Psychological Evaluation and Assessment

Virtual Assessment and the Comprehensive Evaluation

There are two levels of work on this page, and it helps to know the difference before you begin. The first is a focused assessment: Dr. Della S. Lusk meets with you either in person in our Flagstaff office or  by secure video, takes a careful history, uses standardized questionnaires and interviews where they fit, and answers a defined question. Diagnostic clarification is often accomplished this way. Someone who has wondered for years whether what they live with is depression, anxiety, or something else can usually get a clear answer and a direction for treatment without a full day of testing.

The second is the comprehensive evaluation described further down: roughly 12 to 15 or more hours of clinical work, with standardized tests given in the office and a long written report. That level of work is the right tool when an institution requires it, when a memory question is complex, or when the diagnosis itself depends on instruments that have to be given in person. It is not always indicated, and we do not begin there by default.

Each situation is different, so we sort this out at the start rather than assuming what your needs are. The way to begin, whatever your question, is a diagnostic intake with Dr. Lusk, ; that meeting is where the next steps are decided. Some instruments require in-person administration. If your question needs in person, we coordinate an appointment at our Flagstaff office, or for non-local clients we will refer out to local resources in your area.

Every Evaluation Begins With a Diagnostic Intake

Whatever kind of evaluation you are considering, the process starts the same way: with a diagnostic intake with Dr. Della S. Lusk. This is the meeting where we take the history, hear the question in your own words, and decide together whether a focused assessment will answer it or whether the comprehensive evaluation is called for. For children and younger adolescents, this first meeting is usually with the parents alone, for reasons described below.

We start with assessment rather than therapy for two reasons. The first has to do with bias. If you may want follow-up therapy with Dr. Lusk, the assessment has to be done first. Once a clinician has become someone's therapist, she has a relationship with that person and a view of them that is hard to set aside, and an evaluation done afterward is less objective than one done at the start. Doing the assessment first keeps the findings clean and keeps the option of working with her afterward open. The same concern runs the other way: when one of Dr. Lusk's existing therapy clients needs an evaluation, she often refers that person to another psychologist for it, because of this same potential for bias.

The second reason is that the assessment almost always provides extremely helpful insight into the most appropriate treatment modalities. Knowing whether a difficulty is rooted in attention, learning, mood, memory, or some combination changes what treatment should look like, and it is far better to know that before treatment begins than to discover it months in. That is true whether treatment will happen with us, with a clinician who referred you, or with someone else entirely.

All of these decisions are made in an honest and forthright discussion with Dr. Lusk at that initial meeting, not by a policy applied to everyone. Whether a full evaluation is indicated, how much testing your question actually needs, whether the question can be handled virtually or requires time in the office, whether the work is local to Flagstaff or you are farther away, which school or institution the documentation is for and what it will expect, and whether an existing client is better served by a referral to another psychologist are each talked through plainly, with the reasons on the table. You should leave that conversation knowing what we recommend and why, and free to decide what you want to do.

ADHD and Autism Diagnosis

Questions about ADHD and autism are among the most common reasons people contact us for evaluation, in adults as well as children. These diagnoses usually require an in-office evaluation. The instruments that distinguish attention and executive function difficulties from other explanations, and the structured observations used in an autism assessment, are not designed to be given over video, and we do not tell people otherwise.

What a focused virtual conversation with Dr. Lusk can do is help decide whether that in-office evaluation is needed at all. Sometimes the history points clearly toward testing. Sometimes it points somewhere else, such as untreated anxiety, a sleep problem, or a learning difference, and a different kind of assessment is the better next step. Starting with that conversation saves people from committing to a long process before anyone has asked whether it is the right one. Our ADHD assessment page describes the testing, therapy, and coaching we offer once the picture is clearer.

Psychoeducational Evaluations for Children and Adolescents

When a child is struggling in school, parents and teachers usually see the effect before anyone understands the cause. A psychoeducational evaluation looks at how a child learns: cognitive ability, reading, writing, and math skills, language, attention, memory, and processing speed, measured with standardized instruments and compared with other children of the same age. The aim is to describe where the difficulty actually sits, whether that is a specific learning disability, an attention problem, a language weakness, anxiety that shows up as avoidance, or some combination.

For children and younger adolescents, the first meeting is usually with the parents alone, without the child present. That allows the important issues to be discussed in a frank and direct way: what the parents are seeing at home and hearing from school, what has already been tried, and what they are worried about. Having that conversation with the child in the room is often uncomfortable for both the parents and the child, and it tends to leave important things unsaid. Dr. Lusk meets the child at the testing sessions that follow, with the parents' concerns already understood.

