and with others. The evaluation also includes observing the client and animal interact.

Click On The Following Links To Find Information about ESA laws in NJ, NY & PA.
Click on the following link to access information from the US federal government on the use ESAs on airplanes. It is recommended that you contact the individual airlines to get specific information about ESAs.