Introduction to Psychological Assessment of Children

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					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/Problem-
 Diagnostic
       Differential and Comorbid Conditions
   Therapy Oriented
       Identify target problems
       Develop preliminary intervention plan
   Progress evaluation
       How well are ongoing interventions working?
        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
             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
         Psychological Assessment

    Main types of assessment
    1.   Norm-referenced tests
    2.   Interviews
    3.   Observations
    4.   Informal assessment procedures
    5.   Non-norm referenced tests
          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
   Examples
       Intelligence
       Academic skills
       Neurocognitive skills
       Motor skills
       Behavioral and emotional functioning
             Norm-Referenced Tests

   Psychometric properties
       Demographically representative standardization
       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
                “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 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
     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
     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
     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 child’s behavior while
        still correctly administering the test
       Self-awareness: how do children typically
        react to your style, body language,
  Examiner Nonverbal Behavior
   Positive Behaviors         Negative Behaviors
Good eye contact            Avoiding eye contact,
                            staring or peering
Body posture—leaning        Body posture - laid back,
towards child               feet propped up
Interested, natural voice   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
       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

   Types of interviews:
       Unstructured—allow child/parent to ―tell their
       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
         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)
       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
          Example Developmental
A.   History of presenting problem
B.   Prenatal, perinatal, and early postnatal history
C.   Medical history
D.   Acquisition of age-related milestones
E.   School history
F.   Personality, social, emotional, behavioral
G.   Family history
H.   Expectations about assessment visit
            Example Developmental
A.       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
            Example Developmental

B.       Prenatal, perinatal, and early postnatal
          Pregnancy
          Labor and delivery
          Birth weight
          Apgar scores
          Complications post-birth
            Example Developmental

C.       Medical history
          Across all ages
          Accidents & injures
          Major illnesses
          Ear infections
          Neurological conditions
          Congenital and genetic conditions
          Hearing and eyesight
             Example Developmental
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
F.   Personality, social, emotional/mood, behavioral
     history across development
        Temperament as an infant and toddler
        2.5-5 years: Development of play, aggression,
        5-11 years: Hobbies, activities, friendships, family
        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

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 child’s level
       Open vs. Closed questions
    Developmental Considerations
   6 year olds might be asked about the
    difference between preschool and
   Young teens might be asked about the
    transition to individualized school
    schedules and homework, and peer
   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
       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
   ―Is there anything else I didn’t ask
    about that you think it would be
    important for me to know?‖
             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
         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,
       Behavioral Observations

   How child relates to parent?
   How child relates to examiner?
   How child reacts to test materials or
   Is the child age appropriate in
   How is the child’s concentration?
         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
            Informal Assessment

   Self-monitoring records
   Report cards
   Personal documents
       Diaries, poems, stories
   Role playing
          Multimodal Assessment

   Obtaining information from several
       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
   INTEGRATING results from multiple
    sources is a critical clinical skill
      Final Steps in Assessment

   Develop intervention strategies and
   Write a report
   Provide feedback
   Follow-up
                Key Ingredients

   Successful assessment requires
    knowledge of:
       Psychological tests
       Psychopathology
       Interviewing
       Statistics
       Development
       Hypothesis testing
       Your self