The goal of the evaluation process is to get a complete picture of your child's strengths and weaknesses as a basis for determining how to intervene. It is very important to evaluate your child's development across a range of areas.
For some parents, the idea that their child may have a delay or difficulty in more than one area can seem overwhelming. However, it is important to think of such delays as different pieces of one interlocking problem, rather than as distinct problems to deal with. For example, a child with a language difficulty may also have fine and gross motor delays that are not necessarily apparent to the parents. When these motor problems are identified and treated, the child's language skills may develop much more readily.
As the parent, you play a vital role in the evaluation process. You are the resident "expert" on your child, and your observations and understanding of your child, along with the evaluations performed by professionals, are essential to getting a complete picture of where your child is developmentally. Work with professionals who value your input, and work together with all of them to reach a consensus.
The evaluation process should not rely exclusively on standardized testing. Many people have difficulty performing upon command for strangers; this is especially true for children with communication, learning and/or social relating difficulties. Results from such testing are valid only to the degree that your child has the processing capacities to take the test. For example, a test may call for a child to follow verbal instruction in order to demonstrate his skills in a particular area. A child with auditory processing problems may not perform because he is unable to understand the instruction; the test results, therefore, will not represent the child’s true abilities.
The Evaluation Team
If at all possible, parents should seek independent evaluations. There can be an inherent conflict of interest in having one institution (such as the local school district or county) responsible for identifying difficulties which, by law, it is required to remedy. With an independent evaluation, you may be likely to obtain a higher level of public services for your child.
The evaluation should be conducted by a team of professionals from a variety of disciplines. The “team” may not be in one place; go to the best experts you can find in each discipline, including at least one session each with a:
- Psychologist or psychiatrist with expertise in early childhood development
- Speech/language pathologist experienced in receptive and expressive language
- Occupational therapist skilled in sensory integration
Depending on your child’s needs, the evaluation team may also need to include one or more of the following:
- Doctor or health professional experienced with conducting health reviews of children with developmental difficulties. A child with a communication, learning or social relating problem may appear to be generally healthy, but may indeed suffer from health problems, such as allergies, nutritional deficits and digestive problems, not readily apparent to traditional pediatricians.
- Developmental pediatrician
- Pediatric neurologist
- Physical therapist
- Special educator
- Social worker
What Is Included in an Evaluation?
You should expect to meet with the team, or the team’s representative, to review the results of the evaluation, which should be given to you in writing. These reports should include:
- Observations of parent-child interactions (both parents
- or other significant caregivers). Multiple observations are recommended.
- Description of the issues which led you to have your child evaluated
- Developmental history of your child* including pregnancy, labor,
- delivery and birth history, developmental milestones, and medical history
- Description of your child's daily living skills, including eating, sleeping, bathing, dressing, toilet training, and other self-help skills
- Description of your child's strengths and weakness
- Assessment of your child’s development in all areas of functioning, including:
- fine and gross motor skills
- receptive and expressive language
- sensory reactivity, processing and motor planning
- functional emotional milestones: this assessment, based on at least 30-45 minutes of observation of parent-child, includes:
- regulation and attention
- engaging with the parent
- using gestures to communicate needs
- using gestures to problem solve
- using ideas for pretend play
- using language to carry on conversations
- reasoning and thinking
- Results of the formal evaluations by each member of the team.
- Conclusions and recommendations for further evaluations, interventions or treatments. Each evaluation should outline detailed recommendations for treatment which must be strongly supported by the findings of the evaluation. Each functional area should be addressed. Evaluations should specify the frequency and nature of the therapy required in order to help you obtain the services your child needs. You can negotiate changes in the evaluation if you are not satisfied with it.
- Plan for follow-up
Be aware that insurance companies often do not cover services or treatment for a diagnosis that refers to a developmental, rather than physiological, problem. Parents and evaluators can discuss insurance issues before the evaluation is finalized.