February 24, 2025 • 40 mins
Dr. Lev Gottlieb, a neuropsychologist discusses his unique approach to neuropsychology and child development, emphasizing the importance of collaboration among caregivers, and a strengths-based approach to treatment. He highlights the need for effective communication between parents and professionals and the challenges of navigating labels and accommodations in education. Dr. Gottlieb advocates for a comprehensive care model that focuses on the whole child rather than just their diagnoses, encouraging parents to trust their instincts and create open channels for communication.
About Dr. Lev Gottlieb: He is a neuropsychologist and UCLA Assistant Clinical Professor. He assesses children, adolescents, and adults, and coordinates their care. Dr. Gottlieb earned his Bachelor’s Degree in Psychology from University of Pennsylvania and Doctoral Degree in Clinical Psychology from Northwestern University School of Medicine. He completed specialty training in Neuropsychology at Children’s Hospital of Chicago, NYU Child Study Center, Johns Hopkins University School of Medicine, Kennedy Krieger Institute, The Help Group, and UCLA, where he continues to serve on the clinical faculty.
Dr. Gottlieb has extensive experience providing evaluations and treatment to those with neurodevelopmental differences and acquired brain injuries, and has published and presented research on these conditions and their treatment as well as on learning, memory, and talent.
To learn more about Dr Gottlieb's clinic:
https://www.theintegratedclinic.com/
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com
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Transcript
Episode Transcript
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Unknown (00:00):
Hi everybody. Welcome back to your child is normal.
(00:03):
Today, I'm joined by Dr LevGottlieb, a neuropsychologist
with extensive experiencehelping children and families
navigate learning, behavioraland emotional challenges. Dr
Gottlieb leads multiple clinicsacross southern California, and
he brings a unique, thoughtfulperspective to
neuropsychological testing anddiagnosis. So in this episode,
we talk about the nuances ofneuropsych testing when it's
(00:23):
helpful when it might not be,and how we can approach labels
in a way that supports ratherthan limits children. Dr
Gottlieb's approach to treatmentis refreshingly holistic, and he
has a lot to offer parentslooking for guidance. I can't
wait for you to hear hisinsights. So let's get started.
And if you're enjoying thispodcast or this episode, I'd
love to hear what you think.
Please consider leaving a fivestar rating wherever it is. You
listen to podcasts, it reallyhelps spread the word. Dr
(00:45):
Gottlieb, I'm so happy to haveyou on the podcast. Thank you so
much for being here. I can'twait to talk to you and tell
everybody about the work thatyou
do. Oh, that was so nice. I'mhappy to be here. Thanks,
Jessica. So tell everybodywhat do you
do for work? Sure, so, um, so aslike my clinical profession, I'm
a neuropsychologist. Some of youmay have heard of that. To break
(01:07):
that down, neuro means mind andpsych means function. For me, at
least. So you're quantifying themind through puzzles and tests
to explain how someonefunctions. But the idea is,
you're capturing someone'sthinking style in the context of
their development, their aging,an injury, a gift, whatever. But
there's something that's sort ofnot working for them, usually in
(01:28):
the mainstream, that they wantto quantify and understand, and
then you make a plan around it.
So I'll unpack that more later,but that's the that's the
orientation of aneuropsychologist. And I'm
just curious, just for theaudience, to get to know you.
How did you come to this field?
What drew you to the field ofneuropsychology? I
don't know. There's probably,like, a better answer that I'm
going to give. The true answeris you just, sort of, I found my
(01:51):
way step after step, and youjust, like, put your foot in
front of you in the mostreasonable place. And I sort of
found myself here. The evolutionwas something like, I was at a
college when Facebook came out,and I didn't really want to be
behind a computer, so I wantedto work with people, which
became psychology. And then Irealized I didn't, truthfully,
have the patience to fully be onthe journey of everyone's
(02:11):
treatment path, and I was alittle more medical and
assessment based, so I movedinto medicine, slash neuro and
testing. And then I, like, sortof working with kids, because
kids are expansive and growingand complex, honestly, from a
neural perspective, so but thosedecisions I didn't think about
beforehand, I just sort of ineach moment, tried to make the
(02:32):
most reasonable, next bestdecision for me, and I ended up
becoming a neuropsychologist.
And you also, you're aneuropsychologist that
specializes in children.
Correct? That'strue from a clinical
perspective. I see kids like twoto 39 you know, 39 is not really
a kid, but the developmentalarc. And then the person I work
with, who I run the clinic with,sees people like 16 to 100 so we
really do lifespanneuropsychology, but we each
(02:53):
specialize a little bit in ourdomain. So I am a more of a
child development specialist.
And then we run health andwellness clinics in Santa Monica
and LA, but also other cities inCalifornia.
And just to explain a littlemore about what you mentioned
previously, you said you dolifespan assessments. So what
does that mean? Exactly?
Lifespan means like across thelifespan. So I'm like a
(03:15):
developmental specialist. Mykind of clinic co manager is an
adult specialist. So we doanything that affects your
functioning in everyday life,that isn't a sort of a crisis or
an active injury, we're reallyhelpful to quantify what's going
on and what you might do goingforward, which all again, that
(03:36):
takes the form of, does my kidhave attention differences,
learning differences, reading,writing? Did I have a
concussion? How is it affectingme? So it could be something
really clear, like that, or itcould be something like, you
know, my kid's really bright andthinks a little differently. And
some of those kids alsosometimes have a mild delay in
social and emotional skillscompared to cognition, which can
create a lot of internaldistress that sometimes gets
expressed. And there are these,like patterns of mind, styles,
(03:59):
let's say there's like 10 to 50that are pretty well
represented, and then there's,like, some individuality beneath
that. We're trying to quantifyall that and then make it really
tailored plan for someone.
So there's a few things that youmentioned that I really like.
The first is, I love this ideaof a light being a lifespan
provider. Because, for example,myself as a pediatrician, you
know, once kids hit college,they have to graduate from us
(04:20):
and go on to an internist or adifferent specialist, and I love
that you're able to take care ofyour patients throughout their
life. That's a really unique,special ability that I think you
have as a neuropsychologist,thanks
for saying that. Yeah, it'sinteresting. We're because of
the way mental health andneuropsychology generally works
outside of an academic medicalcenter. It's usually some kind
(04:41):
of private model. You get asuper bill, you get reimbursed,
although that may change. And Ithink because of that, we may
not be as bound as like anacademic medical center or a
pure medical model. If you're aminor and you're an adult like
that distinction resonates nowthat I heard you say it because,
like when I worked at UCLA, inplaces like you're either in the
peds care under 18, and thensuddenly there's this, like
chasm, and then. Like you're anadult and you have to make all
(05:01):
your independent decisions. Andwe tried to bridge that, but it
was pretty different, becausewe're basically allowed to
practice our work without reallymany constraints besides ethics
and laws, we can follow thetypes of like clients or
conditions that we're best atacross their actual arc, as
opposed to somewhat of anartificial arc that like 18, you
become an adult, right? So thatso like ADHD, you could see
(05:26):
from, you know, whatever, fourto six, roughly, although you
could technically see a signalto two, probably, you know, you
could follow through someone'slifespan. There's so many things
you can assess, like, if youjust take kids again, I'm not
really diagnostic. I'm trying tomap a mind to explain function,
to give a precision plan thatsaid, just to be
straightforward, people comewith a referral question, and it
tends to take the form of alabel, because that's the way in
(05:48):
which we understand people. Sothere's for kids, it's ADHD,
dyslexia, or like learningdifferences, math issues like
dyscalculia, autism, and thenyou have anxiety and depression
or emotional overlays, then youcan also have epilepsy or head
injuries or genetic syndromes.
And there's so many syndromes,at some point there's a shared
overlap that you can if you'veseen enough syndromes, you kind
(06:09):
of know what you're looking for.
But you could imagine, as apediatric provider who also has
to know what's normative, if Ialso needed to know everything
about dementia, that's too much,you know. So that's where, like,
there's some amount, Ithink, where, like the saying
goes, jack of all trades, masterof none, absolutely. Yeah, I
think evenin assessment. But there are a
few people I've met who try todo the whole, the whole true
lifespan, you know. So I'm aquasi lifespan neuropsych, but
(06:31):
our clinic does lifespan becauseI have an adult counterpart,
basically, who cares the adultcases. That's
fantastic. That makes a lot ofsense. So, okay, so you had
mentioned a few of theconditions that parents take
kids into. CU, I want toelaborate on that a little bit
more so that people that arelistening maybe they can, maybe
they'll think that their child,their child may be a good fit
for your clinic. So youmentioned that you take care of
(06:53):
kids with learning differences,autism. ADHD, you mentioned
earlier, gifted children maycome to see you. Anything else
that you're that you're that youguys are proficient at taking
care of that you hadn'tmentioned? Sure,
I'm mixed about answering this.
To be honest. I appreciate thequestion. Here are my thoughts.
One is, I really don't like todefine people based on the
label. Labels are like aheuristic that guide
intervention, but it's, it'skind of the a quantified
(07:13):
assessment of the mind isdimensional. But I also get the
question, you know, and thenfinally, we, I'm happy to
provide this, like, be on thispodcast, just to share what we
do, and also, if someone wantsto see us, that's great. But I
just want to be clear, too, thatI don't want to, I don't want to
sell something. I know you'reasked in a kind way, but I just
have to say that you can editthat out if you want. But just
(07:34):
to be frank, I don't have anylike, pitch really, my brand and
who I am is someone who, like,tries to do their best and show
up without, like, a hugeorientation to some secondary
gain. But that probably worksitself out, like, if I'm being
realistic, because people likesomeone like that working for
them, so I just lean into that.
But to answer, like youroriginal question about what we
see, anything you know, theconditions that people are most
(07:56):
common, like, commonly aware ofor curious about, are ADHD
learning differences, AutismSpectrum Disorders, dementias,
brain injuries, like concussionsand head injuries, and then like
epilepsies, genetic syndromes orother things that seem to affect
the mind, including anxiety,depression that seems to have a
legitimate cognitive toll, orone that's not straightforward
(08:19):
for The therapist. Otherwise, wesee people where there's
complexity, because if you thinkabout it, in most parts of the
country, you do a response tointervention model, which is
basically you see some doctor orsomeone, you do the most likely
thing that would help, which isthe intervention. You see, how
you respond to thatintervention. And if it was a
wise choice, it might just work.
Often it does. If it wasn't justthe right choice, you get data
(08:41):
about why it wasn't, and that'sits own assessment model that
prioritizes treatment and notassessment up front. And there's
like, there's a real merit tothat, to be honest. I mean, we
do these big, big assessments,but a lot of times you could do
a response to intervention modelto help someone just as much
too. So if you have a hunchthat, like, someone has a
reading issue, you could get areading specialist. And if you
(09:03):
don't think there's somethingelse impacting, then that was
probably the right thing to do.
