About Dr. Whitman

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Lindsay Whitman, PhDLindsay Whitman, Ph.D. conducts neuropsychological assessments with children and adolescents. A neuropsychological evaluation is helpful when it is suspected that a child is struggling with a learning disability, developmental delay, or intellectual disability and/or is experiencing difficulty with skills such as attention, memory, or executive functioning (i.e., working memory, organization, planning). This type of evaluation may also be indicated for children who are experiencing behavioral, social, or psychological difficulties or in whom the reason for difficulty is largely unclear. The process often helps to identify any appropriate clinical diagnoses, but more importantly, works to clearly identify the types of support services will enable a child to perform at their best.

Dr. Whitman conducts all neuropsychological procedures herself, strives to generate reports that are streamlined and clearly written, and provides timely verbal feedback sessions. A comprehensive written report follows within days of the feedback session. It is standard procedure for Dr. Whitman to speak confidentially with teachers and any outside providers who know the child well as well as complete brief classroom visitations in children with whom these procedures are deemed appropriate.

Dr. Whitman’s clinical training includes the evaluation of children, adolescents, and adults presenting with a variety of cognitive risk factors including developmental delay, intellectual disability, autism spectrum disorder (ASD), learning disabilities, (e.g., dyslexia), attention deficit hyperactivity disorder (AD/HD), traumatic brain injury, and psychiatric/mood difficulties. Her postdoctoral fellowship at New York University Comprehensive Epilepsy Center provided specialized training in the cognitive assessment and pre-surgical evaluation of individuals with seizures/epilepsy. Dr. Whitman has presented empirical research at national and international neuropsychology conferences and has published several peer-reviewed articles on issues related to cognitive functioning in epilepsy and adolescent personality development.

Dr. Whitman is a licensed clinical psychologist in the state of New York. She completed a Ph.D. in clinical psychology/neuropsychology at Rosalind Franklin University of Medicine and Science/The Chicago Medical School. She completed clinical internship at West Virginia University School of Medicine and a two-year postdoctoral fellowship in clinical neuropsychology at New York University Comprehensive Epilepsy Center. Dr. Whitman holds a masters degree in early childhood risk and development from Harvard Graduate School of Education and a bachelors degree in nutritional sciences from Cornell University.

Dr. Whitman has met the education and training requirements for practice certification by the American Board of Clinical Neuropsychology (ABCN). ABCN certification is a voluntary process for neuropsychologists designed to ensure competent assessment via intensive peer review of practice knowledge and clinical skill level. The process is much like board certification in medicine and is designed to provide external validation of thorough competence in a specialty area. Dr. Whitman is currently in the process of obtaining board certification in clinical neuropsychology through the American Board of Professional Psychology.

Payment via credit card, check, or cash accepted.  Dr. Whitman is happy to provide receipts for out-of-network insurance benefits. Such receipts are provided upon completion of the written report.

Office: One Grand Central Place – 60 East 42nd Street Suite 1060 New York, NY 10165

Email: [email protected] | Phone: 347-560-1399

A Useful Intervention Technique for Behavioral or Attentional Difficulties

Effective teachers and parents use behavioral intervention techniques to help students control their attention and behavior. One of the most useful interventional techniques is verbal reinforcement of desirable behaviors.

The most common form of verbal reinforcement is praise. Praise is a type of positive reinforcement that should be given not only when a child completes or is engaging in an appropriate behavior, but also when they are exhibiting clear effort toward a desirable behavior. The key is to look for a behavior to highlight well before the child gets “off task”. This will provide the incentive for the child to continue to engage in the appropriate behavior, rather than getting distracted or enticed by a less desirable pattern.

Although negative consequences may temporarily change behavior patterns, they may actually increase the frequency and intensity of inappropriate behavior by reinforcing misbehavior with with attention. In addition, punishment on its own only teaches children what not to do. Positive reinforcement is intended to teach children the specific behaviors needed to succeed. Theoretically, positive reinforcement produces the changes in the attitudes and thoughts that will shape a student’s behavioral and learning trajectory into a successful one.

