Expert Answers to Common Parent Questions
Psychology
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A licensed psychologist has completed a doctoral degree in psychology, obtained extensive experience and supervision, passed licensing exams, and has continued to meet all requirements for the professional practice of psychology.
After high school, the psychologist obtained a 4-year undergraduate degree in psychology or related field, and then applied through a competitive process and successfully gained entry into a graduate program in psychology.
After being accepted into a graduate program, at least 5-6 years of graduate training is obtained, including intensive field work, supervised experience, and often research as well. A 1 year internship, and often another 1 - 2 year postdoctoral fellowship is then required before the psychologist can begin practicing independently.
Finally, there are intensive board and state exams that need to be passed with high marks to become a licensed psychologist.
The entire process typically takes at least 10 - 12 years.
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Pediatric clinical psychologists, like Dr. Graber, are licensed psychologists who specialize in the assessment and treatment of mental and behavioral health challenges during childhood, adolescence, and early adulthood.
Because children’s lives are interwoven with those of adults, children’s parents, teachers, and others who surround them are also often the clients of pediatric psychologists.
Although some psychologists may decide to work with children later in their training or career, Dr. Graber has been focused on child and adolescent psychology since before her graduate studies began, for a total of almost two decades working in pediatrics.
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Although anyone with specialized experience and appropriate credentialing in counseling or related therapy may be referred to as a ‘therapist’ or ‘counselor,’ the term most often applies to mental health practitioners with a master’s degree, rather than a doctoral degree, in psychology or related field. A master’s degree is typically a 2 - 3 year program, whereas a doctoral degree is about twice as long with more extensive training and supervised experience and across a wider range of areas.
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Whenever a parent/guardian or child is seeking to better understand the child’s mind and behavior is an appropriate time to reach out to a psychologist. Schools or pediatricians may also initiate the process through a direct referral to the psychologist, or by advising a parent to seek a psychologist on their own.
Although a licensed psychologist’s level of training and expertise may not be required for many behavioral health services and therapies, they are generally the best (or only) qualified professionals to complete psychological testing which can help with determining the best next steps for supporting a child’s emotional and behavioral health needs.
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At Wildflower Pediatric Psychology, the assessment tools we use depend on the questions being asked and the unique child’s areas of strengths and challenges. Common diagnostic evaluation tools used in our practice include:
The Autism Diagnostic Observation Schedule (ADOS-2) is widely considered the ‘gold standard’ observational tool for autism diagnostics. It is semi-structured (so that it feels natural), yet highly standardized (so that it is reliable).
The Autism Diagnostic Interview-Revised (ADI-R) is considered the gold standard interview for autism diagnostics, often administered alongside the ADOS-2.
The Childhood Autism Rating Scale (CARS-2) is a flexible and validated tool used by experts to synthesize information from a variety of sources (e.g., observations, interactions, interviews, and records review/history) to assess likelihood of autism.
The Vineland Adaptive Behavior Scales (Vineland-3) is the leading instrument for supporting the diagnosis of intellectual and developmental disabilities. In addition to answering diagnostic questions, the Vineland-3 provides valuable information for developing educational goals and treatment plans.
The Conners’ and Vanderbilt rating scales are often used for assessing ADHD specific concerns.
The Differential Abilities Scale (DAS-II) is a standardized yet flexible cognitive assessment battery that can be used to measure intellectual functioning for persons across the full range of social and speaking abilities and can be administered to focus on certain types of abilities (e.g., nonverbal reasoning).
The Kaufman Brief Intelligence Test (KBIT-2) is a brief measure of verbal and nonverbal intelligence used with individuals age 4 through adulthood. It can be adapted for individuals who are totally nonspeaking as well as for children with giftedness who may have twice exceptionality (e.g., both giftedness/high intelligence and a disability like ADHD or autism).
Applied Behavior Analysis
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Applied Behavior Analysis (or “ABA”) is the scientific approach to human behavior based on the foundational principles of learning, which are applicable to all people. Board Certified Behavior Analysts (BCBAs) have specialized training in the principles of learning such that learning can be broken down into its component parts and applied to teach a wide array of socially meaningful behaviors to persons with all types of learning abilities and challenges.