And then if it doesn't work, orit only works so well, maybe you
assess them, but at the veryleast you have more data. You
know, I think sometimes peopleare very quick to always assess
first, and that's that's like aluxury, and it's something
mainly most useful when there'scomplexity, if it's a one
straightforward thing, like, mykids grade everything, but
(09:24):
they're just not learning toread. Or, you know, they're
doing so well when they'reinterested that when they're
not, they just can't focus.
Like, if it's just one thing, dothe one thing, like go in that
domain, you might there's a goodcase to be made for that. But
again, high SES communities,people tend to assess first,
want to know everything firstand then move forward,
particularly with kids. Peopledo it for their kids because
they really want to know. Youknow, I think that's part of the
(09:46):
driving impulse to do such a bigassessment. And again, if it's
complex, it's really needed. Ifit's not complex, arguably, you
have to decide, could you make agood choice without the
assessment? Save money and timeor like. Do I need for myself or
my kid? Just to do I need to gothrough this process to really
know, you know, but if you ifyou have a hunch of what you
need to do as a parent, I wouldusually empower that parent to
(10:07):
try to make that choice, and youdon't have to necessarily do a
big assessment. There'sa couple things that you said
that I wholeheartedly, thatwholeheartedly resonate with me.
The first is, I love that youwant to stay away from labels,
because I agree with you. Imean, I think sometimes labels
can be helpful because it canhelp guide the intervention or
the treatment in the mostefficient way. But I think we
live in a society. We live at atime now where we're so quick to
(10:29):
put a label on a child, and somuch of the time it's just
normal kid behavior. And we allhave different our brains work
differently, which is, I look atit like it's beneficial for
society to have different typesof brains out there. So I, I
love that you said that first ofall, because I feel like
nowadays it's so common to havea have a label for a kid, and
I'm and I would say so much atthat time, it's not helpful for
(10:52):
the child, if anything, I worrythat it might affect their self
esteem. That's my that's myconcern. Yeah, yes,
interesting. I was gonna I wouldlove to add on to that point
later, but finish your secondthought. I'm curious what you're
goingto say, but I agree with you. I
mean, I'm curious what youthink, but from my perspective
as a pediatrician, that ideathat we're so quick to assess
first, I agree with you. A lotof times, parents come in they
(11:13):
want to get an assessment, orthey're told to get an
assessment, and thoseassessments are anywhere from
678, $1,000 and I think tomyself, Okay, if this child is
acting out, maybe they're havinga hard time with math at school
and they're throwing a tantrum,or they're throwing a they're
not happy when parents ask themto sit and do their math
homework. Instead of puttingthat money into an expensive
assessment, why not put thatmoney and time into a tutor? Why
(11:34):
not put that time into a sportafter school to see if they get
their energy out? Maybe they'llbe calmer and more willing and
able to do their homework. Imyself, you know, I agree with
that approach that, why not trythings first and then you get
that, you get that feedback inreal time. An assessment can
come later on down the line,yeah,
(11:54):
or in parallel, if you need to,like, if someone's like, I
really need to know, let's sayit's more urgent and, you know,
like it's sort of devolving andit is complex, the same thing.
Case is still true. You shouldstart the treatment, see the
response to intervention, and doit concurrently with the
assessment, if you need theassessment for complexity,
because more data is alwaysbetter. So there's a sense of,
it's sort of binary. They'reactually overlapping, you know,
(12:16):
but I do, I do encourage likepeople to follow through on
their gut and reach out to aresource and get a little input,
because for a good assessor,especially if you have a little
runway and there's not animmediate crisis, and the kids
younger having some response tointervention data, like, I tried
a tutor for six weeks or eventhree months, and it's like,
here's what happened, and youcan talk to that person adds a
non trivial value, but if youalready can have that from
(12:38):
teachers and people and the bellis ringing, you know, deal with
it, whether or not you assess.
Does that make sense? So it'ssort of Yes, but it's proactive.
Evens more proactive assessment.
I'm just thinking, for example,a lot of parents have a hunch
that their child might bedyslexic, so they're, you know,
waiting for a long time to get ato get a assessment to see if
their child is dyslexic. Why nothave a reading specialist that
(13:01):
that can show them how to reador teach them as if they had
dyslexia? Would that be harmfulin any way? Well, no,
and it's actually reallyimportant. And I'm not trying to
be like a fear monger, but thething is, like literacy, you can
learn between, like pre K andthird grade, or late pre K, K
and third and if you don't, thenthe kids are reading to learn.
They're not learning how to readafter third grade, and arguably,
in a high kind of enrichedenvironment. It could even be
(13:21):
like by the end of second and ifyou don't meet that
environmental model by second orthird grade and aren't reading
fluently, you you basically havetrouble keeping up with the
mainstream. You feel othered anddifferent, and you usually feel
not smart for like, like as ayoung kid, for lack of a better
word, your whole early learningexperience is defined by reading
like. Who's reading early? Whatare you reading? If you can't
read, and you felt like that foryears, you it is very hard to
(13:44):
not to come through that with apositive early sense of self
around your learning. Probablythe same case could be made
around attention, but attentionhas a longer runway. Many
people's attention just havetrouble sitting and paying
attention when they're bored. Issort of the fundamental
challenge and but that you canwork on, unless a kid's falling
out or getting down. There's notreally an urgency, but for
literacy, you really only havethese precious few years. And so
(14:07):
if you wait like six months foran assessment, that was, I
really don't recommend that,you're so much better off
starting with the readingintervention with someone who's
really good at the thing you'reworried about. And then you get
in, when you get into theassessment, and maybe by the
time you get to the assessmentwait list in six months, you're
already good, and you've movedon, right? Also, I don't hold a
wait list personally in ourpractice for more than a couple
I basically get people in withinwithin a month. Because if
(14:29):
someone's ready to do this bigassessment, the last thing I
want to do is wait six months. Ithink that's a fundamental
problem, the feeling people needto solve their wait list or
refer out or deal with it. It'snot really appropriate to wait
six months these it's money andtime you've committed. It takes
a lot of energy as a parent tosay, I want to do this, to then
say, Hey, you got to wait sixmonths and your whole treatment
(14:49):
hinges on. It is totallyunreasonable and is not a good
clinical model. So I mean, Idon't mean to judge and but
people have to do what makessense. But I think even if a
parent really wants to seesomeone, they need to find. The
clinicians need to makethemselves available somehow,
and people need to find someoneavailable if, especially if the
treatment hinges on thisassessment. I guess part of what
I'm saying is it doesn't pursueyour treatment independent of an
(15:11):
assessment, get your responseintervention, and never feel
like you're waiting on the neuroPsych. I can't tell you how many
people give us that feedback.
They usually give us a whenthey're in the biggest crisis,
which is the worst time to waitfor info. If you're in a crisis,
go do something now, even ifit's not just right, that's the
whole point. Also, I'vehad parents where they get a
neuro psych, and they're waitingfor the neuropsychologist to get
back to them, and they'll wait amonth, two months, to get the
(15:32):
results back. Maybe someonetakes
a little longer to write theselong things, which is probably a
relic of our field. And themoney people pay they want these
big reports. I don't know howuseful those always are, but you
need the feedback within a weekor so, and the plan. What human
being wants to wait a month ortwo months? Could you imagine
waiting for your lab results forlike, two months? And when you
have to, it's nauseating. Ithink the field needs to shift.
(15:54):
We're in a much faster kind ofworld now, and I think it is
happening some, but truthfully,there's an old guard and just a
traditionalism or a field wherewe're like, there's a pressure
that we all experience to, like,document everything and see
everything, and your writtenreport is a reflection of
everything you knew, so youbetter put it in there. And
that's hard, because people willlook at that and won't even call
us. They'll just be like, well,here's the report. So probably
(16:15):
there's a little too muchemphasis on this written
document. That's my take. And weshould really be, like, figuring
out what's going on observing aschool, we should get to this,
but like getting home videos,getting and talking to all the
providers, get the real storyand give an actionable plan that
works, and then, if there's somedocumentation around it for
certain bodies that need it,great. But the idea that anyone
wants to read a 3050, pagereport to somehow guide a plan
(16:37):
is, I think, unrealistic. Ican't tell you how happy it
makes me to hear you say this,because I completely agree with
you. I get a lot of reports.
Parents spend all this money onthese neuro psych reports, fine,
but then I'll get a copy of thereport, and nobody ever calls me
to explain it to me, tell mewhat they found. Tell me what
they think would be helpful forthat child. And to be honest, a
lot of the reports look verysimilar. Yeah,
(16:58):
I know like you're busy, right?
So are you going to read 40pages then? No, you're going to
skim to some results or summarythat doesn't feel as
boilerplate. And then at thatpoint, why did you produce 40
pages for what audience, youknow? So that's, I mean, that's
my sort of bent. You have todocument certain things for
like, accommodation law anddisability law. So they're going
to be a few kind of things youhave to include, you know, and
you have to have, like, certainbackground info. But there are
(17:19):
other schools of thought comingout with, like, a three page
neuro Psych and the data. Idon't mean
to sound like I'm minimizing inany way what the neuro psych
tests are doing, what they'reattempting to do. It's more I'm
just for my end. I want to feellike I'm able to help the family
after they've invested all thistime in getting the neuro psych
test done. Your approach sounds,honestly, more beneficial for
(17:41):
the individualchild. There are certain people
who really want it alldocumented. They want to read
through it, and over years, theywant everything written. And
there are, I will acknowledge,there are some cases and people
on teams who really want that,but otherwise I would, I agree,
like I think in general, peopleare coming with a functional
problem. The data matters onlyinsofar as it solves the
functional concern they have,and the way to get there, you
(18:01):
know, and the process and theoutcome matter, but it's, it's,
it's not about a it's not asmuch about the label or like,
it's more, and it's not evenabout the report. I usually find
people just want their kids tobe like, doing better, you know.
And so really, how I came tothis and then we can move on, is
I found there was a period oftime when I don't do this
anymore, just to be honest, likesomeone said, Hey, you can know
if someone will someone opensyour email. Like, that's an open
(18:23):
source thing. I was like, Oh, Iwonder if people are really
reading my reports, because itwas on my mind, because I was
spending about 80% of my timewriting. And I was like, I know
this isn't my true strength, butI like, people demand it. So
then I checked, and I like,something like 70 to 90% of
those emails weren't opened,which was pretty which was
pretty illuminating, but alsodisappointing, because I was
(18:44):
like, Oh, how much of my lifehave I put into these documents
people aren't reading? So I madea that's when I made the pivot.
But the traditional school ofneuro psych does want you to,
like, go through all the resultsand explain what you were
thinking and what the testmeasure and how it relates, and
what it isn't including what itis that doesn't make sense
clinically to me, like itdoesn't it makes sense as an
intellectual exercise,definitely.
