“How our Kids Learn, Part B: Learning disabilities and extended time” – with Dr. Marla Baum PsyD

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics on women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Dr. Marla Baum, Psy.D., child neuropsychologist, friend, awesome human. How are you doing, Marla? Welcome to “Healthful Woman.” 

 

Dr. Baum: Thank you for having me, Natey, or should I say Dr. Fox? 

 

Dr. Fox: You should say Dr. Fox. No, you can call me Natey, but hopefully in social situations, you can refer to me as Dr. Fox. That’d pretty creepy. 

 

Dr. Baum: No problem. 

 

Dr. Fox: Yeah. So for those listening, Marla and I, we grow up together. We’ve known each other since we were little kids. You’re AKA Marla Verson [SP] but now you’re Baum. So we go way back, Ida Crown [SP], Hillel Torah, the whole thing. Yeah, then Marla reappeared in my life when my wife, Mikhail [SP], came home and said, “You know Marla?” I was like, “Yeah, I know Marla.” She is like, “Yeah, we’re in school together at [inaudible [00:01:05] for Psy.D.” And then since then, you know, we live near each other, we’re friends, we hang out. 

 

Dr. Baum: Yeah. 

 

Dr. Fox: Yeah. And you and my wife are colleagues, professional colleagues, which is cool. 

 

Dr. Baum: It’s awesome. I love having you guys in my life, absolutely. 

 

Dr. Fox: Marla was one of the few people who was of right mind and knew to come over to the Fox house when the Cubs were winning the World Series so we could celebrate that together. It was an amazing event. 

 

Dr. Baum: And prevent [inaudible 00:01:33] having a heart attack also, you know, in those last couple of pitches. 

 

Dr. Fox: It did get ugly, but yeah. 

 

Dr. Baum: It’s not a little ugly. I was happy we were together to lean on each other. 

 

Dr. Fox: It’s a beautiful thing. But, yeah, listen I’m really glad that you agreed to come on to take time out of your busy schedule helping children of the world and to talk to our listeners about what you do. And just so they can understand, I mean, there’s so much going on in your field and parents have so many questions. And I think it’s gonna be really helpful for them. And I, obviously, have a preview because I already know that you’re awesome, but now all our listeners will find out as well. 

 

Dr. Baum: Wow. Okay. 

 

Dr. Fox: How have you been during the whole pandemic? What’s going on with kids, with COVID, with you? What’s the mood out there? 

 

Dr. Baum: There is a lot of different levels to what’s going on during COVID. In terms of work, you know, psychologists, in general, have been doing much more of their work remotely on Zoom or Facetime, which in some ways have had some good, you know, positive outcomes from that in terms of flexibility of scheduling and, you know, some people are just a little more comfortable talking over the phone than they might be coming in and talking face to face. So that’s been interesting. 

 

But, you know, mostly, you know, our kids are suffering. If they’re little kids, they’re feeling more fear and anxiety, and I’m seeing a lot more, you know, emotional regulation issues and things like that. Doing a lot of consulting with my psychiatrist colleagues over, you know, whether to medicate, what’s going on, you know, it’s very situational because of COVID. Or do we need to, you know, handle this medically so that the child is not in such distress, seeing a lot of that. 

 

And personally, I find that being home more has just made it easier to have, like, a work…a better, healthier work-family balance. I’m not spending so much time in the car commuting. And I’m more up to date than I’ve ever been in terms of my reports for evaluations that I do. So there have been some positives also. 

 

Dr. Fox: Are your boys happy with this or they want you out of the house? 

 

Dr. Baum: No, they’re fine with it as long as…you know, just so everyone knows, I have two teenaged boys and they’re quite the teenager. So, you know, they don’t mind, they like having me around to make them lunch if they’re home. 

 

Dr. Fox: If you just left the food on the floor somewhere, I think they’d be fine also. 

 

Dr. Baum: Yes, that’s very true. I could bring it to them and they would welcome it with open arms. You know, there are some positives and there are negatives. I think probably the main thing that I’ve added into the therapeutic work that I do with the kids is that I do, you know, this, sort of, three-minute exercise where we go over what we’re grateful for and what our coping mechanisms are. And, you know, I do that in a more structured way at some point during my therapy sessions with my patients. I don’t know if I ever did that in such a structured way before. But I think during COVID, it was important to check in with the kids about it even if it’s not what they were necessarily gonna talk about at the session on a given day. 

