child psych assessment
TRANSCRIPT
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Introduction to PsychologicalAssessment of Children
Gregg Selke, Ph.D.
PSY 4930October 3, 2006
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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?
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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 synthesize
results
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Psychological Testing
Require standardized proceduresforbehavior measurement
Consistency and use of the same Item content
Administration procedures
Scoring criteria
Designed to reduce personal differencesand biases of examiners and other externalinfluences on the childs performance
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Psychological Assessment
Main types of assessment
1. Norm-referenced tests
2. Interviews
3. Observations
4. Informal assessment procedures
5. Non-norm referenced tests
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Norm-Referenced Tests
Tests that are standardized on a clearlydefined group Normative versus clinical reference groups
Goal: quantify the childs functioning Scores represent a rank within the comparison
group Examples
Intelligence Academic skills Neurocognitive skills Motor skills
Behavioral and emotional functioning
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Norm-Referenced Tests
Psychometric properties
Demographically representative standardizationsample
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
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Most attempt to be normally distributed
Standard deviation: Commonly used measure of theextent to which scores deviate from the mean
In a Normal distribution, 68% of cases fall between 1 SDabove the mean and 1 SD below the mean
The threshold for meeting clinical significance variesacross tests, typically > 1 to 2 SDs above or below mean
Normal or Bell curve
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Norm-Referenced Tests
Percentile ranks
Determines childs position relative to thecomparison group
Example: What does it mean when a child is inthe 35th %tile on an Intelligence test??
Age-Equivalent and Grade-Equivalent scores
Frequently used on academic achievement tests Sometimes questionable validity
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Variables Affecting Test Scores
Demand characteristics
Child may give a certain type of response
in order to obtain a desired outcome Response bias
Childs response to one item may influence
how they respond to subsequent items Social desirability
Tendency to present ones self in a positive
light
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Variables Affecting Test Scores
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
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Variables Affecting Test Scores
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 affectedby examiner characteristics
Familiar vs. unfamiliar examiner
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Administering Tests
Administering psychological tests tochildren requires specific skills
Flexibility: breaks, time to warm up,establishing rapport
Vigilance: attend to childs behavior whilestill correctly administering the test
Self-awareness: how do children typicallyreact to your style, body language,mannerisms
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Examiner Nonverbal Behavior
Positive Behaviors Negative Behaviors
Good eye contact Avoiding eye contact,staring or peering
Body postureleaningtowards 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 handsthrough hair, etc.
Taking minimal notes whilecontinuing to make
frequent eye contact
Taking excessive notes andseldom looking at child
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Other Testing Issues
Introducing yourself to child
Explaining what the child will be doing
Letting them know where their parent will beduring the assessment
Providing adequate expectations
Developmental considerations
Younger children Older children
Praising effort NOT performance
Setting limits on behavior
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Establishing Rapport
the sense of mutual trust and harmonythat 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
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Establishing Rapport
Use of communication skills
Acknowledgements
Descriptive Statements Reflections
Praise
Periodic Summaries Elaboration
Clarification
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Establishing Rapport
Avoid:
Lack of interest or not attending
Sarcasm Lecturing
Interrupting
Commands No eye contact
Criticisms
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Interviewing
Types of interviews: Unstructuredallow child/parent to tell their
story
Semi-structuredprovide flexible guidelines, astarting point
Structuredmost often used to make diagnoses orin 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 clinicalskill??
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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
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Interviewing Techniques
Establishing rapport is crucial Moving from open-ended to closed-ended
questions (general to specific)
Tell me about why youre here today? What about school is most difficult for you? Are you failing math because you didnt hand in
your homework.not studyingdidntunderstand the material?
Avoid Double-barreled questions (and, or) Long, multiple questions Leading questions
Psychological jargon
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Example DevelopmentalInterview
A. History of presenting problem
B. Prenatal, perinatal, and early postnatal history
C. Medical historyD. Acquisition of age-related milestones
E. School history
F.
Personality, social, emotional, behavioralhistory
G. Family history
H. Expectations about assessment visit
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Example DevelopmentalInterview
A. History of presenting problem
Parental description of problem
Childs view of problem Onset
Duration
Interventions attempted Prior assessments
Parents sense of effects of problem, andsense of childs understanding
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Example DevelopmentalInterview
B. Prenatal, perinatal, and early postnatalhistory
Pregnancy Labor and delivery
Birth weight
Apgar scores Complications post-birth
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Example DevelopmentalInterview
C. Medical history
Across all ages
Accidents & injures Major illnesses
Ear infections
Neurological conditions Congenital and genetic conditions
Hearing and eyesight
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Example DevelopmentalInterview
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
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Example DevelopmentalInterview
F. Personality, social, emotional/mood, behavioralhistory 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
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Example DevelopmentalInterview
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
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Developmental Considerations
Young children tend to think in concreteways, while teens may reflects more onfeelings and motivations
While age is an obvious indicator ofdevelopmental level, language and cognitivelevels may also vary with age
Interview format should be adjusted to theindividual childs level
Open vs. Closed questions
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Developmental Considerations
6 year olds might be asked about thedifference between preschool andkindergarten
Young teens might be asked about thetransition to individualized schoolschedules and homework, and peer
pressures. Older teens might be asked about
college, vocational plans, or separatingfrom parents
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Format of the Interview
Who will be interviewed is often aquestion with young patients
e.g., Children under 6 typically aregenerally interviewed with parents, thensometimes parents are seen alone
e.g., Older children and adolescents areoften seen as a family first and then latermay be interviewed alone
Sex abuse may be an exception
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Format of the Interview
If the clinicians sees family together itallows for:
Observation of interactional patternsAreas of agreement and disagreement
Tell family how their time will be
structuredAllow them to know if they can save
sensitive topics for when they are alone
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Closing the Interview
Summarize what has been learned Make sure you understand what the
interviewee has reported
Helps determine what additionalinformation might be needed
Ask the child/family if they have
questionsIs there anything else I didnt ask
about that you think it would be
important for me to know?
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Behavioral Observations
Psychological assessments always includeobservations about the patients behaviorduring 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
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Behavioral Observations
General response style
Mood and affect
Euthymic vs. dysthymic Labile, blunted, etc.
Reactions to being evaluated
Response to encouragementAttitude towards self
Unusual habits, mannerisms,vocalizations
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Behavioral Observations
How child relates to parent?
How child relates to examiner?
How child reacts to test materials ortoys?
Is the child age appropriate in
behavior?
How is the childs concentration?
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Behavioral Observations
Are tantrums seen?
Does the child cooperate?
What is the extent of childs responses? short vs. elaborate
How is the childs speech and language
development?
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Informal Assessment
Self-monitoring records
Report cards
Personal documents Diaries, poems, stories
Role playing
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Multimodal Assessment
Obtaining information from severalsources
Integrate information from several sources Recognize limitations of any one source
Using several assessment methods
Assessing several areas of functioning Strengths and weaknesses
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Interpreting Results
Are test results congruent with otherinformation obtained?
How can you account for discrepanciesin teacher, parent, child reports?
Do findings appear to be reliable and
valid? INTEGRATING results from multiple
sources is a critical clinical skill
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Final Steps in Assessment
Develop intervention strategies andrecommendations
Write a report Provide feedback
Follow-up
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Key Ingredients
Successful assessment requiresknowledge of:
Psychological tests Psychopathology
Interviewing
Statistics
Development Hypothesis testing
Your self