(19:05):
And I, and the reports that Iget back, they'll talk about all
these tests that were done,these cognitive tests that were
done that I know I learned aboutthese tests some at some time in
my career, in medical school, ormaybe in, you know, a psych
rotation, but it's blurry to menow. And so they give, they give
all these details that don't,don't amount to much clinically,
or I can't figure out how to usethat information to help the
(19:26):
child. So you're aclinician trained in the space
who's, like, really experienced,and I think what happens is,
there's, again, this sort ofinternal pressure we experience
to do that in our culture, butit will shift because, like, you
know, the consumer needssomething, and that's driving
and I think medicine is shiftingfor all sorts of reasons. Some
pressures aren't good, but thereare a lot of pressures to shift
healthcare to kind of whatpeople want more quickly, and
(19:48):
it will shift because ofpractices that exist like yours.
Okay,yeah, thanks for saying that. I
mean, I would like people towrite shorter reports. I think
it would help people and. Takethe time and reallocate it.
Don't just like, cut the time,but where would the time be used
unless someone really needsthat? I have had a few cases
where, for what is, where peoplecome back, like, I really need
this or this document, and thenwhat I'll do is I'll write the
(20:10):
long version. I'm always happyto do that. I just need it to be
useful. That's sort of what Ilearned. So I write what I know
is needed, and then if someoneneeds more, I really will. It's
not about, like trying to cut acorner. It's more about doing
effective work. And I'mjust curious. I know you have,
you've mentioned how you have aunique approach when it comes to
care coordination and takingcare of your kids and writing
reports. Is there anything elsethat you feel like is unique in
(20:32):
your approach other than whatwe've been talking
about? Sure, yeah. I mean, Ithink the things that I that I
sort of do more strongly, orthat I more passionate about
really, are some of thequalitative stuff. So like, you
know, there are good amount ofpeople who will observe a kid at
school before they've met thekid. So it's like a blind
observation, you see. But if youthink about how useful it is for
like, under 12 to see a kid witha peer group with the age
(20:55):
expectations and the teacher andthe real world setting they're
in all day is probably worththree hours of testing, and I
can do that in 30 minutes. Youhave to drive there and back.
And you know, it depends on yourskill set and what you absorb,
but you can see a lot if youknow what to look for in that
setting. That's not easilytrained, that's more
experiential, I think, or and alittle intuitive, but it's a
more qualitative style. So I dothat. I get home videos over the
(21:19):
years. If you see snippets ofvideos, you kind of can map out
the longitudinal course of theirdevelopmental arc in a pictorial
like life story. Then it'scorroborated by Parent Report.
But I also saw it with my eyes,as if I was there. And that's a
little unique. It istrue, though. It's it's
different, like for myself inthe office, I can see a child,
and it's, you know, I can gleansome insight. But if you see
them, you know, so to speak, inthe wild with their friends
(21:41):
playing. And you see how theyhow they take turns, or they
play it by themselves. How dothey treat other children? You
know, what are they like in theclassroom? I can see how that
can be incredibly useful,especially if you're in child
development all the time. Andthen you talk to everyone. So if
you talk to like, two or threeteachers and maybe a tutor and
one specialist, then you haveone on one learning. You have
group learning from differentspecialists at different time
(22:01):
who you can interview. So thenlike, plus Parent Report,
because parents know their kidsbest. But if you take that whole
story and wrap it up, youbasically coalesce like, a
relative truth about how thiswho this kid is, and how they're
doing that almost everyone willagree on if you, if you really
weave like, weave it together ina way that makes sense. You
can't just take one person'sstory and discount someone, but
(22:22):
if you basically bring the teamtogether through a shared
understanding of the kid, andthat's what's meaningful anyway,
that's why they came to you. Andthen you quantify why it's
happening, and then you connectthe quantified map to what we
all understood, which gives youa precision plan, because you
have 500 data points about whythey're doing what they're
doing. And, you know, evidencebased care, that's beneath it.
That's really what I think neurosex about, as opposed to which
(22:43):
label Did you fit? Which is why,if someone calls me, like, do
you do ADHD testing? I was like,not, not directly, but I can
answer if your kid meetscriteria for ADHD. And the
reason why is, if I only testedfor ADHD, you'd be giving like,
rating forms of attention toparents and teachers and a
boredom test in the office, andsomeone might not do well on
that, but also you might falselythink it's true, but it's not
(23:05):
like, what if they're justpreoccupied by ancient in their
head and you just didn't see itbecause you didn't get to know
them, but they were inattentivebecause they were preoccupied,
or because they're depressed andnot concentrating, or there's a
few other reasons. But the pointis, like the whole nature of
what we do is to map up the mindand make a plan. So we're not
doing isolated diagnostictesting. I'm testing to explain
someone's life as understood byeveryone who knows that person
(23:27):
well, to give a precision kindof opening or plan. Whether
that's parent intervention,teacher strategies, Ed
therapist, which is likespecialized tutoring with
someone with a specialcredential, there's occupational
therapy, physical therapy.
Sometimes someone needs to see aneurologist, but not usually.
After seeing me, they'veprobably already seen one. You
know, psychiatry, sometimesfamily therapy. Maybe it's the
(23:51):
parent needed some support.
Maybe it's couples this, butyou're basically getting a
window to the kid's whole life.
So because people let us in somuch into their world, if we
really do our work, you have theability to pay potentially make
recommendations across home,school and interventions. The
only thing we're not reallydirectly involved in is sort of
crisis care and high needmedical care, because nuance
(24:12):
matters less, to be frank, inthose moments, and you just need
to get the job done. So youdon't assess for the most part,
unless there's like, a verydiscrete thing.
This sounds so beneficial, and Ithink for so many parents
listening, hopefully they'rethinking, oh my goodness, I know
where I want to take my kids,because I'm hearing you say the
wait list isn't very long. Youget a by doing a real life
(24:34):
assessment, looking at homevideos, going to the school,
talking to the parents, youreally glean the whole picture
and really understand the childfor who they are and what they
need, and then it sounds likeyou're able to offer them help
in the way that might fit themthe best with all the therapies
you mentioned, parentintervention. So this sounds
like a 360 complete package tohelp kids that are in need. So
(24:56):
kudos to you for the clinic thatyou developed. It sounds
incredibly. Helpful and useful.
Thanks,Jessica, that was so nice. I'm
not comfortable with that much,like positive attention.
Sorry, I can't help it. That'sfine. No. I mean, we're proud
of it. It's a good clinicalservice. It's like a high end
interdisciplinary service, andwe care about that partly
because, as neuropsychologists,we're coming over these
(25:18):
coordinated plans. I can't tellyou how defeating it is on the
flip side to not be able toactualize the results, because
you can't get someone in withsomeone, or find someone
available, or get a group totalk. And for me, that's really
important. I want to, like, getthe job done. I'm sort of a
doer, so if I do this wholething and then I can't get it
done, like, I don't know Ineeded a clinic for that, to be
frank. Does that make sense? Soit's really designed to fill
(25:39):
that need, and I'm happy to bedoing it. Yeah. And when did you
start? I want everyone tounderstand how fabulous your
growth has been. When did youstart the clinic? Where is it
and how many clinics do you havenow?
So I started. I mean, you know,most doctors start on their own,
unless they're in an academicmedical center. So I started on
my own, and, like my mainclinic, co manager, also started
(26:00):
on his own. And we're kind oflike we were good friends, but
each doing our big neuro psychpractice. We've been doing that
for a decade, you know, but wecame together and started a
clinic, like five years ago. Andwe're in Santa Monica, like the
broader LA area, we're in theSouth Bay, so like the beach
cities down that area, we do goas far as like Pasadena and into
Santa Barbara, including aclinic we have there, but I
(26:21):
would say that that's a prettybig catchment area. But from
like Santa Barbara to, like,maybe an hour east of Pasadena
to the South Bay, we see withour clinic and a couple
satellites, and then we have aSan Francisco clinic that's a
little more standalone.
So altogether, you told me youhave 10 clinics. I
(26:42):
don't know if overstatement. Iwould say, well, like five, but
it depends how you like, sliceup the offices in the space,
but, um, but we have a lot of wehave a big team. We have like 50
people on our team. So we havea, we have a sizable thing
going, but we're not an academicmedical center, you know, we're
not, we're not a Kaiser, we'renot that size, obviously, at
all.
(27:02):
But yeah, so there's somethingelse. There's something else
that you mentioned earlier whenyou talk about your unique
approach to helping yourpatients, and that is, I like
how you focus on what a person'sgifts are, rather than
emphasizing what their perceivedweaknesses are or their labels
are. And so I just wanted totalk with you about that,
(27:22):
because I completely agree withthis message. I think for so
many kids that I see, it's soeasy to focus on what they're
lacking, and to me, focusing ontheir gifts and their skills
seems like so much more fruitfulfor the individual
person I like you said that,yeah, it's for me, it's like a
yes and right, it depends on thesituation and the age, not to
give an overly complex answer,but let's say, the younger they
(27:44):
are, the more I might directlytreat something that's really
important. Because we not likereading, because we just know
how important it's going to be,we might have to head on deal
with it, even though there isn'ta super straightforward strength
based workaround, and the oldersomeone generally gets, I
recommend less treatment andmore string space work around
because, truthfully, the brainbecomes less plastic and you
have less time to work on stuff.
