| WHAT IS A PSYCHOLOGICAL ASSESSMENT? |
A psychological assessment is a process by which a psychologist obtains detailed information about a child’s functioning in order determine whether a diagnosis might be appropriate and to provide recommendations for the most appropriate treatment, if applicable. The different symptoms and difficulties that a child is experiencing will determine the type of evaluation needed and where it will be completed.
| MAKING AN APPOINTMENT |
v Search for the Right Professional
A psychologist performing a psychological assessment should hold a PhD or PsyD and be licensed in the state of practice. The psychologist should also have a child or pediatric specialty, meaning that they have specialized knowledge of children’s mental health problems and treatment.
A neuropsychologist is a psychologist who is specially trained in neuropsychological assessment, neuroanatomy, and brain function. This person will hold a PhD or PsyD and have predoctoral and postdoctoral training working with children who have acquired brain injury and/or neurodevelopmental disorders. All neuropsychologists should be licensed and some will also be recognized by the professional board in this discipline (e.g., ABCN, ABPN). Child neuropsychologists may be found in medical settings, rehabilitation centers, educational contexts, and private practice.
v Standard Psychological v. Neuropsychological Assessment
Standard psychological assessment typically evaluates general cognitive and behavioral functioning to arrive at hypotheses about a person and their behavior, personality, and strengths and weaknesses. This type of assessment can evaluate intellectual functioning, as well as psychological, emotional, or behavioral disorders. Through a combination of norm-referenced assessments, interviews, and behavioral observations as well as the clinician’s clinical judgment, a comprehensive evaluation is made to provide possible diagnoses as well as recommendations for school, home and social settings tailored to the individual being assessed.
Neuropsychological assessment involves the comprehensive assessment of a range of cognitive processes. This type of assessment can evaluate neurological or neurodevelopmental disorders, and help to understand the etiology and evolution of a disorder. It is not restricted to measures of intelligence and achievement but examines other areas of functioning that also have an impact on performance in the classroom, with peers, at home, or in the community. Neuropsychological assessment is structured to investigate aspects or subcomponents of a child’s performance within a given domain to better understand brain-behavior relationships and clarify the nature of detected weakness within that specific area. With a comprehensive assessment across numerous areas of functioning, neuropsychologists can generate a profile of specific strengths and weaknesses that inform treatment planning and adaptation in daily life.
| PREPARING FOR THE APPOINTMENT DAY |
v Gather Materials
Prior to the appointment day, review your child’s developmental history. Especially for an older child, looking through baby books and photo albums can help reinforce your memory for your child’s early years. Gather any records that may be useful for the psychologist (e.g., medical, school, previous assessment reports). Complete parent rating scales and gather completed teacher rating scales (if sent prior to appointment).
v Prepare Your Child
Explain the appointment to your child. For most children, participating in a psychological evaluation will be a new experience, and they may feel nervous or confused about why they need to go. Some children may worry about what is “wrong” with them when they learn that they need to go for testing. Let your child know that many children and teens go for evaluations at some point to understand how they think, learn, or experience and deal with their emotions. Reassure your child that everyone has things that are easy for them and things that are hard for them and the psychologist will help them with anything that might be difficult.
Avoid describing the appointment as “playing games.” Children often find some of the tasks involved in evaluations fun, but some tasks may be challenging or boring to your child. Your child may be disappointed or upset to find that the tasks are not what they would consider to be “games.” Instead, you can tell your child that they will likely be asked to answer questions and complete tasks, some of which will be easy and some that might be more difficult.
Make sure your child gets a good night’s sleep before the appointment. A good night of sleep is important to ensure that a child is able to perform their best at testing. A child’s ability to pay attention and their level of effort can be affected by a poor night's sleep.
Make sure your child has eaten well before the appointment. Food is also essential to a child’s ability to think and pay attention. If testing is taking place in the morning, make sure your child eats a good breakfast. If your child is being tested in the afternoon, consider giving them a snack on the way. Also, you can ask the professional doing the testing if it is okay to bring a drink or snack for your child if testing will last a few hours.
Follow instructional guidelines on medication use. For differing reasons, the psychologist may wish to see your child with or without the aid of stimulant medication. Check the instructional packet for guidelines concerning medication use and dosage timing. If unsure, call the psychologist’s office to request this information before the appointment.