 

Dr. Fox: Yeah, that’s cool. I appreciate that. I think that’s a great idea. Now, Marla, in your practice, there’s several things that you do. I know you do neuropsychological testing, and we’ll get into that, what that means. And you do therapy, and you do what you refer to at least on your website is executive function/organizational coaching, which is a mouthful for kids, but we’re gonna get into that also, obviously. But before we jump into, you know, get knee-deep in what you do every day, tell us a little bit, how did you get to where you are? You know, from here you are, you’re in high school, and you’re playing basketball, and you’re playing softball and, you know, you’re in Chicago, in Skokie, and now you’re a big, fancy child psychologist. How did you get from point A to point B? 

 

Dr. Baum: Right. Well, I went to Wisconsin. It’s a very interesting story. I love my stories. I went to University of Wisconsin, Madison. And while I was there, I solidified the idea that I wanted to go into psychology. So as you said, Natey, you know, I’m from Chicago. I had met my significant other, now-husband, while we were at Wisconsin. And he was from New Jersey so I knew that I was going to end up moving to the East Coast. 

 

During my senior year at Wisconsin, there was this huge initiative through the National Institute of Mental Health, MIH, to do a nationwide study of the best treatment modality for ADHD, attentional issues. And two of the six sites across the country were in New York with some of the top psychiatrists and psychologists at LIJ and Columbia Presbyterian, New York Psychiatric Institute. So I thought that would be a really nice bridge for me to, you know, make sure that I got enough work experience to make sure that I wanted to do this for a living, as well as make my way to the East Coast to be with my now-husband. 

 

So I applied and I got that job, and it was really one of the most fascinating jobs I’ve ever had. We ran a camp for kids at one of the private schools in Riverdale in the Bronx. And then we all went into the kids’ classrooms in the fall semester and we basically administered a full-day behavioral protocol in the context of the camp day and then the school day. And the kids themselves were randomized into different groups because this was a clinical research study. So some kids got medication, some kids only got the behavioral, you know, camp experience and the school experience. Some kids got both, and some kids got neither. 

 

And what we would do is we would run the camp all day and then we would crunch the data at night, you know, as we weren’t your regular type of camp counselors. We, obviously, ran a nice camp during the day, but while some of us were running the activities, others of us were taking data on how the kids were doing. And so it was a really nice balance for me to see the application of research into day-to-day clinical practice. So that experience really sealed the deal for me in terms of wanting to do this for a living. 

 

And so then I applied to grad school and I went to Yeshiva University, their graduate school for psychology, it’s called Ferkauf, and it’s on the Einstein campus in the Bronx. And I had an amazing experience while I was there. My motto was it’s a lot of work but if you wanna do this, it worth every penny, and it really was. And it was worth the blood, sweat, and tears, so to speak. 

 

Dr. Fox: Was there a lot of bleeding that went on during your psychology training? 

 

Dr. Baum: No. Only when I had to cover the psychiatric ER at Kings County Hospital on internship. That was the only [inaudible 00:08:54]. Otherwise, it’s just a Band-Aid here and there if they trip coming into my office. So what happened is I did my internship at Kings County Hospital in Brooklyn. I worked in their Developmental Evaluation Clinic. So I did neuropsych evaluations during the day, and also early intervention evaluations, and then I did a lot of therapy after school hours. 

 

And what happened is I wanted to start a family, and so I found my senior colleague, Antoinette Lind [SP], who has been doing this a very long time, I found her through a classmate who did their internship with her. And I started doing more testing. And I really found the process nearly fascinating. I liked when I did a lot of it on internship. I got very interested in it actually during graduate school. And I, sort of, carried it forth so I was constantly being trained on testing and doing therapy. 

 

So what happened is that when my kids were younger, I didn’t feel that I have the head space to do therapy, you know, because you’re very tired when you have little kids at home. So I did mostly neuropsych testing and I also got trained on some remediation techniques for executive function issues. So I did those and then as my kids have gotten older, I built the therapy component of practice back up. 

 

Dr. Fox: Fascinating. 

 

Dr. Baum: So now I do all three. Yeah. 