But all that said it's alwaysgood to look at both like a good
(28:06):
story. Anecdote I got. I wastalking to a family once, and I
would never give someone'sdirect info, but just this is a
general story, and this hashappened more than once. Someone
called and said, you know, youdon't need to go to like school,
for example. They're doing wellthere. And I think, you know, I
hear you, but the whole point,if I find how they're doing
well, that might be the solutionto the problem in another
(28:27):
setting. So like, why is itgoing well? There is just as
important as why it's not goingwell, and that's really the idea
you're capturing all of it, thestrengths and the challenges,
the place the kid does well, andthe place they don't do well,
and your pattern, recognizingwhy and what you can do? Because
the answer is out there. It's inthe qualitative story of the
kid's life, probably. But thattotally makes sense. Let's say a
(28:47):
child is excellent in math,excellent in baseball. Of
course, we should spend timefocusing and building those
strengths, but also you don'twant to forget about the other
areas of school and aspects oflife that you wouldn't want to
have underdeveloped so I can seethat as a yes and absolutely
mindful. Like, elementary schoolis like more treatment than a
combination. For me, MiddleSchool is a wash. High school is
(29:10):
more a combination thantreatment. College, you're just
playing to your strengths,hopefully, if you're you know,
hopefully, but you might stillneed treatment. You maybe didn't
get it, like you might have tocome back to it, but that's the
arc of what we do. But eitherway, knowing the strengths
becomes how you how you takewhat works. Like maybe that kid
did well at school, because theydo well with lots of structure,
(29:30):
social pressure of kids aroundthem, and academic work. And we
find that it's like, okay, well,sometime at home, why don't we
just start there? Anotherexample is some kids like get
concepts better often. Kids whoare dyslexic kind of see the
gist but miss some details. Soyou give them thematic ways to
learn literacy wherever you can,or that one more example is
someone who doesn't comprehendvery well, but who's good at
(29:53):
systems. Will give them asystematic way to comprehend,
like read the tape, read theback of the book first, which
has like. The summary of whatpeople thought. Then read the
Table of Contents, which is likethe systematic outline of the
entire thing. So you went frombig picture to systematic
outline, and then you read likethe first paragraph of every
chapter, and then you read thebook, and you've deconstructed a
(30:13):
book to comprehend based on asystem. But that solution makes
more sense if you're systematic,obviously, and if you have
trouble comprehending the gisteasily, right? So that's the
kind of like, that's not adiagnosis, but those are the
types of things we're trying topick up. If you can find three
to five of those in anassessment, you can meaningfully
change someone's life, even ifyou assess 500 things. And
that's a little bit the luxuryof the work on some level,
(30:36):
without over diagnosing. Like,if you could capture your style,
you can't differentiate everykid, and you can't make class
just right for everyone, but aspeople get older, they could
know themselves more on how tolean into things. And there's
sort of a self awarenesshappening around psychology and
the destigmatization of mentalhealth and like a neuro
divergence movement, but I thinkit's incomplete. This is an
interesting note to maybe endon, but this is sort of my
(30:58):
personal opinion, but it's beenformed by my clinical judgment
over the years. I feel likepeople are more okay with a
diagnosis now, particularlyadolescents and particularly
like the individual, butsometimes the answer is the end,
like, I have this, and that'ssort of a natural human
response, like, please, like, Ihave attention issues. Of
(31:19):
course, I couldn't payattention, or I have dyslexia.
That's why I can't read. Andthat is partly true, but from my
perspective, that's sort of thestart of the journey you have to
accept. What is you do what yourealistically can, and you
somehow move through it enoughthat you can function ideally in
a way that works for you. Andthat's sort of the more heroic
outcome that I think, is gettinga little lost in some of the
(31:41):
destigmatization mental healthand the neuro divergence
movement, which is great andprideful, but it's the
beginning, you know, and wecan't have an accommodation plan
for half the kids at school,like, then it's not a mainstream
school at some point. Andsometimes the rates are like,
not, non trivially, like 25% andI think there's a real case that
people have real issues thatneed help and support. But
(32:03):
anyway, the the assessment isthe start of your journey to
like health, you know, and inthe care coordination, the
treatment you do after is howyou move through things while
being vulnerable and open aboutyour issues. If you if you
choose to be, and I can't tellyou how often that feels less
salient in the conversations ofhaving with people like around
their health, they're, they'resort of good with just the
(32:26):
answer of what they had. I'm alittle concerned about that. No,
I agree with you. I thinkthere's this idea now, okay, if
you, if you have a label, it'ssort of an excuse not to try,
and you want to think about it.
The opposite way, trying iseverything you know, overcoming
an obstacle is, I think, the keyto success. I totally agree that
if you spend too much timefocusing and dwelling on what
your child is, quote, unquote,lacking, I could see it getting
(32:48):
in the way of them makingprogress that is available for
them to do, like I reallybelieve all of us, if we have a
challenge, the fun is learninghow to move past that challenge
and how to how to let us how to,let it help us grow and be the
best that we possibly can be. Iagree. I mean, it's an
explanation. Assessments and ordiagnoses are explanations for
what might be partly challengingand how someone functions, and
(33:11):
it might be a guide of what todo, but that's the whole point,
explanation and a guide. I mean,it's not just an explanation and
we're done, and it's actuallywhat the hard part is. If you
really have a difference, thatmeans your life's going to be
harder in some way, probablybecause mainstream life sort of
adjusts to people in the middle,so including strengths sometimes
on the high end can be reallyhard, but that's part of the
(33:32):
work. It's like you take a beat,you might mourn a loss, you
might celebrate it. It might beheavy, but you acknowledge what
is, and then that's a call toaction. Of like, how am I going
to now deal with this, given thestrengths I do have and what's
hard? How do I make a functionalplan? And I just, I really hope
people encourage young people todo that more. I'm not sure I
(33:53):
love it, because you sound verysolution oriented rather than
anything else. I guess that'spart of what I mean. That's the
solution. That's the back end ofit, and the journey through it
is probably just as important asthe outcome. But there needs to
be the journey. You don't juststop, and I can't again, that's
really we're all, a lot of us,including me, are part of that
(34:14):
problem, because when we makethese accommodations and labels
for these kids who have a lot ofcapacity but are overwrought,
and do have some issues. Youknow, we're kind of propping
them up in a way that isn't theworld's not going to continue to
do. Probably, that's been myexperience after potentially
high school and college, and soit's tricky. There's a lot of
pressure to have these kidsfunction always at their best
all the time. But there's acounterpoint of development,
(34:36):
which is sometimes you don't,and you have to find a way
through and life doesn'taccommodate you, and I just the
pendulum has shifted very hardtowards accommodations. And
again, as a when I individuallysee a client, have had the data,
I make the case, because myresponsibility is to the client.
As a doctor, I see the client, Idocument what I see. I get
behind them, I support them, Itell them what I really think is
(34:56):
true, but I still document whatthey need. Need. It's a tricky
hat, because I have my opinions,as you clearly heard about it,
and I try to do what's wise as aclinician, but I wouldn't it's
not my call to make to, like,tell someone, you know, you need
these accommodations, maybe,maybe not. Here's the data. You
arguably need them, but I wantyou to work through it. You
know, it's not really my choice.
(35:17):
It's technically their choice.
I get a fair amount of requestswhere kids are asking for longer
time testing in school, andthey'll tell me that, oh,
there's so many other kids in myclass that get longer testing
time, and I want that longertime too. It's hard for me to
finish my test in the allot oftime. I get anxiety. Also can't,
can't you write me a doctor'snote to get more time? I don't
(35:39):
want to say no to say no totheir request. I'm sympathetic.
I remember how hard tests were,how stressful it is to finish in
the allotted time, but I alsoknow that instead of me writing
them an excuse, probably betteris for them to get better at the
material study more, wake upearlier. There's other things
that they can do to finish thetest faster, and not everybody
has to get an A on a test,right? I mean, you
(36:00):
know, just to quickly touch onthat you generally don't want to
accommodate anxiety, because ifyou accommodate anxiety, you're
validating for the person. Thisis a real issue. That's why
we're all bending over backwardsand accommodating it. So you do
it in the near term on a highstakes test, maybe because it's
going to be invalid becausethey're too anxious. Otherwise,
you could make a case for that.
But you want to move throughanxiety, generally speaking. Now
dyslexia add those are kind ofdifferent, and there's actually
(36:22):
a stronger case foraccommodations with
neurodevelopmental disordersthan like emotional conditions.
But you usually don't want toaccommodate anxiety, just like
you don't necessarily want toalways reassure your kid. You
want to cheer them or coach themthrough, because if you're
always the agent of change, youremove their agency to move
through their anxiety. Soaccommodations for anxiety are
tricky, but they're sometimesneeded. And then the second
(36:43):
thing I'll just say, and this isnot like a formal statement, but
my perception is the premise ofstandardized testing is that
timing is not supposed to affectmost people. I think that's a
false premise, because timingdoes affect most people, and I
think that's part of theproblem, if I really look at it,
because if the premise is mostpeople can finish this test on
time and time is not a factor,then, of course, if you have a
(37:04):
disability that affects yourspeed, you should be
accommodated. But if it's truethat most people would benefit
for more time, then then you'regoing to set the stage for
abuse. I really think that'spart of the problem. And so I
think from my perspective, likeif I step way out, either time
does matter and we measure it orit doesn't, and we don't, I
don't know if people want theirkids to have issues or need
(37:25):
accommodations as much as theywant their kids to do well. And
if the test has a somewhat, Ithink, false premise, that's my
personal opinion. You know,timing affects probably at least
half, if not most, people withhow they perform, you know. And
so do you see what I mean? Sothat's anyway. That's another
soapbox, but I do have someissue with that. I don't know
what we can do as a doctor. It'stricky on a one to one level
(37:47):
again, because we have tofunction within the ecosystem
we're in. We have to help kidsthrive within the world they're
in. It's more of us, like apolitical, you know, broader
issue, but there's like someonemight on the other side be like,
Disability Matters totallydisability law totally matters,
and there's so much need, butyou could see how there's
probably movements on bothsides. Just for example, like
(38:09):
autism care gets so muchinsurance coverage in California
because there's great advocacy,but like, ADHD, is not going to
get behavioral care. It's goingto get rejected, even though the
kid is probably sometimes moredangerous, and it's more
significant, they get rejectedthe behavioral care because they
don't have autism. That'sbecause there's an advocacy
group, not because it makessense, right? So anyway, this is
the principal part of me comingout. There are certain things I
(38:30):
can't totally address, buthopefully some people will. You
know, I'm happy to hopefully bepart of some of the solution to
that stuff. This has beensuch an interesting
conversation. You have so manygood thoughts and ideas, so I
really appreciate you sharingthem. Any any final thoughts or
pieces of advice that you wantto offer to parents listening,
huh? I should have had a goodanswer for that, but I guess on
(38:52):
a spot saying no, I would sayparents generally know their
kids best, and that's a reallybig resource. They often,
usually care the most. And ifyou know, lean into that,
because you can do a lot as aparent, you know, if you trust
your gut and your care, oftenparents have it you know they
have it close. You know parentsoften are quite right. They're
(39:12):
probably the most right. Theonly counterpoint to that is
just be open minded that yourkid may present differently in
different settings. So if you'rean open minded person, you
acknowledge your kid as this orthis a little different, people
will feel like they can talk toyou and they're not going to
upset you. And then you'll findout what's really going on
better. And so if you can,that's one other thing you can
do as a parent working withteachers or specialists, is make
sure they know you can hearstuff, and you'll hear more, and
(39:35):
then you can decide if you careto hear what they had to say or
not later, but at least you'vegot the info. You know, I think
sometimes, not me, I'm not goingto be direct Anyways, my job.
But there are teachers andpeople who just aren't really
given the leeway to be thatdirect. And if you've closed the
door from their perception,they're going to be really
careful what they say. And ifyou don't have the information,
you can't be empowered as aparent to do what you need to
(39:56):
do. So that's like, it's alwaysa long, quick answer, but. That
you know your kid best, but alsocreate channels where people
will talk to you.
I believe it's an art not tocome off as defensive.