Mastery of the foundational principles of learning also gives a special lens for studying and understanding behaviors that have become very ‘costly’ (e.g., dangerous, isolating, disturbing, etc.) and which may appear ‘irrational’ for a person, such as compulsive, aggressive, or self harming behaviors.
Although ABA is most commonly associated with early, intensive behavioral intervention (EIBI), because of the nearly universal mandate for insurances to provide coverage for ABA services for young children with autism, ABA is commonly applied in a much wider variety of settings. These include: dual language learning programs, teaching children to read, giftedness education, smoking cessation, exercise science, physical and speech therapies, providing specialized support to children who are having trouble making/keeping friends, improving college teaching practices, and improving quality of life for older adults.
Because ABA is the application of the foundational principles of learning, ABA underlies many common and evidence based therapies, including Naturalistic Developmental Behavioral Intervention (NDBI), pivotal response teaching (PRT), acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT), to name a few.
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Similar to the question above about therapists/counselors versus psychologists, a BCBA requires a master’s degree in behavior analysis, whereas a BCBA-D requires a doctoral degree. Similar to a doctorate representing the highest level of training in psychology, A BCBA-D represents the highest level of training and expertise in the field of applied behavior analysis.
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A functional behavior assessment, or “FBA” is a process for identifying the function, or the ‘why’ behind any given behavior. When working with individuals clinically, the focus of an FBA is usually on behaviors that are very ‘costly’ for an individual. For example, they may require extensive time, energy, and be emotionally or physically exhausting for a person, such as with compulsive behavior. Behaviors of focus in an FBA may also be those that are dangerous to the person engaging them, and often dangerous to others as well. The FBA applies the foundational principles of learning and a rigorous, comprehensive evaluation process to understand the ‘why’ behind any given behavior and to design a therapy program that meets that person’s needs in a way that will improve quality of life and open up more opportunities for the person in the future.
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At Wildflower Pediatric Psychology, we have expertise in a full range of Functional Behavior Assessment (FBA) methodologies. These include:
Our FBAs involve in-depth reviews of records, including prior therapy, healthcare, and educational records/data when available. We offer expertise in an array of types of data analysis, including with these historical sources of information. We can use this information to help determine the extent to which the current approaches to the behavioral health concern are ‘working,’ or may even be making the problem worse.
Interviews, such as with parents, educators, and others (per guardian request) provide valuable sources of data that help to contextualize the historical records and direct observations that follow. We often use a constructional approach to our interviewing to help understand a child’s behavior over time, including when the problem first started, how things were before the problem, and where the family would like to find themselves after the areas of concern are remedied.
Naturalistic, direct observations, such as unobtrusively observing the child playing and interacting with their world as they typically do, often across contexts. During this stage, we often begin to identify patterns surrounding behaviors of concern as well as adaptive behaviors we want to increase.
Experimental analysis - These are methodologies based on ‘single case design,’ which allow highly experienced BCBAs to make the most scientifically informed determinations about the ‘why’ behind a behavior. There are a vast range of experimental analyses. One type that we often use at Wildflower Pediatric Psychology is called a ‘Concurrent Operants Assessment,’ or choice-based assessments. Even more foundational to our practice are the use of experimentally validated preference assessments, so that we don’t have to guess or assume what another person wants. We almost always measure emotional indices during experimental analyses as well, such as levels of smiling, laughing, or other indicators of joy when a person is engaging in various activities.
Nonlinear contingency analysis - This provides a framework through which we can understand a child’s behavior in the context of not only the variables in the immediate environment (what happens just before and after certain behaviors) but also in context to longer-term and complex, often overlapping layers and systems in a child’s life.
We value making assessment decisions in collaboration with caregivers and the child themselves. Whatever tools we use, the child’s safety, comfort, and dignity are always the top priorities.
