Psychological Evaluations for Children and Adolescents Glenn Mesman,

Psychological Evaluations for Children and Adolescents Glenn Mesman,

Psychological Evaluations for Children and Adolescents Glenn Mesman, PhD Assistant Professor Objectives Participants will be able to state the different between psychological evaluation and psychological testing Participants will be able to identify five different psychological measures Participants will be able to define a standard score and a percentile score

Participants will be able to recognize four components of a psychological evaluation Definition Process of gathering and integrating data about a persons cognitive, emotional, behavioral, and social functioning Sources of data include:

Record review History taking Behavioral observation Clinical interviews Collateral interviews Psychological tests Role of Testing Administration of specific instruments to obtain samples of behavior, which are evaluated and scored using a standardized process Any single assessment method provides only partial, incomplete, and/or biased data which are

likely to differ from that provided by other methods Psychological tests should never be the sole source of information on which diagnostic or treatment decisions are made Types Clinical Psychoeducational: evidence to suggest the possibility of learning disorder, intellectual disability, or other deficits in cognitive functioning (e.g., poor academic performance) Neuropsychological: evidence to suggest the possibility of neurologic involvement (e.g., history of

seizures, head injury, oxygen deprivation); need for in-depth assessment of cognitive functioning Types Projective: questions that have not or cannot be answered by means of other procedures or measures (e.g., thought disorder, perceptual disturbances, suicidal or homicidal ideation) Appropriate uses: Classification: aid in differential diagnosis, confirm or refute clinical impressions Description: describe symptomatology and functioning Prediction: determine prognosis, manage risk Intervention: guide treatment planning, provide assessment

feedback as a therapeutic intervention Tracking: monitor treatment response and outcomes Types Forensic Address issues related to the legal system (e.g., competencies, workmans compensation, social security benefits, child custody) Differences from clinical evaluations

Less confidential Court/lawyer is the client Fact finding Less advocacy When Psychological Evaluations are Useful Clinician or client has focused, salient questions Multiple treatment approaches exist and data exist linking treatment methods to client characteristics Client has had poor response to previous or current treatment Multiple treatment goals exist which must be

prioritized When Psychological Evaluations are Useful Client is curious and motivated Procedures are used to engage the client Family members, other informants, and other health care providers are invited to provide information Family members, other informants, and other health care providers are given detailed feedback about results Components

Identifying information and reason for referral Procedures Background history Behavioral observations Testing results and interpretations

Diagnostic impressions Summary Recommendations Patient Information and Reason for Referral Identifying information Age, sex, ethnicity, grade, school Specific reason why patient is receiving the assessment Patient was referral for a psychological evaluation for purposes of diagnostic clarification due to concerns related to anxiety, learning difficulties, and

inattention. Patient was referral for a psychological evaluation in order to determine custody arrangements. Procedures Sources of data Review of records

Behavioral observations Interview for background information Psychological testing Clinical interview/structured diagnostic interviews Collateral Background Interview

Medical and developmental history Family functioning Maltreatment history Family psychiatric history School history Social, emotional, behavioral functioning Legal history Substance use history Psychiatric history Behavioral Observations

General presentation appearance, behavior, attitude, speech Mood and affect euthymic, anxious, irritable Perceptions - hallucinations Thought processes goal-directed, logical Sensorium concentration, alertness, lucidity Judgment ability to make good decisions Insight recognize he/she is having difficulties Reliability credibility, believability Common Measures Intelligence: Wechsler scales (WPPSI-IV, WISC-V, WAIS-IV), Stanford-Binet-5, KBIT-2, RIAS, Leiter-3, TONI-IV

Academic achievement: WIAT-III, WJ-IV, WRAT-IV Language: CELF-5, TOLD, PPVT-4, EOWPVT/ROWPVT-4 Visual processing: Beery VMI, Bender-Gestalt Common Measures Adaptive behavior: Vineland-III