Especially, I think people havean especially difficult time
when it comes to their children,because it might feel like a
reflection of them. So I agreewith you learning how to put the
ego away, put the defense away,and be open to hearing what your
(40:20):
kids are like, ultimately, Ithink we'll be if you're open to
hearing that conversation,ultimately, I think it will help
your children. So that's greatadvice. Cool. Thanks, Jessica,
thanks for having me. Thank youso much for coming on. Dr
Gottlieb, you're fantastic, andI appreciate your time. Thank
you so much. Thank you forlistening, and I hope you
enjoyed this week's episode ofyour child is normal. Also, if
you could take a moment andleave a five star review
(40:42):
wherever it is. You listen topodcasts, I would greatly
appreciate it. It really makes adifference to help this podcast
grow. You can also follow me onInstagram at ask Dr Jessica. See
you next Monday. You.
Hi everybody. Welcome back to your child is normal.
(00:03):
Today, I'm joined by Dr LevGottlieb, a neuropsychologist
with extensive experiencehelping children and families
navigate learning, behavioraland emotional challenges. Dr
Gottlieb leads multiple clinicsacross southern California, and
he brings a unique, thoughtfulperspective to
neuropsychological testing anddiagnosis. So in this episode,
we talk about the nuances ofneuropsych testing when it's
(00:23):
helpful when it might not be,and how we can approach labels
in a way that supports ratherthan limits children. Dr
Gottlieb's approach to treatmentis refreshingly holistic, and he
has a lot to offer parentslooking for guidance. I can't
wait for you to hear hisinsights. So let's get started.
And if you're enjoying thispodcast or this episode, I'd
love to hear what you think.
Please consider leaving a fivestar rating wherever it is. You
listen to podcasts, it reallyhelps spread the word. Dr
(00:45):
Gottlieb, I'm so happy to haveyou on the podcast. Thank you so
much for being here. I can'twait to talk to you and tell
everybody about the work thatyou
do. Oh, that was so nice. I'mhappy to be here. Thanks,
Jessica. So tell everybodywhat do you
do for work? Sure, so, um, so aslike my clinical profession, I'm
a neuropsychologist. Some of youmay have heard of that. To break
(01:07):
that down, neuro means mind andpsych means function. For me, at
least. So you're quantifying themind through puzzles and tests
to explain how someonefunctions. But the idea is,
you're capturing someone'sthinking style in the context of
their development, their aging,an injury, a gift, whatever. But
there's something that's sort ofnot working for them, usually in
(01:28):
the mainstream, that they wantto quantify and understand, and
then you make a plan around it.
So I'll unpack that more later,but that's the that's the
orientation of aneuropsychologist. And I'm
just curious, just for theaudience, to get to know you.
How did you come to this field?
What drew you to the field ofneuropsychology? I
don't know. There's probably,like, a better answer that I'm
going to give. The true answeris you just, sort of, I found my
(01:51):
way step after step, and youjust, like, put your foot in
front of you in the mostreasonable place. And I sort of
found myself here. The evolutionwas something like, I was at a
college when Facebook came out,and I didn't really want to be
behind a computer, so I wantedto work with people, which
became psychology. And then Irealized I didn't, truthfully,
have the patience to fully be onthe journey of everyone's
(02:11):
treatment path, and I was alittle more medical and
assessment based, so I movedinto medicine, slash neuro and
testing. And then I, like, sortof working with kids, because
kids are expansive and growingand complex, honestly, from a
neural perspective, so but thosedecisions I didn't think about
beforehand, I just sort of ineach moment, tried to make the
(02:32):
most reasonable, next bestdecision for me, and I ended up
becoming a neuropsychologist.
And you also, you're aneuropsychologist that
specializes in children.
Correct? That'strue from a clinical
perspective. I see kids like twoto 39 you know, 39 is not really
a kid, but the developmentalarc. And then the person I work
with, who I run the clinic with,sees people like 16 to 100 so we
really do lifespanneuropsychology, but we each
(02:53):
specialize a little bit in ourdomain. So I am a more of a
child development specialist.
And then we run health andwellness clinics in Santa Monica
and LA, but also other cities inCalifornia.
And just to explain a littlemore about what you mentioned
previously, you said you dolifespan assessments. So what
does that mean? Exactly?
Lifespan means like across thelifespan. So I'm like a
(03:15):
developmental specialist. Mykind of clinic co manager is an
adult specialist. So we doanything that affects your
functioning in everyday life,that isn't a sort of a crisis or
an active injury, we're reallyhelpful to quantify what's going
on and what you might do goingforward, which all again, that
(03:36):
takes the form of, does my kidhave attention differences,
learning differences, reading,writing? Did I have a
concussion? How is it affectingme? So it could be something
really clear, like that, or itcould be something like, you
know, my kid's really bright andthinks a little differently. And
some of those kids alsosometimes have a mild delay in
social and emotional skillscompared to cognition, which can
create a lot of internaldistress that sometimes gets
expressed. And there are these,like patterns of mind, styles,
(03:59):
let's say there's like 10 to 50that are pretty well
represented, and then there's,like, some individuality beneath
that. We're trying to quantifyall that and then make it really
tailored plan for someone.
So there's a few things that youmentioned that I really like.
The first is, I love this ideaof a light being a lifespan
provider. Because, for example,myself as a pediatrician, you
know, once kids hit college,they have to graduate from us
(04:20):
and go on to an internist or adifferent specialist, and I love
that you're able to take care ofyour patients throughout their
life. That's a really unique,special ability that I think you
have as a neuropsychologist,thanks
for saying that. Yeah, it'sinteresting. We're because of
the way mental health andneuropsychology generally works
outside of an academic medicalcenter. It's usually some kind
(04:41):
of private model. You get asuper bill, you get reimbursed,
although that may change. And Ithink because of that, we may
not be as bound as like anacademic medical center or a
pure medical model. If you're aminor and you're an adult like
that distinction resonates nowthat I heard you say it because,
like when I worked at UCLA, inplaces like you're either in the
peds care under 18, and thensuddenly there's this, like
chasm, and then. Like you're anadult and you have to make all
(05:01):
your independent decisions. Andwe tried to bridge that, but it
was pretty different, becausewe're basically allowed to
practice our work without reallymany constraints besides ethics
and laws, we can follow thetypes of like clients or
conditions that we're best atacross their actual arc, as
opposed to somewhat of anartificial arc that like 18, you
become an adult, right? So thatso like ADHD, you could see
(05:26):
from, you know, whatever, fourto six, roughly, although you
could technically see a signalto two, probably, you know, you
could follow through someone'slifespan. There's so many things
you can assess, like, if youjust take kids again, I'm not
really diagnostic. I'm trying tomap a mind to explain function,
to give a precision plan thatsaid, just to be
straightforward, people comewith a referral question, and it
tends to take the form of alabel, because that's the way in
(05:48):
which we understand people. Sothere's for kids, it's ADHD,
dyslexia, or like learningdifferences, math issues like
dyscalculia, autism, and thenyou have anxiety and depression
or emotional overlays, then youcan also have epilepsy or head
injuries or genetic syndromes.
And there's so many syndromes,at some point there's a shared
overlap that you can if you'veseen enough syndromes, you kind
(06:09):
of know what you're looking for.
But you could imagine, as apediatric provider who also has
to know what's normative, if Ialso needed to know everything
about dementia, that's too much,you know. So that's where, like,
there's some amount, Ithink, where, like the saying
goes, jack of all trades, masterof none, absolutely. Yeah, I
think evenin assessment. But there are a
few people I've met who try todo the whole, the whole true
lifespan, you know. So I'm aquasi lifespan neuropsych, but
(06:31):
our clinic does lifespan becauseI have an adult counterpart,
basically, who cares the adultcases. That's
fantastic. That makes a lot ofsense. So, okay, so you had
mentioned a few of theconditions that parents take
kids into. CU, I want toelaborate on that a little bit
more so that people that arelistening maybe they can, maybe
they'll think that their child,their child may be a good fit
for your clinic. So youmentioned that you take care of
(06:53):
kids with learning differences,autism. ADHD, you mentioned
earlier, gifted children maycome to see you. Anything else
that you're that you're that youguys are proficient at taking
care of that you hadn'tmentioned? Sure,
I'm mixed about answering this.
To be honest. I appreciate thequestion. Here are my thoughts.
One is, I really don't like todefine people based on the
label. Labels are like aheuristic that guide
intervention, but it's, it'skind of the a quantified
(07:13):
assessment of the mind isdimensional. But I also get the
question, you know, and thenfinally, we, I'm happy to
provide this, like, be on thispodcast, just to share what we
do, and also, if someone wantsto see us, that's great. But I
just want to be clear, too, thatI don't want to, I don't want to
sell something. I know you'reasked in a kind way, but I just
have to say that you can editthat out if you want. But just
(07:34):
to be frank, I don't have anylike, pitch really, my brand and
who I am is someone who, like,tries to do their best and show
up without, like, a hugeorientation to some secondary
gain. But that probably worksitself out, like, if I'm being
realistic, because people likesomeone like that working for
them, so I just lean into that.
But to answer, like youroriginal question about what we
see, anything you know, theconditions that people are most
(07:56):
common, like, commonly aware ofor curious about, are ADHD
learning differences, AutismSpectrum Disorders, dementias,
brain injuries, like concussionsand head injuries, and then like
epilepsies, genetic syndromes orother things that seem to affect
the mind, including anxiety,depression that seems to have a
legitimate cognitive toll, orone that's not straightforward
(08:19):
for The therapist. Otherwise, wesee people where there's
complexity, because if you thinkabout it, in most parts of the
country, you do a response tointervention model, which is
basically you see some doctor orsomeone, you do the most likely
thing that would help, which isthe intervention. You see, how
you respond to thatintervention. And if it was a
wise choice, it might just work.
Often it does. If it wasn't justthe right choice, you get data
(08:41):
about why it wasn't, and that'sits own assessment model that
prioritizes treatment and notassessment up front. And there's
like, there's a real merit tothat, to be honest. I mean, we
do these big, big assessments,but a lot of times you could do
a response to intervention modelto help someone just as much
too. So if you have a hunchthat, like, someone has a
reading issue, you could get areading specialist. And if you
(09:03):
don't think there's somethingelse impacting, then that was
probably the right thing to do.
And then if it doesn't work, orit only works so well, maybe you
assess them, but at the veryleast you have more data. You
know, I think sometimes peopleare very quick to always assess
first, and that's that's like aluxury, and it's something
mainly most useful when there'scomplexity, if it's a one
straightforward thing, like, mykids grade everything, but
(09:24):
they're just not learning toread. Or, you know, they're
doing so well when they'reinterested that when they're
not, they just can't focus.