Here are some tips on the use of praise in the classroom and at home.

1. Clearly identify the behavior. Your comments should include exactly what part(s) of the child’s behavior is/was desirable. Look for concrete aspects of what the child was/is doing. For example, instead of praising a child for “not disrupting his neighbor”, a child should be praised for “sitting quietly at his desk and working in his workbook”.

2. Be sure to vary the types of statements given as praise. When students hear the same praise statement repeated over and over, it will likely lose salience become less and less effective.

3. Give praise at the exact time the behavior occurred. The closer in time the praise and the behavior can be, the better.

4. Be consistent. Teachers and parents should work together as much as possible. Consistency among teachers with respect to which (specific) behaviors are being praised is very important. If different beahviors are being reinforced, it is possible the student will become confused or frustrated. Daily home-school report cards or spiral notebooks passed back and forth between the parent and teacher can be helpful in this regard

Pediatric Neuropsychological Evaluations: FAQs

Lindsay Whitman, Ph.D.
Pediatric Neuropsychologist
New York, New York

 What is pediatric neuropsychology? Pediatric neuropsychology is a specialty that focuses on cognition, learning, and behavior in children and adolescents. A pediatric neuropsychologist typically holds a Ph.D. in clinical psychology and is specially trained to understand the ways that thinking, learning, and behavior are associated with neurodevelopment, brain structures, and brain systems.

A pediatric neuropsychologist uses standardized tests to measure cognitive skills such as attention, executive functioning, memory, visuospatial processing, and language. A pediatric neuropsychologist utilizes the numerical results of these “objective” tests in conjunction with parent/teacher reported functional difficulties, a child’s behavioral presentation, and a detailed clinical history to draw conclusions, consider clinical diagnoses, and generate recommendations.

Pediatric neuropsychologists often work with a child’s doctors and/or therapists to help set goals, monitor progress, and manage expectations. They commonly consult with teachers and/or school officials to help provide necessary educational or academic accommodations. A pediatric neuropsychologist often helps families connect with the appropriate types of therapists (e.g., psychotherapists, speech/language therapists, occupational therapists) in an effort to develop a comprehensive treatment plan.

Pediatric neuropsychologists work in different clinical settings. Many work independently in private practice. Others work in a medical or academic-medical setting such as a hospital, medical school, or specialized health clinic. Often, neuropsychologists divide their time between clinical work with clients and research.

What is a standardized test? A standardized test is a test that is administered and scored in a consistent manner. They are designed in such a way that all questions, test materials, and testing conditions (e.g. in a quiet room, at a desk) are constant across administrations. One must possess specific professional credentials to purchase and utilize standardized neuropsychological tests.

How does a neuropsychological evaluation differ from an assessment performed in school? School based assessments (also known as psychoeducational assessments) are typically performed with one goal in mind: to determine whether a child qualifies for special education programs or therapies. School based assessments focus almost exclusively on intellectual and academic achievement skills. Although this type of evaluation suffices for some children, it is difficult for a professional to responsibly diagnose any difficulty other than a clear specific learning disability with the limited amount of clinical data gathered in this type of evaluation.

What types of children are referred for a neuropsychological evaluation? Children and adolescents are usually referred for a neuropsychological evaluation by a parent, doctor, teacher, school psychologist, or other professional because of one or more of the following reasons.