Bring glasses or hearing aids (if worn).
| ASSESSMENT PROCEDURES |
v Multi-Method Approach
In the clinical setting, a multi-method, multi-informant approach is typically employed in the comprehensive assessment of children who may have ADHD. This approach is important because different informants may provide different perspectives on the child’s behavior. Relevant symptoms may shift across settings. Additionally, different aspects of symptomology may require different methods of evaluation.
v Assessment Procedures
Review of Records. The psychologist will review relevant records to get a comprehensive picture of your child’s background and history, including:
· Parent questionnaire
· Medical
· Academic (IEP or Section 504 plans, report cards, conduct reports, etc.)
· Previous Assessments (school-based or private)
· Services (speech/language therapy, psychotherapy, etc.)
Parent/Caregiver Interview. Evaluations often begin with a meeting between the child’s caregivers and the psychologist. During this meeting, the psychologist gathers comprehensive information about the child, including:
· Health, illness, and treatment (both physical and psychiatric), including current medications
· Family health and psychiatric history
· Child’s development
· School and academic performance
· Family and peer relationships
· Daily functioning: Self-care, leisure activities/hobbies
· Current concerns and difficulties: When symptoms began, where/when they occur, duration/intensity of symptoms
· Strengths
Child Interview. The psychologist will talk with the child in order to ask him or her about home, school and his or her feelings. The child is also given a chance to ask questions about the evaluation session.
Rating Scales. Parents/caregivers may be asked to complete rating scales assessing the child’s behavioral and emotional functioning. The child may also be asked to complete self-report rating scales assessing his/her own view of current difficulties. With parent permission, the psychologist will often seek out additional information about a child through rating scales completed by other significant adults in the child’s life (e.g., teachers, therapist, and/or pediatrician).
Teacher Interview. With parent permission, the psychologist may speak with the child’s teachers directly to gather more information about the nature of the child’s problems in the school setting.
In-School Observation. The psychologist may want to observe the child at school in order to see his/her behavior in a different environment and with peers. Notably, this may not be offered by all psychologists, and interested caregivers should inquire about the possibility of an in-school observation when making an appointment.
Behavioral Observation. The psychologist will observe the child’s behavior during the office visit, and may watch the child engage in ordinary activities (e.g., playing with toys). Observations (Restricted Academic Task) are often conducted to attempt to determine the child’s rate of off task behavior while he/she completes academic worksheets.
Battery of Tests. Your child will engage in a number of tests involving paper and pencil and hands-on activities, answering questions, and sometimes using a computer. Many psychologists employ trained examiners, or technicians, to assist with the administration and scoring of tests, so your child may see more than one person during the evaluation. Parents are usually not in the room during testing, although they may be present with very young children. Standard psychological testing typically lasts between 2-4 hours, while neuropsychological testing typically lasts between 5-8 hours. Depending on the length of testing, as well as the age of the child, either type of assessment may be conducted over multiple assessment days.
| DOMAINS OF ASSESSMENT |
v Standard Psychological Assessment
Intellectual. Intellectual, or cognitive, functioning is a measure of general intelligence, encompassing skills of reasoning, problem solving, and abstract thinking. With most intelligence tests, an Intelligence Quotient, or IQ, is determined which is an overall score that describes one’s current intellectual functioning. This usually includes tests of verbal and nonverbal abilities.
Achievement. Assessment of academic achievement measures developed skill or knowledge, usually targeted at knowledge learned in a given grade level. It often includes reading, math, spelling, and written language subtests that determine at what grade level and age level a child is functioning.
Behavior and Mood. Behavior and mood may be assessed through observation as well as norm-referenced parent-, teacher-, and self-report measures. These measures generally target externalizing behaviors (e.g., hyperactivity, aggression, and conduct), internalizing behaviors (e.g., anxiety, depression, and somatization), and school problems (e.g., attention and learning).
v Neuropsychological Assessment
Attention. Attentional functioning refers to how the child becomes receptive to and begins to process incoming stimuli. Components of attention typically assessed include the encoding of information, sustained attention, shifting attention, response inhibition, and processing speed.
