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Psychological Assessments

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Psychological Assessments

1.0. Main Assessment Issues

Psychological assessments encompass an organized series of interviews, uniform tests, and surveys intended to assess the child’s strengths and weaknesses in significant areas (Yale Medicine, 2021). Additionally, the purpose of assessment is to support the diagnosis and scheduling of treatment to help children move towards constructive mental health (Yale Medicine, 2021). Concerning the referral of the 8-year-old child, where the teacher and parent are questioning specific diagnoses, such as learning disability or ADHD. In this context, the evaluation would aim to explore the child’s present concerns, particularly inattention, low performance at school, and disruptive behaviors. The assessment should collect comprehensive information to inform possible diagnoses and use this information to plan treatment to ensure that the child’s mental health needs are being met. The most common learning disabilities in children below the age of 12years are ADHD, opposition, defiant, and conduct disorders. This referral case will incorporate psycho-educational, neuropsychological, and psychological tests to evaluate the child. Psycho educational assessment has been done by the school teacher who already thinks the child presents symptoms of ADHD, mainly inattention and disruptive behaviors leading to poor performance. This assessment is done in a school setting, focusing on learning behaviors and mental health. Psychological assessments will focus on the child’s learning behaviors and mental health in school settings, at home, and in the broader community (Srinath et al., 2019).

In this referral case, the assessment will be personalized to incorporate the family, school, and the community. The tests will assess intelligence by testing developmental delays, learning disabilities, linguistic and communication skills, swiftness at gripping and processing new information, and nonverbal cognitive skills. The child will also be assessed on achievement by evaluating their fluency in reading, math, and writing (Srinath et al., 2019). Educational and psychological tests used will determine the academic strengths and diagnose learning disabilities. This will assist in developing a personalized education plan to ensure the learning needs of the child are met. Neuropsychological testing will be used to assess the child’s memory and attention. It is ideal in the diagnosis of ADHD, which the teacher in our case is suspecting. Neuropsychological assessment is used to establish DSM-5 diagnoses as it measures the child’s memory skills, exclusive functioning, planning, structural skills, and cognitive abilities (Yale Medicine, 2021). The assessment tools used will appraise behavior, social and emotional development. The assessment will assess how social insufficiencies, hopelessness, and anxiety contribute to the child’s behavior at home and school. If issues of mental health arise, the assessment will provide appropriate procedures for behavior management. The use of DSM-5 and ICD-10 will be helpful in the diagnosis criteria as they are universally accepted standardized tools for assessment (Srinath et al., 2019).

2.0 Psychological explanations to consider in Diagnosis

According to Ogundele (2018), a systematic and holistic assessment of mental health presentations is necessary as a child or an adolescent may present with comorbid diagnoses or present with symptoms that may intersect with other diagnoses. Regarding the referral, inattention and impaired functioning affect the child’s school performance (Ogundele, 2018). Disruptive behavior as a symptom is present in many mental health diagnoses. However, based on the purpose of referral, the child’s age, and information, possible psychological justifications may be one of the subsequent diagnoses (Boat & Wu, 2015). The DSM-5 criteria used in the assessment will define all developmental and learning disorders that arise in early childhood and are categorized by intellectual disabilities and behavioral issues (Boat & Wu, 2015).

