Ep 173: Beyond Labels: Understanding the Whole Child. Lev Gottlieb, PhD

Dr. Lev Gottlieb, a neuropsychologist discusses his unique approach to neuropsychology and child development, emphasizing the importance of collaboration among caregivers, and a strengths-based approach to treatment. He highlights the need for effective communication between parents and professionals and the challenges of navigating labels and accommodations in education. Dr. Gottlieb advocates for a comprehensive care model that focuses on the whole child rather than just their diagnoses, encouraging parents to trust their instincts and create open channels for communication.

About Dr. Lev Gottlieb: He is a neuropsychologist and UCLA Assistant Clinical Professor. He assesses children, adolescents, and adults, and coordinates their care. Dr. Gottlieb earned his Bachelor’s Degree in Psychology from University of Pennsylvania and Doctoral Degree in Clinical Psychology from Northwestern University School of Medicine. He completed specialty training in Neuropsychology at Children’s Hospital of Chicago, NYU Child Study Center, Johns Hopkins University School of Medicine, Kennedy Krieger Institute, The Help Group, and UCLA, where he continues to serve on the clinical faculty.

Dr. Gottlieb has extensive experience providing evaluations and treatment to those with neurodevelopmental differences and acquired brain injuries, and has published and presented research on these conditions and their treatment as well as on learning, memory, and talent.

To learn more about Dr Gottlieb's clinic:

https://www.theintegratedclinic.com/

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com

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Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody. Welcome back to your child is normal. Today, I'm joined by Dr Lev Gottlieb, a neuropsychologist with extensive experience helping children and families navigate learning, behavioral and emotional challenges. Dr Gottlieb leads multiple clinics across southern California, and he brings a unique, thoughtful perspective to neuropsychological testing and diagnosis. So in this episode, we talk about the nuances of neuropsych testing when it's helpful when it might not be, and how we can approach labels in a way that supports rather than limits children. Dr Gottlieb's approach to treatment is refreshingly holistic, and he has a lot to offer parents looking for guidance. I can't wait for you to hear his insights. So let's get started. And if you're enjoying this podcast or this episode, I'd love to hear what you think. Please consider leaving a five star rating wherever it is. You listen to podcasts, it really helps spread the word. Dr Gottlieb, I'm so happy to have you on the podcast. Thank you so much for being here. I can't wait to talk to you and tell everybody about the work that you do. Oh, that was so nice. I'm happy to be here. Thanks, Jessica. So tell everybody what do you do for work? Sure, so, um, so as like my clinical profession, I'm a neuropsychologist. Some of you may have heard of that. To break that down, neuro means mind and psych means function. For me, at least. So you're quantifying the mind through puzzles and tests to explain how someone functions. But the idea is, you're capturing someone's thinking style in the context of their development, their aging, an injury, a gift, whatever. But there's something that's sort of not working for them, usually in the mainstream, that they want to quantify and understand, and then you make a plan around it. So I'll unpack that more later, but that's the that's the orientation of a neuropsychologist. And I'm just curious, just for the audience, to get to know you. How did you come to this field? What drew you to the field of neuropsychology? I don't know. There's probably, like, a better answer that I'm going to give. The true answer is you just, sort of, I found my way step after step, and you just, like, put your foot in front of you in the most reasonable place. And I sort of found myself here. The evolution was something like, I was at a college when Facebook came out, and I didn't really want to be behind a computer, so I wanted to work with people, which became psychology. And then I realized I didn't, truthfully, have the patience to fully be on the journey of everyone's treatment path, and I was a little more medical and assessment based, so I moved into medicine, slash neuro and testing. And then I, like, sort of working with kids, because kids are expansive and growing and complex, honestly, from a neural perspective, so but those decisions I didn't think about beforehand, I just sort of in each moment, tried to make the most reasonable, next best decision for me, and I ended up becoming a neuropsychologist. And you also, you're a neuropsychologist that specializes in children. Correct? That's true from a clinical perspective. I see kids like two to 39 you know, 39 is not really a kid, but the developmental arc. And then the person I work with, who I run the clinic with, sees people like 16 to 100 so we really do lifespan neuropsychology, but we each specialize a little bit in our domain. So I am a more of a child development specialist. And then we run health and wellness clinics in Santa Monica and LA, but also other cities in California. And just to explain a little more about what you mentioned previously, you said you do lifespan assessments. So what does that mean? Exactly? Lifespan means like across the lifespan. So I'm like a developmental specialist. My kind of clinic co manager is an adult specialist. So we do anything that affects your functioning in everyday life, that isn't a sort of a crisis or an active injury, we're really helpful to quantify what's going on and what you might do going forward, which all again, that takes the form of, does my kid have attention differences, learning differences, reading, writing? Did I have a concussion? How is it affecting me? So it could be something really clear, like that, or it could be something like, you know, my kid's really bright and thinks a little differently. And some of those kids also sometimes have a mild delay in social and emotional skills compared to cognition, which can create a lot of internal distress that sometimes gets expressed. And there are these, like patterns of mind, styles, let's say there's like 10 to 50 that are pretty well represented, and then