Introduction to Psychological Assessment of Children

1. Introduction to Psychological Assessment of Children Gregg Selke, Ph.D. PSY 4930 October 3, 2006

2. Purpose of Psych. Assessment Goal Driven • Broad Screening versus Focused/Problem-Specific • Diagnostic • Differential and Comorbid Conditions • Therapy Oriented • Identify target problems • Develop preliminary intervention plan • Progress evaluation • How well are ongoing interventions working?

3. Testing vs. Assessment • Both involve • Identifying areas of concern • Collecting data • Psychological Testing • Administering tests • Focuses solely on collection of data • Psychological Assessment • More broad goals • Involves several clinical tools • Uses clinical skill to interpret data and synthesize results

4. Psychological Testing • Require standardized procedures for behavior measurement • Consistency and use of the same • Item content • Administration procedures • Scoring criteria • Designed to reduce personal differences and biases of examiners and other external influences on the child’s performance

5. Psychological Assessment • Main types of assessment • Norm-referenced tests • Interviews • Observations • Informal assessment procedures • Non-norm referenced tests

6. Norm-Referenced Tests • Tests that are standardized on a clearly defined group • Normative versus clinical reference groups • Goal: quantify the child’s functioning • Scores represent a rank within the comparison group • Examples • Intelligence • Academic skills • Neurocognitive skills • Motor skills • Behavioral and emotional functioning

7. Norm-Referenced Tests • Psychometric properties • Demographically representative standardization sample • Reliability • Internal consistency, test-retest stability • Validity • Correlation with other tests measuring same construct • Ecological • Psychological tests are imperfect • Examiner, the child, and the environment can affect responses and scores

8. “Normal” or “Bell” curve • Most attempt to be normally distributed • Standard deviation: Commonly used measure of the extent to which scores deviate from the mean • In a Normal distribution, 68% of cases fall between 1 SD above the mean and 1 SD below the mean • The threshold for meeting “clinical significance” varies across tests, typically > 1 to 2 SDs above or below mean

9. Norm-Referenced Tests • Percentile ranks • Determines child’s position relative to the comparison group • Example: What does it mean when a child is in the 35th %tile on an Intelligence test?? • Age-Equivalent and Grade-Equivalent scores • Frequently used on academic achievement tests • Sometimes questionable validity

10. Variables Affecting Test Scores • Demand characteristics • Child may give a certain type of response in order to obtain a desired outcome • Response bias • Child’s response to one item may influence how they respond to subsequent items • Social desirability • Tendency to present one’s self in a positive light

11. Variables Affecting Test Scores • Misinterpretation of Items • Misunderstanding directions • Format of instructions • Oral vs. written • Response format • True-false, written, oral, timed, untimed • Setting variables • Location, time of day, medication status • Previous testing experience • Practice effects

12. Variables Affecting Test Scores • Reactive effects • Assessment procedure affects responses • Timed, anxiety provoking • Examiner-examinee variables • Individual characteristics may affect responses (e.g., gender, age, warmth) • Research suggests that children of low SES and/or ethnic minorities are more affected by examiner characteristics • Familiar vs. unfamiliar examiner

13. Administering Tests • Administering psychological tests to children requires specific skills • Flexibility: breaks, time to warm up, establishing rapport • Vigilance: attend to child’s behavior while still correctly administering the test • Self-awareness: how do children typically react to your style, body language, mannerisms

14. Examiner Nonverbal Behavior

15. Other Testing Issues • Introducing yourself to child • Explaining what the child will be doing • Letting them know where their parent will be during the assessment • Providing adequate expectations • Developmental considerations • Younger children • Older children • Praising effort NOT performance • Setting limits on behavior

16. Establishing Rapport • “the sense of mutual trust and harmony that characterizes a good relationship” • Good rapport = • child/family perceives the clinician as caring, interested, competent, and trustworthy • Clinician feels positive regard, genuineness, and empathy • Necessary condition

17. Establishing Rapport • Use of communication skills • Acknowledgements • Descriptive Statements • Reflections • Praise • Periodic Summaries • Elaboration • Clarification

18. Establishing Rapport • Avoid: • Lack of interest or not attending • Sarcasm • Lecturing • Interrupting • Commands • No eye contact • Criticisms

19. Interviewing • Types of interviews: • Unstructured—allow child/parent to “tell their story” • Semi-structured—provide flexible guidelines, a starting point • Structured—most often used to make diagnoses or in research studies, standardized • May interfere with rapport • Does not provide info on family interactions or a functional analysis of behavior • Which types of interview require the most clinical skill??