  • Difficulty with regard to learning and/or academic performance despite adequate attendance and seemingly good attention and effort
  • Difficulty paying attention, maintaining adaptive behavior, socializing, or maintaining emotional control
  • A history of neurological or developmental difficulty known to affect the brain and/or brain systems (e.g., epilepsy, perinatal toxic exposure, a metabolic disorder, possible Autism Spectrum Disorder or ADHD diagnosis)
  • Suspected developmental delay (language, motor, etc.) that are potentially accompanied by other areas of difficulty
  • A brain injury from head trauma or another type of physical stress
  • It is possible that a child may be “gifted” and proper documentation is required
  • It is necessary or desirable to document a child’s current functioning (a “baseline”) or assess progress or change (a re-evaluation or follow-up evaluation)

Which cognitive skills does a neuropsychological evaluation measure? A neuropsychological evaluation aims to provide a clear picture of a child’s cognitive functioning with regard to intelligence, academic skills, memory, attention, visuoperception, language, executive functioning (e.g., organization, planning, behavioral inhibition), fine motor skills, emotional functioning, and (sometimes) personality. Depending on the referral question and goal(s) of the evaluation process, some areas of cognition may be measured in more detail than others.

What will the results of a neuropsychological evaluation tell me about my child? Standardized test results enable a pediatric neuropsychologist to compare a child’s test scores to scores of children who are of similar age. With these numbers, a neuropsychologist creates a profile of cognitive strengths and weaknesses. This information is utilized to devise recommendations regarding how to best support this child in school, at home, and perhaps with peers. A neuropsychological evaluation should help one understand the factors that may be interfering with a child’s ability to reach his or her greatest potential.

If I decide to go forth with a neuropsychological evaluation, what should I expect? A neuropsychological evaluation includes a parent/guardian interview regarding the child’s medical, psychological, and academic history, an interview with the child, behavioral observation of the child, and standardized testing. Testing typically involves paper and a pencil, hands on activities, verbal or nonverbal items, and a laptop computer.

During testing, parents will be asked to fill out questionnaires about their child’s development, functioning, and behavior. Teachers will be asked to complete similar forms. The time required to complete testing depends on the characteristics of the child or teen; adolescents may complete testing in one long day (with breaks), whereas younger children may require up to four shorter testing sessions. Dr. Whitman completes every aspect of testing herself (she does not involve psychometrists or clinical trainees).

It is important to make sure a child has a good night’s sleep the night before an evaluation. If a child has special language needs, it is important to be sure that the neuropsychologist is well aware of these. If a child wears glasses, a hearing aid, or any other device, make sure to bring the device along. If a child is on medication, do not refrain from administering it on testing day. If a child has had previous school testing, an individual educational plan (IEP), or has related medical records, bring copies of these documents to the appointment for review.

What should I tell my child before the evaluation? Pediatric neuropsychologists are trained to emotionally prepare children for the testing process once they arrive at the office. However, it is usually appropriate to begin to prepare your child for the process before arriving for a neuropsychological evaluation. Most often, it is best to keep explanations brief and simple. Relate your explanations to a problem that your child is familiar with (e.g., “feeling frustrated with school”). If your child seems nervous or anxious about performing “well”, remind him or her that their only job is to try their best and that the process is intended to help them.

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If you have further questions regarding the nature or process of a neuropsychological evaluation, please contact Dr. Whitman for consultation.

A Parent’s Guide to the Differences Between a Psychoeducational and a Neuropsychological Evaluation

Parents of children with learning differences are often faced with the decision of which type of evaluation will best meet the needs of their child. This decision is important to ensuring that a child is supplied with the interventions/supports that will provide the greatest potential for success.

A psychoeducational evaluation usually includes an assessment of a child’s social history, intellectual abilities, and basic academic skills (reading, mathematics, spelling) as well as a psychological screening. A psychoeducational evaluation will typically includes 2-4 hours of formal testing, depending on the school and/or individual approach of the clinician. The results of this type evaluation usually provide enough information to identify specific learning disabilities/differences as well as to pick up on clear psychological distress that is affecting a child’s functioning. A psychoeducational evaluation does not provide the clinical or psychometric data required to reliably capture cognitive difficulties associated with attention or executive functioning weaknesses (e.g., ADHD), Autism Spectrum Disorder, or more subtle psychological/social difficulties. This type of evaluation will provide recommendations for very general learning and counseling support.

