When I first started doing assessments, it was not unusual for parents to cry when I shared a diagnosis of intellectual disability. I was glad to be there with parents to process this new information and plan next steps. Now, I rarely have parents cry during a feedback session (though it’s perfectly OK if they do!). Today, I walk to the conclusion with families, so there are no big surprises at the end. When I anticipate a particularly challenging feedback session, I find Steve Finn’s (2007) three levels of feedback helpful.

Level 1 findings

Level 1 findings are consistent with how a parent already views their child. This information is typically readily accepted.

“As you told me, Frank is a very smart kid. The assessment shows that he is indeed gifted.”

“You’ve always wondered if you have ADHD. I would agree, you do meet the criteria for ADHD.”

Level 2 findings

Level 2 findings are mildly discrepant from the way a parent views their child. Findings often modify or deepen a parent’s existing perceptions rather than contradicting them outright. They are generally not experienced as threatening to a parent’s sense of their child or their narrative about their child.

“Frank is very smart. He also has a lot of difficulty with reading, despite trying hard and getting a lot of help. We call this a specific learning disorder in reading. Let’s talk about ways we can help him.”

“You noticed that Said’s reading skills are behind his classmates and he seems frustrated with school. His reading skills are a bit behind, but the biggest difficulty seems to be in his focus and concentration. He is also really active and has trouble sitting for long. I think he has ADHD and I suggest considering treatment for that first, before starting a new reading intervention.”

Level 3 findings

Level 3 findings differ markedly from how a parent currently understands their child and can be anxiety-provoking or destabilizing. Without preparation and careful framing, a parent may struggle to integrate or may dismiss level 3 information.

“You were wondering why Katy has trouble making friends and seems behind the other kids at school. Based on this assessment, she meets criteria for Autism. Let’s talk about what that means.”

“I heard from you that although you know Dave has always needed more time to learn than his siblings, you believe he will catch up. The assessment shows that Dave has an intellectual developmental disorder which means he will always need support.”

Setting the stage for feedback

The process of preparing families to accept level 3 information starts from the beginning of an assessment.

• Invite parents to work collaboratively with you to identify the questions you will be answering.
• Gather specific, concrete examples and quotes that you can return to in the feedback session.
• Be open about what diagnostic questions you are considering (“Given your concern about X, one of the things we will look at is Y”).
• It is also helpful to listen for what Stephanie Nelson describes as “secret questions.” According to Dr. Nelson, secret questions are “those questions you listen for in the intake with your inner ear. The questions that tell you the parent’s hopes, dreams, wishes, and fears. The questions that wake them up at 3 AM. The questions they don’t really want to say out loud if they don’t have to.” Don’t miss reading the first and second parts of Dr. Nelson’s series on secret questions.

More than once, after hearing parents describe characteristics that sound consistent with Autism in an intake, I’ve asked “have you ever wondered if your child might have Autism?” This opened them up to talk about previously feeling dismissed for considering that, or “secretly wondering.”

More tips

Finn recommends presenting feedback in order of levels, starting with level 1, with most information landing at level 2. When you are presenting level 3 findings, it’s worth stepping back to consider how you can “walk there together” with the family. Perhaps you need another meeting to gather information and consider additional questions together with the family. It’s also important that if you hear information from parents that doesn’t fit with what you are presenting, take time to listen and consider your own biases. We are all wrong sometimes.

When receiving level 3 information, parents may be grappling with feelings of grief or loss for expectations they once held. Rita Eichenstein’s book Not What I Expected: Help and Hope for Parents of Atypical Children (2015) offers a thoughtful exploration of these normal experiences. She helps parents understand their own emotional experience, nurture themselves in addition to their kids, and embrace their child with acceptance, compassion and joy.

Conclusion

Feedback to parents is a relational process that shapes how families come to understand their child and, by extension, how children come to understand themselves. When we listen carefully to understand a parent’s perspective, it helps us align with them and walk together toward a shared understanding.

References

Eichenstein, R. (2015). Not what I expected: Help and hope for parents of atypical children. Fair Winds Press.

Finn, S.E. (2007). In our clients’ shoes: Theory and techniques of Therapeutic Assessment. Mahwah, NJ: Erlbaum