Like, if it's just one thing, dothe one thing, like go in that
domain, you might there's a goodcase to be made for that. But
again, high SES communities,people tend to assess first,
want to know everything firstand then move forward,
particularly with kids. Peopledo it for their kids because
they really want to know. Youknow, I think that's part of the
(09:46):
driving impulse to do such a bigassessment. And again, if it's
complex, it's really needed. Ifit's not complex, arguably, you
have to decide, could you make agood choice without the
assessment? Save money and timeor like. Do I need for myself or
my kid? Just to do I need to gothrough this process to really
know, you know, but if you ifyou have a hunch of what you
need to do as a parent, I wouldusually empower that parent to
(10:07):
try to make that choice, and youdon't have to necessarily do a
big assessment. There'sa couple things that you said
that I wholeheartedly, thatwholeheartedly resonate with me.
The first is, I love that youwant to stay away from labels,
because I agree with you. Imean, I think sometimes labels
can be helpful because it canhelp guide the intervention or
the treatment in the mostefficient way. But I think we
live in a society. We live at atime now where we're so quick to
(10:29):
put a label on a child, and somuch of the time it's just
normal kid behavior. And we allhave different our brains work
differently, which is, I look atit like it's beneficial for
society to have different typesof brains out there. So I, I
love that you said that first ofall, because I feel like
nowadays it's so common to havea have a label for a kid, and
I'm and I would say so much atthat time, it's not helpful for
(10:52):
the child, if anything, I worrythat it might affect their self
esteem. That's my that's myconcern. Yeah, yes,
interesting. I was gonna I wouldlove to add on to that point
later, but finish your secondthought. I'm curious what you're
goingto say, but I agree with you. I
mean, I'm curious what youthink, but from my perspective
as a pediatrician, that ideathat we're so quick to assess
first, I agree with you. A lotof times, parents come in they
(11:13):
want to get an assessment, orthey're told to get an
assessment, and thoseassessments are anywhere from
678, $1,000 and I think tomyself, Okay, if this child is
acting out, maybe they're havinga hard time with math at school
and they're throwing a tantrum,or they're throwing a they're
not happy when parents ask themto sit and do their math
homework. Instead of puttingthat money into an expensive
assessment, why not put thatmoney and time into a tutor? Why
(11:34):
not put that time into a sportafter school to see if they get
their energy out? Maybe they'llbe calmer and more willing and
able to do their homework. Imyself, you know, I agree with
that approach that, why not trythings first and then you get
that, you get that feedback inreal time. An assessment can
come later on down the line,yeah,
(11:54):
or in parallel, if you need to,like, if someone's like, I
really need to know, let's sayit's more urgent and, you know,
like it's sort of devolving andit is complex, the same thing.
Case is still true. You shouldstart the treatment, see the
response to intervention, and doit concurrently with the
assessment, if you need theassessment for complexity,
because more data is alwaysbetter. So there's a sense of,
it's sort of binary. They'reactually overlapping, you know,
(12:16):
but I do, I do encourage likepeople to follow through on
their gut and reach out to aresource and get a little input,
because for a good assessor,especially if you have a little
runway and there's not animmediate crisis, and the kids
younger having some response tointervention data, like, I tried
a tutor for six weeks or eventhree months, and it's like,
here's what happened, and youcan talk to that person adds a
non trivial value, but if youalready can have that from
(12:38):
teachers and people and the bellis ringing, you know, deal with
it, whether or not you assess.
Does that make sense? So it'ssort of Yes, but it's proactive.
Evens more proactive assessment.
I'm just thinking, for example,a lot of parents have a hunch
that their child might bedyslexic, so they're, you know,
waiting for a long time to get ato get a assessment to see if
their child is dyslexic. Why nothave a reading specialist that
(13:01):
that can show them how to reador teach them as if they had
dyslexia? Would that be harmfulin any way? Well, no,
and it's actually reallyimportant. And I'm not trying to
be like a fear monger, but thething is, like literacy, you can
learn between, like pre K andthird grade, or late pre K, K
and third and if you don't, thenthe kids are reading to learn.
They're not learning how to readafter third grade, and arguably,
in a high kind of enrichedenvironment. It could even be
(13:21):
like by the end of second and ifyou don't meet that
environmental model by second orthird grade and aren't reading
fluently, you you basically havetrouble keeping up with the
mainstream. You feel othered anddifferent, and you usually feel
not smart for like, like as ayoung kid, for lack of a better
word, your whole early learningexperience is defined by reading
like. Who's reading early? Whatare you reading? If you can't
read, and you felt like that foryears, you it is very hard to
(13:44):
not to come through that with apositive early sense of self
around your learning. Probablythe same case could be made
around attention, but attentionhas a longer runway. Many
people's attention just havetrouble sitting and paying
attention when they're bored. Issort of the fundamental
challenge and but that you canwork on, unless a kid's falling
out or getting down. There's notreally an urgency, but for
literacy, you really only havethese precious few years. And so
(14:07):
if you wait like six months foran assessment, that was, I
really don't recommend that,you're so much better off
starting with the readingintervention with someone who's
really good at the thing you'reworried about. And then you get
in, when you get into theassessment, and maybe by the
time you get to the assessmentwait list in six months, you're
already good, and you've movedon, right? Also, I don't hold a
wait list personally in ourpractice for more than a couple
I basically get people in withinwithin a month. Because if
(14:29):
someone's ready to do this bigassessment, the last thing I
want to do is wait six months. Ithink that's a fundamental
problem, the feeling people needto solve their wait list or
refer out or deal with it. It'snot really appropriate to wait
six months these it's money andtime you've committed. It takes
a lot of energy as a parent tosay, I want to do this, to then
say, Hey, you got to wait sixmonths and your whole treatment
(14:49):
hinges on. It is totallyunreasonable and is not a good
clinical model. So I mean, Idon't mean to judge and but
people have to do what makessense. But I think even if a
parent really wants to seesomeone, they need to find. The
clinicians need to makethemselves available somehow,
and people need to find someoneavailable if, especially if the
treatment hinges on thisassessment. I guess part of what
I'm saying is it doesn't pursueyour treatment independent of an
(15:11):
assessment, get your responseintervention, and never feel
like you're waiting on the neuroPsych. I can't tell you how many
people give us that feedback.
They usually give us a whenthey're in the biggest crisis,
which is the worst time to waitfor info. If you're in a crisis,
go do something now, even ifit's not just right, that's the
whole point. Also, I'vehad parents where they get a
neuro psych, and they're waitingfor the neuropsychologist to get
back to them, and they'll wait amonth, two months, to get the
(15:32):
results back. Maybe someonetakes
a little longer to write theselong things, which is probably a
relic of our field. And themoney people pay they want these
big reports. I don't know howuseful those always are, but you
need the feedback within a weekor so, and the plan. What human
being wants to wait a month ortwo months? Could you imagine
waiting for your lab results forlike, two months? And when you
have to, it's nauseating. Ithink the field needs to shift.
(15:54):
We're in a much faster kind ofworld now, and I think it is
happening some, but truthfully,there's an old guard and just a
traditionalism or a field wherewe're like, there's a pressure
that we all experience to, like,document everything and see
everything, and your writtenreport is a reflection of
everything you knew, so youbetter put it in there. And
that's hard, because people willlook at that and won't even call
us. They'll just be like, well,here's the report. So probably
(16:15):
there's a little too muchemphasis on this written
document. That's my take. And weshould really be, like, figuring
out what's going on observing aschool, we should get to this,
but like getting home videos,getting and talking to all the
providers, get the real storyand give an actionable plan that
works, and then, if there's somedocumentation around it for
certain bodies that need it,great. But the idea that anyone
wants to read a 3050, pagereport to somehow guide a plan
(16:37):
is, I think, unrealistic. Ican't tell you how happy it
makes me to hear you say this,because I completely agree with
you. I get a lot of reports.
Parents spend all this money onthese neuro psych reports, fine,
but then I'll get a copy of thereport, and nobody ever calls me
to explain it to me, tell mewhat they found. Tell me what
they think would be helpful forthat child. And to be honest, a
lot of the reports look verysimilar. Yeah,
(16:58):
I know like you're busy, right?
So are you going to read 40pages then? No, you're going to
skim to some results or summarythat doesn't feel as
boilerplate. And then at thatpoint, why did you produce 40
pages for what audience, youknow? So that's, I mean, that's
my sort of bent. You have todocument certain things for
like, accommodation law anddisability law. So they're going
to be a few kind of things youhave to include, you know, and
you have to have, like, certainbackground info. But there are
(17:19):
other schools of thought comingout with, like, a three page
neuro Psych and the data. Idon't mean
to sound like I'm minimizing inany way what the neuro psych
tests are doing, what they'reattempting to do. It's more I'm
just for my end. I want to feellike I'm able to help the family
after they've invested all thistime in getting the neuro psych
test done. Your approach sounds,honestly, more beneficial for
(17:41):
the individualchild. There are certain people
who really want it alldocumented. They want to read
through it, and over years, theywant everything written. And
there are, I will acknowledge,there are some cases and people
on teams who really want that,but otherwise I would, I agree,
like I think in general, peopleare coming with a functional
problem. The data matters onlyinsofar as it solves the
functional concern they have,and the way to get there, you
(18:01):
know, and the process and theoutcome matter, but it's, it's,
it's not about a it's not asmuch about the label or like,
it's more, and it's not evenabout the report. I usually find
people just want their kids tobe like, doing better, you know.
And so really, how I came tothis and then we can move on, is
I found there was a period oftime when I don't do this
anymore, just to be honest, likesomeone said, Hey, you can know
if someone will someone opensyour email. Like, that's an open
(18:23):
source thing. I was like, Oh, Iwonder if people are really
reading my reports, because itwas on my mind, because I was
spending about 80% of my timewriting. And I was like, I know
this isn't my true strength, butI like, people demand it. So
then I checked, and I like,something like 70 to 90% of
those emails weren't opened,which was pretty which was
pretty illuminating, but alsodisappointing, because I was
(18:44):
like, Oh, how much of my lifehave I put into these documents
people aren't reading? So I madea that's when I made the pivot.
But the traditional school ofneuro psych does want you to,
like, go through all the resultsand explain what you were
thinking and what the testmeasure and how it relates, and
what it isn't including what itis that doesn't make sense
clinically to me, like itdoesn't it makes sense as an
intellectual exercise,definitely.
(19:05):
And I, and the reports that Iget back, they'll talk about all
these tests that were done,these cognitive tests that were
done that I know I learned aboutthese tests some at some time in
my career, in medical school, ormaybe in, you know, a psych
rotation, but it's blurry to menow. And so they give, they give
all these details that don't,don't amount to much clinically,
or I can't figure out how to usethat information to help the
(19:26):
child. So you're aclinician trained in the space
who's, like, really experienced,and I think what happens is,
there's, again, this sort ofinternal pressure we experience
to do that in our culture, butit will shift because, like, you
know, the consumer needssomething, and that's driving
and I think medicine is shiftingfor all sorts of reasons. Some
pressures aren't good, but thereare a lot of pressures to shift
healthcare to kind of whatpeople want more quickly, and
(19:48):
it will shift because ofpractices that exist like yours.
