Assessment

Psychodiagnostics offers a broad range of psychological assessment, focusing on the following domains:
1) Personality
2) Mental Illness
3) Behavioral Disorders
4) Developmental Disabilities
5) Intelligence
6) Academic and Learning Disabilities

Often, assessments are composed of tests which, together, measure many, or even all six, of these domains. Generally, the referral question will dictate which domains are measured. For an illustration of how a referral question is answered see an example of an adult with post-traumatic stress disorder or a child with academic difficulties. As a rule of thumb, vague referral questions require broad batteries; batteries in which many of the above listed domains are at least sampled. For example, academic underachievement requires in-depth assessment of academic abilities (domain six), but also screening for mental illness (domain two), behavioral disorders (domain three) and intelligence (domain five). This allows the source of the learning problem to be identified by ruling out alternative and competing explanations. Read more on test battery construction

In contrast, specific referral questions can result in pointed assessments from only one or two of the above listed domains. For example, an adult might want to know about his personality and ask for a focused descriptive report. Similarly, a parent might want a second opinion on an intellectual assessment conducted in a school.

Areas of Specialty

Psychodiagnostics offers general assessment and diagnostic services. Yet, there are some areas of specialty; questions, problems and disorders which are commonly seen and assessed:

• Personality description and diagnosis
• Trauma and post-traumatic stress disorder assessment and diagnosis
• Autism and related pervasive developmental disabilities
• Learning disabilities
• Fetal alcohol syndrome
• Mental retardation

Describing Functioning and Reporting Results

All reports are customized and describe assessment results in a narrative format. In addition, all efforts are made to describe the examinee rather than the exam. Too often, it is the exam that becomes the focus of the report, leaving the reader, on one hand, frustrated because she cannot easily understand the report, and on the other hand, impatient about having to read about a test instead of herself or her child. Here is an excerpt from a report that focuses on the exam instead of the examinee:

Findings from a measure of intelligence: “The WISC-IV is comprised of four indexes that measure various components of intellectual functioning. The Verbal Comprehension Index (VCI) measures the examinee’s ability to listen to a question, apply information that has been learned both formally and informally, form a response, and state thoughts aloud. The examinee’s strongest subtest result was in the area of verbal comprehension, which required him to answer various questions about different aspects of life. This task required the examinee to access knowledge that he acquired at home and school. He was able to answer many of these questions correctly, although many of his responses were incomplete and merited only partial credit…In contrast to the VCI, which involves language-based measures, the Perceptual Reasoning Index (PRI) assesses abilities that involve problem solving with visual information. The subtests of the PRI required the patient to examine a problem, assess and manipulate visual information, organize her thoughts, and create and test solutions.”

Again, results are better written in a narrative style that focuses on the person instead of the test. The test remains in the background; only its formal results are mentioned. It is the performance of the individual that comes to the foreground.

Findings from a measure of attention: Informally, it was observed that the examinee was 1) restless, as evidenced by his walking around room, moving in his chair and fidgeting; 2) distractible, as evidenced by his picking up objects in the room, handling the computer, phone, and lamp; and 3) intrusiveness, as evidenced by his touching prohibited items on the opposite side of the table and standing close to the examiner. These three deficits, restlessness, distractibility, and intrusiveness, all suggest that this examinee has general problems with attention and self regulation. On formal tests of attention and self-regulation, deficits were found, confirming these initial observations. The patient’s vigilance, or ability to attend over a period of time, is notably impaired, falling within the Extremely Low range. When he intends to focus on a task, he frequently drifts off, forgetting to respond according to directions. In addition, his planning and organizational abilities are extremely limited and also fall within this Extremely Low range. Likewise, deficits in self-regulation were found. Truly, he does not show an age-appropriate ability to pay attention, plan towards future goals or stay still. Furthermore, he cannot adapt to new situations. He responds out of habit and cannot easily exchange an old behavior for a new one. When he tried to suppress his natural inclinations and respond differently, he made many mistakes and worked slowly.

In addition to formal assessment, all efforts are made to observe and describe behavior. The following are some of the classes of behavior that might be noted in the psychological report:

1) Posture and bearing
2) Emotions and Feelings
3) Understanding and comprehension
4) Cooperation, effort and motivation
5) Fine motor movements
6) Openness and honesty
7) Overt symptoms
8) Speech and vocabulary
9) Autonomy and attachment

Such behaviors are written in a short narrative. Below are two examples of how such behaviors are used in narrative form; one from a young girl and one from a young boy:

An eight-year-old female with a history of intellectual delays

The patient presented as meek, speaking with a small voice and generally avoiding eye contact. Her voice was so low as to cause one to lean forward and listen with full attention. She seemed to allow herself to be directed fully by the adults around her, avoiding any active participation. After her mother took her coat off, she separated from her with a small degree of hesitation. Simple directions, such as go straight back or take the chair to the left, proved confusing to her. She needed to be more overtly directed; truly, she needed to be shown the way. This same confusion was expressed verbally once in the examination room. Not only could the patient not answer questions, she seemed overwhelmed by them. Especially when questions were asked rapidly and in a conversational tone, the patient seemed confounded and fell mute. Speaking more softly and slowly seemed to draw her out to some degree. Yet, she still had trouble answering basic questions. For example, when asked where she went to school, she did not answer at all. Directly after, the patient had trouble stating where she lived. She was finally able to give a street address, but did not provide the name of a town. When asked if she lived in New Jersey she seemed rather confused than otherwise. Moreover, these comprehension problems were manifest during the formal testing. She sometimes had trouble understanding directions and needed them to be repeated and supplemented with examples. In addition, she committed many rule violations. In these instances she acted contrary to the stated directions. Even when her mistakes were pointed out, she often persisted in her errors, showing a slow rate of learning. Despite these comprehension problems, it was clear that the patient wanted to please and tried to do her best. She was invariably cooperative and compliant. She attempted all the work given to her, showing perseverance and age-appropriate frustration tolerance.

An eleven-year-old male with a history of oppositional behavior:

This patient exhibited flat affect that was occasionally punctuated with weak laughter and a reluctant smile. He often slouched in his chair or put his head down on the table. He was resistant to a sizable portion of the work presented to him. He expressed his disapproval of hard work either physically by putting his head down on the table or verbally by directly saying he could finish because the work was too difficult. He occasionally asserted, in a slightly oppositional manner, that he was finished and punctuated these statements by putting his pencil down or placing his head on the table. It appeared that he pondered refusing to go on, although he always reluctantly continued. After one notable instance of frustration and associated resistance, he became tearful; when asked to continue, however, he resumed work without a word or protest. He was minimally responsive to redirection and encouragement from the examiner. This resistance appeared to be motivated by his perception of the testing process as a frustrating series of tasks that were largely beyond his ability. He asked to see his mother a few times and requested a break early in the assessment. He kept his jacket on throughout the testing session despite the comfortable room temperature. He swaddled himself in his coat, which appeared to be a method of insulating himself from the unfamiliar situation and taxing demands. Similarly, he happily accepted the division between himself and the examiner made by the testing materials, finding this separation comforting. The patient cradled his head in his arm when under increased stress caused by particularly difficult tests.

The patient did not grasp directions when they were formally administered. Instead, he often needed additional instruction, examples and reformulation. There were instances when the examiner had to try hard to make him understand. Similarly, he did not readily generalize learning acquired from one situation to the next situation. Whether due to embarrassment or some other motivation, he resisted responding to questions that he was unsure of. He disliked guessing and believed that it was better to not answer than to indicate a best approximation. Also, the patient had some trouble sitting in his seat for an extended period of time. He occasionally rose and moved towards the door or adjusted his position. However, he benefited from short breaks, after which his motivation and rate of work increased for several minutes.

During conversation he readily drew a distinction between his present behavior and his behavior over the last few years. According to his own report, he is currently completing his homework and striving to improve his grades so as to please his mother. During the past two years, he reported getting into several verbal and physical fights, disrespecting his teacher and receiving five school suspensions. He freely admitted being reprimanded for a variety of behaviors in the last two years including, intrusiveness, disrespecting authority figures and fighting with other students. He attributed his improved behavior to making up his mind to do the right thing. However, he did not consider himself to be a bad child, nor was he ashamed of himself. He simply reported engaging in negative behaviors and experiencing associated feelings of guilt. The patient additionally denied any symptoms of depression, asserting that his mood was stable, his sleep uninterrupted, and his appetite unchanged. He reported being friends with everyone in his class and stated that he does not get ridiculed or excluded in any manner. He also reported contributing liberally towards the completion of household chores including, mopping the floor and laundering clothes. He seemed to be motivated by praise and gratitude from his family and evinces a feeling of communion and community among them. According to his own report, he attends all mainstream classes with no special accommodations.

Referral Questions

A question always precedes psychological testing. Some want to know more about their personality; some want to know if they have a mental illness; some want to know if their child has a developmental disability like autism; some wonder whether they or their child have a learning disability; some simply wonder why their child is doing poorly in school. Whether general or specific, whether about one’s self or a family member, whether asked by a lay person or professional, these questions are the reason why assessment is sought. Consequently, these questions should be answered. Sometimes the answer is concrete and singular, sometimes it is abstract and plural, but in either case an answer should be given. At times, psychological testing will fail to find the answer to the referral question. In such cases, every effort is made to provide appropriate referrals to other professionals and assessment procedures that can provide the sought for answers.