20. Explaining Confidentiality • Parents sign releases of information • Review concept of confidentiality and its limits early in clinical interaction • Limits to confidentiality: • Specific threat to someone else (homicidal ideation) • Self-harm is threatened (suicidal plan/intent) • Sexual and physical abuse (history or current) • Insurance requests • Courts • Generally referral source

21. Interviewing Techniques • Establishing rapport is crucial • Moving from open-ended to closed-ended questions (general to specific) • Tell me about why you’re here today? • What about school is most difficult for you? • Are you failing math because you didn’t hand in your homework….not studying……didn’t understand the material? • Avoid • Double-barreled questions (“and”, “or”) • Long, multiple questions • Leading questions • Psychological jargon

22. Example Developmental Interview • History of presenting problem • Prenatal, perinatal, and early postnatal history • Medical history • Acquisition of age-related milestones • School history • Personality, social, emotional, behavioral history • Family history • Expectations about assessment visit

23. Example Developmental Interview • History of presenting problem • Parental description of problem • Child’s view of problem • Onset • Duration • Interventions attempted • Prior assessments • Parents sense of effects of problem, and sense of child’s understanding

24. Example Developmental Interview • Prenatal, perinatal, and early postnatal history • Pregnancy • Labor and delivery • Birth weight • Apgar scores • Complications post-birth

25. Example Developmental Interview • Medical history • Across all ages • Accidents & injures • Major illnesses • Ear infections • Neurological conditions • Congenital and genetic conditions • Hearing and eyesight

26. Example Developmental Interview • Acquisition of age-related milestones • Motor • Language • Toileting • School history • Preschool experiences to present – Settings • Achievement, grades, strengths and weaknesses • Behavioral, emotional, social functioning • IEPs, 504 Plans, accommodations, modifications • What teachers think

27. Example Developmental Interview • Personality, social, emotional/mood, behavioral history across development • Temperament as an infant and toddler • 2.5-5 years: Development of play, aggression, interests • 5-11 years: Hobbies, activities, friendships, family relationships • 11 to adolescence: Development of interest in opposite sex, dating and sex, activities, drug and alcohol use, family relationships, self-concept, goals and aspirations

28. Example Developmental Interview • Family history • Parental history: marriage(s), # children • Demographics, ages, education, occupation, SES • Siblings: ages, problems, school history • Medical, genetic, developmental, psychological, abuse problems • Expectations about assessment visit

29. Developmental Considerations • Young children tend to think in concrete ways, while teens may reflects more on feelings and motivations • While age is an obvious indicator of developmental level, language and cognitive levels may also vary with age • Interview format should be adjusted to the individual child’s level • Open vs. Closed questions

30. Developmental Considerations • 6 year olds might be asked about the difference between preschool and kindergarten • Young teens might be asked about the transition to individualized school schedules and homework, and peer pressures. • Older teens might be asked about college, vocational plans, or separating from parents

31. Format of the Interview • Who will be interviewed is often a question with young patients • e.g., Children under 6 typically are generally interviewed with parents, then sometimes parents are seen alone • e.g., Older children and adolescents are often seen as a family first and then later may be interviewed alone • Sex abuse may be an exception

32. Format of the Interview • If the clinicians sees family together it allows for: • Observation of interactional patterns • Areas of agreement and disagreement • Tell family how their time will be structured • Allow them to know if they can save sensitive topics for when they are alone

33. Closing the Interview • Summarize what has been learned • Make sure you understand what the interviewee has reported • Helps determine what additional information might be needed • Ask the child/family if they have questions • “Is there anything else I didn’t ask about that you think it would be important for me to know?”

34. Behavioral Observations • Psychological assessments always include observations about the patient’s behavior during the assessment • Collected throughout the assessment • Areas assessed/observed: • Orientation (person, place, time) • General appearance and behavior • Gait, posture, dress, personal hygiene, activity level • Speech and thought • Coherence, speed, open vs. guarded

35. Behavioral Observations • General response style • Mood and affect • Euthymic vs. dysthymic • Labile, blunted, etc. • Reactions to being evaluated • Response to encouragement • Attitude towards self • Unusual habits, mannerisms, vocalizations

36. Behavioral Observations • How child relates to parent? • How child relates to examiner? • How child reacts to test materials or toys? • Is the child age appropriate in behavior? • How is the child’s concentration?

37. Behavioral Observations • Are tantrums seen? • Does the child cooperate? • What is the extent of child’s responses? • short vs. elaborate • How is the child’s speech and language development?

38. Informal Assessment • Self-monitoring records • Report cards • Personal documents • Diaries, poems, stories • Role playing

39. Multimodal Assessment • Obtaining information from several sources • Integrate information from several sources • Recognize limitations of any one source • Using several assessment methods • Assessing several areas of functioning • Strengths and weaknesses

40. Interpreting Results • Are test results congruent with other information obtained? • How can you account for discrepancies in teacher, parent, child reports? • Do findings appear to be reliable and valid? • INTEGRATING results from multiple sources is a critical clinical skill

41. Final Steps in Assessment • Develop intervention strategies and recommendations • Write a report • Provide feedback • Follow-up

42. Key Ingredients • Successful assessment requires knowledge of: • Psychological tests • Psychopathology • Interviewing • Statistics • Development • Hypothesis testing • Your self