there's, like, some individuality beneath that. We're trying to quantify all that and then make it really tailored plan for someone. So there's a few things that you mentioned that I really like. The first is, I love this idea of a light being a lifespan provider. Because, for example, myself as a pediatrician, you know, once kids hit college, they have to graduate from us and go on to an internist or a different specialist, and I love that you're able to take care of your patients throughout their life. That's a really unique, special ability that I think you have as a neuropsychologist, thanks for saying that. Yeah, it's interesting. We're because of the way mental health and neuropsychology generally works outside of an academic medical center. It's usually some kind of private model. You get a super bill, you get reimbursed, although that may change. And I think because of that, we may not be as bound as like an academic medical center or a pure medical model. If you're a minor and you're an adult like that distinction resonates now that I heard you say it because, like when I worked at UCLA, in places like you're either in the peds care under 18, and then suddenly there's this, like chasm, and then. Like you're an adult and you have to make all your independent decisions. And we tried to bridge that, but it was pretty different, because we're basically allowed to practice our work without really many constraints besides ethics and laws, we can follow the types of like clients or conditions that we're best at across their actual arc, as opposed to somewhat of an artificial arc that like 18, you become an adult, right? So that so like ADHD, you could see from, you know, whatever, four to six, roughly, although you could technically see a signal to two, probably, you know, you could follow through someone's lifespan. There's so many things you can assess, like, if you just take kids again, I'm not really diagnostic. I'm trying to map a mind to explain function, to give a precision plan that said, just to be straightforward, people come with a referral question, and it tends to take the form of a label, because that's the way in which we understand people. So there's for kids, it's ADHD, dyslexia, or like learning differences, math issues like dyscalculia, autism, and then you have anxiety and depression or emotional overlays, then you can also have epilepsy or head injuries or genetic syndromes. And there's so many syndromes, at some point there's a shared overlap that you can if you've seen enough syndromes, you kind of know what you're looking for. But you could imagine, as a pediatric provider who also has to know what's normative, if I also needed to know everything about dementia, that's too much, you know. So that's where, like, there's some amount, I think, where, like the saying goes, jack of all trades, master of none, absolutely. Yeah, I think even in assessment. But there are a few people I've met who try to do the whole, the whole true lifespan, you know. So I'm a quasi lifespan neuropsych, but our clinic does lifespan because I have an adult counterpart, basically, who cares the adult cases. That's fantastic. That makes a lot of sense. So, okay, so you had mentioned a few of the conditions that parents take kids into. CU, I want to elaborate on that a little bit more so that people that are listening maybe they can, maybe they'll think that their child, their child may be a good fit for your clinic. So you mentioned that you take care of kids with learning differences, autism. ADHD, you mentioned earlier, gifted children may come to see you. Anything else that you're that you're that you guys are proficient at taking care of that you hadn't mentioned? Sure, I'm mixed about answering this. To be honest. I appreciate the question. Here are my thoughts. One is, I really don't like to define people based on the label. Labels are like a heuristic that guide intervention, but it's, it's kind of the a quantified assessment of the mind is dimensional. But I also get the question, you know, and then finally, we, I'm happy to provide this, like, be on this podcast, just to share what we do, and also, if someone wants to see us, that's great. But I just want to be clear, too, that I don't want to, I don't want to sell something. I know you're asked in a kind way, but I just have to say that you can edit that out if you want. But just to be frank, I don't have any like, pitch really, my brand and who I am is someone who, like, tries to do their best and show up without, like, a huge orientation to some secondary gain. But that probably works itself out, like, if I'm being realistic, because people like someone like that working for them, so I just lean into that. But to answer, like your original question about what we see, anything you know, the conditions that people are most common, like, commonly aware of or curious about, are ADHD learning differences, Autism Spectrum Disorders, dementias, brain injuries, like concussions and head injuries, and then like epilepsies, genetic syndromes or other things that seem to affect the mind, including anxiety, depression that seems to have a legitimate cognitive toll, or one that's not straightforward for The therapist. Otherwise, we see people where there's complexity, because if you think about it, in most parts of the country, you do a response to intervention model, which is basically you see some doctor or someone, you do the most likely thing that would help, which is the intervention. You see, how you respond to that intervention. And if it was a wise choice, it might just work. Often it does. If it wasn't just the right choice, you get data about why it wasn't, and that's its own assessment model that prioritizes treatment and not assessment up front. And there's like, there's a real merit to that, to be honest. I mean, we do these big, big assessments, but a lot of times you could do a response to intervention model to help someone just as much too. So if you have a hunch that, like, someone has a reading issue, you could get a reading specialist. And if you don't think there's something else impacting, then that was probably the right thing to do. And then if it doesn't work, or it only works so well, maybe you assess them, but at the very least you have more data. You know, I think sometimes people are very quick to always assess first, and that's that's like a luxury, and it's something mainly most useful