 

Dr. Fox: That’s a really interesting story, and there’s really only one aspect that I want to probe a little bit further into. And that is, why is it that your assumption was you would have to move to New Jersey for John instead of him moving to Chicago? What the hell is that about? I mean, what was this, like, the ’50s? I mean, come on. 

 

Dr. Baum: Well, maybe we should tell our listeners that, you know, most Chicago people go back home. It is very rare. Natey and I are two of the few and proud that did not go home. And also, my husband’s business is in New Jersey so he couldn’t up and move the whole business as much as my mother tried to get him to. 

 

Dr. Fox: All right. Well, you’re a saint to the human, Marla, for coming out East for John. I mean, he’s a good guy, I guess he’s worth it. He’s a good dude. 

 

Dr. Baum: It’s not so bad living in New York and New Jersey, not so bad. 

 

Dr. Fox: So I wanted to start with what you’re referring to that you started your career with, which is testing or neuropsychological testing. How would you explain, what is that? Like, that’s a lot, neuropsychological testing, what does that mean? 

 

Dr. Baum: It means that you look at every aspect of how the brain can support a child’s ability to learn in order to figure out what’s going on for a child that they’re having trouble learning. So a traditional evaluation will give you the cognitive piece, which is an IQ part, which shows how you process verbal information, visual-perceptual, and visual-spatial information, and also some affects of working memory and processing speed. And so that’s, sort of, a baseline of what the child’s cognitive profile is. 

 

Now, I don’t ever think of a child completely in terms of their performance on an IQ test, kids are much more than how they perform on these types of measures. But it gives you a good baseline in order to start thinking about what kind of learner or what kind of processor the child is. And so what happens next is the idea is that you’re supposed to achieve in school up to the level that’s shown by your IQ, meaning if you have average cognitive abilities, you should be performing at the average level academically. 

 

So a lot of times, parents will go to the board of education because their child’s having some sort of discrepancy or delay in their learning, and they will show…they’ll do the ISA cognitive and academic part and they’ll say, “Yes, there is a discrepancy, we will give your child services.” I was never satisfied with that because I always wanted to know why. I wanted to know why the discrepancy with there. And I found that if you could figure out why the discrepancy is there, you can save a lot of time and resources by being much more targeted in how you handle the discrepancy itself. 

 

So, for example, if the child comes in with a possible case of dyslexia or reading disability, the general type of testing that you’re always trained on in graduate school [inaudible 00:13:37] will say, “Yes, you have it,” or, “No, you don’t.” But they don’t tell you why you have it if you have it. They don’t say, “Well, it could be the perceptual part of reading that’s getting in your way. It could be the sequencing part of reading that’s getting in your way.” And if you do the neuropsychological portion of these types of evaluations, you basically look at every lobe of the brain in terms of how they contribute to a kid’s learning. And that information will tell you why a discrepancy exists between your child’s intellectual potential and their learning. 

 

So what are those neuropsychological functions so to speak? That is your language processing skills, receptive language, expressive language, pragmatic, or something called social language. It’s your visual-spatial processing. It’s your attention and executive function. It is your ability to learn and remember information, and it’s also your [inaudible 00:14:41] motor skills in terms of how you hold a pencil and how you control a pencil. So you hear a lot of terms in the field, psychological testing, psychoeducational testing, and then what I do, which is neuropsychological testing. 

 

So psychological testing by definition is the cognitive and also some emotional assessments. And psychoeducational evaluation is the cognitive and the academic. But again, based on what I said before, I was never fully satisfied with that much information. I wanted more, and that’s where I find that the neuropsychological testing is really important because it tells you why a discrepancy exists. 

 

Dr. Fox: So to understand, just so I can clarify this, so pretty much all kids get some form of an IQ test, right, in school that measures what they’re…and not everyone knows the number and this we know, we try to avoid giving people numbers. But they get some sort of assessment of their cognitive abilities. And you’re saying that if…let’s say, a student’s performance is not matching his or her, you know, cognitive abilities as defined is this test, that might be a reason to do neuropsychological testing. 

 

Is there ever an indication to do neuropsychological testing if maybe it’s the opposite where the IQ results come back, let’s say, lower than the parents or the school would have expected, saying, “This doesn’t seem right, maybe there’s something causing that on the testing,” or is it only if you’re underperforming as compared to your IQ? 