Emotional/behavioral/social functioning: Broad-band: Conners-3, Achenbach scales (CBCL/TRF/ YSR), BASC-3, CSI/YI/ASI-4, SCL-90. Narrow-band: CDI-2, MASC-2, UCLA PTSD Index, TSCYC/TSCC Autism Spectrum Disorder ADOS-II, CARS-2, GARS-3, GADS, SRS-2 Common Measures Personality: Objective: MMPI-A, MCMI/MAPI, PIC/PIY Projective: Rorschach, TAT/CAT, HTP, Sentence Completion

Neuropsychological: Halsted-Reitan, Luria-Nebraska, Wisconsin Card Sorting Test, DKEFS, WMS, CMS, TEA-Ch Rationale for Normed Measures Without norms, test responses are of limited value. Raw scores are converted into transformed scores, which allow you to make comparisons to normative samples. Test Scores Raw score: number of items endorsed or

answered correctly Developmental score: relative standing in years or grade levels Age equivalent: age at which the obtained raw score corresponds to average performance Grade equivalent: grade at which the obtained raw score corresponds to average performance Percentile score: percentage of people that the examinee scored as high as or higher than; scale of 0-100 Test Scores Standard score: relative standing in standard

deviation units from the mean Standard score: mean of 100, SD of 15 Scaled score: mean of 10, SD of 3 T score: mean of 50, SD of 10 Z score: mean of 0, SD of 1 Confidence interval: range of scores within an examinees true score is likely to fall; most common are 95% and 99%

Clinical Interview Process of evaluating a patient to reveal important information pertaining to past or current condition Characteristics Directed content to achieve a specific purpose Defined roles between participants Occurs at a definite time and place Serves as basic context for rest of psychological evaluation Unstructured or semi-structured

Clinical Interview Advantages Tends to have open-ended questions Facilitates the building of a therapeutic relationship Obtain data regarding frequency, intensity, duration, and severity Disadvantages Decreased reliability May obtain information that is not pertinent Does not necessarily provide data with explicit

diagnostic relevance Not as comprehensive as structured diagnostic, interview Structured & Diagnostic Interviewing Strategies Clinical inquires and probes Sequencing of clinical queries Systematic ratings of patient responses Characteristics

Organized by syndromes Feature unidirectional scoring Vary in respect to depth of coverage Vary in degree of structure and comprehensiveness Structured & Diagnostic Interviewing Advantages Reliability Reduction of information Provides information on duration and temporal

sequencing Addresses question of impairment Provides data with explicit diagnostic relevance Disadvantages Time intensive Routinization of assessment process; response bias Dependence on DSM-5 criteria Diagnostic Impressions DSM-5 diagnoses Neurodevelopmental ADHD, Specific Learning Disorder, Autism Spectrum Disorder

Depressive Disorders Major Depressive Disorder, Persistent Depressive Disorder, Disruptive Mood Dysregulation Disorder Anxiety Disorders Generalized Anxiety Disorder, Separation Anxiety Disorder, Social Anxiety Disorder Diagnostic Impressions DSM-5 diagnoses Traumatic and Stress-Related Disorders Posttraumatic Stress Disorder, Adjustment Disorder, Reactive Attachment Disorder

Disruptive, Impulse-Control, and Conduct Disorders Oppositional Defiant Disorder, Conduct Disorder Summary Restate identifying information and reason for referral Summarize test results and interpretations Rationale for diagnoses Integrate data from background interview, behavioral observations, test results, clinical/structured diagnostic interviews, and collateral sources

Functional implications of findings Recommendations School conference, special education services/504 Plan, tutoring, placement, daily report card Psychotherapy specific empirically-support treatments based on diagnostic impression Medication consultation with pediatrician or child and adolescent psychiatrist Medical hearing, vision, weight management, sleep Recommendations

Other therapies/evaluation occupational, physical, speech and language, auditory processing Supportive services case management, community supports Symptom and behavior monitoring Re-evaluation Parent psychoeducation Family custody, visitation, termination of parental rights (forensic evaluations) Closing Thoughts Some questions cant be answered by means of a psychological evaluation.

Its often difficult to achieve diagnostic certainty or predict future behavior. Practical considerations may at times take precedence in the evaluation process. Its okay to acknowledge the limits of our knowledge and methods.

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