The report is written so a school team can use it. It describes the child's strengths as well as the areas of difficulty, and it ties recommendations to the findings so that an IEP or 504 plan, classroom accommodations, or outside tutoring can be shaped around what the testing actually showed. We meet with parents afterward to go through the results in plain language, and with the student when that is appropriate for their age. Children in Flagstaff Unified School District (FUSD) schools are a regular part of this work, and so are children from other districts in Arizona and elsewhere; the report is written for whichever school team will read it. Testing for children is done in our dedicated assessment space at the Flagstaff office. Which school the documentation is for, and what that school will expect, is part of the initial meeting with Dr. Lusk.

When Parents and a School District Disagree

Sometimes a school district has already evaluated a child, and the parents do not agree with what it found, or with the services and eligibility that followed. The disagreement may be about whether a diagnosis applies, whether the child's needs were fully measured, or whether the services offered match those needs. In that situation, parents sometimes seek an evaluation from a psychologist who is not part of the district. These are often called independent educational evaluations.

Our role in an independent evaluation is the same as in any other: to test carefully, to compare the results with the right normative data, and to describe what we find in a report the school team can read and respond to. We review the district's evaluation as part of the history, and we may reach similar conclusions or different ones. What we provide is a thorough, independent description of the child; how the district and the family use it is worked out between them. We cannot promise a particular finding or a particular result at the school.

Accommodations for College and National Testing

College students often need current documentation of a learning difference or attention concern before a university or community college disability office can arrange accommodations such as extended time or a reduced-distraction setting. That is true for students at Northern Arizona University (NAU) and Coconino Community College (CCC) here in Flagstaff, and it is equally true at colleges and universities anywhere else; each disability office has its own requirements, and we write to them. Adults preparing for the MCAT, LSAT, SAT, ACT, or GRE face a similar requirement from national testing boards, and those boards tend to be particular about what they accept. A letter from a physician usually does not meet the criteria. They ask for standardized testing, scores compared with normative data, a clinical history, and a written report that connects the findings to specific functional limitations, such as how slowed processing speed affects a timed exam.

For many students this is the situation that calls for the comprehensive evaluation, because the documentation standard is set by the institution rather than by us. When the question is one that can be handled virtually, we work with students and schools nationwide, within the same rules that govern all of our virtual care: Dr. Lusk sees you by video when you are physically located in Arizona or a participating PSYPACT state. Which school the documentation is for, how much testing it will take, whether any of it can be done by video, and whether the work is local or at a distance are all settled in the initial meeting with Dr. Lusk. Students and faculty in Flagstaff can also read our page for the NAU community.

Memory, Brain Injury, and Other Neurocognitive Questions

For older adults and their families, a brief screening in a medical office can tell you that something has changed, but it cannot reliably separate normal aging from conditions such as Alzheimer's disease, Lewy body dementia, or frontotemporal dementia. A neurocognitive evaluation looks at memory, attention, language, and visuospatial skills in enough depth to describe the pattern, which is the kind of information a neurology or memory-care team asks for. It can also give a family a clear account of what the person can still do well, which matters when decisions about driving, finances, or living arrangements are coming up.

A traumatic brain injury raises a different version of the same question. After a concussion, a fall, or a motor vehicle accident, a person or their family may notice changes in memory, concentration, speed, or mood that are hard to put into words. An evaluation measures current functioning against what would be expected for that person, describes what has changed, and gives the treating physicians and any rehabilitation team something concrete to work from. Other medical conditions that affect thinking are approached the same way. In each case, the first conversation decides how much testing the question actually needs.

Evaluations That Clarify the Best Mode of Treatment

Not every evaluation ends in a diagnosis for an institution. Counselors, psychiatrists, social workers, and other professionals often refer a client to us because treatment has stalled or the picture is unclear, and the question is practical: what is actually going on, and what kind of treatment is most likely to help? A client who is not progressing in talk therapy may have an attention or learning problem no one has measured. Someone whose mood has not responded as expected may have a different diagnosis than the one being treated. A clear evaluation lets the referring professional adjust the plan instead of continuing to guess.

Much of this work is diagnostic clarification, and many of these evaluations are accomplished through virtual assessment with Dr. Lusk, with in-person testing added only when an instrument requires it. The report goes back to the referring professional, with your consent, with findings and recommendations about the mode of treatment: whether therapy, coaching, a medication consultation with a prescriber, educational support, or a combination is the better fit, and what to watch for. We are glad to talk with a referring clinician before the evaluation so the question is framed well.

What a Comprehensive Evaluation Includes

When the full evaluation is what the situation calls for, it involves roughly 12 to 15 or more hours of clinical work, much of it outside the testing room. Here is what that time is spent on.

Step 1: In-depth clinical intake, 1 to 2 hours. You meet with Dr. Lusk, along with a family member if that is helpful, to talk through academic struggles, goals for accommodations, or concerns about memory and behavioral changes. For a child or younger adolescent, this meeting is usually with the parents alone. This conversation shapes which tests are given, so that the results speak to what a university, a K-12 school such as FUSD, a national testing board, or a neurology team asks for.