 

Dr. Baum: Okay, so that’s interesting. So it’s a very interesting question. 

 

Dr. Fox: Thank you. 

 

Dr. Baum: So let me break that down. 

 

Dr. Fox: That’s why I have a podcast, man. This is why. I’m getting in there, we’re probing. 

 

Dr. Baum: Yeah, it’s an interesting question. So, you know, 9 times out of 10, the kids are coming in because they’re either not “grafting” the information being taught in school or they can’t think abstractly, for example. And so, sometimes if a child’s cognitive capacities are lower than how they’re doing in school, first of all, you have to look at the whole child. Because, as I said before, I don’t think it’s appropriate to judge a whole of the child’s ability than their IQ. You know, if the child, let’s say, is a more concrete thinker, in general, they’re not the most abstract in terms of like their concept formation skills, then that would also be important for teachers to know because they might need to, you know, really break things down or, you know, make things a little more concrete and less abstract for that child to understand what you’re trying to teach them. 

 

So, you know, the other thing to look at is the IQ itself is an average of five different domains of functioning. And as anyone with a background in statistics knows, an average is only a meaningful number if there isn’t too much variability between all the numbers going in. If a child has, let’s say, a 100 IQ, an IQ of 100, that’s 50th percentile, completely average. So if their functioning across the five domains are also average, then you can say with confidence, this kid is an age-appropriately developing child in terms of their cognitive abilities. But most of the time what I see in my practice is the kids have these big slips between really, really strong language skills, really weak visual-spatial skills. And that can lead to a whole host of issues in terms of their ability to learn across domains. 

 

So that’s why I kind of think it’s important to do all of these pieces together. I never feel satisfied that I have all the information about a child just based on how they do on the IQ. And I always want to see the five actual numbers that go into the IQ because if you’re completely average, then the IQ number itself is an appropriate measure. If there’s too much variability, the IQ means nothing. 

 

Dr. Fox: Right, like if a kid gets, you know, like a 130 on 4 sections and an 80 on the 5th, you’re like, something is either off, like maybe they fell asleep at that point of the test, or maybe they have a specific concern. 

 

Dr. Baum: Right, exactly, exactly. 

 

Dr. Fox: Yeah. I have some inside information on this because in addition to being a friend and a colleague, Marla is also in charge of all of the neuropsychological assessments and treatment of my four children. So I’m also a member. 

 

Dr. Baum: That’s right, that’s right. 

 

Dr. Fox: So we’ve seen it all just in our family. And so when you’re doing this, how do kids or families or parents get to you? Is it that the teacher, sort of, looks at this and recommends it? Is it someone in the school like at an administrative level, like a school psychologist or a principal or, you know, head of a department, sort of, says this? Or do the parents just find you on their own and say, “Hey, you know, my daughter is not doing well in math, what can you do?” I mean, how does it work? 

 

Dr. Baum: It could really work in a number of ways. The main way that it happens…Schools vary in terms of their ability to identify these issues and refer the parents. The schools that do this best are the ones that have a school psychologist on staff whose job it is to meet with the teachers, talk about whichever kids the teachers are concerned about, the school psychologist then monitors the situation and makes the determination if a full evaluation is necessary. That’s the more traditional way. 

 

You know, I’ve got cases on my roster where a child is diagnosed with attentional issues by a psychiatrist, and that’s fine because maybe they could use some medication to help with their level of attention, but there’s all these other learning issues that go along with it potentially. And a lot of the psychiatrists I worked with will also refer. Sometime pediatricians are the gatekeepers because they ask questions at those yearly checkups about how the child is doing developmentally, and academically, and emotionally. 

 

Nine times out of 10, it comes from the school or the treating psychiatrist. But I also have colleagues that do only therapy and the parents come in and say something that it makes something that maybe they need to be tested. And they then collaborate with the school and determine if this is an appropriate way to go. Because it is very time-consuming and it’s costly, and insurance coverage is quite variable for it. So, you know, it’s usually a pretty well thought out process by whoever’s involved. 

