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Individuals with neurocognitive challenges, such as learning disorders, executive functioning difficulties, and autism spectrum disorder (ASD) often present for psychotherapy with symptoms of low self-esteem, depression, and anxiety. Parents will refer their children for treatment to address oppositionality or emotional reactivity. Psychiatric disorders are two-to-four times more common in children with learning disabilities than those without (Dekker & Koot, 2003). By the time they seek out therapy, the identified patients will have experienced repeated incidents of social and/or academic/professional failures due to their neurodivergence. Additionally, families of children with learning disabilities often experience high levels of stress. Moreover, they report increased levels of parenting discrepancies, negative reactions from extended family members, difficulty in interacting with the school, and mixed effects upon siblings (Dyson, 2010). Similarly, compared with normative data, children with ADHD had more parent-reported problems in terms of emotional-behavioral role function, behavior, mental health, and self-esteem (Klassen et al., 2004). Overall, parenting clinically referred children results in higher levels of self-reported stress (Pastor-Cerezuela et al., 2016; Theule et al., 2013).
Despite the connection between neurocognitive challenges and psychiatric symptoms, patients and/or their families often do not connect the individual’s neurocognitive differences to these difficulties. Instead, symptoms are attributed to a personal flaw related to their motivation or volition. This leads to tension within households as well as a cycle of shame and low self-worth on the part of the identified patient (Rasmussen et al., 2022). Helping families understand the interplay between neurocognitive functioning and symptom presentation starts with a thorough neurocognitive assessment.
A thorough neurocognitive assessment begins with a comprehensive clinical interview as we