testing/assessment

[biscuitsbiscuits]

How common is it for a psychologist (non-neuro) to have a career that is heavily focused on assessment/testing? I don't see very many people talking about testing as a major interest. Is there a negative impression of someone who wants to focus on testing? Or is it just not particularly exciting?

I'm curious because what I'd like to see myself doing in the future is working primarily as a school psychologist but with an active side gig in testing (and maybe some ABA work). How realistic does that sound? I'm not currently in the field, so these are hypotheticals to me and I'm sure there are things I'm not seeing. It would be great to hear from those in the field.

Thanks in advance.

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[WisNeuro]

How common is it for a psychologist (non-neuro) to have a career that is heavily focused on assessment/testing? I don't see very many people talking about testing as a major interest. Is there a negative impression of someone who wants to focus on testing? Or is it just not particularly exciting?

I'm curious because what I'd like to see myself doing in the future is working primarily as a school psychologist but with an active side gig in testing (and maybe some ABA work). How realistic does that sound? I'm not currently in the field, so these are hypotheticals to me and I'm sure there are things I'm not seeing. It would be great to hear from those in the field.

Thanks in advance.

Not wholly uncommon, but not common either. The big problem is people doing it poorly because they lack the training to know what they are doing. Every now and then I get a community "neuro" report from someone who had no neuro fellowship, and it's usually a butcher job. Additionally, some states, and more are considering it, will not allow you to bill for neuropsychology codes if you are not boarded or board eligible in neuro.

 

[Justanothergrad]

It depends on the context. In many settings, neuropsychological evaluations are less common then other specialty assessments. For instance, forensic evaluations rarely include a nurse psychologist as the focus point. There is plenty of testing that does not involve neuropsychological testing IMHO. I think our field has tried to push everything into "neuropsychological" because it sounds so science-y, but the truth is there are many areas that don't need to be there (e.g., ADHD given that diagnostic interviews are one of the most reliable assessment approaches). It's why there is also a board certification in assessment psychology in addition to the ABPP in neuropsych.

What type of testing are you interested in is a good question to be able to answer since that will drive it neuro is appropriate/needed.

 

[FadedC]

As a school psychologist I've spent time working in a clinic supporting individuals with Intellectual Disability/Autism, where I did mostly cognitive and Autism testing. Many doctoral level school psychologists will also do private psychoeducational evaluations where they have the opportunity to give a much more in depth level of testing then they could give if they were in a school.

 

[AcronymAllergy]

The above (psychoeducational, ID/Autism/developmental, and forensic) are the main areas I can think of where psychodiagnostic testing would be most common.

The others would be fitness for duty (e.g., police, fire), child custody, and organ transplant evaluations, which tend to be psychodiagnostic more so than neuropsychological.

 

[Therapist4Chnge]

AA nailed it.

One thing I'd add is that straight psych assessment (personality, mood disorders, etc) can be difficult to get approved via insurance coverage, at least in regard to being paid for the work you actually do. I don't do work in this area, but I sometimes will be sent referrals that want a traditional psych eval, so I did some digger for my own curiosity.

In regard to ADHD assessment, plenty of people offer assessment, but most stink or aren't offering much in regard to usefulness. The biggest issue is that neuropsych assessment isn't that useful for this patient population (at least in the traditional sense of differential diagnosis). The people who really excel in this area do more in regard to recs and intervention.

Fitness for duty is interesting, but ripe w. pitfalls if you don't know what you are doing. Like most/all niche assessment, mentorship and additional training are STRONGLY recommended.

 

[biscuitsbiscuits]

Ah- I see that the word I probably should have used is psychoeducational. The sort of testing I have in mind is ADHD, ASD, learning disability, IQ (and more I'm sure I'm not currently aware of) in a preschool-grade 12 population.

I'll be applying to clinical, combined school-clinical, and some school psychology doctoral programs this year and what I'd like to do is get as much assessment experience as possible along the way (and afterward) so I can become proficient in it and possibly specialize. At some point down the road, maybe apply to be an ABAP member (I see that there's an educational subspecialty).

I'd like to do this but I'd like to not be a hack. Any advice on how to get there other than seeking experience in practica/internship?

And let's say, hypothetically, I do eventually get there and I'm decent at it. Is there enough of a market for this sort of work, given that insurance doesn't cover most of it?

Thanks to all for your responses- very helpful.

 

[Justanothergrad]

Ah- I see that the word I probably should have used is psychoeducational. The sort of testing I have in mind is ADHD, ASD, learning disability, IQ (and more I'm sure I'm not currently aware of) in a preschool-grade 12 population.