 

Dr. Fox: Yeah. I was gonna follow up asking you, you know, when people are referred to you, you know, how often is it very…they’re referred to you for testing, they walk in, and they get tested. I mean, that’s what’s gonna happen verses they get referred to you, you meet with them, you talk to them, and then you help decide, do they need testing or not? Because I imagined it can go both of those directions. 

 

Dr. Baum: Yeah. Yes, I’ve had multiple situations. Actually, I have an almost 5-year-old on my roster now that the parents approach me when he was 4, and I thought it was too early to test. You know, this child, in particular, had a host of developmental delays and, you know, is dealing with a lot. So I made the determination that there really is no reason to test him, you know, until he is closer to kindergarten, and so we could wait on that. 

 

So there are certainly times where I think it might not be a great idea to do testing and we might pivot and maybe do some parenting work or, you know, some consultation with teachers. You know, it can certainly go a number of different ways that, you know, the kids could be coming in for an attentional issue but really it’s an anxiety disorder. You know, after talking with the parents a lot, it becomes very clear it’s not really an attentional issue. It’s more anxiety based on what they’re reporting. And then also, you know, it doesn’t sound like testing is what we need, it sounds like we need to go the therapy route and give your child the skills to help cope, as an example. 

 

Dr. Fox: And you said it was, you know, long and this, so just explain, what exactly when you do the testing, sort of logistically, like, what happens? How long is it? What kind of tests are you doing? You know, how do the kids respond to this? Obviously, it’s gonna depend on their age, but just walk us through what that would look like. Because I think most parents don’t even know what it entails. 

 

Dr. Baum: Well, it usually starts with a quick phone call with me just to determine that we should go ahead and do an intake. Usually, it’s to cover the financial aspect of it, which, of course, I understand. And then we schedule an intake where I get a detailed history of, you know, the child’s development and the history of the presenting problem. And then for elementary school and younger, I usually go to the school. I like to observe the child. I like to do that before I start any testing sessions because the child doesn’t know me and will just be himself in the room, whereas if I meet him and then I go observe, he’ll feel self-conscience, which, of course, I don’t want the child to feel that way. But also, they might mask whatever they’re dealing with because they know I’m in the room. 

 

So I usually like to go observe before the testing. Then the testing is…usually, it’s once a week. For elementary school and older, it’s about seven to eight hours of testing that’s usually broken up into four sessions of two hours each. For preschoolers and pre-K, and kindergarten, it’s usually about five hours of testing also broken up into three or four sessions, usually depending on the child’s attention span and, you know, how long they can do things. Are they okay to work for longer if they just take a break? 

 

So, you know, I take all those factors into account because I want the child to feel comfortable. You know, and I’m a big believer in spreading these sessions out over time. I know some colleagues and services in the city like the promote themselves as being able to get it all done in a day. But I firmly believe that that does nothing except to make the child really tired, and I think bored, and maybe a little stressed out also. It’s a lot. 

 

Dr. Fox: It’s pretty gruesome. I mean, five hours, that’s like making a 6-year-old take an SAT. 

 

Dr. Baum: It’s a lot to do in a day. And some people really pride themselves on being able to do that and I just don’t see the point. I want it to be a very relaxed, positive experience for the kids. I pride myself on giving that experience so I want to do it in the least stressful way possible. Now, of course, there are some situations that are more emergent for different reasons that maybe I would schedule two or three sessions in one week just to get things done faster, but that, of course, is on a case-by-case basis depending. And sometimes the high schoolers, because they can work all day and then usually have homework, sometimes for them I’ll do two sessions in a day with a lunch break in between or something. 

 

So once you’re done with the testing, then I spend a week or two going through the results, going through the history, analyzing how the child did on all the tests. And then I come back with the parents. I meet with the parents alone to go over the results and the recommendations, which could lead from anything from, you know, is your child in the right school given the issues that we’re having? What remediation the child will need. What other services the child might need. And I work with all the service providers that are involved to make sure the recommendations are put in place. 

 

So, for example, if I’m recommending reading remediation for dyslexia, I work with the parents and make sure that they find the right tutor for their child. I often talk to the tutors to make sure that they can address what comes up in the evaluation, and I make sure all the recommendations are put in place. And then there’s a full report, a very long, long report. Many of us in the field joke about, you know, we should all start to just write five-page reports and then we’ll all do it, and then it will be okay. But no one wants to pull that trigger so we still write these 20-page reports. But it really ends up being…all joking aside, it ends up being very helpful for the schools and the service providers that come into play after the evaluation because they really get a very detailed breakdown of how the child did on all the different tests across the different domains. 

