A 10-year-old boy was referred for a neuropsychological evaluation due to concerns about inattention and disruptive behavior both at home and school. He struggled with maintaining focus, organizing tasks, and managing his emotions, often acting impulsively. These behaviors  impacted his academic performance, ability to maintain friendships, and his self-esteem. IMPACT's therapeutic approach to assessment emphasizes helping children formulate their own questions about themselves. The child identified wanting to know “Why I am bored in school but also not doing well” and “How I can make and keep friends better.” Previously diagnosed with ADHD, testing revealed that this child had very high intellectual abilities (95th percentile) and  demonstrated strengths in verbal comprehension and working memory. The assessment also revealed a wide range of sensory sensitivities that had not been identified before and were surely impacting his academic and social world. A child with this combination of high IQ, ADHD and sensory challenges is often described as “twice exceptional” or “2e”. Twice-exceptional children have unique strengths and challenges. In contrast to children with average intelligence, they require more intense intellectual stimulation. However, they also have the additional challenge of learning or developmental differences, making individualized academic and social support essential... Recommendations included school accommodations, individual therapy, a social skills group, and consultation with a child psychiatrist for further support. Feedback with the parents alleviated some of the strain they were feeling and helped them make sense of what their child was experiencing. A developmentally appropriate feedback with the child allowed him to better understand why he was struggling in school and with his peers. We identified concrete steps he could take to grow in these areas including the upcoming IEP meeting with the school and participation in a social skills group.

A 35-year-old nursing student sought an evaluation due to persistent distractibility and difficulty completing timed assessments, impacting his ability to pass his licensing exam. Despite utilizing extensive coping strategies throughout his education and career, these symptoms have consistently hindered his performance under timed conditions. Over two sessions, behavioral observations and neuropsychological assessments indicated significant challenges with executive functioning, particularly in areas requiring sustained attention, impulse control, and flexible thinking. Diagnostic interviews and collateral information from his father confirmed these difficulties had been present since childhood. Given his symptoms, accommodations such as extended testing time, breaks, and a private testing environment were recommended to support his efforts in passing the licensing exam. Additionally, the collaborative case conceptualization used in the IMPACT’s Therapeutic Assessment model, highlighted the client’s desire to communicate the nature of his difficulties to his wife and children. The clinician and client worked together to create a clear narrative about the ways in which ADHD impacted him, highlighting positive aspects of this form of neurodiversity as well. The psychologist then facilitated a conversation between the client and his family that was very healing for all involved.

A 10-year-old girl was referred for evaluation by her parents and school psychologist due to concerns about her social difficulties and potential twice exceptionality (2e). While she excelled in math and science, she struggled with social interactions, often making comments that were inappropriate or confusing to her peers.This had impacted her self-esteem and led to conflicts at school. The collaborative consultation identified the client’s goal of understanding “Why no one laughs at my jokes and I don’t have anyone to sit with at lunch.” The parents’ wondered if their child had autism and asked, “How can our daughter be simultaneously so bright and also so thrown off course by simple social interactions?”  Cognitive and achievement testing indicated that the client had advanced intellectual abilities with notable strengths in working memory, processing speed and mathematics. The client also exhibited traits consistent with autism spectrum disorder (ASD) including difficulties in reciprocal social interactions. Additionally, she was experiencing a high level of anxiety. The evaluation provided recommendations for individualized support at school and at home to help her develop stronger social skills and better manage her anxiety. The family was provided with extensive resources to learn about neurodiversity and supporting the needs of a child with ASD, including a neurodiversity group for parents at IMPACT. Feedback with the child focused on celebrating the strengths of her brain and the uniqueness of her perspective on the world. The clinician was able to use concrete examples the client had provided to address her concerns and provide resources to help her feel less alone. Several developmentally appropriate resources were recommended for further reading and the psychologist consulted with the school, attended the client’s IEP meeting and ensured that the family was connected with resources going forward.

A 34-year-old woman, self-referred for a psychological evaluation due to concerns about possible ADHD, citing issues with impulsivity, fluctuating motivation, and difficulties with emotion regulation. Though she had never sought any form of psychological treatment before, she had a long history of informal “diagnosis” by family members, teachers, and employers and named at least five different diagnostic categories that had been attributed to her in the past. Employed as a teacher, she reported difficulties maintaining focus, staying organized, and managing moments of high stress in the classroom and in her personal life. In the collaborative consultation process, the client stated, “My reactions are usually larger than they need to be and I feel like I want to crawl out of my skin a lot of the time.”  She reported a history of bulimia, non-suicidal self-injury, and intense romantic relationships that ended “in a blaze of glory usually.” She reported a long history of emotional and environmental instability during childhood. Cognitive testing revealed superior verbal reasoning and working memory, but average nonverbal reasoning abilities. Although she wondered if she had ADHD, her symptoms fell below the clinical threshold and were more consistent with a history of unresolved, relational trauma. The evaluation highlighted the client’s resilience and determination and the collaborative case conceptualization emphasized her many strengths. The evaluation helped identify the presence of complex post-traumatic disorder which helped explain her long history of emotion dysregulation, negative beliefs about herself and interpersonal difficulties. The client was relieved to have a clear answer to what she had struggled with for so long and felt “seen and understood” as her long history of trauma was acknowledged. A detailed intervention plan was developed in consultation with the client and she pursued both individual and group therapy, began a low dose of an antidepressant (SSRI), read several books recommended by the psychologist who did the assessment. She wrote a letter one year later to update the clinician and to express her gratitude - she was now excelling at work, had done very hard work in therapy to heal trauma wounds, no longer “flew off the handle”, and was in a stable and healthy romantic relationship.