Independent/Private Practice
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In a hospital setting, psychologists generally work alongside many other professionals, including those across an array of disciplines. However, services are still usually compartmentalized such that one specialty service is accessed at a time, largely separately from other services. Psychologists working in hospitals or other larger institutional settings tend to have much less control over their schedule and service structure than independently practicing psychologists. There are often complex systems in place to ensure that a wide variety of types of services can be provided through a single center/institution/financial system. Larger systems usually accept more insurances, including some with low levels of reimbursement, as these financial losses can be offset to some degree by other practices in the institutions. Within this complex system, children and families may find long wait times (sometimes more than a year, even for some critical, time-sensitive care needs). They may find their care less personal or direct, as well, as there are more layers separating a clinician from a patient (e.g., administration, support staff, training structures, etc.).
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Many healthcare providers find that it has become increasingly complex and resource intensive to rely on insurance for funding their practice. The more time that is spent requesting and then obtaining reimbursement from insurances, the less time that can be spent directly with patients. Insurances also constrain the number of hours that can be provided per service, which, unfortunately, does not often align with what is best practice. Insurance can also deny or delay reimbursement for a provider for long periods of time, making insurance coverage a less reliable way to fund a practice than private pay, even if hourly rates are about the same.
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Families who have the means usually find little to no wait times and more individualized, flexible care through independent practice providers, compared to larger institutional systems of care. Working with an independent practice can also provide a greater level of data/healthcare privacy in some cases.
Autism Evaluations & Early Signs
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Autism can present differently in each child, but if your child exhibits one or more of the following behaviors, it may be helpful to consult a professional.
6 - 9 Months
More interested in objects than faces.
Content playing alone, with little interest in social interaction.
Does not smile back when smiled at.
Avoids eye contact or looks away from faces.
Does not imitate sounds, such as a parent making “raspberries.”
9 - 12 Months
Makes long or unusual sounds that don’t imitate speech (but may mimic environmental noises, like a fan or motor).
Shows little interest in peek-a-boo or other interactive games.
Does not laugh or smile in response to playful behavior.
Less interested in cruising (early walking attempts) or seeing what others are looking at.
12 - 18 Months
Not yet saying or attempting to say words, and shows little interest in imitating speech.
Limited use of gestures (e.g., rarely pointing to objects to share interest).
Gestures are not well-coordinated with eye contact or sounds (e.g., does not point while vocalizing or checking for your reaction).
Enjoys lining up, sorting, or organizing objects in patterns (e.g., by color or size).
Watches spinning objects or moves items back and forth repeatedly.
Spins in circles while tilting their head or looking out of the corner of their eyes.
Makes self-stimulatory sounds (e.g., high-pitched squeals, motor-like noises) often paired with repetitive movements (e.g., hand flapping, tiptoeing, or muscle tensing).
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By about 3 months of age, most babies are paying close attention to others’ faces and beginning to attempt to imitate some facial expressions.. Some children may begin to show autism-related differences as early as a few months of age.
Other children may be developing very typically, or even precociously, until about 7 - 12 months of age, when their social development seems to plateau and/or begins to regress (e.g., was attempting to/beginning to say words at 9 months, but by 12 months, they are no longer saying/approximating words that have r) For a child who will eventually be diagnosed with autism, there are always autism-related differences by age 3, even if those differences are not obvious to non-experts.
In most cases, a professional who is expert in identifying autism early in life can reliably and validly do so before the child is 24 months of age.
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Lining up objects is a typical play behavior for children ages 2–3. However, it may be worth exploring further if:
Most of your child’s play consists of lining up or sorting objects (e.g., by color or size), especially if this continues for weeks or months.
Your child is under 20 months old and already spends a significant amount of time lining up objects.
If your child engages with you while lining up items—such as showing off their arrangement for praise or using it in pretend play (e.g., saying, “cars driving!” while pointing to their row of cars)—this is not typically associated with autism.
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Tantrums are common in all young children, including those with autism, and often stem from frustration or difficulty communicating. Children with autism may have more frequent tantrums due to language delays.