when there's complexity, if it's a one straightforward thing, like, my kids grade everything, but they're just not learning to read. Or, you know, they're doing so well when they're interested that when they're not, they just can't focus. Like, if it's just one thing, do the one thing, like go in that domain, you might there's a good case to be made for that. But again, high SES communities, people tend to assess first, want to know everything first and then move forward, particularly with kids. People do it for their kids because they really want to know. You know, I think that's part of the driving impulse to do such a big assessment. And again, if it's complex, it's really needed. If it's not complex, arguably, you have to decide, could you make a good choice without the assessment? Save money and time or like. Do I need for myself or my kid? Just to do I need to go through this process to really know, you know, but if you if you have a hunch of what you need to do as a parent, I would usually empower that parent to try to make that choice, and you don't have to necessarily do a big assessment. There's a couple things that you said that I wholeheartedly, that wholeheartedly resonate with me. The first is, I love that you want to stay away from labels, because I agree with you. I mean, I think sometimes labels can be helpful because it can help guide the intervention or the treatment in the most efficient way. But I think we live in a society. We live at a time now where we're so quick to put a label on a child, and so much of the time it's just normal kid behavior. And we all have different our brains work differently, which is, I look at it like it's beneficial for society to have different types of brains out there. So I, I love that you said that first of all, because I feel like nowadays it's so common to have a have a label for a kid, and I'm and I would say so much at that time, it's not helpful for the child, if anything, I worry that it might affect their self esteem. That's my that's my concern. Yeah, yes, interesting. I was gonna I would love to add on to that point later, but finish your second thought. I'm curious what you're going to say, but I agree with you. I mean, I'm curious what you think, but from my perspective as a pediatrician, that idea that we're so quick to assess first, I agree with you. A lot of times, parents come in they want to get an assessment, or they're told to get an assessment, and those assessments are anywhere from 678, $1,000 and I think to myself, Okay, if this child is acting out, maybe they're having a hard time with math at school and they're throwing a tantrum, or they're throwing a they're not happy when parents ask them to sit and do their math homework. Instead of putting that money into an expensive assessment, why not put that money and time into a tutor? Why not put that time into a sport after school to see if they get their energy out? Maybe they'll be calmer and more willing and able to do their homework. I myself, you know, I agree with that approach that, why not try things first and then you get that, you get that feedback in real time. An assessment can come later on down the line, yeah, or in parallel, if you need to, like, if someone's like, I really need to know, let's say it's more urgent and, you know, like it's sort of devolving and it is complex, the same thing. Case is still true. You should start the treatment, see the response to intervention, and do it concurrently with the assessment, if you need the assessment for complexity, because more data is always better. So there's a sense of, it's sort of binary. They're actually overlapping, you know, but I do, I do encourage like people to follow through on their gut and reach out to a resource and get a little input, because for a good assessor, especially if you have a little runway and there's not an immediate crisis, and the kids younger having some response to intervention data, like, I tried a tutor for six weeks or even three months, and it's like, here's what happened, and you can talk to that person adds a non trivial value, but if you already can have that from teachers and people and the bell is ringing, you know, deal with it, whether or not you assess. Does that make sense? So it's sort of Yes, but it's proactive. Evens more proactive assessment. I'm just thinking, for example, a lot of parents have a hunch that their child might be dyslexic, so they're, you know, waiting for a long time to get a to get a assessment to see if their child is dyslexic. Why not have a reading specialist that that can show them how to read or teach them as if they had dyslexia? Would that be harmful in any way? Well, no, and it's actually really important. And I'm not trying to be like a fear monger, but the thing is, like literacy, you can learn between, like pre K and third grade, or late pre K, K and third and if you don't, then the kids are reading to learn. They're not learning how to read after third grade, and arguably, in a high kind of enriched environment. It could even be like by the end of second and if you don't meet that environmental model by second or third grade and aren't reading fluently, you you basically have trouble keeping up with the mainstream. You feel othered and different, and you usually feel not smart for like, like as a young kid, for lack of a better word, your whole early learning experience is defined by reading like. Who's reading early? What are you reading? If you can't read, and you felt like that for years, you it is very hard to not to come through that with a positive early sense of self around your learning. Probably the same case could be made around attention, but attention has a longer runway. Many people's attention just have trouble sitting and paying attention when they're bored. Is sort of the fundamental challenge and but that you can work on, unless a kid's falling out or getting down. There's not really an urgency, but for literacy, you really only have these precious few years. And so if you wait like six months for an assessment, that was, I really don't recommend that, you're so much better off starting with the reading intervention with someone who's really good at the thing you're worried about. And then you get in, when you get into the assessment, and maybe by the time you get to the assessment wait list in six months, you're already good, and you've moved on, right? Also, I don't