I'll be applying to clinical, combined school-clinical, and some school psychology doctoral programs this year and what I'd like to do is get as much assessment experience as possible along the way (and afterward) so I can become proficient in it and possibly specialize. At some point down the road, maybe apply to be an ABAP member (I see that there's an educational subspecialty).

I'd like to do this but I'd like to not be a hack. Any advice on how to get there other than seeking experience in practica/internship?

And let's say, hypothetically, I do eventually get there and I'm decent at it. Is there enough of a market for this sort of work, given that insurance doesn't cover most of it?

Thanks to all for your responses- very helpful.

Depends on location. There are plenty of kiddos that need those assessments done since families building IEPs may seek outside consultation. If kids are going to/about to leave for college and needing accommodations, they will need testing. Thats a wide range of ages though and you would likely want to narrow your focus developmentally because compenently giving all those tests to a pre-schooler is an entirely different game (requiring different tests) than a late adolescent would require. I know plenty of folks who supplement traditional services with assessment. While it can provide a higher paycheck, it is typically one and done so those looking to sustain entirely on psychoeducational assessment struggle to get enough referrals.

 

[biscuitsbiscuits]

Many doctoral level school psychologists will also do private psychoeducational evaluations where they have the opportunity to give a much more in depth level of testing then they could give if they were in a school.

Thanks so much for your reply. This is exactly the kind of work I'd like to do. Is there a regular need for this or is it done once in a while, as needed?


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[biscuitsbiscuits]

Depends on location. There are plenty of kiddos that need those assessments done since families building IEPs may seek outside consultation. If kids are going to/about to leave for college and needing accommodations, they will need testing. Thats a wide range of ages though and you would likely want to narrow your focus developmentally because compenently giving all those tests to a pre-schooler is an entirely different game (requiring different tests) than a late adolescent would require. I know plenty of folks who supplement traditional services with assessment. While it can provide a higher paycheck, it is typically one and done so those looking to sustain entirely on psychoeducational assessment struggle to get enough referrals.

Gotcha.

I'd like to work in a school full time and pick up assessment work on the side, so hopefully I'd be able to handle the ebb and flow. I live just outside of a big city, so if there's a need at all I imagine it would be here.

And thanks for clarifying re age range. That was something I was wondering about as well.




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[FadedC]

Thanks so much for your reply. This is exactly the kind of work I'd like to do. Is there a regular need for this or is it done once in a while, as needed?


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I think most psychologists do it as more of a supplemental income thing. I live in Manhattan and there are a lot of parents with high income who will happily spend a lot of money on an extensive evaluation if it means getting their child the help they think they need. But there are also a lot of psychologists, and as someone said it's the sort of thing people only do once. So it's a question of what your network is and how people are finding you.

Most school psychologists in my area do some form of testing on the side. That's a big part of what makes school psychology so potentially lucrative in the right area. When you work 7 hour days and 9 month years, you have a lot of time to earn supplemental income if you so choose. The clinic where I did ID/Autism testing also happily hired people on a fee per service basis.

 

[Therapist4Chnge]

Thanks so much for your reply. This is exactly the kind of work I'd like to do. Is there a regular need for this or is it done once in a while, as needed?

It depends. The best setup is to work in an affluent area and develop good relationships with one or two private schools. There is a need in many communities, but being in an affluent one will be easiest. /unfair but true

 

[biscuitsbiscuits]

I think most psychologists do it as more of a supplemental income thing. I live in Manhattan and there are a lot of parents with high income who will happily spend a lot of money on an extensive evaluation if it means getting their child the help they think they need. But there are also a lot of psychologists, and as someone said it's the sort of thing people only do once. So it's a question of what your network is and how people are finding you.

Most school psychologists in my area do some form of testing on the side. That's a big part of what makes school psychology so potentially lucrative in the right area. When you work 7 hour days and 9 month years, you have a lot of time to earn supplemental income if you so choose. The clinic where I did ID/Autism testing also happily hired people on a fee per service basis.

Great info, thanks so much!


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[deleted343839]

It depends. The best setup is to work in an affluent area and develop good relationships with one or two private schools. There is a need in many communities, but being in an affluent one will be easiest. /unfair but true

This. I can name off the top of my head several non-neuropsychologists in my city who are making good money taking cash for psychoeducational and developmental assessments. They all have a good background in child clinical psych, they practice in very affluent areas, and they have made their way onto the "go-to" referral lists for area preschools and private grade schools.

