What does psychological Assessment for children look like?
For many people, psychology and psychological testing are mysterious. What exactly is the psychologist trying to measure? Why did my child’s pediatrician refer him for an evaluation? What do the results mean? Who will be able to see them? Is there some sort of permanent psychological record that will follow my child for her entire life?
If your child has been referred for a psychological evaluation or if you’ve been considering questions about their mood, thinking, or behavior, this post provides a clearer picture of what a psychological evaluation is and how it can help.
What are common reasons children are referred for psychological assessment?
Many children are referred for psychological evaluations, so rest assured that a recommendation for evaluation does not mean that your pediatrician or other professional thinks your child is flawed in some way. In 2021-2022 in the United States, 7.3 million students ages 3-21 received academic services through an Individualized Education Program (IEP), which equals about 15% of all students enrolled in public school. Although it is not necessary for every student served under special education law (IDEA) to undergo psychological evaluation, a large majority of these students did. That gives a broad idea of just how many children were evaluated through the school system alone. If we count the evaluations that occur at psychological practices and hospitals around the country, there would be many more.
Common reasons children are referred for psychological assessment include possible Autism Spectrum Disorder, concerns for learning disability or learning problems, signs of giftedness or academic excellence, suspected developmental or cognitive concerns, attention or executive functioning challenges, behavioral disturbance that has been resistant to intervention, emotional difficulties that affect the child’s functioning, and common medical problems or disorders that can be associated with learning or mental health challenges (e.g., birth defects, family history of challenges, and complicated births).
Psychological evaluations are especially helpful for answering questions about a child’s functioning. The results of an evaluation are used to guide specific recommendations based on a child’s strengths and areas of growth to help them to succeed and meet their goals.
What IS psychological assessment?
Psychological assessment is the process of understanding how a person thinks, feels, and behaves. It often involves some or all of the following:
A detailed interview with the parent(s) and child, when appropriate. This interview, also called an “intake,” is a key part of the evaluation process and should include information about the child’s birth history, medical and mental health histories, developmental history, aspects about their family life and any changes or traumatic events that have happened over time, history of family mental health or developmental concerns, current concerns or questions the child or family have, and information about the child’s level of independence in everyday activities.
A measurement of cognitive functioning (commonly called “IQ testing”) provides a summary of someone’s problem solving and knowledge across multiple areas. Typical standardized tests include measures of verbal understanding and processing of language-based information; visual spatial skills, including solving puzzles and replicating designs seen in pictures; the ability to apply previously learned information to new problems and situations, often referred to as “fluid reasoning”; the ability to hold information in your mind for short periods and make changes to it (i.e., working memory); and the ability to do simple things quickly (i.e., processing speed).
The evaluation of school-based skills, often referred to as “achievement testing” is common. This includes measuring the child’s progress in learning traditional academic subjects, like reading, writing, and math, and their foundations. Testing may evaluate how a child understands phonics, quantities, or other aspects of learning, and how quickly and efficiently the child processes information necessary to complete schoolwork. Achievement testing is a key part of the evaluation of learning disabilities and giftedness.
Other assessments of cognitive functioning may look at memory, attention, impulse control, problem solving, planning, organization, language, social understanding, and visual perception.
The assessment of social communication and play skills is often used to evaluate the presence of Autism Spectrum Disorder. Social skills are typically evaluated using an interactive play or activity based measure, like the Autism Diagnostic Observation Schedule - 2nd Edition (ADOS-2), as well as parent-report forms and other observations by the examiner.
Parents are asked to complete questionnaires that measure their perceptions of the child’s behavior, emotions, and self-help skills. Teachers are also commonly asked to complete questionnaires with similar information that helps the psychologist understand how the child functions in settings outside of the home.
All of the information collected during the assessment is then used to create a cohesive picture of the child’s strengths and challenge areas. The psychologist scores and interprets the results and may provide diagnoses that describe the pattern of thinking, feeling, and/or behavior the child exhibits.
How do you compare one child to another?
The process of standardization is what compares a child to their appropriate peer group. Tests that are standardized are given to large numbers of children in order to provide a clear picture of what most children in a certain age group are able to do (i.e., fall in the average range), skills that are above average for the child’s age, and those that a child should be able to do but is not yet able (below average). Intelligence, as measured by IQ tests, is thought to be stable after a certain age (typically between 5-7). That means that if tested repeatedly, a person’s IQ is likely to fall within a specific range (i.e. “confidence interval”).
What does a psychological assessment look like?
A psychological assessment doesn’t necessarily look like play, but it also doesn’t typically look like school tests (except for achievement testing). There are many small activities, called “subtests,” that are completed with the child. These activities usually start with some instruction from the psychologist (e.g., “listen and answer these questions”). Some psychologists use iPads to administer tests, while others stick to paper-and-pencil. Regardless of the use of technology, the evaluation uses different ways of measuring skills. Some subtests may include blocks, while others include writing, drawing, or answering questions out loud. Some parts of the assessment, including the ADOS-2, do involve toys. It is common for children to think that some of the activities they have done are fun, while others are boring.
From an observer’s perspective, the assessment looks like a child seated at a table with an adult who is asking them to do different things. Of course, if the child isn’t able to sit at the table or has a lot of energy, you may also observe the psychologist or their helpers moving around the room to engage the child’s attention.
What do the results of the assessment mean?
The results of the assessment help to provide a clear path forward for your child and your family. A diagnosis is not always given, but there should always be a discussion of the child’s strengths and growth areas. While diagnoses can be used to open doors for services and accommodations that a child may need to thrive, they aren’t the only goal of the evaluation. If your child’s evaluation does not provide a diagnosis, the results should at least provide an understanding of how to support them through any challenges they are experiencing. For example, a child who has a hard time understanding complex directions may benefit from a schedule that includes pictures, a checklist they can complete when doing a task, or shortened directions from their parents. A teen who works well with puzzles and hands-on activities may prefer classes that use these strategies to teach lessons, rather than those that are lecture-based. Autistic children often benefit from different teaching and discipline strategies than their non-autistic peers.
Who will be able to see them?
In most situations, you (the parent) are able to decide who sees your child’s results. If the school is providing the assessment and you have consented to it, then you and the school will be the only ones who see the results, unless you explicitly give permission for the results to be shared elsewhere. If you decide that you want to take your child to a psychologist outside of the school system, then you are in charge of who sees the results of their testing. Sometimes medical providers who care for your child will be able to see their results, if they share an electronic medical record system with the psychologist who completed the evaluation. It is often helpful to share the report or results with pediatricians or other professionals who are involved in your child’s care; however, there is no universal system or mental health record that will follow your child as they grow. That is, there is no mental health “permanent record.”
What are the benefits of psychological assessment?
The benefits of psychological evaluation depend on the person and the situation. For children who are experiencing challenges in school or social settings, the evaluation may help to answer why they are having difficulties and how to help them overcome their challenges. Many mental health and medical providers benefit from seeing the results of a psychological evaluation and the recommendations that accompany it in order to make a plan of care that is individualized to the child. Parents and children will learn strategies to help make life better and less stressful at home and other settings.
In sum, psychological assessment is not meant to be a scary or overwhelming process. We all have strengths and growth areas that reveal themselves throughout our lives. Psychological assessment is one tool that can help to identify a child’s superpowers and make their lives a little easier.
About the author
Dr. Jenna Wallace (PsyD) is a clinical psychologist who specializes in the assessment and treatment of children with neurodevelopmental disorders and medical complexities. She is the co-owner of Unlocked Potential, PLLC.
References: https://nces.ed.gov/programs/coe/indicator/cgg/students-with-disabilities