An autistic meltdown, however, is a prolonged distress response that occurs when a child is overwhelmed—often by sensory overload or an unexpected change in routine. Unlike a tantrum, a meltdown does not stop if the child gets what they originally wanted and may involve intense emotional dysregulation. A child in meltdown may also withdraw or resist comfort.
While meltdowns can happen in any child, they are more common in autism, ADHD, and language delays. If they occur frequently, seeking professional guidance may be helpful.
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Licensed psychologists (PhD or PsyD) and medical doctors (MD) are the only professionals who are able to diagnose autism. Not all licensed psychologists or medical doctors, however, are personally qualified to diagnose autism based on their training and experience. For example, research has shown that most pediatricians do not feel qualified to diagnose autism, as they usually do not receive extensive training and supervised experience in this area.
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Some children are not identified as having autism until they are school-aged, or in adolescence, and some people do not receive their diagnosis until adulthood. As children get older, the social expectations become more complex, and for some children, their autism-related differences are not ‘clinically significant’ by most people’s standards until this later developmental period. It is never too late to seek more understanding and support for your child.
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Children with autism often experience sensory input differently than neurotypical children, sometimes showing heightened sensitivity or an unusual lack of response to certain sensations. While every child’s experience is unique, some common signs include:
A child may be highly sensitive to certain sounds, such as feeling distressed by vacuums or blenders, yet actively seek out and repeatedly listen to loud or high-pitched noises. Others may seem hyperaware of airflow, quickly locating vents or fans, even in new environments. Some children have an exceptional ability to memorize and mimic sounds, recreating them with surprising accuracy.
Pain perception can also differ—some children show a high pain tolerance, barely reacting to injuries like burns or head bumps, while others display strong pain responses to mild sensations, such as a light touch or bright light causing discomfort. Many children with autism are also drawn to visual movement, like watching spinning objects or tracking motion out of the corner of their eyes while spinning or riding in a car.
Because sensory differences vary widely, noticing patterns in what a child seeks out or avoids can help determine whether sensory sensitivities may be affecting daily life.
Evaluation Process & What to Expect
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An autism evaluation should be a comfortable and even enjoyable experience for your child. At Wildflower Pediatric Psychology, assessments are designed to be natural, flexible, and engaging while ensuring accurate, research-based results.
For younger children or those with limited language, evaluations are play-based and may include bubbles, interactive toys, and activities alongside a parent. If a child does not want to engage in a particular activity, the evaluator provides an opportunity without creating distress.
For older children and those with more advanced language, evaluations remain relaxed and child-centered, often including books, conversations, and discussions about social situations at a developmentally appropriate level. While sessions typically last about 45 minutes, more verbal children may have longer interactions if they are especially engaged.
At Wildflower Pediatric Psychology, our top priority is the comfort of both the child and parent. We create a collaborative, individualized process that adapts to each family's unique needs while maintaining the highest standards of clinical rigor.
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An autism evaluation includes record review, caregiver interviews, and direct observations of the child. At Wildflower Pediatric Psychology, we tailor the evaluation structure to fit each family’s needs while maintaining clinical accuracy.
In most cases, the evaluation is completed within:
One extended session (90–150 minutes) or
Two shorter sessions (45–90 minutes each)
The direct observation, where your child is present, typically lasts 45–60 minutes. A separate follow-up appointment is scheduled to review results and discuss next steps.
For more details on the evaluation process, CLICK HERE.
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Your child should show up for their autism testing, whether it is virtual or in-person, just as they are. There should be no pressure for your child to ‘perform.’ The testing is designed to meet children right where they are. If there are concerns that your child is having an ‘off-day’ or otherwise not acting like themselves during testing and you are worried this will affect the accuracy of the evaluation, discuss this with the examiner and they should arrange for other methods of observing the child that will provide a more complete picture of that unique child’s development and behavior (but without putting any extra stress on the child).
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Research has consistently shown high levels of concurrent validity between in-person and virtual methods of testing. This means that, in most cases, these modalities are equally valid. This does, of course, depend on the examiner’s expertise in both autism and telehealth diagnostics.