Intellectual Developmental Disorder (IDD) is a neurodevelopmental condition that is manifest in childhood and is categorized by intellectual difficulties as well as challenges in theoretical, societal, and practical areas of living (DSM-5) (Child Mind Institute, 2021). Regarding the referral, the child presents with two of the mandatory requirements of IDD, which include deficits in intellectual functioning, including low school performance and inattention, and deficits in adaptive functioning such as disruptive behaviors. However, to correctly diagnose the child with IDD, additional information is needed about the onset of the intellectual and adaptive deficits during the developmental period, specifically historical, genetic, and environmental factors that have influenced presentation, or whether the presentation appeared this year only in the schooling context. To fully meet the requirements of the diagnosis, the child’s IQ should be below 70 after taking the IQ test (Child Mind Institute, 2021).Equally, the child may be manifesting symptoms of Intellectual Giftedness (IG) which in children with learning disabilities affects abstraction, logic, understanding, self-awareness, and learning. Gifted children have significantly higher than average IQ (Barbier et al., 2019). Despite being linked to high performance, research suggests that children with IG tend to manifest signs such as declined functioning like low academic performance, distractibility, hyperactivity, and inattention. This is theorized to respond to poor reaction to unstimulating surroundings as school, work, and social backgrounds. However, to diagnose intellectual giftedness, it is vital to consider performance in various settings such as stimulating versus unstimulating to assess whether this route for diagnosis is applicable. Gifted children can have learning disabilities like ADHD, ADD, dyslexia, Asperger’s, and other processing disorders. The child in the referral may be gifted with a learning disability because they have difficulties with school work and their performance is below average (Barbier et al., 2019). According to the American Psychiatric Association (2021), Specific Learning Disorder (SLD) is a neurodevelopmental disorder that manifests in school-age children. Children have problems in one of three areas of reading, writing, and math, which are foundational to one’s ability to learn (DSM-5). Comparable to the above, research suggests if the SLD is not managed, it may impact an individual’s daily functioning. This includes academic and career performance. It can also affect an individual’s mental health, causing a higher risk of reduced concentration, psychological agony, and behavioral problems. However, similar to above, to diagnose this, information regarding the onset of the presentation is essential as research suggests that difficulties tend to present at kindergarten. In our case, there is a need to establish if the eight-year-old child started earlier or recently started exhibiting low performance. This will indicate if this may be the most appropriate diagnosis based on the child’s presentation (American Psychiatric Association, 2021).Furthermore, in addition to the above, research suggests that one-third of persons experiencing learning disabilities are also projected to have attention deficit hyperactivity disorder (ADHD) (CDC, 2020). It is an insistent pattern of inattentiveness and hyperactivity-impulsivity that impedes functioning and development. Similar to the 8-year-olds presentation, persons with ADHD display disruptive behaviors such as difficulty staying in the seat during class or leaving the classroom and habitually has difficulty organizing tasks and activities, affecting school performance and attention difficulties. Nevertheless, to diagnose ADHD, it is essential to consider whether the manifestations are present in two or more settings, especially at home, school, or work, with friends or relatives, and in other activities. It is evident that the symptoms interfere with the quality of the functioning, such as low social functioning in addition to poor academic performance (CDC, 2020). Clinicians, educators, and families use the psychological assessment of children to improve their understanding of issues related to their behavior and cognition development. While employing a combination of approaches and valuation techniques, psychologists focus on comprehending a child’s inclusive level of functioning and any substantial indications of strengths and weaknesses underscored in the children’s skills to improve the planning and use of interventions founded on the DSM-5 criteria (Woodcock, 2018). The resulting information and viewpoint help plan for the achievement of the child’s medical, social and educational needs. In particular, the psychological assessment offers benefits concerning;The explanation of baseline functioning in people.The quantification and qualitative account of variabilities in individual functioningDetecting the manifestations of syndromes such as Autism and ADHDMonitoring fluctuations in skills or functioning.Perceiving the prevalence of an illness or diseaseTracking recovery Developing a diversity of mediation programs, using the current valuation functioningExplaining the cognitive, emotional, and behavioral processes that affect a child’s functioning in school, work, and social situationsEndorsing the need for continued management or the provision of alternative environmental accommodation to enhance recovery.Directing parents and guardians on critical decision-making, including issues such as school placement (Woodcock, 2018).

3.0. Details from History and Background

Family history and background are a vital part of any psychological assessment in diagnosing learning disabilities in children. It gives crucial information on developmental delays, health, mental issues, behavior concerns, family and cultural influences that could be adding to the child’s learning difficulties (Nasir et al., 2019). The psychologist will need information on whether there are other family members with mental health disorders, strengths of the child at home and community, any physical problems and disabilities of the child, health problems, and any medical treatments being administered (Nasir et al., 2019). The psychologist will need to know the child’s quality of relations with associates and family members, whether the child has been exposed to traumatic experiences such as divorce, bereavement of a family member, past exploitation, or displacement from home. The languages used in the home setting should be provided, particularly in multilingual households. On background information, the psychologist will need information on the child’s early learning capabilities, such as when they learned to recite, count and spell, their academic history, and their exceptional interests. Information will be sought on developmental milestones, how the child functions in different settings, specifically home and school, and medical conditions such as sleep disturbances, poor vision, and dietary concerns. This information will enable the psychologist to know if there are any particular concerns or assessment accommodations required (Nasir et al., 2019)