 

[WisNeuro]

Ah, yes, I should have clarified, my previous comments were geared more towards neuro assessments. Non neuropsychologists can go have a field day with psychoeducational assessments. I find them tedious and usually only accept those referrals when I need to fill slots.

 

[biscuitsbiscuits]

It depends. The best setup is to work in an affluent area and develop good relationships with one or two private schools. There is a need in many communities, but being in an affluent one will be easiest. /unfair but true

This. I can name off the top of my head several non-neuropsychologists in my city who are making good money taking cash for psychoeducational and developmental assessments. They all have a good background in child clinical psych, they practice in very affluent areas, and they have made their way onto the "go-to" referral lists for area preschools and private grade schools.

Yeah. Makes total sense. Competency + location (proxy for wealth) + network.

Thanks, all.

 

[Therapist4Chnge]

I wish competency was a requirement....but ideally it would be included.

 

[biscuitsbiscuits]

To be clear, I'm not eyeing an assessment career so I can make bank off the children of the wealthy. I hadn't thought of it that way before. I mean, of course making money wouldn't hurt, but it wasn't my main motivation.

It is truly of interest to me and I think it fits my strengths and interests in the field.

Just felt like I should get that down for the record!



Edit: not to disparage anyone who is making bank. Go for it, man.

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[AcronymAllergy]

One of the reasons folks are suggesting working in an affluent area (if it hasn't been mentioned already; I've skimmed posts and may have missed it) is that psychoeducational evals aren't covered by insurance. Thus, if you're assessing for something like ADHD or LD, odds are you're being paid out-of-pocket by clients. Seeing as how these evals are expensive, it's often only the more financially well-to-do folks who can afford them. Such evals may also be conducted by doctoral-level school psychologists while in the actual schools, although I have zero experience with any of that.

And as T4C mentioned, given that people are paying a good deal for the evals, they're probably going to expect more than a bare bones evaluation. There will likely also be pressure from parents (or, if working with adults, the patients themselves) to make a diagnosis due to having paid out of pocket for the eval, so if you go into the field, be ready to handle some potentially strong backlash in situations where no diagnosis is made.

Edit: Forgot to mention above that while it might fall under the umbrella of "forensic," sex offender evaluations are also often a high-need area. Such evals are generally court-mandated and, as with psychoed evals, aren't covered by insurance.

Double Edit: Another assessment area (for those interested, since these most definitely aren't psychoeducational) would be sex reassignment procedures (e.g., hormone therapy, surgery) and, more generally, pre-surgical evals (besides "just" transplants). Neurologically-based procedures such as pre-DBS will likely require a neuropsych, whereas other surgical procedures (e.g., bariatric, spinal cord stimulator) may be more psychodiagnostic.

 

[Therapist4Chnge]

All great info above.

The Ed v. Psych v. Med split is a significant issue w. many different types of assessment, so knowing the differences is important.

 

[ClinicalABA]

My billed services as a psychologist are almost exclusively autism diagnostic assessments for children under 4. Huge need in my area for psychologists with this skillset, with wait lists for Medicaid clients a year or more.

Trainees should look for coursework or in-program clincal experience offereing specific training in the ADOS-2 (including toddler module), as well as general child assessment- looking for coverage of cognitive (e.g. Bayley; WPPSI) and language (Bayley; PLS) tests. Expand on this training with community based practicum placements. Internship should be child focused (duh!). Further refine skills with assessment opportunities at a post-doc. It's unlikely that you would train in just ASD diagnosis. In my agency, the psychologists have rounded out their training with neuropsych assessment training (including post doc) or behavior analysis/ASD treatment training. Hopefully, along the way you'll get some training and experience in good "bedside manners." You will be working with families at a potentially vulnerable time. Some of the moms will cry when you report on the diagnosis. Though less dads than moms will come to the assessments, a larger percentage of them will cry. It can be difficult, and ideally you'll have some training to fall back on in these situations.

 

[biscuitsbiscuits]

My billed services as a psychologist are almost exclusively autism diagnostic assessments for children under 4. Huge need in my area for psychologists with this skillset, with wait lists for Medicaid clients a year or more.

Trainees should look for coursework or in-program clincal experience offereing specific training in the ADOS-2 (including toddler module), as well as general child assessment- looking for coverage of cognitive (e.g. Bayley; WPPSI) and language (Bayley; PLS) tests. Expand on this training with community based practicum placements. Internship should be child focused (duh!). Further refine skills with assessment opportunities at a post-doc. It's unlikely that you would train in just ASD diagnosis. In my agency, the psychologists have rounded out their training with neuropsych assessment training (including post doc) or behavior analysis/ASD treatment training. Hopefully, along the way you'll get some training and experience in good "bedside manners." You will be working with families at a potentially vulnerable time. Some of the moms will cry when you report on the diagnosis. Though less dads than moms will come to the assessments, a larger percentage of them will cry. It can be difficult, and ideally you'll have some training to fall back on in these situations.

