Psychological testing

No child or adolescent assessment can be complete without some assessment of intellectual and academic functioning and attainment. At the very least, some sort of simple assessment needs to be performed, along the lines of asking about the ages at which a child reached early developmental milestones (such as crawling/bottom shuffling, babbling, first words, first multi-word sentences) and finding out whether the child can read and understand language at something approaching an age-appropriate level. Information from teachers is particularly useful here, since it also provides a good picture of the child's attainment (which may be further elucidated through the use of standardized tests, such as the revised version of the Woodcock-Johnson Psychoeducational Battery (27>), whatever the measured intelligence may be. It is important to bear in mind that the specific disorders of reading and mathematical ability are associated with child psychopathology, particularly the disruptive behaviour disorders.

Detailed assessment of intellectual ability requires special training and, with low-functioning or pervasively developmentally disordered children (e.g. autistic children), a good deal of special experience. A good psychological evaluation should include subtest performances on an IQ test like the Wechsler. (28) Measures of language, reading, and mathematical ability can be invaluable diagnostic tools, particularly when educational failure is a part of the clinical picture. It is important to remember, however, that the diagnosis of mental retardation is not simply based upon IQ scores, but also upon functional disability which must also be measured (for instance, with the Vineland Adaptive Behavior Scales(29)). The results of relatively 'general' tests such as these may be supplemented by the addition of more specific individual neuropsychological tests or reasonably well-normed test batteries. An excellent introduction to the topic of psychological testing in child and adolescent psychiatry can be found in Halperin and McKay,(30) and an overview of the assessment of language and learning disorders can be found in the Practice Parameters of the American Academy of Child and Adolescent Psychiatry.'3!ยป

The once ubiquitous projective tests have proved relatively unreliable, and were long ago shown to add little to the evaluation that could not be obtained more efficiently by direct means and probably now have little part to play in the evaluation of most clinically referred children and adolescents. One exception may be in the area of assessing affective states in preschool children and those in the early grades, where some recent work suggests that useful information may be gleaned from story completion tasks and standardized interactions with puppets. It remains to be seen whether such techniques deserve to become part of the typical assessment of younger children.

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