Executive. Executive functions are the capacities that enable a child to control his/her behavior and engage successfully in independent, purposive, goal-directed activities. Assessment of executive functioning focuses on skills required to prepare for and execute complex behavior, such as working memory, planning and organization, inhibition, reasoning, self-monitoring, cognitive flexibility, and set-shifting.
Sensory-Motor. Sensory-motor function involves the integration of sensory-perceptual processes, such as detection and processing of incoming sensory information, and motor functioning, including manual dexterity, motor speed, and bilateral coordination.
Visuospatial. Visuospatial processing involves a variety of skills related to perception and processing of visuospatial information. These behaviors require specific skills, including visual attention, visual discrimination, spatial reasoning, visual-motor integration, and constructional ability.
Learning and Memory. Learning and memory are the processes by which the child encodes, stores, and retrieves information. Evaluation of memory often includes assessment of short-term retention, learning capacity and how well newly learned material is retained, and efficacy of retrieval of both recently learned and long-stored information. Memory functions should be assessed through receptive and expressive modalities.
Language. Language assessment often involves evaluation of expressive language (e.g. naming, vocabulary, storytelling), verbal fluency (e.g., fluency of speech, writing, reading), and receptive language (e.g., following directions, attending to spoken language, comprehension of information).
Intellectual, Achievement, and Behavior and Mood are also evaluated during a neuropsychological assessment. See descriptions above.
| FOLLOWING THE ASSESSMENT |
v Results of the Assessment
Feedback. The final step in the evaluation process is a meeting in which the psychologist shares the results of the evaluation with the family. Some professionals will meet with the parents and child together, others will meet with the parents and child separately, and some will do both depending on the child’s age. Generally, these meetings involve:
· An explanation of the diagnoses, if any, that the psychologist has made and why the psychologist came to this conclusion.
· Information about the diagnoses, such as how the diagnoses typically progresses or changes over time and the outcomes that may be expected.
· Recommendations for how to promote success for the child at home, school, and in the community.
In order to take advantage of recommendations received, parents are encouraged to ask the psychologist what he/she considers to be the most important recommendations for the family and the school to address first.
Report. A comprehensive report will also be provided at or following feedback, which summarizes all of the information obtained from the evaluation, including diagnoses and detailed recommendations. This report belongs to the family and can be shared with service providers as deemed necessary.
v Requesting and Revising Services
School Meeting. For an additional fee, many psychologists are also willing to be present during IEP or other academic planning meetings to explain results of testing and assist in planning school-based services. The psychologist may also advocate for specific recommendations to provide the optimal school environment for your child’s academic performance.
v Follow-Up Assessment
Scheduling a follow-up assessment allows the psychologist to get an updated view of your child’s functioning to help measure the outcome of treatment and monitor the child’s development over time. It is recommended that children receive testing every 2 – 3 years to update or alter diagnoses and recommendations. This will also help to tailor accommodations received through an IEP or Section 504 Plan as the child progresses through school.
| SOURCES |
This handout was created for use by the UAB Civitan-Sparks Clinics – ADHD Parent Support Group. Information provided on this handout was drawn from sources including:
American Academy of Child and Adolescent Psychiatry. (2008). Facts for Families: Comprehensive Psychiatric evaluation. No. 52 [Brochure]. Washington, D.C.: Author.
Children’s Mental Health Resource Center. http://www.mentalhealth4kids.org/
Davis, A. S. (Ed.). (2011). Handbook of Pediatric Neuropsychology. Springer Publishing Company.
Division 40 (Child Neuropsychology), American Psychological Association. (2001). Pediatric Neuropsychology: A guide for parents. [Brochure]. Washington, D.C.: Author.
Gabowitz, D., Zucker, M., & Cook, A. (2008). Neuropsychological assessment in clinical evaluation of children and adolescents with complex trauma. Journal of Child & Adolescent Trauma, 1(2), 163-178.
Sattler, J. M. & Hoge, R. D. (2006). Assessment of Children: Behavioral, Social and Clinical Foundation (5th ed.). La Mesa: Jerome M. Sattler, Publisher, Inc.
Tsatsanis, K. D. & Volkmar, F. R. (2001). Unraveling the Neuropsychological Assessment. The Source.