Introduction to Psychological Assessment of Children Gregg Selke, Ph.D. PSY 4930 October 3, 2006

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-Specific 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 interpret data and

synthesize resultssynthesize results

Psychological Testing

Require standardized proceduresstandardized 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 assessment1. Norm-referenced tests2. Interviews3. Observations4. Informal assessment procedures5. 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 group Examples

Intelligence Academic skills Neurocognitive skills Motor skills Behavioral and emotional functioning


Psychometric properties Demographically representative

standardization sample 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

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

““Normal” or “Bell” curveNormal” or “Bell” curve


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 light


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


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, mannerisms

Examiner Nonverbal Behavior

Positive Behaviors Negative BehaviorsGood eye contact Avoiding eye contact,

staring or peering

Body posture—leaning towards child

Body posture - laid back, feet propped up

Interested, natural voice

Interrupting child often

Not engaging in distracting gestures

Looking at watch, chewing gum, running hands through hair, etc.

Taking minimal notes while continuing to make frequent eye contact

Taking excessive notes and seldom looking at child

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 trustworthy

Clinician feels positive regard, genuineness, and empathy

Necessary condition


Use of communication skills Acknowledgements Descriptive Statements Reflections Praise Periodic Summaries Elaboration Clarification


Avoid: Lack of interest or not attending Sarcasm Lecturing Interrupting Commands No eye contact Criticisms

Interviewing

Types of interviews: Unstructured—allow child/parent to “tell

their story” 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 skill??

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 Interview

A. History of presenting problemB. Prenatal, perinatal, and early postnatal

historyC. Medical historyD. Acquisition of age-related milestonesE. School historyF. Personality, social, emotional, behavioral

historyG. Family historyH. Expectations about assessment visit


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


B. Prenatal, perinatal, and early postnatal history

Pregnancy Labor and delivery Birth weight Apgar scores Complications post-birth


C. Medical history Across all ages Accidents & injures Major illnesses Ear infections Neurological conditions Congenital and genetic conditions Hearing and eyesight


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


F. Personality, social, emotional/mood, behavioral history across development

Temperament as an infant and toddler 2.5-5 years: Development of play, aggression,

interests 5-11 years: Hobbies, activities, friendships,

family relationships 11 to adolescence: Development of interest in

opposite sex, dating and sex, activities, drug and alcohol use, family relationships, self-concept, goals and aspirations


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 kindergarten

Young teens might be asked about the transition to individualized school schedules and homework, and peer pressures.

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 structured 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

questions “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


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,

vocalizations


How child relates to parent? How child relates to examiner? How child reacts to test materials

or toys? Is the child age appropriate in

behavior? How is the child’s concentration?


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 development?

Informal Assessment

Self-monitoring records Report cards Personal documents

Diaries, poems, stories Role playing

Multimodal Assessment

Obtaining information from several sources 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 valid?

INTEGRATING results from multiple sources is a critical clinical skill

Final Steps in Assessment

Develop intervention strategies and recommendations

Write a report Provide feedback Follow-up

Key Ingredients

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

Documents

Introduction to Psychological Assessment of Children Gregg Selke, Ph.D. PSY 4930 October 3, 2006