How an Evaluation Should Actually Be Done 

I train psychologists to do these evaluations. You might be wondering about Autism, ADHD, Learning Disabilities, or mental health for your child. You might be unsure whether there is even something worth evaluating. Here’s what a good assessment looks like, what the process involves, and how to tell whether you’re getting one.

Most parents come to me after a long stretch of wondering.

Something has been different for a while. Maybe a teacher said something. Maybe your mother-in-law said something, unhelpfully, at Thanksgiving. Maybe you have been up at 2 a.m. with your phone six inches from your face, reading about “masking” and feeling your stomach drop in recognition.

By the time you’re ready to book an evaluation, you don’t want a maybe. You want to know what’s going on with your kid, and you want to know what to do about it.

The single best question I hear from parents, and I hear it often, is some version of “how do we help him?” I love that question, because a comprehensive assessment is built to answer exactly that.

Here’s the part nobody tells you: psych evaluations vary enormously in quality.

Two families can pay similar amounts, wait similar months, and walk away with wildly different things. One gets a document that opens doors for a decade. The other gets a simpler assessment that answers some questions but does not truly point them toward the precise treatments and recommendations that will help their child now and into the future.

The challenging part here is that clinicians have been trained, myself included, to provide every recommendation that could possibly be useful to you at some point. Unfortunately, this can leave you feeling overwhelmed and exhausted. 

This is where it really matters who you go to for the evaluation. A really good psychologist will not only give you the more exhaustive list but also point you directly to the first few steps you need to take to get life on track. 

In many cases, several good practices in town will send their clients to me after their client’s assessment is done. My practice offers parent education and parent coaching. In those first meetings, we dig in and read these reports, pointing specifically to what the parents can do right now to help their child thrive, given the limitations of time, money, and other local resources.

What You Are Actually Buying

Not a label. A decision-making document.

I’ve spent years writing about assessment and training other practicing psychologists on how to evaluate autism and other developmental conditions accurately. So I want to give you the same thing I give them: a clear picture of what thorough actually looks like, so you can recognize it when you see it, and notice when you don’t.

A good evaluation answers three questions, in this order:

1. What is going on with my child? Not just the headline diagnosis, but the full picture, including anything else riding alongside it.
2. Why is this happening? What’s driving the behavior you see at 6 p.m. on a Tuesday when everything falls apart? Can he control it and I am just being a sucker here? Or is this really a struggle for my child, and if so, why?
3. What now? Specific, actionable recommendations that a school, a therapist, and you at home can all actually use.

If a report answers the first question and gestures vaguely at the third, it isn’t finished. It’s a starting point someone handed you and called a destination.

What The Process Actually Looks Like

A comprehensive child assessment is a full day of testing, sometimes more, spread across several appointments. Here’s how it unfolds.

#1 The Intake Interview. One hour with parents and the psychologist. We talk about your child, your concerns, and…this matters…the questions you want answered. You are not a passive participant here. The referral questions shape everything that follows.

# 2 Planning & Scheduling. Before testing day, your psychologist will assemble the list of conditions to evaluate and select the specific measures to use. This list is different for every child. It should be. An evaluator who runs the identical battery on every kid who walks in is not really focused on the right efforts here. The evaluator only has so much time to help your child. You want the clinicians to focus on YOUR child’s particular constellation of needs and symptoms.

#3 Testing Day. Most practices will let you stay in the waiting room. Your child can bring a water bottle, a sweatshirt, and any comfort objects: favorite toy, fidget, whatever helps. Bring snacks. It’s a long day.

Here’s roughly what it covers:

• Intelligence and cognitive testing: about two hours. Verbal questions, puzzles, remembering things to recall later, working quickly against a time limit.
• Social assessment: up to two hours, often less. Play-based or conversational, where your child engages in back-and-forth interaction with the examiner. This is where a skilled evaluator earns their keep. These measures are only as good as the clinician using them, which is precisely why the training exists.
• Emotional assessment: one to two hours. Usually an interview. Your child might be asked what they like doing that makes them feel happy, or asked to draw pictures and talk about them, or shown images and invited to tell a story from their imagination.
• Attention and executive functioning testing: about two hours. Focus, concentration, organization, processing speed, memory. Often a computerized attention task, card sorting, a pegboard, or maze-type activities.
• Adaptive assessment: one to two hours, typically online questionnaires completed by parents and teachers. Your child may complete a self-report version too.

All told, that’s usually six to ten hours in person with the clinician. Less for younger children. More for teenagers and young adults.