hold a wait list personally in our practice for more than a couple I basically get people in within within a month. Because if someone's ready to do this big assessment, the last thing I want to do is wait six months. I think that's a fundamental problem, the feeling people need to solve their wait list or refer out or deal with it. It's not really appropriate to wait six months these it's money and time you've committed. It takes a lot of energy as a parent to say, I want to do this, to then say, Hey, you got to wait six months and your whole treatment hinges on. It is totally unreasonable and is not a good clinical model. So I mean, I don't mean to judge and but people have to do what makes sense. But I think even if a parent really wants to see someone, they need to find. The clinicians need to make themselves available somehow, and people need to find someone available if, especially if the treatment hinges on this assessment. I guess part of what I'm saying is it doesn't pursue your treatment independent of an assessment, get your response intervention, and never feel like you're waiting on the neuro Psych. I can't tell you how many people give us that feedback. They usually give us a when they're in the biggest crisis, which is the worst time to wait for info. If you're in a crisis, go do something now, even if it's not just right, that's the whole point. Also, I've had parents where they get a neuro psych, and they're waiting for the neuropsychologist to get back to them, and they'll wait a month, two months, to get the results back. Maybe someone takes a little longer to write these long things, which is probably a relic of our field. And the money people pay they want these big reports. I don't know how useful those always are, but you need the feedback within a week or so, and the plan. What human being wants to wait a month or two months? Could you imagine waiting for your lab results for like, two months? And when you have to, it's nauseating. I think the field needs to shift. We're in a much faster kind of world now, and I think it is happening some, but truthfully, there's an old guard and just a traditionalism or a field where we're like, there's a pressure that we all experience to, like, document everything and see everything, and your written report is a reflection of everything you knew, so you better put it in there. And that's hard, because people will look at that and won't even call us. They'll just be like, well, here's the report. So probably there's a little too much emphasis on this written document. That's my take. And we should really be, like, figuring out what's going on observing a school, we should get to this, but like getting home videos, getting and talking to all the providers, get the real story and give an actionable plan that works, and then, if there's some documentation around it for certain bodies that need it, great. But the idea that anyone wants to read a 3050, page report to somehow guide a plan is, I think, unrealistic. I can't tell you how happy it makes me to hear you say this, because I completely agree with you. I get a lot of reports. Parents spend all this money on these neuro psych reports, fine, but then I'll get a copy of the report, and nobody ever calls me to explain it to me, tell me what they found. Tell me what they think would be helpful for that child. And to be honest, a lot of the reports look very similar. Yeah, I know like you're busy, right? So are you going to read 40 pages then? No, you're going to skim to some results or summary that doesn't feel as boilerplate. And then at that point, why did you produce 40 pages for what audience, you know? So that's, I mean, that's my sort of bent. You have to document certain things for like, accommodation law and disability law. So they're going to be a few kind of things you have to include, you know, and you have to have, like, certain background info. But there are other schools of thought coming out with, like, a three page neuro Psych and the data. I don't mean to sound like I'm minimizing in any way what the neuro psych tests are doing, what they're attempting to do. It's more I'm just for my end. I want to feel like I'm able to help the family after they've invested all this time in getting the neuro psych test done. Your approach sounds, honestly, more beneficial for the individual child. There are certain people who really want it all documented. They want to read through it, and over years, they want everything written. And there are, I will acknowledge, there are some cases and people on teams who really want that, but otherwise I would, I agree, like I think in general, people are coming with a functional problem. The data matters only insofar as it solves the functional concern they have, and the way to get there, you know, and the process and the outcome matter, but it's, it's, it's not about a it's not as much about the label or like, it's more, and it's not even about the report. I usually find people just want their kids to be like, doing better, you know. And so really, how I came to this and then we can move on, is I found there was a period of time when I don't do this anymore, just to be honest, like someone said, Hey, you can know if someone will someone opens your email. Like, that's an open source thing. I was like, Oh, I wonder if people are really reading my reports, because it was on my mind, because I was spending about 80% of my time writing. And I was like, I know this isn't my true strength, but I like, people demand it. So then I checked, and I like, something like 70 to 90% of those emails weren't opened, which was pretty which was pretty illuminating, but also disappointing, because I was like, Oh, how much of my life have I put into these documents people aren't reading? So I made a that's when I made the pivot. But the traditional school of neuro psych does want you to, like, go through all the results and explain what you were thinking and what the test measure and how it relates, and what it isn't including what it is that doesn't make sense clinically to me, like it doesn't it makes sense as an intellectual exercise, definitely. And I, and the reports that I get back, they'll talk about all these tests that were done, these cognitive tests that were done that I know I learned about these tests some at some time in my career, in medical school, or maybe in, you know, a psych rotation, but it's blurry to me