Thanks so much- a really helpful post. I'm going to email this to myself.

That's an interesting observation about the parental response and a good point about sensitivity. I'm a parent myself (not that one must be in order to do this sort of work, of course) and I hope that it might help provide prospective and empathy toward other parents who are going through something like this.

 

[futureapppsy2]

My billed services as a psychologist are almost exclusively autism diagnostic assessments for children under 4. Huge need in my area for psychologists with this skillset, with wait lists for Medicaid clients a year or more.

Trainees should look for coursework or in-program clincal experience offereing specific training in the ADOS-2 (including toddler module), as well as general child assessment- looking for coverage of cognitive (e.g. Bayley; WPPSI) and language (Bayley; PLS) tests. Expand on this training with community based practicum placements. Internship should be child focused (duh!). Further refine skills with assessment opportunities at a post-doc. It's unlikely that you would train in just ASD diagnosis. In my agency, the psychologists have rounded out their training with neuropsych assessment training (including post doc) or behavior analysis/ASD treatment training. Hopefully, along the way you'll get some training and experience in good "bedside manners." You will be working with families at a potentially vulnerable time. Some of the moms will cry when you report on the diagnosis. Though less dads than moms will come to the assessments, a larger percentage of them will cry. It can be difficult, and ideally you'll have some training to fall back on in these situations.

The point on crying is interesting--I've been working in an ASD assessment clinic for the past year-ish, and I've never had a parent cry when we gave them our findings (ASD or not) . In fact, many seem almost relieved at the diagnosis--they've been experiencing a lot of challenges with their child and are happy to get a diagnosis and related information in order to move forward in getting their child help. My clients have been older (mostly 7-10 years), so maybe that's the difference? Actually, some of the harder feedbacks have been with families where we didn't give their child an ASD diagnosis, interestingly.

 

[ClinicalABA]

The point on crying is interesting--I've been working in an ASD assessment clinic for the past year-ish, and I've never had a parent cry when we gave them our findings (ASD or not) . In fact, many seem almost relieved at the diagnosis--they've been experiencing a lot of challenges with their child and are happy to get a diagnosis and related information in order to move forward in getting their child help. My clients have been older (mostly 7-10 years), so maybe that's the difference? Actually, some of the harder feedbacks have been with families where we didn't give their child an ASD diagnosis, interestingly.

My experience is similar to yours. The mode response is "I knew it." Most families have been well prepared and informed by early intervention professionals before they get to me. I think I've gotten pretty good at conveying how getting the diagnosis is a good thing, as it gives some explanation to what they've seen, ends speculation, and- most importantly- opens doors to treatment. However- though rare-,you do need to be prepared for the occasional upset recipient of the news.

I agree on the relative difficulty of the cases where no diagnosis is given, particularly when differential diagnosis is nebulous, as it often is with children under 2 with the combo of speech delays, behavioral problems, and developementally APPROPRIATE social-communication abilities.

 

[FadedC]

I've also found parents are often more upset when they don't get the diagnosis, or when their test scores are too high to get government assistance despite the help the parent feels they need. I've had parents cry about that before. Working with very low functioning individuals I've also seen parents cry just from the stress of bringing the child (or adult) in to work with me.

Regarding psychoeducational evaluations it's very true that parents will often expect very elaborate reports if they are paying a lot for them. I've read psychoeducational reports that were longer then my dissertation. Personally I don't think I'd be capable of writing something like that.

 

[deleted343839]

Double Edit: Another assessment area (for those interested, since these most definitely aren't psychoeducational) would be sex reassignment procedures (e.g., hormone therapy, surgery) and, more generally, pre-surgical evals (besides "just" transplants). Neurologically-based procedures such as pre-DBS will likely require a neuropsych, whereas other surgical procedures (e.g., bariatric, spinal cord stimulator) may be more psychodiagnostic.

Adding another to the list: evaluations for egg/sperm donors (also more likely in affluent areas given that IVF, etc. are not covered by many insurers).

 

[AcronymAllergy]

Adding another to the list: evaluations for egg/sperm donors (also more likely in affluent areas given that IVF, etc. are not covered by many insurers).

I've actually never heard of that particular use/area before, but it makes sense. Interesting.