Okay,yeah, thanks for saying that. I
mean, I would like people towrite shorter reports. I think
it would help people and. Takethe time and reallocate it.
Don't just like, cut the time,but where would the time be used
unless someone really needsthat? I have had a few cases
where, for what is, where peoplecome back, like, I really need
this or this document, and thenwhat I'll do is I'll write the
(20:10):
long version. I'm always happyto do that. I just need it to be
useful. That's sort of what Ilearned. So I write what I know
is needed, and then if someoneneeds more, I really will. It's
not about, like trying to cut acorner. It's more about doing
effective work. And I'mjust curious. I know you have,
you've mentioned how you have aunique approach when it comes to
care coordination and takingcare of your kids and writing
reports. Is there anything elsethat you feel like is unique in
(20:32):
your approach other than whatwe've been talking
about? Sure, yeah. I mean, Ithink the things that I that I
sort of do more strongly, orthat I more passionate about
really, are some of thequalitative stuff. So like, you
know, there are good amount ofpeople who will observe a kid at
school before they've met thekid. So it's like a blind
observation, you see. But if youthink about how useful it is for
like, under 12 to see a kid witha peer group with the age
(20:55):
expectations and the teacher andthe real world setting they're
in all day is probably worththree hours of testing, and I
can do that in 30 minutes. Youhave to drive there and back.
And you know, it depends on yourskill set and what you absorb,
but you can see a lot if youknow what to look for in that
setting. That's not easilytrained, that's more
experiential, I think, or and alittle intuitive, but it's a
more qualitative style. So I dothat. I get home videos over the
(21:19):
years. If you see snippets ofvideos, you kind of can map out
the longitudinal course of theirdevelopmental arc in a pictorial
like life story. Then it'scorroborated by Parent Report.
But I also saw it with my eyes,as if I was there. And that's a
little unique. It istrue, though. It's it's
different, like for myself inthe office, I can see a child,
and it's, you know, I can gleansome insight. But if you see
them, you know, so to speak, inthe wild with their friends
(21:41):
playing. And you see how theyhow they take turns, or they
play it by themselves. How dothey treat other children? You
know, what are they like in theclassroom? I can see how that
can be incredibly useful,especially if you're in child
development all the time. Andthen you talk to everyone. So if
you talk to like, two or threeteachers and maybe a tutor and
one specialist, then you haveone on one learning. You have
group learning from differentspecialists at different time
(22:01):
who you can interview. So thenlike, plus Parent Report,
because parents know their kidsbest. But if you take that whole
story and wrap it up, youbasically coalesce like, a
relative truth about how thiswho this kid is, and how they're
doing that almost everyone willagree on if you, if you really
weave like, weave it together ina way that makes sense. You
can't just take one person'sstory and discount someone, but
(22:22):
if you basically bring the teamtogether through a shared
understanding of the kid, andthat's what's meaningful anyway,
that's why they came to you. Andthen you quantify why it's
happening, and then you connectthe quantified map to what we
all understood, which gives youa precision plan, because you
have 500 data points about whythey're doing what they're
doing. And, you know, evidencebased care, that's beneath it.
That's really what I think neurosex about, as opposed to which
(22:43):
label Did you fit? Which is why,if someone calls me, like, do
you do ADHD testing? I was like,not, not directly, but I can
answer if your kid meetscriteria for ADHD. And the
reason why is, if I only testedfor ADHD, you'd be giving like,
rating forms of attention toparents and teachers and a
boredom test in the office, andsomeone might not do well on
that, but also you might falselythink it's true, but it's not
(23:05):
like, what if they're justpreoccupied by ancient in their
head and you just didn't see itbecause you didn't get to know
them, but they were inattentivebecause they were preoccupied,
or because they're depressed andnot concentrating, or there's a
few other reasons. But the pointis, like the whole nature of
what we do is to map up the mindand make a plan. So we're not
doing isolated diagnostictesting. I'm testing to explain
someone's life as understood byeveryone who knows that person
(23:27):
well, to give a precision kindof opening or plan. Whether
that's parent intervention,teacher strategies, Ed
therapist, which is likespecialized tutoring with
someone with a specialcredential, there's occupational
therapy, physical therapy.
Sometimes someone needs to see aneurologist, but not usually.
After seeing me, they'veprobably already seen one. You
know, psychiatry, sometimesfamily therapy. Maybe it's the
(23:51):
parent needed some support.
Maybe it's couples this, butyou're basically getting a
window to the kid's whole life.
So because people let us in somuch into their world, if we
really do our work, you have theability to pay potentially make
recommendations across home,school and interventions. The
only thing we're not reallydirectly involved in is sort of
crisis care and high needmedical care, because nuance
(24:12):
matters less, to be frank, inthose moments, and you just need
to get the job done. So youdon't assess for the most part,
unless there's like, a verydiscrete thing.
This sounds so beneficial, and Ithink for so many parents
listening, hopefully they'rethinking, oh my goodness, I know
where I want to take my kids,because I'm hearing you say the
wait list isn't very long. Youget a by doing a real life
(24:34):
assessment, looking at homevideos, going to the school,
talking to the parents, youreally glean the whole picture
and really understand the childfor who they are and what they
need, and then it sounds likeyou're able to offer them help
in the way that might fit themthe best with all the therapies
you mentioned, parentintervention. So this sounds
like a 360 complete package tohelp kids that are in need. So
(24:56):
kudos to you for the clinic thatyou developed. It sounds
incredibly. Helpful and useful.
Thanks,Jessica, that was so nice. I'm
not comfortable with that much,like positive attention.
Sorry, I can't help it. That'sfine. No. I mean, we're proud
of it. It's a good clinicalservice. It's like a high end
interdisciplinary service, andwe care about that partly
because, as neuropsychologists,we're coming over these
(25:18):
coordinated plans. I can't tellyou how defeating it is on the
flip side to not be able toactualize the results, because
you can't get someone in withsomeone, or find someone
available, or get a group totalk. And for me, that's really
important. I want to, like, getthe job done. I'm sort of a
doer, so if I do this wholething and then I can't get it
done, like, I don't know Ineeded a clinic for that, to be
frank. Does that make sense? Soit's really designed to fill
(25:39):
that need, and I'm happy to bedoing it. Yeah. And when did you
start? I want everyone tounderstand how fabulous your
growth has been. When did youstart the clinic? Where is it
and how many clinics do you havenow?
So I started. I mean, you know,most doctors start on their own,
unless they're in an academicmedical center. So I started on
my own, and, like my mainclinic, co manager, also started
(26:00):
on his own. And we're kind oflike we were good friends, but
each doing our big neuro psychpractice. We've been doing that
for a decade, you know, but wecame together and started a
clinic, like five years ago. Andwe're in Santa Monica, like the
broader LA area, we're in theSouth Bay, so like the beach
cities down that area, we do goas far as like Pasadena and into
Santa Barbara, including aclinic we have there, but I
(26:21):
would say that that's a prettybig catchment area. But from
like Santa Barbara to, like,maybe an hour east of Pasadena
to the South Bay, we see withour clinic and a couple
satellites, and then we have aSan Francisco clinic that's a
little more standalone.
So altogether, you told me youhave 10 clinics. I
(26:42):
don't know if overstatement. Iwould say, well, like five, but
it depends how you like, sliceup the offices in the space,
but, um, but we have a lot of wehave a big team. We have like 50
people on our team. So we havea, we have a sizable thing
going, but we're not an academicmedical center, you know, we're
not, we're not a Kaiser, we'renot that size, obviously, at
all.
(27:02):
But yeah, so there's somethingelse. There's something else
that you mentioned earlier whenyou talk about your unique
approach to helping yourpatients, and that is, I like
how you focus on what a person'sgifts are, rather than
emphasizing what their perceivedweaknesses are or their labels
are. And so I just wanted totalk with you about that,
(27:22):
because I completely agree withthis message. I think for so
many kids that I see, it's soeasy to focus on what they're
lacking, and to me, focusing ontheir gifts and their skills
seems like so much more fruitfulfor the individual
person I like you said that,yeah, it's for me, it's like a
yes and right, it depends on thesituation and the age, not to
give an overly complex answer,but let's say, the younger they
(27:44):
are, the more I might directlytreat something that's really
important. Because we not likereading, because we just know
how important it's going to be,we might have to head on deal
with it, even though there isn'ta super straightforward strength
based workaround, and the oldersomeone generally gets, I
recommend less treatment andmore string space work around
because, truthfully, the brainbecomes less plastic and you
have less time to work on stuff.
But all that said it's alwaysgood to look at both like a good
(28:06):
story. Anecdote I got. I wastalking to a family once, and I
would never give someone'sdirect info, but just this is a
general story, and this hashappened more than once. Someone
called and said, you know, youdon't need to go to like school,
for example. They're doing wellthere. And I think, you know, I
hear you, but the whole point,if I find how they're doing
well, that might be the solutionto the problem in another
(28:27):
setting. So like, why is itgoing well? There is just as
important as why it's not goingwell, and that's really the idea
you're capturing all of it, thestrengths and the challenges,
the place the kid does well, andthe place they don't do well,
and your pattern, recognizingwhy and what you can do? Because
the answer is out there. It's inthe qualitative story of the
kid's life, probably. But thattotally makes sense. Let's say a
(28:47):
child is excellent in math,excellent in baseball. Of
course, we should spend timefocusing and building those
strengths, but also you don'twant to forget about the other
areas of school and aspects oflife that you wouldn't want to
have underdeveloped so I can seethat as a yes and absolutely
mindful. Like, elementary schoolis like more treatment than a
combination. For me, MiddleSchool is a wash. High school is
(29:10):
more a combination thantreatment. College, you're just
playing to your strengths,hopefully, if you're you know,
hopefully, but you might stillneed treatment. You maybe didn't
get it, like you might have tocome back to it, but that's the
arc of what we do. But eitherway, knowing the strengths
becomes how you how you takewhat works. Like maybe that kid
did well at school, because theydo well with lots of structure,
(29:30):
social pressure of kids aroundthem, and academic work. And we
find that it's like, okay, well,sometime at home, why don't we
just start there? Anotherexample is some kids like get
concepts better often. Kids whoare dyslexic kind of see the
gist but miss some details. Soyou give them thematic ways to
learn literacy wherever you can,or that one more example is
someone who doesn't comprehendvery well, but who's good at
(29:53):
systems. Will give them asystematic way to comprehend,
like read the tape, read theback of the book first, which
has like. The summary of whatpeople thought. Then read the
Table of Contents, which is likethe systematic outline of the
entire thing. So you went frombig picture to systematic
outline, and then you read likethe first paragraph of every
chapter, and then you read thebook, and you've deconstructed a
(30:13):
book to comprehend based on asystem. But that solution makes
more sense if you're systematic,obviously, and if you have
trouble comprehending the gisteasily, right? So that's the
kind of like, that's not adiagnosis, but those are the
types of things we're trying topick up. If you can find three
to five of those in anassessment, you can meaningfully
change someone's life, even ifyou assess 500 things. And
that's a little bit the luxuryof the work on some level,
(30:36):
without over diagnosing. Like,if you could capture your style,
you can't differentiate everykid, and you can't make class
just right for everyone, but aspeople get older, they could
know themselves more on how tolean into things. And there's
sort of a self awarenesshappening around psychology and
the destigmatization of mentalhealth and like a neuro
divergence movement, but I thinkit's incomplete. This is an
interesting note to maybe endon, but this is sort of my
(30:58):
personal opinion, but it's beenformed by my clinical judgment
over the years. I feel likepeople are more okay with a
diagnosis now, particularlyadolescents and particularly
like the individual, butsometimes the answer is the end,
like, I have this, and that'ssort of a natural human
response, like, please, like, Ihave attention issues. Of
(31:19):
course, I couldn't payattention, or I have dyslexia.