4.0 Psychometric assessments

The psychologist in the referral will use various psychometric assessments to measure the 8-year-olds functioning level based on their intellectual competencies and personality traits. In this case, they include;

The Wechsler Intelligence Scale for Children (WISC), which is an independently controlled intelligence test for children the ages of 6 and 16 to distinguish between IDD, giftedness, and potentially screen for SLD (Gomez, Vance & Watson, 2016). It will produce a full IQ scale score on the child’s general intellectual ability measured through cognitive aptitudes, verbal understanding, perceptual thinking, working memory, and processing speed. WISC-IV subtests are central in the diagnosis of ADHD, which the school teacher already suspects. Nevertheless, there are limitations in the factor structure of the WISC-IV tests for children with ADHD (Gomez, Vance & Watson, 2016).K-SADS (Kiddie SADS). This semi-structured interview will be ideal for measuring the present and previous signs of mood, anxiety, psychotic, and disruptive behavior disorders in children aged 6-18 years (Nishiyama et al., 2020). The eight-year-old referral case presents disruptive behaviors, and from the interview question answers, the psychologist will make comprehensive clinical judgments. The psychologist will have more flexibility to assess the symptom items while drawing from the DSM criteria. Research has also proven its standard rationality for DSM-5 is good for the diagnosis of childhood and adolescent mental disorders (Nishiyama et al., 2020)ADHD diagnosis according to DSM-IV or DSM-5 criteria. Children with ADHD will show persistent patterns of attention and hyperactivity that interfere with development and functioning. This is the case with our eight-year-old referral.DSM-1V. This criterion is suitable for disorders identified in infancy, childhood, and adolescence. Symptoms of inattention and hyperactivity should have continued for more than six months to a degree varying with development level. Like in the referral case, the child may fail to give close attention to schoolwork and other activities and has problems sustaining attention in schoolwork and play activities. Due to these disruptive behaviors, the child may fail to follow commands to finish the homework and is reluctant to engage in tasks that need a constant mental effort like homework. The child is also forgetful and easily distracted (Substance Abuse and Mental Health Services Administration, 2016)DSM-V. Criterion is ideal for the diagnosis of neurodevelopmental disorders. For ADHD, a persistent pattern (6months or more) of inattention and hyperactivity-impulsivity interfering with functioning and development and academic performance is a red flag. The symptoms should not also be merely a display of oppositional behavior. The childlike in our referral may fail to pay close attention to schoolwork and other activities and have difficulties sustaining attention in tasks and play activities (Substance Abuse and Mental Health Services Administration, 2016).Semi-structured diagnostic interview with parent and child. They will allow the psychologist to question symptoms, make knowledgeable judgments, and score answers flexibly, taking into account the severity of signs. In the referral case, the Child and Adolescent Psychiatric Assessment (CAPA) interview can be used. Items should be appraised on a 3-point scale for severity not present, sub-threshold, and threshold—which combines both modest and severe manifestations. The Parent, child, and summary ratings are made, pointing to a possible diagnosis (Neuschwander et al., 2017).RATING SCALE NICHQ (National Institute for Children’s Health Quality) Vanderbilt Assessment ScaleADHD Predominantly Inattentive. This is ideal for diagnosing ADHD in the referral case as the ratings are considered based on the child’s age. Questionnaires will be given to teachers and parents. A diagnosis is made based on responses and the assessment scale of 0-3 (National institute for children’s health quality, 2002). The Acute Stress Checklist for Children (ASC-Kids). This brief self-report measure of severe traumatic stress responses, including ASD diagnostic criteria in children and adolescents aged eight to 17, could also be used in the referral case. It has 29 items relating to the ASD diagnostic criteria and accompanying features that identify situational stressors in the child’s life.

