Gifted Issues Discussion homepage Forums Twice Exceptional cost of evaluation???

We are having our DD4 evaluated and our insurace covers ten visits and the psychologist says she needs seven more beyond that so that we would pay about $900 out of pocket. Does this sound about right? My DD4 does not have any extreme behaviors, in fact, since going to OT has come a long way. She is intense and talks continuously and is always on and on HIGH, can get fixated, obviously has advanced cognitive abilities (that is why I am on this board), massive tantrums in the past, but they are getting much better, impulse control, diagnosed with sensory seeking (wants to touch grab make noise move constantly). She can sit and focus, but rarely goes ten seconds all day without talking and talking loudly. She used to seem oblivious to others reactions to her and seemed not to get consequences, but she makes eye contact, seeks out others, engages in elaborate pretend play for hours a day, makes comments such as, "He said he liked my lizard, but he doesn't (she could tell by tone of voice). She will actually say, "Why did you say that in a lazy way?" I really don't see her issues as that extreme and we are not in a place where we want to spend money where we do not need to spend it. Any insight welcome.

Twinkle Toes,

Just to clarify, are you saying that evaluation itself will take 17 visits (I am assuming this because you titled your post "cost of evaluation")?

I have not been down this road, but know friends who have, and that sounds like a lot of visits simply for evaluation.

I'm certain others with more personal knowledge will chime in soon.

Best of luck.

Are they doing standardized testing, or just observing your DD for 17-20 hours?

Since you suspect possible spectrum issues: is this person an expert in that area, or a general psych? I don't think a general psych has the expertise or experience to do an eval of this kind, especially on a girl.

Our evaluation for autism spectrum disorders was about a day and a half worth of testing (spread over three visits, with breaks), and consisted of a battery of standardized assessments. Key tests to assess spectrum-related issues are the ADOS, Vineland, and PDDBI.

Edited to add: here's the list of tests:

Stanford Binet 5 (cognitive)
Woodcock Johnson III (academic achievement)
WIAT-II Word Fluency (academic achievement supplement)
Children's Memory Scale (memory)
VMI-V (visual-motor integration)
NEPSY Social Perception (social awareness/understanding)
ADOS (autism diagnostic observation schedule)
Vineland (adaptive behavior - parent report)
PDDBI (ASD characteristics - parent report)
CBCL/TRF (general behavior - parent/teacher report)
PLSI (pragmatic language - teacher report)

HTH,
DeeDee

Hi,

I think she wants her to come in for ten visits, then says it will take seven hours to evaluate and write a report. That seems very excessive to me, but I am not sure what is typical.

She has already done some testing (and already said she wasn't showing signs of Aspergers from the inital meeting) now she will do testing for ADHD and then an IQ test. After that, I am not sure what the plan is, but am wondering if ten in office visits which will be testing oriented are warrented esp. since she is actually doind so much better across the board. She has friends at pre-k,, can play well at a playdate, more self control, less massive tantrums, etc. What we are left with now is mostly the high intensity, constant talking, and the high need for stimulation: grabbing jumping singing making noise etc. Honestly, it is hard on me to be around all that all day since I prefer quiet and minimal commotion. Maybe all she needs is the right environment, but who knows where that will be...

Thanks for the response, DeeDee. She does work specificially with kids on the spectrum, but I know girls can be tricky. On the surface my daughter looks the opposite of someone on the spectrum: outgoing needs constant engagement from others, hyper verbal, etc but there have been a few things that have made us wonder a little bit and maybe this will help us to put some worries to rest or take a new approach.

I don't know the entire plan yet, but the first appointment was a structured play session with targeted activities to observe autism spectrum type behaviors. She said she saw tons of good things, but has said little more. The next appointment will be to look at ADHD type behaviors but I am not sure what test it will be. After that, she is doing some IQ testing.

My one concern is that she may not be familiar with gifted kids.

Did insurance cover all of your testing?

thanks again

Is each visit about 50 to 70 minutes? I've never really hear of IQ test being done in such small chunks, but maybe the tester is saving you money by not doing it all at once?

It's hard to spend that much money when things are going 'pretty ok' - think of all the babysitting that 900$ or talk-therapy for you the 900$ would buy. In the end, of course you'll have to trust you mom-gut. The security of knowing that if your DD does turn out in her teen years to be on the autistic spectrum that you did everything humanly possible to get an early diagnosis and not loose those early years is worth quite a bit, in my experience.

But the whole question about 'ist this tester really experienced enough with HG/PG kids to be useful in sorting out this very delicate issues bothers me, though. Worth re-reading 'Misdiagnosis and Dual Diagnosis' again (sorry)

I wonder if you can talk to the Tester and see
a) show her the old IQ test and ask her how many evaluations she has done with kids with higher IQ scores than your DD in the last 5 years.
b) try telling her that the 900 out of pocket is really going to hurt and is there an '2nd best' alternative

Your other option is to get on the waiting list with a tester that really knows PG and really gets AS girls, Dee Lovecky comes to mind. It involves traveling, but better that than throwing good money after bad, I think. In our family the wrong diagnosis delayed certian options for several years - although who know if that was or wasn't for the best.

Love and More Love,
Grinity

I've never heard of testing done that way. It sounds to me as though she is relying more on clinical observation than on standardized tests. I'd prefer someone who used both.

I think you would be reasonable to ask what her game plan is, and on what her diagnosis will be based.

Yes, our insurance covers all diagnostic testing of this kind; but they surely wouldn't cover an open-ended process like the one your psych is using.

HTH,
DeeDee

If no standardized testing is used then I can't see how this evaluation would ever take more than 10 visits. But if it was going to take 10 visits, I would definitely want some part of those 10 visits to include some standardized testing.

We had to pay all out of pocket for our son, and this is because we weren't ruling out any diagnosis and didn't have any behavior concerns really. If we had said we saw symptoms it probably would have been free or significantly less. Instead it was a set amount in advance that covered: SB5, WIAT, Torrance creativity, and something else that I can't remember so must not have been that important. It also included a school observation and the psychologist attending a school meeting (which we saved until school started the next year). The testing itself was broken up into 4-5 mornings maybe a couple hours each morning. I realize that she had to spend more time writing up the report and everything...but I didn't think doctors bill for the time it takes them to do paperwork. Anyhow, I would really check into what you are getting from all of this. Maybe a breakdown of sessions and why it is going to take so many (and what she is doing each session). This may help you to decide parts of testing that are not as important to you and help prioritize how the 10 visits should be spent. If it's just a r/o of a PDD and/or adhd and cognitive testing that you are looking for I think that could be done in 10 visits. Of course I am a therapist, not a doctor. Good luck!

Could the 10 visits be therapy sessions? I know when we had OT, speech, and ABA evaluations they estimated how many sessions we would need, or how many they recommended. Some were covered by insurance, some were not. Nan

I'm with others - I've never heard of testing being spread out like that. Typically a neuropsych will take 1-4 sessions, an OT one session and an SLP one session. Scoring and writing the report would be additional time, and then giving the parents a read out is usually a one hour meeting.

The cost in the Boston area for a neuropsychological evaluation runs from $2500 to $3500 depending upon the evaluator.

I sounds to me like there is some therapy going on during the visit and perhaps the evaluator will use this time for observation that could be included in the report?