A neuropsychological evaluation includes a detailed investigation of a child’s developmental, medical, social, and psychological history and an extensive testing battery that examines a child’s intellectual, academic, attention, executive functioning, language, visuospatial, visuoconstructional, memory, and fine motor skills. A detailed investigation of a child’s psychological/social functioning that includes both a clinical interview and a series of standardized parent, teacher, and self-report measures (if appropriate) is completed. This type of evaluation typically includes anywhere from 6 to 12 hours of testing. For many children, the inclusion of a direct classroom observation period is ideal and should be provided. The results of a neuropsychological evaluation are intended to identify not merely any intellectual or learning differences, but also any other cognitive or psychological difficulty that may be contributing to a child’s profile (e.g., language disorder, fine motor difficulties, attention problems). Data obtained in a neuropsychological evaluation will provide the information needed to generate a very comprehensive description of the child’s learning and support needs. This description should be used to identify the specific learning/therapeutic interventions that will work best to support the explicit needs of the child.

Understanding the Value of a Comprehensive Evaluation for Reading Disorder/Dyslexia

I field many questions from parents who are concerned with their child’s ability to read. Indeed, there are many confusing pieces of information on the internet that have the potential to mislead parents or teachers in understanding the reasons why one should (or should not) be concerned with a child or adolescent’s reading skill development. Other parents ask me to describe the ways that a neuropsychological or psychoeducational evaluation may help their child if indeed a reading difficulty is identified. This piece is intended to define dyslexia and discuss the process and value of a comprehensive evaluation process.

Dyslexia is another term for Reading Disorder, which is the technical term for reading difficulties used in the Diagnostic and Statistical Manual-IV-TR (“DSM”: the manual used by psychologists and social workers which lists and describes all possible diagnoses). In order to meet DSM-IV-TR criteria for reading disorder/dyslexia, a child’s reading skills must be substantially below what would be expected given her/his age, intelligence level, and education (as noted below, this objective “discrepancy” is NOT the only nor the most important criterion to consider). In addition, the child’s reading difficulty must interfere to a noticeable degree with both his/her academic performance and any general life skills that require reading proficiency. Finally, if the child has a sensory problem (e.g., vision difficulty), his/her reading difficulties must be over and above what would be expected based on the sensory difficulty alone.

There are two types of dyslexia: developmental dyslexia (e.g., an individual is born with difficulties) and acquired dyslexia (e.g., an individual ‘acquires’ reading difficulties secondary to a sudden occurrence such as a neurological injury). Developmental dyslexia is common among individuals with first-degree relatives with learning disorders. Thus, although dyslexia appears to be highly heritable, a child’s environment (e.g., how much the child’s parents encourage or model reading behaviors, how many books or reading materials are in the home) also seems to play an important role in the development of different types of reading profiles (Haiyou-Thomas, 2008).

Recent research shows that there are clear functional differences in the “brain systems” of children and young adults diagnosed with developmental dyslexia (Richlan, Kronbichler, & Wimmer, 2011). Research has also demonstrated that the functionality of disrupted “brain systems” has the potential to change upon exposure to high quality reading remediation (Shaywitz, Lyon, & Shaywitz, 2006). In other words, research suggests that with proper and timely reading intervention, the brains of children with dyslexia can change to function more similarly to the brains of children without dyslexia. This suggests that it is very important to identify early vulnerabilities to reading difficulties in children so that high quality programming may be initiated as soon as possible. In general, a younger child’s brain is more “plastic” or malleable than an older child’s brain, and thus, there is greater potential for more efficient change in younger children. (Identification of reading vulnerabilities before age six or seven is ideal.)

If I am concerned about my child, what kind of evaluation should a neuropsychologist do to evaluate whether or not my child meets the criteria for dyslexia?