now. And so they give, they give all these details that don't, don't amount to much clinically, or I can't figure out how to use that information to help the child. So you're a clinician trained in the space who's, like, really experienced, and I think what happens is, there's, again, this sort of internal pressure we experience to do that in our culture, but it will shift because, like, you know, the consumer needs something, and that's driving and I think medicine is shifting for all sorts of reasons. Some pressures aren't good, but there are a lot of pressures to shift healthcare to kind of what people want more quickly, and it will shift because of practices that exist like yours. Okay, yeah, thanks for saying that. I mean, I would like people to write shorter reports. I think it would help people and. Take the time and reallocate it. Don't just like, cut the time, but where would the time be used unless someone really needs that? I have had a few cases where, for what is, where people come back, like, I really need this or this document, and then what I'll do is I'll write the long version. I'm always happy to do that. I just need it to be useful. That's sort of what I learned. So I write what I know is needed, and then if someone needs more, I really will. It's not about, like trying to cut a corner. It's more about doing effective work. And I'm just curious. I know you have, you've mentioned how you have a unique approach when it comes to care coordination and taking care of your kids and writing reports. Is there anything else that you feel like is unique in your approach other than what we've been talking about? Sure, yeah. I mean, I think the things that I that I sort of do more strongly, or that I more passionate about really, are some of the qualitative stuff. So like, you know, there are good amount of people who will observe a kid at school before they've met the kid. So it's like a blind observation, you see. But if you think about how useful it is for like, under 12 to see a kid with a peer group with the age expectations and the teacher and the real world setting they're in all day is probably worth three hours of testing, and I can do that in 30 minutes. You have to drive there and back. And you know, it depends on your skill set and what you absorb, but you can see a lot if you know what to look for in that setting. That's not easily trained, that's more experiential, I think, or and a little intuitive, but it's a more qualitative style. So I do that. I get home videos over the years. If you see snippets of videos, you kind of can map out the longitudinal course of their developmental arc in a pictorial like life story. Then it's corroborated by Parent Report. But I also saw it with my eyes, as if I was there. And that's a little unique. It is true, though. It's it's different, like for myself in the office, I can see a child, and it's, you know, I can glean some insight. But if you see them, you know, so to speak, in the wild with their friends playing. And you see how they how they take turns, or they play it by themselves. How do they treat other children? You know, what are they like in the classroom? I can see how that can be incredibly useful, especially if you're in child development all the time. And then you talk to everyone. So if you talk to like, two or three teachers and maybe a tutor and one specialist, then you have one on one learning. You have group learning from different specialists at different time who you can interview. So then like, plus Parent Report, because parents know their kids best. But if you take that whole story and wrap it up, you basically coalesce like, a relative truth about how this who this kid is, and how they're doing that almost everyone will agree on if you, if you really weave like, weave it together in a way that makes sense. You can't just take one person's story and discount someone, but if you basically bring the team together through a shared understanding of the kid, and that's what's meaningful anyway, that's why they came to you. And then you quantify why it's happening, and then you connect the quantified map to what we all understood, which gives you a precision plan, because you have 500 data points about why they're doing what they're doing. And, you know, evidence based care, that's beneath it. That's really what I think neuro sex about, as opposed to which label Did you fit? Which is why, if someone calls me, like, do you do ADHD testing? I was like, not, not directly, but I can answer if your kid meets criteria for ADHD. And the reason why is, if I only tested for ADHD, you'd be giving like, rating forms of attention to parents and teachers and a boredom test in the office, and someone might not do well on that, but also you might falsely think it's true, but it's not like, what if they're just preoccupied by ancient in their head and you just didn't see it because you didn't get to know them, but they were inattentive because they were preoccupied, or because they're depressed and not concentrating, or there's a few other reasons. But the point is, like the whole nature of what we do is to map up the mind and make a plan. So we're not doing isolated diagnostic testing. I'm testing to explain someone's life as understood by everyone who knows that person well, to give a precision kind of opening or plan. Whether that's parent intervention, teacher strategies, Ed therapist, which is like specialized tutoring with someone with a special credential, there's occupational therapy, physical therapy. Sometimes someone needs to see a neurologist, but not usually. After seeing me, they've probably already seen one. You know, psychiatry, sometimes family therapy. Maybe it's the parent needed some support. Maybe it's couples this, but you're basically getting a window to the kid's whole life. So because people let us in so much into their world, if we really do our work, you have the ability to pay potentially make recommendations across home, school and interventions. The only thing we're not really directly involved in is sort of crisis care and high need medical care, because nuance matters less, to be frank, in those moments, and you just need to get the job done. So you don't assess for the most part, unless there's like, a very discrete thing. This sounds so beneficial, and I think for so many parents listening, hopefully they're thinking, oh my goodness, I know where I want to