#4 The Wait. You generally won’t get results on testing day. Everything has to be scored, integrated, and written up. Most clinicians schedule feedback about two weeks out. I know two weeks feels long when you’ve already waited months. It’s the part where the actual thinking happens.

#5 The Feedback Meeting. This is where you sit down and go through what the testing found with your clinician. In my practice this is online, with parents. Teenagers have the option to attend. Clients over 18 always attend, and they decide whether parents join. This is a conversation, not a verdict delivered from a know-it-all. Ask questions. Tell your clinician if something doesn’t match the child you know. Good clinicians are on a team with you, working together to describe your child’s strengths and needs in the best way. 

#6 Your Report. In my practice I review the report with you during the feedback meeting, we make any adjustments together, and the finalized version goes out that day or the next through a secure health records system.

Expect something substantial; anywhere from 15 to 50 pages depending on the testing done and how complex your child’s profile is. Clinicians do reports a bit differently but most standard reports will include these elements:

…Reason for referral

…Background information

…Assessments administered

…Behavioral observations

…Results

…Diagnostic impressions

…Clinical summary

…Recommendations

…Clinician signature

…Appendix of scores

Once you have it, you should have what you need for the school, the pediatrician, therapists, and insurance.

But What If My Child Freaks Out?

One more thing about testing day, because parents worry about this, is what if your child just isn’t having it? What if you get to testing day and your kiddo just won’t do it? Remember, these are child psychologists, people! We eat these challenges for breakfast. Some moments are tiring, and a few can be a little stressful. But kids overwhelmingly walk out proud of themselves for working hard, and feeling like somebody finally paid close attention to them. For most children and families, this ends up being a genuinely positive experience.

How Do I Know If This Is A Good Evaluation

Now, here’s the important part. If you are going to invest the money and time to do this, you want to make sure you get an evaluation that tells you how to help your child now. This is the whole dang point and somehow it gets lost in the noise. Here’s what you need.

A thorough developmental history

This is not a form you fill out in the waiting room. It is a genuine conversation about early milestones, language, sensory patterns, sleep, feeding, play, friendships, and how things have shifted over time.

Autism and ADHD are developmental conditions. You cannot assess them well without understanding development, which means you cannot assess them without spending real time with the person who was there. Further, most behavioral and mental health conditions have evolved within certain environmental contexts. It is important for your psychologist to truly understand these factors.

A caveat here is if you are working with a practice that is doing a ‘brief’ evaluation to remain compliant with certain insurance or other restrictions, this thorough developmental history is probably the first thing to get cut. That does not mean the clinician did your report wrong. It is just that you are essentially paying for a certain number of hours and the clinician has to focus on the diagnoses and recommendations. As you can imagine, though, sometimes cutting out the history leaves gaps in the important story that led up to today’s set of challenges and needs.

A Genuine Differential Diagnosis

This is the piece that is the most important and cannot be skipped. Autism overlaps with, and frequently coexists with, ADHD, anxiety, learning disabilities, giftedness, depression, and the effects of trauma. A child who has been through something frightening can look, on a checklist, remarkably like a child who is autistic. They are not the same, and they do not need the same plan. Sorting that out is the work. If the clinician is not highly trained in complex differentials, be advised that you might be in the wrong place. If your child is gifted, potentially autistic, or has experienced a trauma, you need a specialist. A more general practitioner is going to be less familiar with these complex profiles.

Information From Other Professionals

Teachers, therapists, mentors, tutors, and coaches can be important sources of information. Children behave differently across settings, and that variation is data. This is another area that may be a part of your evaluation and may not be, depending on the type of evaluation you requested. A brief diagnostic assessment is not going to include much data from outside providers. A comprehensive psychological assessment or neuropsychological assessment usually will include these elements. If your particular case has a legal or child welfare component, the collateral data and record review is absolutely necessary as it is a major part of decision making and recommendations.

Putting It All Together

Somebody has to sit with all of it and think. This is unglamorous, invisible, takes hours, and is the entire difference between a report and a pile of scores. When it comes to integration, this is the most important part. In my practice, I spend the bulk of my time synthesizing and organizing data. The parents do not need to understand every single test result. They need to know what this is and what to do about it. I sit with the results and ask,

“What is the most important thing for this family to know and do now?”

This is the main deliverable at the end of the day.

Wise Use Of Assessments

Interestingly, in my practice, I have noticed through the years that I run fewer and fewer tests. I see other practices that do far more tests than I do and I have stopped to wonder what is happening. Although, there is absolutely no problem with gathering more data, my practice operates differently.

