Introduction to Psychological Assessment of Children

Gregg Selke, Ph.D. PSY 4930 October 3, 2006

Purpose of Psych. Assessment

Goal Driven Broad Screening versus Focused/ProblemSpecific Diagnostic

Differential and Comorbid Conditions Identify target problems Develop preliminary intervention plan How well are ongoing interventions working?

Therapy Oriented

Progress evaluation

Testing vs. Assessment

Both involve

Identifying areas of concern Collecting data Administering tests Focuses solely on collection of data More broad goals Involves several clinical tools Uses clinical skill to interpret data and synthesize

Psychological Testing

Psychological Assessment

results

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 childs performance

Psychological Assessment

Main types of assessment

1. 2. 3. 4. 5.

Norm-referenced tests Interviews Observations Informal assessment procedures Non-norm referenced tests

Norm-Referenced Tests

Tests that are standardized on a clearly defined group

Goal: quantify the childs functioning Scores represent a rank within the comparison group Examples

Normative versus clinical reference groups

Intelligence Academic skills Neurocognitive skills Motor skills Behavioral and emotional functioning

Norm-Referenced Tests

Psychometric properties

Demographically representative standardization sample Reliability

Internal consistency, test-retest stability Correlation with other tests measuring same construct Ecological

Validity

Psychological tests are imperfect

Examiner, the child, and the environment can affect responses and scores

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

Norm-Referenced Tests

Percentile ranks

Determines childs position relative to the comparison group Example: What does it mean when a child is in the 35th %tile on an Intelligence test?? Frequently used on academic achievement tests Sometimes questionable validity

Age-Equivalent and Grade-Equivalent scores

Variables Affecting Test Scores

Demand characteristics

Child may give a certain type of response in order to obtain a desired outcome Childs response to one item may influence how they respond to subsequent items Tendency to present ones self in a positive light

Response bias

Social desirability

Variables Affecting Test Scores

Misinterpretation of Items

Misunderstanding directions

Format of instructions

Oral vs. written

True-false, written, oral, timed, untimed Location, time of day, medication status Practice effects

Response format

Setting variables

Previous testing experience

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

Administering Tests

Administering psychological tests to children requires specific skills

Flexibility: breaks, time to warm up, establishing rapport Vigilance: attend to childs behavior while still correctly administering the test Self-awareness: how do children typically react to your style, body language, mannerisms

Examiner Nonverbal Behavior

Positive Behaviors
Good eye contact Body postureleaning towards child Interested, natural voice

Negative Behaviors
Avoiding eye contact, staring or peering Body posture - laid back, feet propped up Interrupting child often

Not engaging in distracting Looking at watch, chewing gestures gum, running hands through hair, etc. Taking minimal notes while Taking excessive notes and continuing to make seldom looking at child frequent eye contact

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

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

Establishing Rapport

Use of communication skills

Acknowledgements Descriptive Statements Reflections Praise Periodic Summaries Elaboration Clarification

Establishing Rapport

Avoid:

Lack of interest or not attending Sarcasm Lecturing Interrupting Commands No eye contact Criticisms

Interviewing

Types of interviews:

Unstructuredallow child/parent to tell their story Semi-structuredprovide flexible guidelines, a starting point Structuredmost 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??

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

Interviewing Techniques

Establishing rapport is crucial Moving from open-ended to closed-ended questions (general to specific)

Avoid

Tell me about why youre here today? What about school is most difficult for you? Are you failing math because you didnt hand in your homework.not studyingdidnt understand the material?

Double-barreled questions (and, or) Long, multiple questions Leading questions Psychological jargon

Example Developmental Interview

A. B. C. D. E. F.

G. H.

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

Example Developmental Interview

A.

History of presenting problem

Parental description of problem Childs view of problem Onset Duration Interventions attempted Prior assessments Parents sense of effects of problem, and sense of childs understanding

Example Developmental Interview

B.

Prenatal, perinatal, and early postnatal history

Pregnancy Labor and delivery Birth weight Apgar scores Complications post-birth

Example Developmental Interview

C.

Medical history
Across all ages Accidents & injures Major illnesses Ear infections Neurological conditions Congenital and genetic conditions Hearing and eyesight

Example Developmental Interview

D.

Acquisition of age-related milestones

Motor Language Toileting

E.

School history
Preschool experiences to present Settings Achievement, grades, strengths and weaknesses Behavioral, emotional, social functioning IEPs, 504 Plans, accommodations, modifications What teachers think

Example Developmental Interview

F.

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

Example Developmental Interview

G.

Family history
Parental history: marriage(s), # children Demographics, ages, education, occupation, SES Siblings: ages, problems, school history Medical, genetic, developmental, psychological, abuse problems

H.

Expectations about assessment visit

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 childs level

Open vs. Closed questions

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

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

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

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 didnt ask about that you think it would be important for me to know?

Behavioral Observations

Psychological assessments always include observations about the patients 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 Coherence, speed, open vs. guarded

Speech and thought

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

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 childs concentration?

Behavioral Observations

Are tantrums seen? Does the child cooperate? What is the extent of childs responses?

short vs. elaborate

How is the childs speech and language development?

Informal Assessment

Self-monitoring records Report cards Personal documents

Diaries, poems, stories

Role playing

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

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

Final Steps in Assessment

Develop intervention strategies and recommendations Write a report Provide feedback Follow-up

Key Ingredients

Successful assessment requires knowledge of:

Psychological tests Psychopathology Interviewing Statistics Development Hypothesis testing Your self