 

Dr. Fox: Right. And you must be called in to work with the schools and the teachers as well. 

 

Dr. Baum: Constantly. Nine times out of 10, there is meeting at school at the end where we go where I present the results and recommendations, and we work together to figure out what can the child get in school, what might the parents have to supplement with after school. And them, you know, we make a general plan that everyone’s on board with so everyone knows what their marching orders are in terms of helping the child in whatever way that they need help. 

 

Dr. Fox: Right. And then when you’re doing the testing, a lot of parents get a little anxious about their kids being “tested.” What are you actually doing with the child during this five hours, seven hours of testing? What happens? 

 

Dr. Baum: So, you know it’s a lot of questions back and forth. You know, I ask some questions about…you know, like, I ask them to define words. You know, we build with blocks. We do a lot of different types of, you know, structured tasks like what they would see in school. The academic work is very much like what they do in school. And in terms of the neuropsychological measures, you know, it’s how well they take in language, how well they can express themselves in language. I particularly enjoy the executive functioning battery because that’s a lot of like problem-solving games and things like that. 

 

So it’s a very interactive process. I purposely only leave the child alone to do a specific attention measure because I want to see if they can shore up their attention on their own. But, you know, I’m in the room with the child and, you know, we are working together. It’s very interactive. The kids usually find most of this to be really fun because they get to show a lot of what they know. The sub-tests are all designed to give the child a sense of mastery before it gets more challenging. So the kids usually feel really nicely reinforced by that. 

 

But I always tell the parents, you know, if the child expresses some, you know, stress or something following the testing session, I want to know about that so that I can, you know, try to make it more comfortable for them in the latter session. You know, part and parcel of the work, some of the tasks are gonna end up being quite challenging because of the reason why they’re there. 

 

Dr. Fox: Right. And is this kind of testing the type of testing where the findings that you receive, they’re always there? Meaning, if you retested someone three or four years later, you would see the same things but, you know, they’ve been educated in a way that, you know, can sort of work around it. Or if you tested someone three or four years after the changes, would they somehow like get a different score, like, do better? Do you know what I’m asking? 

 

Dr. Baum: That’s an interesting question. So back in graduate school, we were taught that most of these things are fixed. So it’s developmental and once they reach their peak in their development and they solidify at that level, 9 times out of 10, we were taught that that is where the child is at. So, for example, the IQ score is supposed to be relatively stagnant, that’s not supposed to fluctuate over time. But I think what we’ve learned in the process of having early intervention and also just intensive intervention when kids are younger, then a lot of times you can see real fluctuations and changes for the better in the IQ. 

 

Usually what happens is the IQ thing is relatively the same, but where you will want to see changes is in the child’s academic achievements. So usually you wanna see that things get stronger there. If a child has a language processing disorder and I recommend speech-language therapy for that child, and they come back in a couple of years, I wanna see strengthening on the language processing measures. And the same thing if there is an attention or an organizational issue, if we intervene in the various ways that you can intervene with that, I would like to see a strengthening in the kid’s performance on those particular measures. A lot of the neuropsychological and academic tests, you can see real changes in their functioning. 

 

So the point where if there isn’t enough of an improvement, that gives me significant information about what still has to be addressed in school. And sometimes through the remediation, they learn how to be more active in their learning and their processing, which can then strengthen their cognitive functioning to a degree. 

 

Dr. Fox: It’s really interesting because I think that there’s two things at play here. I think one of it is just, in general, the limitations of testing, right? Testing, it’s one thing we have. You know, so an IQ test, for example, you’re not gonna come up with a test that’s perfect. It just doesn’t work like that. There’s always gonna be some reason why a child could do better or worse that’s not related to their, you know, intellectual abilities. Whether it’s, you know, language or, sort of, you know, social upbringing, whatever it is, or just how they perform that day. So that’s one issue. 