take my kids, because I'm hearing you say the wait list isn't very long. You get a by doing a real life assessment, looking at home videos, going to the school, talking to the parents, you really glean the whole picture and really understand the child for who they are and what they need, and then it sounds like you're able to offer them help in the way that might fit them the best with all the therapies you mentioned, parent intervention. So this sounds like a 360 complete package to help kids that are in need. So kudos to you for the clinic that you developed. It sounds incredibly. Helpful and useful. Thanks, Jessica, that was so nice. I'm not comfortable with that much, like positive attention. Sorry, I can't help it. That's fine. No. I mean, we're proud of it. It's a good clinical service. It's like a high end interdisciplinary service, and we care about that partly because, as neuropsychologists, we're coming over these coordinated plans. I can't tell you how defeating it is on the flip side to not be able to actualize the results, because you can't get someone in with someone, or find someone available, or get a group to talk. And for me, that's really important. I want to, like, get the job done. I'm sort of a doer, so if I do this whole thing and then I can't get it done, like, I don't know I needed a clinic for that, to be frank. Does that make sense? So it's really designed to fill that need, and I'm happy to be doing it. Yeah. And when did you start? I want everyone to understand how fabulous your growth has been. When did you start the clinic? Where is it and how many clinics do you have now? So I started. I mean, you know, most doctors start on their own, unless they're in an academic medical center. So I started on my own, and, like my main clinic, co manager, also started on his own. And we're kind of like we were good friends, but each doing our big neuro psych practice. We've been doing that for a decade, you know, but we came together and started a clinic, like five years ago. And we're in Santa Monica, like the broader LA area, we're in the South Bay, so like the beach cities down that area, we do go as far as like Pasadena and into Santa Barbara, including a clinic we have there, but I would say that that's a pretty big catchment area. But from like Santa Barbara to, like, maybe an hour east of Pasadena to the South Bay, we see with our clinic and a couple satellites, and then we have a San Francisco clinic that's a little more standalone. So altogether, you told me you have 10 clinics. I don't know if overstatement. I would say, well, like five, but it depends how you like, slice up the offices in the space, but, um, but we have a lot of we have a big team. We have like 50 people on our team. So we have a, we have a sizable thing going, but we're not an academic medical center, you know, we're not, we're not a Kaiser, we're not that size, obviously, at all. But yeah, so there's something else. There's something else that you mentioned earlier when you talk about your unique approach to helping your patients, and that is, I like how you focus on what a person's gifts are, rather than emphasizing what their perceived weaknesses are or their labels are. And so I just wanted to talk with you about that, because I completely agree with this message. I think for so many kids that I see, it's so easy to focus on what they're lacking, and to me, focusing on their gifts and their skills seems like so much more fruitful for the individual person I like you said that, yeah, it's for me, it's like a yes and right, it depends on the situation and the age, not to give an overly complex answer, but let's say, the younger they are, the more I might directly treat something that's really important. Because we not like reading, because we just know how important it's going to be, we might have to head on deal with it, even though there isn't a super straightforward strength based workaround, and the older someone generally gets, I recommend less treatment and more string space work around because, truthfully, the brain becomes less plastic and you have less time to work on stuff. But all that said it's always good to look at both like a good story. Anecdote I got. I was talking to a family once, and I would never give someone's direct info, but just this is a general story, and this has happened more than once. Someone called and said, you know, you don't need to go to like school, for example. They're doing well there. And I think, you know, I hear you, but the whole point, if I find how they're doing well, that might be the solution to the problem in another setting. So like, why is it going well? There is just as important as why it's not going well, and that's really the idea you're capturing all of it, the strengths and the challenges, the place the kid does well, and the place they don't do well, and your pattern, recognizing why and what you can do? Because the answer is out there. It's in the qualitative story of the kid's life, probably. But that totally makes sense. Let's say a child is excellent in math, excellent in baseball. Of course, we should spend time focusing and building those strengths, but also you don't want to forget about the other areas of school and aspects of life that you wouldn't want to have underdeveloped so I can see that as a yes and absolutely mindful. Like, elementary school is like more treatment than a combination. For me, Middle School is a wash. High school is more a combination than treatment. College, you're just playing to your strengths, hopefully, if you're you know, hopefully, but you might still need treatment. You maybe didn't get it, like you might have to come back to it, but that's the arc of what we do. But either way, knowing the strengths becomes how you how you take what works. Like maybe that kid did well at school, because they do well with lots of structure, social pressure of kids around them, and academic work. And we find that it's like, okay, well, sometime at home, why don't we just start there? Another example is some kids like get concepts better often. Kids who are dyslexic kind of see the gist but miss some details. So you give them thematic ways to learn literacy wherever you can, or that one more example is someone who doesn't comprehend very well, but who's good at systems. Will give them a systematic way to comprehend, like read the tape, read the back of the book first, which has