I have honed and curtailed evaluations down to a small number of tests.

Why?

I have this lovely child in front of me for a limited number of hours. In that time, I have to do 3 things:

• Truly connect with this child: This is a key opportunity to make a connection. I want to know what makes this child tick. What do they love, what is fun, and what fun can we have together? No matter what, I make time for this effort. Some clinicians call this rapport building. I see it as much more than that. It is a time of genuine and authentic human connection. We laugh and we play. Every time.
• Answer the question: Most of the kids who come to my practice have highly complex profiles. I know when they arrive there that if this was obvious, the family would not be here. This is why the tests I decide to use for the child are so specific and individualized. I test until I have answered all the referral questions. Full stop.
• Find out what they need: As I get to know each child, I am watching carefully for what cues and accommodations help them get their work done. What trips them up? What triggers them? How do you help them get unstuck? 

Always we answer the main question that brought this parent here, “How do we help him?” Or “What does she need?” To me, that is the psychologist’s main duty. We must walk away knowing how to help this child.

Why Thin Evaluations Cost You

This is the part I wish more families understood before they book. It really does matter that we get this right the first time. Here’s why it is important to choose your evaluator wisely.

Schools act on specifics. A report naming a diagnosis without documenting functional impact and required supports is not very helpful to the school. Vagueness costs you services. The other problem with poor school recommendations is that schools only can do so much. If a clinician recommends everything but the kitchen sink, the school is going to screen this report out as noise. Schools already have a problem and they need genuine advice within the context of that building and that set of resources. A really good clinician can not only make school recommendations but can point directly to the services and accommodations that are realistically available in your child’s unique school context.

The wrong diagnosis or symptom profile wastes years. If a social skills problem is driving the behavior and the plan treats sensory issues, you can spend two years in the wrong intervention while the real problem grows. I’ve met these families. The grief is real, and it was preventable. Usually, the big ‘miss’ here is that the profile is a bit more complex than the clinician realizes.

The diagnosis may be right but the context is unclear.

Sometimes a kid does have autism and the clinician has correctly diagnosed that. However, the report does not explain the evolution of this child’s mental health profile and clarify basically ‘what came from what.’

• Is it trauma or autism or both?
• Is ADHD part of the picture?
• Are there layers of mental health issues now on top of the rest?
• Where did these challenges come from and how has this picture evolved over time?

This is a really important distinction. You want your evaluator to not only make a diagnosis but really understand how your child’s unique profile evolved and what to do to chart a path toward a hopeful future.

Re-evaluation is expensive. Paying twice is a common outcome of a cheap evaluation. Although you may or may not need to go get your child evaluated again, I have seen many families in this situation. They come to my practice so frustrated because they keep getting really confusing, conflicting, or vague answers. They know the results do not really represent their child’s profile but now they spent the money and feel stuck with the results. In many cases, I have been able to clean this up for families. Suffice to say though that you are better off paying more in the beginning than having to start over later.

A Final Word On Evaluations

You know your child better than anyone. You noticed something. That instinct brought you here, and it deserves to be met with real rigor rather than a checklist and a wait-and-see.

A good evaluation should leave you with some real help you can use now. You should understand why the hard things are hard, what strengths are genuinely there, and what to do on Monday. Relief is a normal reaction. So is grief. Confusion is not; that means the job wasn’t finished.

If you’re wondering whether it’s time, it’s usually time.

Ready to talk it through? Schedule a consultation by clicking Book Now on this page, to discuss whether an evaluation is the right next step for your family.

Who Is Dr. Marcy Willard?

Marcy Willard, Ph.D. is a child psychologist who has spent her career working with children whose profiles don’t fit neatly into a single diagnosis, and families who have been told to wait and see one time too many. She specializes in comprehensive psychological assessment for autism, ADHD, giftedness, learning disabilities, and depression, with particular expertise in complex differential diagnosis, including distinguishing developmental differences from the effects of trauma. She is the co-author of specialized textbooks on the assessment of autism spectrum disorder and trains practicing psychologists in how to evaluate autism accurately. Alongside her assessment practice, Dr. Willard provides therapy and parent coaching for neurodivergent children, serves as an expert witness in child psychology cases, and offers transformational life coaching for adults. She was the former co-founder of a company that reached one million families through educational videos, courses, and articles. She now hosts the podcast Juju’s Treasures – a name supplied by her beloved nieces and nephews, who know her for her hugs, laughs, and ‘Juju snacks.’