What is psychological testing?
Psychological evaluation is often helpful in understanding the strengths and challenges a child may have in their cognitive, behavioural, learning and socio-emotional functioning. The psychological assessment process allows for diagnostic clarity and individualized recommendations. Often children who are struggling with managing their behaviour, academic work, social interactions, and emotion regulation have atypical neurological development that can be identified through psychological assessment. In many ways, psychological testing and assessment are similar to medical tests. If a patient has physical symptoms, a primary care provider may order X-rays or blood tests to understand what is causing those symptoms. The results of the tests will help inform develop a treatment plan.
Psychological evaluations serve the same purpose. Psychologists use tests and other assessment tools to measure and observe a child’s behaviour to arrive at a diagnosis and guide treatment. This further allows for parents, teachers, and therapists to provide intervention and accommodations needed to allow each child to reach their potential. It is important to remember that “one size fits all” is not an approach that is applicable to the treatment of psychological disorders and problems.
Psychologists administer tests and assessments for a wide variety of reasons. Children who are experiencing difficulty in school, for example, may undergo aptitude testing or tests for learning disabilities. If a child is having problems in school, or in personal relationships, tests can help a psychologist understand whether he or she might have issues with emotional regulation, communication or interpersonal skills, or certain personality traits that contribute to the problem.
What kinds of tests are available in the community what are processes I need to be aware of?
There are hundreds of different types of psychological tests available in the market and accessible to qualified and trained psychologists. Psychologists choose tests based on factors such as
(i) nature of presenting issues,
(ii) age and abilities of the child,
(iii) validity and reliability of tools and,
(iv) regulation of local and international educational bodies (e.g. Ministry of Education Singapore).
A major component of a psychological assessment is information gained from those who know the child well. Rating scales may be completed by teachers, parents/guardians and the child (dependent upon their age) in order to gain information about the child in various environments and situations. This is an important part of the evaluation process, and allows those who interact with the child to share any concerns that they have about academics, attitudes toward school and home, behaviour (such as inattention, withdrawn behaviour, hyperactivity, conduct issues), socialization, etc. Other relevant background information (e.g. health history, development, any home situations such as divorce, illness of family members, languages spoken at home, etc.) may be collected by an interview, a developmental history form, and or/ with a review of school records. Gaining historical information about the child is vital, as it may help the psychologist in his/her decision making. It is important to recognize that psychological testing is a process.
However, in most cases, psychological assessment should contain a series of measures. These measures often include a standardized cognitive battery of tests (common tests include the Wechsler series of scales), measures of personality, behaviour, social and emotional functioning, and/or adaptive functioning. Diagnostic tools, such as but not limited to ADOS and ADI-R (for Autism and Social Communication Disorders) may also be used depending on the nature of the assessment and training of the psychologist.
I am afraid to test my child as I do not want my child to be labelled? How is someone who has only seen my child for a few hours going to diagnose my child?
As previously mentioned, testing is process. If the purpose of the assessment is to arrive to a diagnosis (to better understand your child’s needs and experiences), it is likely that testing will occur over 6-10 hours. This will ensure that the diagnosis is based on objective tools rather than purely impressions or based on personal biases.
Diagnoses allow your psychologist to better understand the needs for your child. Through a clearer understanding of your child’s unique strengths and weaknesses, the psychologist to identify treatments that are evidenced based and shown to be helpful and efficient among individuals with similar challenges as your child. Furthermore, the diagnosis does not go onto any kind of database and ought to be reviewed on a timely basis.
Let’s look a case of child where testing assisted with targeted intervention.
Mary is a 6 year 10 month old child who was referred for testing by her school. Her mother reported that she was informed that her daughter was at risk from being expelled from school due to her behaviours. These included walking out of the classroom or into the rain, restlessness, walking out of line, talking about unrelated concepts, limited social interaction and hitting her peers. Furthermore, her mother shared that Mary’s teachers had commented that Mary showed characteristics of Autism and ADHD. Mary’s mother added that her daughter reported being bored and school refusal. The present assessment aimed on identifying the underlying DSM-5 diagnosis contributing to her present challenges and developing an individualized treatment plan.
The assessment process comprised of natural observation of Mary in school, an IQ test, various neuropsychological tools assessing attention, executive functioning, memory and social perception, emotional measures and indirect measures of behaviour.
Observations of Mary in school revealed a child who was impulsive, active and struggled with following the routine (even though she had been attending the school for almost 10 months). Due to her behavioural challenges, she appeared to benefit from additional attention (re-directing her back to the task at hand) and learning support. Formal testing revealed that school personnel and her parents struggled with managing her behaviour and related emotional reactions (Mary was starting to engage in emotional outbursts and refuse going to school).
The neuropsychological measures used revealed the absence of challenges with executive functioning, learning, memory and attention; thereby, ruling out ADHD. Social perception tests, which comprised of tasks evaluating affect recognition and theory of mind (both of which are seen as areas of deficits in young children with ASD and Social Communication Disorder), revealed that her abilities in these areas were well developed (and therefore, suggesting no further testing to evaluate for ASD). Interestingly, the cognitive measure revealed that Mary’s Full Scale IQ (FSIQ) score fell in the fell in the Extremely High range when compared to other children her age (FSIQ = 144). Other areas of cognition were also similarly developed. Emotional measures revealed some low mood;
though not clinically significant. Lastly, behavioural observations in session and during the school visit were indicative of sensory seeking behaviours. Further testing confirmed sensory processing issues.
Overall, the findings of the assessment ruled out Autism, Social Communication Disorder and ADHD.
In fact, Mary met the criteria for Giftedness. She also had Sensory Processing issues. Recommendations focused on assisting school her parents managing her behaviour through keeping her stimulated and meeting her cognitive needs. She also received Occupational Therapy to target her sensory needs. After, several months of Occupational Therapy and changes to way teacher approached Mary, her emotional experience was re-assessed and was shown to be within age-expected levels. Her mother also reported that teachers were able to manage her daughter in the classroom. Most importantly, when her cognitive needs were met, Mary enjoyed going to school and being expelled was no longer a worry.
If testing was not considered, the likely treatment approach to manage challenging behaviour would have first been behaviour management and enrolment into social groups. Speech and Occupational Therapies would also been kept in view.
For more information on our testing services at Thomson, please refer to http://www.thomsoncdc.com/our-services/psychology/
Written by: Dr. Sanveen Kang, Principal Clinical Psychologist & Centre Manager