like. The summary of what people thought. Then read the Table of Contents, which is like the systematic outline of the entire thing. So you went from big picture to systematic outline, and then you read like the first paragraph of every chapter, and then you read the book, and you've deconstructed a book to comprehend based on a system. But that solution makes more sense if you're systematic, obviously, and if you have trouble comprehending the gist easily, right? So that's the kind of like, that's not a diagnosis, but those are the types of things we're trying to pick up. If you can find three to five of those in an assessment, you can meaningfully change someone's life, even if you assess 500 things. And that's a little bit the luxury of the work on some level, without over diagnosing. Like, if you could capture your style, you can't differentiate every kid, and you can't make class just right for everyone, but as people get older, they could know themselves more on how to lean into things. And there's sort of a self awareness happening around psychology and the destigmatization of mental health and like a neuro divergence movement, but I think it's incomplete. This is an interesting note to maybe end on, but this is sort of my personal opinion, but it's been formed by my clinical judgment over the years. I feel like people are more okay with a diagnosis now, particularly adolescents and particularly like the individual, but sometimes the answer is the end, like, I have this, and that's sort of a natural human response, like, please, like, I have attention issues. Of course, I couldn't pay attention, or I have dyslexia. That's why I can't read. And that is partly true, but from my perspective, that's sort of the start of the journey you have to accept. What is you do what you realistically can, and you somehow move through it enough that you can function ideally in a way that works for you. And that's sort of the more heroic outcome that I think, is getting a little lost in some of the destigmatization mental health and the neuro divergence movement, which is great and prideful, but it's the beginning, you know, and we can't have an accommodation plan for half the kids at school, like, then it's not a mainstream school at some point. And sometimes the rates are like, not, non trivially, like 25% and I think there's a real case that people have real issues that need help and support. But anyway, the the assessment is the start of your journey to like health, you know, and in the care coordination, the treatment you do after is how you move through things while being vulnerable and open about your issues. If you if you choose to be, and I can't tell you how often that feels less salient in the conversations of having with people like around their health, they're, they're sort of good with just the answer of what they had. I'm a little concerned about that. No, I agree with you. I think there's this idea now, okay, if you, if you have a label, it's sort of an excuse not to try, and you want to think about it. The opposite way, trying is everything you know, overcoming an obstacle is, I think, the key to success. I totally agree that if you spend too much time focusing and dwelling on what your child is, quote, unquote, lacking, I could see it getting in the way of them making progress that is available for them to do, like I really believe all of us, if we have a challenge, the fun is learning how to move past that challenge and how to how to let us how to, let it help us grow and be the best that we possibly can be. I agree. I mean, it's an explanation. Assessments and or diagnoses are explanations for what might be partly challenging and how someone functions, and it might be a guide of what to do, but that's the whole point, explanation and a guide. I mean, it's not just an explanation and we're done, and it's actually what the hard part is. If you really have a difference, that means your life's going to be harder in some way, probably because mainstream life sort of adjusts to people in the middle, so including strengths sometimes on the high end can be really hard, but that's part of the work. It's like you take a beat, you might mourn a loss, you might celebrate it. It might be heavy, but you acknowledge what is, and then that's a call to action. Of like, how am I going to now deal with this, given the strengths I do have and what's hard? How do I make a functional plan? And I just, I really hope people encourage young people to do that more. I'm not sure I love it, because you sound very solution oriented rather than anything else. I guess that's part of what I mean. That's the solution. That's the back end of it, and the journey through it is probably just as important as the outcome. But there needs to be the journey. You don't just stop, and I can't again, that's really we're all, a lot of us, including me, are part of that problem, because when we make these accommodations and labels for these kids who have a lot of capacity but are overwrought, and do have some issues. You know, we're kind of propping them up in a way that isn't the world's not going to continue to do. Probably, that's been my experience after potentially high school and college, and so it's tricky. There's a lot of pressure to have these kids function always at their best all the time. But there's a counterpoint of development, which is sometimes you don't, and you have to find a way through and life doesn't accommodate you, and I just the pendulum has shifted very hard towards accommodations. And again, as a when I individually see a client, have had the data, I make the case, because my responsibility is to the client. As a doctor, I see the client, I document what I see. I get behind them, I support them, I tell them what I really think is true, but I still document what they need. Need. It's a tricky hat, because I have my opinions, as you clearly heard about it, and I try to do what's wise as a clinician, but I wouldn't it's not my call to make to, like, tell someone, you know, you need these accommodations, maybe, maybe not. Here's the data. You arguably need them, but I want you to work through it. You know, it's not really my choice. It's technically their choice. I get a fair amount of requests where kids are asking for longer time testing in school, and they'll tell me that, oh, there's so many other kids in my class that get longer testing time, and I want that