That's why I can't read. Andthat is partly true, but from my
perspective, that's sort of thestart of the journey you have to
accept. What is you do what yourealistically can, and you
somehow move through it enoughthat you can function ideally in
a way that works for you. Andthat's sort of the more heroic
outcome that I think, is gettinga little lost in some of the
(31:41):
destigmatization mental healthand the neuro divergence
movement, which is great andprideful, but it's the
beginning, you know, and wecan't have an accommodation plan
for half the kids at school,like, then it's not a mainstream
school at some point. Andsometimes the rates are like,
not, non trivially, like 25% andI think there's a real case that
people have real issues thatneed help and support. But
(32:03):
anyway, the the assessment isthe start of your journey to
like health, you know, and inthe care coordination, the
treatment you do after is howyou move through things while
being vulnerable and open aboutyour issues. If you if you
choose to be, and I can't tellyou how often that feels less
salient in the conversations ofhaving with people like around
their health, they're, they'resort of good with just the
(32:26):
answer of what they had. I'm alittle concerned about that. No,
I agree with you. I thinkthere's this idea now, okay, if
you, if you have a label, it'ssort of an excuse not to try,
and you want to think about it.
The opposite way, trying iseverything you know, overcoming
an obstacle is, I think, the keyto success. I totally agree that
if you spend too much timefocusing and dwelling on what
your child is, quote, unquote,lacking, I could see it getting
(32:48):
in the way of them makingprogress that is available for
them to do, like I reallybelieve all of us, if we have a
challenge, the fun is learninghow to move past that challenge
and how to how to let us how to,let it help us grow and be the
best that we possibly can be. Iagree. I mean, it's an
explanation. Assessments and ordiagnoses are explanations for
what might be partly challengingand how someone functions, and
(33:11):
it might be a guide of what todo, but that's the whole point,
explanation and a guide. I mean,it's not just an explanation and
we're done, and it's actuallywhat the hard part is. If you
really have a difference, thatmeans your life's going to be
harder in some way, probablybecause mainstream life sort of
adjusts to people in the middle,so including strengths sometimes
on the high end can be reallyhard, but that's part of the
(33:32):
work. It's like you take a beat,you might mourn a loss, you
might celebrate it. It might beheavy, but you acknowledge what
is, and then that's a call toaction. Of like, how am I going
to now deal with this, given thestrengths I do have and what's
hard? How do I make a functionalplan? And I just, I really hope
people encourage young people todo that more. I'm not sure I
(33:53):
love it, because you sound verysolution oriented rather than
anything else. I guess that'spart of what I mean. That's the
solution. That's the back end ofit, and the journey through it
is probably just as important asthe outcome. But there needs to
be the journey. You don't juststop, and I can't again, that's
really we're all, a lot of us,including me, are part of that
(34:14):
problem, because when we makethese accommodations and labels
for these kids who have a lot ofcapacity but are overwrought,
and do have some issues. Youknow, we're kind of propping
them up in a way that isn't theworld's not going to continue to
do. Probably, that's been myexperience after potentially
high school and college, and soit's tricky. There's a lot of
pressure to have these kidsfunction always at their best
all the time. But there's acounterpoint of development,
(34:36):
which is sometimes you don't,and you have to find a way
through and life doesn'taccommodate you, and I just the
pendulum has shifted very hardtowards accommodations. And
again, as a when I individuallysee a client, have had the data,
I make the case, because myresponsibility is to the client.
As a doctor, I see the client, Idocument what I see. I get
behind them, I support them, Itell them what I really think is
(34:56):
true, but I still document whatthey need. Need. It's a tricky
hat, because I have my opinions,as you clearly heard about it,
and I try to do what's wise as aclinician, but I wouldn't it's
not my call to make to, like,tell someone, you know, you need
these accommodations, maybe,maybe not. Here's the data. You
arguably need them, but I wantyou to work through it. You
know, it's not really my choice.
(35:17):
It's technically their choice.
I get a fair amount of requestswhere kids are asking for longer
time testing in school, andthey'll tell me that, oh,
there's so many other kids in myclass that get longer testing
time, and I want that longertime too. It's hard for me to
finish my test in the allot oftime. I get anxiety. Also can't,
can't you write me a doctor'snote to get more time? I don't
(35:39):
want to say no to say no totheir request. I'm sympathetic.
I remember how hard tests were,how stressful it is to finish in
the allotted time, but I alsoknow that instead of me writing
them an excuse, probably betteris for them to get better at the
material study more, wake upearlier. There's other things
that they can do to finish thetest faster, and not everybody
has to get an A on a test,right? I mean, you
(36:00):
know, just to quickly touch onthat you generally don't want to
accommodate anxiety, because ifyou accommodate anxiety, you're
validating for the person. Thisis a real issue. That's why
we're all bending over backwardsand accommodating it. So you do
it in the near term on a highstakes test, maybe because it's
going to be invalid becausethey're too anxious. Otherwise,
you could make a case for that.
But you want to move throughanxiety, generally speaking. Now
dyslexia add those are kind ofdifferent, and there's actually
(36:22):
a stronger case foraccommodations with
neurodevelopmental disordersthan like emotional conditions.
But you usually don't want toaccommodate anxiety, just like
you don't necessarily want toalways reassure your kid. You
want to cheer them or coach themthrough, because if you're
always the agent of change, youremove their agency to move
through their anxiety. Soaccommodations for anxiety are
tricky, but they're sometimesneeded. And then the second
(36:43):
thing I'll just say, and this isnot like a formal statement, but
my perception is the premise ofstandardized testing is that
timing is not supposed to affectmost people. I think that's a
false premise, because timingdoes affect most people, and I
think that's part of theproblem, if I really look at it,
because if the premise is mostpeople can finish this test on
time and time is not a factor,then, of course, if you have a
(37:04):
disability that affects yourspeed, you should be
accommodated. But if it's truethat most people would benefit
for more time, then then you'regoing to set the stage for
abuse. I really think that'spart of the problem. And so I
think from my perspective, likeif I step way out, either time
does matter and we measure it orit doesn't, and we don't, I
don't know if people want theirkids to have issues or need
(37:25):
accommodations as much as theywant their kids to do well. And
if the test has a somewhat, Ithink, false premise, that's my
personal opinion. You know,timing affects probably at least
half, if not most, people withhow they perform, you know. And
so do you see what I mean? Sothat's anyway. That's another
soapbox, but I do have someissue with that. I don't know
what we can do as a doctor. It'stricky on a one to one level
(37:47):
again, because we have tofunction within the ecosystem
we're in. We have to help kidsthrive within the world they're
in. It's more of us, like apolitical, you know, broader
issue, but there's like someonemight on the other side be like,
Disability Matters totallydisability law totally matters,
and there's so much need, butyou could see how there's
probably movements on bothsides. Just for example, like
(38:09):
autism care gets so muchinsurance coverage in California
because there's great advocacy,but like, ADHD, is not going to
get behavioral care. It's goingto get rejected, even though the
kid is probably sometimes moredangerous, and it's more
significant, they get rejectedthe behavioral care because they
don't have autism. That'sbecause there's an advocacy
group, not because it makessense, right? So anyway, this is
the principal part of me comingout. There are certain things I
(38:30):
can't totally address, buthopefully some people will. You
know, I'm happy to hopefully bepart of some of the solution to
that stuff. This has beensuch an interesting
conversation. You have so manygood thoughts and ideas, so I
really appreciate you sharingthem. Any any final thoughts or
pieces of advice that you wantto offer to parents listening,
huh? I should have had a goodanswer for that, but I guess on
(38:52):
a spot saying no, I would sayparents generally know their
kids best, and that's a reallybig resource. They often,
usually care the most. And ifyou know, lean into that,
because you can do a lot as aparent, you know, if you trust
your gut and your care, oftenparents have it you know they
have it close. You know parentsoften are quite right. They're
(39:12):
probably the most right. Theonly counterpoint to that is
just be open minded that yourkid may present differently in
different settings. So if you'rean open minded person, you
acknowledge your kid as this orthis a little different, people
will feel like they can talk toyou and they're not going to
upset you. And then you'll findout what's really going on
better. And so if you can,that's one other thing you can
do as a parent working withteachers or specialists, is make
sure they know you can hearstuff, and you'll hear more, and
(39:35):
then you can decide if you careto hear what they had to say or
not later, but at least you'vegot the info. You know, I think
sometimes, not me, I'm not goingto be direct Anyways, my job.
But there are teachers andpeople who just aren't really
given the leeway to be thatdirect. And if you've closed the
door from their perception,they're going to be really
careful what they say. And ifyou don't have the information,
you can't be empowered as aparent to do what you need to
(39:56):
do. So that's like, it's alwaysa long, quick answer, but. That
you know your kid best, but alsocreate channels where people
will talk to you.
I believe it's an art not tocome off as defensive.
Especially, I think people havean especially difficult time
when it comes to their children,because it might feel like a
reflection of them. So I agreewith you learning how to put the
ego away, put the defense away,and be open to hearing what your
(40:20):
kids are like, ultimately, Ithink we'll be if you're open to
hearing that conversation,ultimately, I think it will help
your children. So that's greatadvice. Cool. Thanks, Jessica,
thanks for having me. Thank youso much for coming on. Dr
Gottlieb, you're fantastic, andI appreciate your time. Thank
you so much. Thank you forlistening, and I hope you
enjoyed this week's episode ofyour child is normal. Also, if
you could take a moment andleave a five star review
(40:42):
wherever it is. You listen topodcasts, I would greatly
appreciate it. It really makes adifference to help this podcast
grow. You can also follow me onInstagram at ask Dr Jessica. See
you next Monday. You.
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