 

And people, you know, take…sometimes people get very upset about the idea of an IQ test because they say you can’t really test it. Okay, there’s definitely a component to that, but the other part is that, like you said, it’s not like we are fixed at birth, right? Some parts of us are, there is that genetic component, but a lot of who we are in terms of personality, in terms of, you know, our intellect, in terms of our behaviors, in terms of how we think can be changed because the brain is developing for the first 24 years of our life or whatever it is, I mean, there’s a lot of things that actually change. So it’s, sort of, recognizing that, like most things, it’s in the middle. Like, on the one hand, you know, there are things about us that are sort of true when we’re born, but on the other hand, there’s a lot of things about us that are quite malleable, and balancing those two and not forgetting either part of those. 

 

Dr. Fox: Yes, yes, exactly. To the point where there is so much research out there that shows that the earlier you intervene, the maximum the chances of your child being able to develop in a more healthy, age-appropriate way in whatever the area of concern is. For example, I’ve had multiple kids in my practice who at age 3 are diagnosed with autism, but after three or four years of significant intervention and placement in the right school, they no longer meet the criteria for autism because they received intensive remediation and they developed. The remediation literally helped to develop and make the neurological connections that because of the autism it wasn’t able to do on its own. 

 

So I think that there’s a lot of room for growth. That’s why I’m in this business, I want to see kids reach their potential. And the longer I’m in this business and the more and more that my kids are coming back to me for their reevaluations later on, I see how fantastic they’re doing when they’re given the right intervention, when they’re placed in the right type of school, when they’re given the right kind of support in that school. 

 

And just to speak to your other point about the nervousness about, you know, can the IQ really capture the whole of my child? It definitely cannot. I pride myself on telling the parents that they know the child longitudinally and I’m coming in at a cross-section. And my job is to take everything that they’re telling me longitudinally and integrating it with what I’m seeing in the moment, and in this moment and time, and what the teachers are seeing. 

 

You know, parents are always skittish about their child being tested per see. You know, I am in this business and I do it every day so I know how positive it is. But I guess I would want to impart to the listeners that they should, you know, do their best not to be nervous about the process. It is, 9 times out of 10…that’s my favorite phrase. Nine times out of 10, it is incredibly helpful and it gives a really solid roadmap for all the people involved in the child’s life to help them reach their potential. 

 

So a lot of parents come in very skittish, you know, they might be worried that their kid is gonna get kicked out of the school that they’re in if the results don’t come back the right way in terms of what the school would expect their students would look like. You know, I work with the parents to work through all of that. Because, you know, parents are also bringing their own feelings to the table and, you know, they might be scared about the process for other reasons than, you know, what’s actually going on with their child. Which, of course, you know, I understand and I help them through it. 

 

Dr. Fox: Yeah. And also, I imagine that all of this really only works best when it’s a team approach, meaning it’s not just you and the child, or it’s not just you and the parents. And like you said before, it has to involve the school, obviously. And if the child is getting services or tutoring, it has to involve those people as well. If the child is getting evaluated by a psychiatrist, certainly the child’s pediatrician. I mean, all these people have to be involved because there’s a lot of areas where the child needs to be helped, and also what you’re recommending, sort of, you know, blends into everything the child does. 

 

Dr. Baum: Exactly, exactly. The child does not live in a vacuum. You know, a child is the product of what all the people in their lives are teaching them and giving them. So it’s always a team approach when you’re working with a child. To the point where I have some colleagues that do not like working with children because you have to…there’s so much more case management, so to speak, involved and having to talk to all the related professionals, and the school, and the parents. And you have the sessions with the child that can be a lot of work, but it’s really important to be very comprehensive when you’re working with children in that way. They don’t live in a bubble. 

 

Dr. Fox: Fantastic. I think that’s such a great message in what you said that, you know, parents are gonna be apprehensive but this is something that’s overall gonna be helpful to their child and, you know, his or her development, and education, and overall growth and development. And I think it’s amazing. And there’s so much more I wanna talk to you about. And so what I think we’re gonna do is we’re actually gonna do a second podcast with you to talk about all the other questions I have. I’m gonna have you on to talk about this again. But Marla, thank you so much for coming on. Thank you so much. 

 

Dr. Baum: Oh, my pleasure. My pleasure, Natey, anything for you. 

 

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healtfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topics you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. 

 

The information discussed in “Healthful Woman” is intended for educational uses only, does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.