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What is a Psychological Assessment? (Part Two)

WHAT IS a PSYCHOLOGICAL ASSESSMENT? (Part Two):

I’ve often wondered what makes up a comprehensive psychological assessment and how conclusions, diagnoses and recommendations are drawn from it.

In last post we addressed the first part of this question by describing how we would conduct such an assessment in order to gather as much information and as many impressions as possible. In this issue we’ll cover how this information is interpreted and applied.

PART TWO: Interpreting a Comprehensive Psychological Assessment

Interpretation:

1. Do the adults in this youngster’s life express any concerns they have in common? How do these concerns affect the child’s ability to function at home and school? Do there appear to be any sustainable solutions to the concerns?

2. Important: Are there any adults who appear to experience very little difficulty with this child? If so, what might account for such a difference?

3. Do the results of the assessment reflect any issues that could affect the youngster’s behavior? For example, does the child exercise appropriate reasoning and completely understand what adults are expecting of him? Are there potential difficulties with academics and learning? If so, what is the extent of these difficulties? More importantly, can these difficulties be corrected or addressed in some way?

4. Throughout the evaluation, were there any signs of defiant or noncompliant behavior, even subtle ones? What was the overall state of rapport with the youngster?

5. What value does the interview part of the evaluation bring to the whole “picture” of the youngster? Does he show remorse or concerns about issues such as failure in school or strife within the family? What would be his “message” to his parents or his teachers (see Part One)? What would be the significance of the message? Could it be addressed in treatment?

6. Is the youngster’s perception of adults reasonable and correct? If the perception is wrong (“Everybody HATES me”), how might it be changed?

7. Does the youngster see his behavior as a problem in any way? Does he have any thoughts as to how circumstances could be improved?

8. Are there any indications of other conditions, such as depression or anxiety? Is the youngster open to receiving help with these problems?

Diagnosis:

1. Is a diagnosis warranted at all? Are there alternatives to a formal diagnosis? Does the child meet criteria for a diagnosis in terms of chronicity of issues (to rule out temporary adjustment issues, such as the loss of a loved one or the stress of moving) and severity of presenting problems?

2. Is the youngster’s behavior severe enough to put him at risk for failure at school, loss of peer relationships or compounded strife at home? Unaddressed, is it possible these issues could affect functioning on into adulthood, such as securing and keeping employment or remaining in a marriage?

3. Is an additional diagnosis warranted (comorbidity)? What would it be, and why? Would this additional diagnosis add to or detract from overall understanding and treatment of this youngster?

Recommendations:

Recommendations flow logically from issues uncovered through the assessment. I have written reports containing close to 20 recommendations. Here are just a few of the more common ones.

1. Would tutoring or program changes at school address behaviors of resistance to academics?

2. In some cases, a good physical examination might be helpful.

3. Is medication indicated? If so, how can it be effectively monitored and adjusted? (This one obviously involves close coordination with a physician.)

4. Treatment in the form of counseling or therapy is often recommended, especially if the youngster is receptive to the idea. If the youngster is receptive, can he identify issues to be addressed? (Rationale: The child is more motivated to work on issues he can understand, experience and address himself. This makes a more successful starting point for therapy.)

Even when the youngster is not receptive to treatment, a trial of two or three sessions might just change his mind, especially if he sees benefits early on, and views the therapist as a resource.

5. One common issue with just about every youngster I have seen involves all they have lost. Everything has been taken away from them (toys, games, electronics, privileges, etc.) as a reaction to the child’s defiance. Although this is quite understandable, it can come with an “I just don’t care about anything anymore” price. This needs to be addressed for treatment to have a good start while, at the same time, honoring parental authority.

6. Another recommendation might to include some easy and quick compliance requests to get things rolling in a positive direction. It is important the adults make this gesture first so the youngster doesn’t believe they are trying to trick him in any way. In other words, they should meet the child more than halfway as a gesture of good faith. If the youngster doesn’t accept the good-faith gesture, that’s significant also.

7. A very important recommendation to the parents is the initiation of simple gestures toward a more positive relationship. Something as simple as a spontaneous hug or an unexpected, quick compliment can make a big difference in turning around a youngster’s perception a little at a time.

8. It’s important that we recognize any early indications of improvement and continue to encourage the youngster on an ongoing basis.

James D. Sutton, EdD, CSP

Consulting Psychologist/Certified Speaking Professional
PO Box 672, Pleasanton, TX 78064
(800) 659-6628 Email: suttonjd@Docspeak.com
Website: http://www.docspeak.com
Blog: https://itsaboutthem.wordpress.com

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May 23, 2011 Posted by | Uncategorized | Leave a comment

What is a Psychological Assessment? Part One

WHAT IS A PSYCHOLOGICAL ASSESSMENT? (Part 1)

I’ve often wondered what makes up a comprehensive psychological assessment and how conclusions, diagnoses and recommendations are drawn from it.