At Wildflower Pediatric Psychology, we have a high level of expertise (including conducting research and training others) in autism diagnostic evaluations both in-person and via telehealth.
Post-Diagnosis & Next Steps
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Autism evaluation reports usually include some written recommendations on next-steps. All too often, these recommendations are not individualized to fit your unique child’s presentation and family circumstances.
At Wildflower Pediatric Psychology, we always provide a detailed report with recommendations/ considerations and suggestions for next steps. We also make every effort to ensure that each family receives recommendations that are individualized, meaningful, and appropriate for their unique child and family circumstances. Our recommendations are based on both research and well-rounded expertise. We discuss the written recommendations with parents before the report is finalized, and make revisions as needed, so that the recommendations reflect the priorities and preferences of the family.
For younger children or those with limited language, evaluations are play-based and may include bubbles, interactive toys, and activities alongside a parent. If a child does not want to engage in a particular activity, the evaluator provides an opportunity without creating distress.
For older children and those with more advanced language, evaluations remain relaxed and child-centered, often including books, conversations, and discussions about social situations at a developmentally appropriate level. While sessions typically last about 45 minutes, more verbal children may have longer interactions if they are especially engaged.
At Wildflower Pediatric Psychology, our top priority is the comfort of both the child and parent. We create a collaborative, individualized process that adapts to each family's unique needs while maintaining the highest standards of clinical rigor.
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An autism diagnosis does not limit potential—it enhances understanding. The goal of an evaluation is to help parents and children gain deeper insight into their unique strengths and challenges while ensuring access to appropriate education, support, and resources to help them thrive.
Your child’s diagnosis is completely confidential. You decide if, when, and how to share the results. At Wildflower Pediatric Psychology, we guide families through next steps so you feel confident in making informed decisions that best support your child’s growth and future opportunities.
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If your child receives a diagnosis, you may choose to share that with your child’s school, and this can often be helpful in making sure that your child’s school is best prepared to support your them developmentally and behaviorally, in light of the new insight about your child’s unique profile of strengths and weaknesses. This may involve you having discussions with the school team about whether special education supports/services are appropriate (i.e., whether they will be beneficial to your child). The evaluation report, however, should never be shared directly with the school, unless you explicitly, knowingly authorize release of those records to the school.
At Wildflower Pediatric Psychology, we take informed consent and autonomy very seriously. We also understand that the next steps after a diagnosis or just as or more important than the diagnosis itself. Therefore, we offer an array of supports to families navigating next steps following a diagnosis, including what to expect if/when you share the results of the evaluation with your child’s school.
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Receiving a diagnosis is not a mandate to receive intervention services. Some children may qualify for a diagnosis but not need any additional support at this time. Even in these cases, it can still be very helpful to have a diagnostic evaluation in order to gain a more complete picture of your child’s development, strengths and weaknesses. A diagnostic report can also be a ‘ticket’ to receiving more services in the future, if/when that is something that your child may benefit from.
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In some cases, an autism evaluation could result in a ‘false positive’ or ‘false negative’ result.
A ‘false positive’ is when ASD is diagnosed even though the child does not have ASD, or when more expert examiners would have made a diagnosis
A ‘false negative’ is when ASD is not diagnosed, even though a more expert examiner would have diagnosed it, or if ASD was not able to be diagnosable at that moment in time, but will be diagnosable later on in development
The more expertise involved in your child’s diagnostic evaluation, the lower the chances for a false positive or negative. In general, professionals who are less experienced are more likely to give a ‘false negative’ result, as autism related differences can be subtle and in some cases not detectable by a less trained observer.
At Wildflower Pediatric Psychology, we take into account a child’s complete developmental history and environmental factors that may be playing a role in behavior, so that we can make sure you are receiving the most appropriate result. If an evaluation result is ambiguous (e.g., scores falling on the ‘cusp’ of a diagnosis) this will always be discussed in detail with the parent, and often this conversation will play an important part in the final determination, including the option to hold off on making a determination and re-test at a later date to see if autism related differences and difficulties have increased or decreased since the prior evaluation.