When a child is referred for a neuropsychological or psychoeducational evaluation, there are often additional concerns (e.g., attention/concentration, mathematics skills, handwriting, impulsivity/behavior, mood, social skills) cited in addition to reading. For this reason, an evaluation should always be always tailored to the individual child. However, there are three parts of any evaluation in whom a reading disorder/dyslexia is diagnosed that are indispensable.

1. Standard scores on decoding and/or reading comprehension tests must be substantially lower than other children who are at her/his age and/or education level in order to diagnose dyslexia. It is important that children being compared have been exposed to the same level of education (e.g., if a child was very sick for a period of years and missed a substantial amount of school, it may not be entirely appropriate to directly compare her/him to his same-aged peer group).

2. In order to diagnose dyslexia, there must be substantial evidence (via history, clinical observation, and patterns of scores on a wide variety of tests) that establishes the extent to which the reading difficulty may be considered unexpected for this child (e.g., the child is very verbal, has a good vocabulary, and demonstrates otherwise strong academic or thinking or language skills).

3. Although recent research indicates that there may be different subtypes of dyslexia which include or do not include phonologic weakness (O’Brien, Wolf, & Lovett, 2011), the traditional understanding of dyslexia includes this clinical feature (e.g., clear and consistent difficulty linking sounds to letters). Thus, a thorough evaluation of dyslexia must thoroughly investigate the presence/absence of this quality in a child’s reading skill set via standardized tests of decoding. Other aspects of a child’s developing reading skills such as oral reading fluency, spelling skills, and reading comprehension are also central to an evaluation of dyslexia.

It is common for schools to rely heavily on the essence of criteria one or a “discrepancy model” (i.e., a 15-standard score point gap between a child’s intelligence level and reading level) to identify reading difficulties in children. This is concerning not only because there are important variations among testing materials between schools, but also because this approach does not necessarily capture the presence or absence of the “phonologic” component of dyslexia. Elimination of this component of an evaluation compromises accurate identification of children with these difficulties and the provision of a clear description of specific learning needs (e.g., type of intervention program, intensity of intervention format), leading to the possibility that a child will be matched with a reading program does not address his/her needs. Pairing a child with the wrong type of services may lead to what seems to be a lack of success when the true reason for difficulty is that his/her needs are not being appropriately supported.

So, in summary, why is a truly comprehensive neuropsychological/psychoeducational evaluation process important if I am concerned about my child?

As noted above, it is very important to identify a reading difficulty as early as possible in a child; the earlier a child is provided with the proper type of supportive services, the higher the chances of rapid progress with remediation. In addition, there are many classroom/school accommodations that can and should be provided to children with reading difficulties that will support them academically and hopefully reduce undue anxiety or stress. Examples of accommodations for children with dyslexia may include (depending on the child, of course) extended time for classwork and standardized tests, a quiet space to complete work, the provision of audiobooks or note taking services, and the use of visually-based learning aides. In sum, a neuropsychological evaluation will not only identify the needs of your child on a very comprehensive (and thereby likely more accurate) level, but also provide a thorough and practical list of the direct (e.g., classroom) or equally important indirect (e.g., therapeutic support to bolster self esteem or reduce anxiety) recommended services to best support him or her through their learning process.

REFERENCES:
Hayiou-Thomas, M.E. (2008). Genetic and environmental influences on early speech, language, and literacy development. Journal of Communication Disorders, 41(5), 397-408.

O’Brien, B., Wolf, M., & Lovett, M. (2011). A Taxometric Investigation of Dyslexia Subtypes. Dyslexia, 18 (1), 16-39.

Richlan, F., Kronbichler, M., & Wimmer, H. (2011). Meta-analyzing brain dysfunctions of children with dyslexia. Neuroimage, 56 (3), 1735-1742.

Shaywitz, B.A., Lyon, G.R., & Shaywitz, S.E. (2006). The role of magnetic resonance imaging in understanding reading and dyslexia. Developmental Neuropsychology, 30 (1), 613-632.