There are a number of ways to conduct such an evaluation; none of them represent the right or wrong way to do it. When I was doing a lot of testing, I followed a format that worked well for me. It’s lengthy, so we’ll break it into two parts, one here and one in the next post.
PART ONE: Conducting a Comprehensive Psychological Assessment
A good and comprehensive psychological assessment can take a lot of guesswork out of treatment and interventions. It can also alert parents and teachers to issues that had been hidden. More than anything, however, a good evaluation provides a snapshot of a youngster as he sees himself and his circumstances. Because of the structure of the assessment (and the skill of the examiner) spontaneous, unique and valuable information often is obtained for the very first time.
What follows are what I see as essential components of a comprehensive psychological assessment.
Review of Available Records and Reports: This could include school records, medical reports, other assessments, and any additional information that could help us get a total picture of this youngster and his behavior.
Interviews with Parents and Teachers: This can be done in writing or in person. My concern here is not everything a child has said or done since birth, but rather what the parent(s) and teacher(s) select as their primary concerns. These can differ greatly from adult to adult. I am not a fan of checklists; the information from them is often unclear. I would prefer these adults take out a sheet of paper and tell me in their own words their concerns regarding this youngster. Consequently, they almost start with the most important impressions first, and work down from there. That is very helpful.
Perceptual-motor Assessment: I prefer to start with this one because, early on, it’s easier for a youngster to “do” something rather than “say” something. It’s a good rapport-builder. I’m usually not all that interested in the scores on instruments like the Bender Visual-motor Gestalt Test or the Goodenough-Harris Drawing Test. I am more interested in the subtle patterns of oppositional and defiant behavior that can surface on these instruments.
Assessment of Intellectual Functioning: IQ testing is critical. (If this information is already available, I don’t see a need in putting a child through it again.) Intellectual assessment not only establishes a youngster’s cognitive “horsepower,” but identifies strengths and needs, as well as learning styles. It also establishes a baseline for a youngster’s abilities to exercise insight, because strong insight connects well with the capacity to change. (This isn’t always an asset, as in the case of an extremely bright child who knows how to work adults.)
Assessment of Academic Functioning: Here’s where we attempt to settle the issue of academic potential versus actual performance. This could be called the diagnosis of will versus skill. This portion of the assessment can help determine if academic difficulties play into a youngster’s behavior.
Projective Assessment: This one drives bright, defiant youngsters crazy because they know they’re being evaluated, but they can’t discern “correct” answers, nor can they pick up on the direction or purpose of the instrument. (I still use the old tried and true Rorschach inkblots, plus sentence completion and thematic instruments.) Projective assessment is a great way to gain a ton of information about perception and behavior without the child even knowing it.
Diagnostic Interview: This one is the very heart of the assessment. A good interview not only collects valuable information in the child’s own words (extremely important), it lets the youngster consider issues he feels are important. This can make all the difference in terms of gaining the youngster’s cooperation and input regarding goals for treatment. Questions in the interview cut across all aspects of the child’s day-to-day life, and even include questions like: “If you could give your parents a message they would hear clearly from you, what would it be?” Through the years, I’ve received some very interesting answers to that question.
In Part Two: Interpreting a Comprehensive Psychological Assessment

James D. Sutton, EdD, CSP

Consulting Psychologist/Certified Speaking Professional
PO Box 672, Pleasanton, TX 78064
(800) 659-6628 Email: suttonjd@Docspeak.com
Website: http://www.docspeak.com
Blog: https://itsaboutthem.wordpress.com

May 17, 2011 Posted by | Counselors, Educators, family, Uncategorized | 15 Comments

“Is There a Connection”

“IS THERE A CONNECTION?”

Is there a connection between ODD and the use of drugs and alcohol?

I believe there can be a connection, although not necessarily in a direct sense. Oppositional Defiant Disorder is a condition of young people exclusively, while the use and abuse of drugs (even prescribed medications) and alcohol is more attributed to adults, or “near” adults. The connection is the need for soothing. The desire to be soothed in difficult moments is not defined by age. Babies need it; adults need it.

Have you ever known a truly ODD youngster whose life was in place, who was authentically happy and was functioning well? Of course not. (If they were doing that well, they wouldn’t be ODD.) The very fact that ODD kids consistently and repeatedly destroy their own outcomes (one condition of the diagnosis) essentially assures they will not be happy. (They can tell you they are happy; but the facts point to a different truth.)

I believe most ODD youngsters need and want to be soothed. They might not do it with drugs and alcohol, but they do it with a focus on things and activities of distraction.

I had a patient once who started bouncing up and down as our session came to a close.

“Why are you bouncing like that?” I asked him.

“Because I’m going to get a TOY, a TOY! I’m going to get a TOY!”

His mother had coaxed him to my office with the promise of a toy before they went home. It was the only thing he could focus on as we were wrapping up. It’s like he was “addicted” to how a new toy would make him feel, although Mom assured me the toy would be completely demolished before he ever got home with it.

If you were to fast-forward this boy’s life 10-15 years, it wouldn’t be much of a stretch to see where abuse of drugs and alcohol could be a real possibility. And just how stable do you think his relationships would be at that point?

This is precisely why early intervention is so important.

James D. Sutton, EdD, CSP

Consulting Psychologist/Certified Speaking Professional
PO Box 672, Pleasanton, TX 78064
(800) 659-6628 Email: suttonjd@Docspeak.com
Website: http://www.docspeak.com
Blog: https://itsaboutthem.wordpress.com

May 10, 2011 Posted by | Uncategorized | 1 Comment