Step 2: Standardized testing sessions, 3 to 8 hours. These take place in our dedicated assessment space at the Flagstaff office, a comfortable room set up specifically for testing. The measures are standardized tests of cognitive ability, memory, executive function, processing speed, and, when relevant, academic achievement. This is the objective data evaluators and physicians look for. It can show functional limitations, such as how slowed processing speed affects a timed exam, or clinical patterns, such as the difference between the rapid forgetting associated with Alzheimer's disease and the visuospatial difficulties more typical of Lewy body dementia.

Step 3: Scoring and clinical interpretation, 3 to 4 hours. This happens behind the scenes. Dr. Lusk scores each measure and compares your results with national normative samples matched for age and education, then considers how the pieces fit together.

Step 4: Report writing, 4 to 6 hours. Also behind the scenes. The result is a comprehensive report, often 15 pages or more, written in the language university disability offices, school districts, and memory-care providers ask for, with the findings laid out so that a reader who was not in the room can follow them.

Step 5: Feedback session, 1 hour. We go through the report together in plain language, answer your questions, and outline reasonable next steps for school or medical care.

What the Report Can and Cannot Do

The report is written to the kind of evidence disability offices and medical specialists ask to see: standardized scores, normative comparisons, a clear statement of what was found, and specific recommendations tied to those findings. Preparing it this way is meant to reduce the back-and-forth that delays decisions.

There are limits we want to be plain about. We cannot promise a particular diagnosis before testing is done; the evaluation describes what the data show, whatever that turns out to be. We also cannot promise that a school, university, or testing board will grant accommodations, or that a school district will change its position. Those decisions belong to the institution. What we can do is make sure the documentation you bring them is thorough, current, and answers the questions they are likely to ask.

Where Evaluations Take Place

In-person testing is held at our Flagstaff office, located at 710 N Beaver Street, BLDG 4, in a dedicated assessment space that is comfortable and specifically designed for assessment: quiet, free of interruptions, and arranged so that a long testing session is as easy as it can be. That is where ADHD and autism evaluations, psychoeducational testing for children, and the standardized testing sessions of a comprehensive evaluation usually happen. Our Flagstaff psychological services overview describes the wider practice.

Virtual assessment with Dr. Lusk is available through secure video for clients across Arizona and in participating PSYPACT states, depending on where you are physically located during the appointment. Whether your question can be clarified by video, and whether the work is local or at a distance, is decided in the diagnostic intake with Dr. Lusk, as described above. You can learn more about Dr. Lusk's training and background on her profile, and about the practice as a whole on our providers page.

Frequently asked questions

Does everyone need the full 12 to 15 hour evaluation?

No. A comprehensive evaluation is the right tool when an institution requires that level of documentation, when a memory or brain injury question is complex, or when the diagnosis depends on instruments that must be given in person. Many situations, including a good deal of diagnostic clarification, can be handled with a more focused assessment. We discuss what your question actually requires before any testing is scheduled.

Can the assessment be done virtually?

Often, yes. Dr. Lusk accomplishes much diagnostic clarification through assessment conducted by secure video when you are located in Arizona or a participating PSYPACT state. ADHD and autism diagnosis are the main exceptions; those usually require an in-office evaluation, although a focused virtual conversation can help decide whether that evaluation is needed. Some other instruments also require in-person administration. That is decided in the diagnostic intake once we understand your question.

My child's school already did an evaluation. Why would we do another?

Usually because the family and the district see the child's needs differently and want an independent look. We review the school's testing as part of the history, test the areas in question ourselves, and write a report the school team can read and respond to. We may agree with the district's findings or differ from them; we describe what we find either way.

Who should come to the intake?

For an adult, you, and anyone whose observations would help. For a child or younger adolescent, the first meeting is usually with the parents alone, without the child, so that the important issues can be discussed frankly; the child meets Dr. Lusk at the testing sessions that follow. Teacher input is often useful as well. For a memory or brain injury evaluation, a spouse, adult child, or other family member often notices changes the person being evaluated does not, and their account is part of the clinical picture.

What should I bring?

Any prior testing or evaluation reports, school records such as an IEP or 504 plan, relevant medical records, and a list of current medications are all helpful. If a counselor, psychiatrist, or social worker referred you, a note from them about what they hope to learn is useful too. If you do not have these, we can still begin; the intake conversation covers much of the same ground. For testing sessions, bring snacks and water. The sessions are long, and it is easier to do your best when you are not hungry or thirsty.

I would like therapy with Dr. Lusk. Why do I need an assessment first?

Two reasons. If follow-up therapy with Dr. Lusk is what you want, the assessment has to be done first to minimize bias; an evaluation done after a therapy relationship has formed is less objective, which is also why Dr. Lusk often refers her existing therapy clients elsewhere when they need an evaluation. And the assessment almost always provides extremely helpful insight into which treatment approaches fit your situation, which makes the therapy that follows better aimed from the first session.