longer time too. It's hard for me to finish my test in the allot of time. I get anxiety. Also can't, can't you write me a doctor's note to get more time? I don't want to say no to say no to their request. I'm sympathetic. I remember how hard tests were, how stressful it is to finish in the allotted time, but I also know that instead of me writing them an excuse, probably better is for them to get better at the material study more, wake up earlier. There's other things that they can do to finish the test faster, and not everybody has to get an A on a test, right? I mean, you know, just to quickly touch on that you generally don't want to accommodate anxiety, because if you accommodate anxiety, you're validating for the person. This is a real issue. That's why we're all bending over backwards and accommodating it. So you do it in the near term on a high stakes test, maybe because it's going to be invalid because they're too anxious. Otherwise, you could make a case for that. But you want to move through anxiety, generally speaking. Now dyslexia add those are kind of different, and there's actually a stronger case for accommodations with neurodevelopmental disorders than like emotional conditions. But you usually don't want to accommodate anxiety, just like you don't necessarily want to always reassure your kid. You want to cheer them or coach them through, because if you're always the agent of change, you remove their agency to move through their anxiety. So accommodations for anxiety are tricky, but they're sometimes needed. And then the second thing I'll just say, and this is not like a formal statement, but my perception is the premise of standardized testing is that timing is not supposed to affect most people. I think that's a false premise, because timing does affect most people, and I think that's part of the problem, if I really look at it, because if the premise is most people can finish this test on time and time is not a factor, then, of course, if you have a disability that affects your speed, you should be accommodated. But if it's true that most people would benefit for more time, then then you're going to set the stage for abuse. I really think that's part of the problem. And so I think from my perspective, like if I step way out, either time does matter and we measure it or it doesn't, and we don't, I don't know if people want their kids to have issues or need accommodations as much as they want their kids to do well. And if the test has a somewhat, I think, false premise, that's my personal opinion. You know, timing affects probably at least half, if not most, people with how they perform, you know. And so do you see what I mean? So that's anyway. That's another soapbox, but I do have some issue with that. I don't know what we can do as a doctor. It's tricky on a one to one level again, because we have to function within the ecosystem we're in. We have to help kids thrive within the world they're in. It's more of us, like a political, you know, broader issue, but there's like someone might on the other side be like, Disability Matters totally disability law totally matters, and there's so much need, but you could see how there's probably movements on both sides. Just for example, like autism care gets so much insurance coverage in California because there's great advocacy, but like, ADHD, is not going to get behavioral care. It's going to get rejected, even though the kid is probably sometimes more dangerous, and it's more significant, they get rejected the behavioral care because they don't have autism. That's because there's an advocacy group, not because it makes sense, right? So anyway, this is the principal part of me coming out. There are certain things I can't totally address, but hopefully some people will. You know, I'm happy to hopefully be part of some of the solution to that stuff. This has been such an interesting conversation. You have so many good thoughts and ideas, so I really appreciate you sharing them. Any any final thoughts or pieces of advice that you want to offer to parents listening, huh? I should have had a good answer for that, but I guess on a spot saying no, I would say parents generally know their kids best, and that's a really big resource. They often, usually care the most. And if you know, lean into that, because you can do a lot as a parent, you know, if you trust your gut and your care, often parents have it you know they have it close. You know parents often are quite right. They're probably the most right. The only counterpoint to that is just be open minded that your kid may present differently in different settings. So if you're an open minded person, you acknowledge your kid as this or this a little different, people will feel like they can talk to you and they're not going to upset you. And then you'll find out what's really going on better. And so if you can, that's one other thing you can do as a parent working with teachers or specialists, is make sure they know you can hear stuff, and you'll hear more, and then you can decide if you care to hear what they had to say or not later, but at least you've got the info. You know, I think sometimes, not me, I'm not going to be direct Anyways, my job. But there are teachers and people who just aren't really given the leeway to be that direct. And if you've closed the door from their perception, they're going to be really careful what they say. And if you don't have the information, you can't be empowered as a parent to do what you need to do. So that's like, it's always a long, quick answer, but. That you know your kid best, but also create channels where people will talk to you. I believe it's an art not to come off as defensive. Especially, I think people have an especially difficult time when it comes to their children, because it might feel like a reflection of them. So I agree with you learning how to put the ego away, put the defense away, and be open to hearing what your kids are like, ultimately, I think we'll be if you're open to hearing that conversation, ultimately, I think it will help your children. So that's great advice. Cool. Thanks, Jessica, thanks for having me. Thank you so much for coming on. Dr Gottlieb, you're fantastic, and I appreciate your time. Thank you so much. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review wherever it is. You listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica. See you next Monday. You.