Every Assessment Starts With a Story, Not a Score
As a licensed clinical psychologist with over 25 years of direct clinical practice, I've worked with more than 2,300 children and adolescents presenting with complex neurodevelopmental conditions. I've also evaluated over 535 adults navigating life after traumatic brain injury. That's a lot of people. And the one thing I've learned, more than anything the research literature taught me, is this: a number on a page does not tell you who someone is. The story does.
This is the belief that shapes everything I do. Before I administer a single test, before I score a single subtest, I sit down and I listen. I trace a person's developmental arc from before they were born to the day they walked into my office. Prenatal history. Early milestones. How they communicated at two, how they handled a classroom at seven, how they've been functioning at work or at home today. That developmental interview is not a formality. It is the foundation on which every evaluation I conduct is built.
Here's where I think a lot of clinical practice goes wrong. The field has an understandable pull toward efficiency. A rating scale, a brief screen, a 15-minute consult, and then a prescription gets written. I watched this play out firsthand in the late 1990s, when pediatricians were being called out by the American Academy of Pediatrics for prescribing stimulant medication to children after exactly that kind of surface-level interaction. The assumption was that a label explained the child. It didn't. It just gave the problem a name.
That observation pushed me toward research. I collaborated with colleagues and published a peer-reviewed randomized controlled trial in the Journal of Developmental and Behavioral Pediatrics in 2003 showing that stimulant medication alone is not the answer for childhood ADHD, particularly because the prefrontal cortex, the very area stimulants target, doesn't fully develop until the mid-twenties. That work wasn't about being contrarian. It was about following the evidence where it led, even when it challenged what was comfortable and convenient.
What the test battery reveals, when it's done right, almost always surprises people. I worked with a middle school student, I'll call him Joey, whose parents and teachers were convinced he was defiant. He never showed his work. He seemed checked out. When I completed the evaluation, I found something entirely different. Joey had dysgraphia, a specific learning disability affecting written expression, combined with a very superior IQ. His visual memory was twice as developed as his auditory memory. He wasn't being difficult. He was being failed by a system that didn't understand how his brain actually worked. Once we put voice-to-text accommodations in place, shifted his learning track, and let him teach his peers what he had mastered, things changed. That's what a story-first assessment makes possible.
The same principle applies to adults I evaluate after brain injury. A neuropsychological evaluation isn't just about documenting what's been lost. It's about understanding the whole person before and after the injury, identifying where function has changed, and building a recovery picture that is grounded in real evidence. When I approach that work, I'm not looking for a single data point that confirms a referral question. I'm building a cognitive profile that reflects how a human being actually thinks, processes, and adapts. The score matters. But only in context.
I also publish because I believe this principle extends beyond my own practice. In 2000, I worked alongside principal investigator Greg Simon, MD, to help lead early telehealth research in depression. That work was about meeting people where they were, both literally and clinically. Getting evidence into the world, through journals like JAMA, the Journal of Consulting and Clinical Psychology, and Behavior Therapy, means other clinicians can apply it too. The belief only has value if it travels.
My book, due in early 2027, will carry a lot of these case examples forward in ways a journal article can't. I want parents, educators, and clinicians to see the full arc of what good assessment can do, not just the conclusion, but the process, the listening, and the story underneath the scores. That is where the real work begins.