Dr. Gindis, on your
website I read that you perform
a "combined developmental, neuropsychological, and educational
the most appropriate for internationally adopted school-age children
with suspected neurological disorders.
What does it mean and what are the advantages of such "combined
for my daughter?
From a message of the mother of a prospective patient.
Ideally, each and every psychological assessment should
be developmental in nature: every child is a growing and rapidly changing
individual, and the goal of a psychological assessment is not only to
describe your child's current psychological "profile" (what
your daughter is now), but to discover the tendencies of her development.
The only way to do this is to consider the child's current functioning
in the context of her past development.
In the case of internationally adopted child like yours,
a correct understanding of her developmental history is of crucial importance.
It includes not only "knowing" the facts of her life before
the adoption (in this respect our knowledge is usually limited to incomplete
information contained in the legal and medical documentation available
for the examiner's review), but it also includes proper "interpretation"
of what is known. That's where the intimate understanding of the child's
cultural background together with a proper orientation in contemporary
research and practice in international adoption issues make a difference
in the outcome of the assessment.
Unfortunately, too often even a good specialist may either
overlook or dismiss some important developmental indicators in a child
affected by institutionalization and brought up in foreign culture and
language. When an internationally adopted child is brought to the office
of a psychologist, the professional sees a well-groomed and nicely dressed
kid accompanied by a middle-class, well-educated parent - a typical
family with typical issues that may be serious, but still "typical."
Even when the specialist is informed that the child is adopted from
abroad, it may still be difficult for anyone who never dealt with post-institutionalized
children to change the mindset and re-examine the ways of assessing
and interpreting the results. This becomes especially obvious in the
assessment of developmental disabilities and issues related to language
processing in international adoptees. For example, after two or three
years in the new family, a child adopted at a pre-school or elementary
school age can completely blend in with the peers in terms of spoken
language, appearance, mannerisms, attitudes, preferences, patterns of
behavior, etc. However, this superficial similarity contains deep-seated
differences, and the distinction is in the past experiences of these
children. Some had lived through severe trauma, deprivation, abandonment,
and abuse. Some may have neurological weaknesses, sometimes subtle,
sometimes significant, initially mentioned in their medical documentation
from their motherland and in many cases ignored or dismissed by medical
professionals unfamiliar with foreign medical notation. Some may have
developed what is known as "cumulative cognitive deficit"
as the result of early childhood cultural deprivation and a lack of
remedial efforts in the new family and school setting. Some will reveal
language difficulties that have nothing to do with "bilingual issues"
but are originated in the abrupt native language loss and the idiosyncratic
way of its replacement by the English language.
Many current behavior excesses and learning difficulties
of international adoptees are rooted in their developmental history,
and that is why I emphasize this part of my assessment and even highlight
it in the title of the procedure and follow up clinical report.
A neuropsychological component of my combined assessment
refers to application of specific neuropsychological tests and procedures
enabling the in-depth evaluation of major psychological functions involved
in learning and age-appropriate adaptive behavior (such as processing
speed, cognitive efficiency, executive functions, language, auditory-visual
An educational component includes the application of major
achievement tests relevant to the age and school grade placement of
the child. An educational assessment part often incorporates "trying
teaching" in a "dynamic assessment" format: test-teach-test
to determine the child's mental modifiability, intrinsic motivation
to achieve in learning activity, and ability to transfer the learned
skills and knowledge to other contexts and situations.
Finally, a major task and the goal of my combined assessment
is to interpret all findings as a whole in the context of current understanding
of brain-behavior interaction, developmental norms and deviations, cultural
and linguistic specificity of the case and educational and remedial
implications for the child. Any assessment is as good as it is comprehensive
enough to become a foundation of any further remedial work with your
B. Gindis, Ph.D.