6.0 Feedback and Management

Feedback in the referral case should be personalized, thorough, and highly involving. Note the parent’s response because a child is an essential part of their lives. Parents in denial will not implement the appropriate strategies to manage their child’s behavior and improve outcomes. The psychologist should provide reports and outcomes with all parties present, using simple terms to describe the meaning of results so that they understand (Dolan, 2019). The psychologist should describe the general treatment plan to address psychological distress while accounting for systemic concerns such as schoolroom ergonomics and learning materials. Using available test results, decide the best steps for support. Engross less on communicating the specifics of the data but rather how the test results can help answer some questions related to the disruptive behaviors, inattention, and poor performance as in our case (Dolan, 2019). The feedback does not always disclose all of a child’s talents or skills. It will give details of the child’s current functioning level in their school and at home, their strengths and weaknesses. Psychologists will offer suggestions on managing the learning disability diagnosed, which is likely to be ADHD in our referral case. They will give commendations on managing disruptive behavior and inattention issues at home and within classroom settings. Thus, they will provide constructive managing strategies enriching the child’s ability and well-being (Dolan, 2019). Teachers will need to be provided with the feedback to provide accurate support for the child’s learning in the class setting. A review every few months should be undertaken to decide which strategies are effective.

7.0. References

American Psychiatric Association. (2021). What is Specific Learning Disorder? https://www.psychiatry.org/patients-families/specific-learning-disorder/what-is-specific-learning-disorder

Barbier, K., Donche, V., & Verschueren, K. (2019). Academic (under) achievement of intellectually gifted students in the transition between primary and secondary education: An individual learner perspective. Frontiers in psychology, 10, 2533.

Centers for Disease Control and Prevention. (2020). Attention Deficit Hyperactivity Disorder (ADHD). https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Child Mind Institute. (2021). Quick Guide to Intellectual Development Disorder. https://childmind.org/guide/quick-guide-to-intellectual-development-disorder/

Dolan, C. (2019). The Provision of Psychological Assessment Feedback to Children: A Survey of Practitioners. Antioch University of New England https://aura.antioch.edu/cgi/viewcontent.cgi?article=1497&context=etds

Gomez, R., Vance, A., & Watson, S. D. (2016). Structure of the Wechsler Intelligence Scale for Children–Fourth Edition in a group of children with ADHD. Frontiers in psychology, 7, 737.

Nasir, A., Zimmer, A., Taylor, D., & Santo, J. (2019). Psychosocial assessment of the family in the clinical setting. BMC psychology, 7(1), 1-8.

National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. https://doi.org/10.17226/21780.

National Institute for Children’s Health Quality. (2002).NICHQ Vanderbilt Assessment Scale used for diagnosing ADHD. https://www.nichq.org/sites/default/files/resource-file/NICHQ-Vanderbilt-Assessment-Scales.pdf

Neuschwander, M., In‐Albon, T., Meyer, A. H., & Schneider, S. (2017). Acceptance of a structured diagnostic interview in children, parents, and interviewers. International journal of methods in psychiatric research, 26(3), e1573.

Nishiyama, T., Sumi, S., Watanabe, H., Suzuki, F., Kuru, Y., Shiino, T., … & Hirai, K. (2020). The Kiddie schedule for affective disorders and schizophrenia present and lifetime version (K-SADS-PL) for DSM-5: a validation for neurodevelopmental disorders in Japanese outpatients. Comprehensive psychiatry, 96, 152148.

Ogundele, M. O. (2018). Behavioural and emotional disorders in childhood: A brief overview for paediatricians. World journal of clinical pediatrics, 7(1), 9-26.

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian journal of psychiatry, 61(Suppl 2), 158-175.

Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance. CBHSQ Methodology Report. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.

Woodcock, E. (2018). Psychometric / Diagnostic Assessments https://www.woodcockpsychology.com.au/psychometric-assessments-2/ Yale Medicine. (2021). Psychological Assessment of Children. https://www.yalemedicine.org/conditions/pediatric-psycholo

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