Main Assessment Issues
Psychological assessment is defined as a multifaceted system of data collection using DSM-5 Criterion techniques of interviews, observation, consultation, and formal psychological testing to generate a holistic understanding of a person’s mental health presentation, such as personality, thoughts, feelings, and behavior (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, the evaluation in this context would explore the child’s present concerns, particularly inattention, low performance at school, and disruptive behavior 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. In most cases, neurodevelopmental disorders in children have comorbidities. For example, children With ADHD will have learning disabilities. Key considerations to inform the assessment process in the referral case would be an evaluation of concerns during a child’s early development. The main assessment issues include; intellectual assessment, neuropsychological assessment, adaptive behavior assessment, ASD assessment, and Psychiatric comorbidities evaluation
Intellectual assessment will evaluate the child’s cognitive strengths and flaws. This will provide clinically valuable information for diagnosis. Persons experiencing intellectual disability with intelligent quotient scores with two standard deviations below the average mean. On the other hand, children experiencing learning disorders demonstrate scores within the normal range on the scale and will display inferior performance in academic skills than the anticipated levels of intellectual functioning. Assessment in the referral case will use The Wechsler Intelligence Scales. The Wechsler Intelligence Scale for Children–Fourth Version (WISC-IV) will be used to assess the 8-year-old (Oh, 2016).Neuropsychological assessments will assess attention problems and executive dysfunctions caused by cognitive insufficiencies in persons with neurodevelopmental disorders. Attention is multifaceted as it encompasses concentrating, sustaining, and changing operations. The psychologist will use Continuous Performance Tests to measure the child’s visual and audio sustained attention, attentiveness, and impulsivity. Trail Making Tests will measure executive functioning, and The WMI of the Wechsler intelligence scales will measure attention and working memory. Children with ADHD have behavior characteristics parallel to executive dysfunction. Important features of ADHD, specifically inattention and hyperactivity-impulsivity, will be evaluated by observing hyperactivity-impulsivity characterized by running extremely, answering questions in class as the teacher talks to the learners. These assessments will clarify the cause of inattention and disruptive behaviors our referral is exhibiting. Deficits in cognitive suppleness could be causing these disruptive behaviors (Oh, 2016).Adaptive Behaviour assessment will assess the skills of daily living required to function individually and meet the demands of a classroom and home setting. It is undertaken using Intelligence Assessment Tests. The psychologist will use the assessment data to guide the development of helpful treatment interventions. The VABs scale measures adaptive behaviors and is available either in interview form or caregiver evaluation. The child’s socialization, communication, daily living skills are also evaluated. Psychologists have noted a connection between cognitive functioning scores of Intelligence Tests and real-life functioning. For example, children with high functioning ASD have scored lower in adaptive functioning compared to intelligence tests (Yale Medicine, 2021). Autism Diagnosis Assessment is essential as the referral child has disruptive behaviors, inattention, and poor academic performance common with high functioning ASD kids. The psychologist will assess any problems in social communication and interactions in diverse settings, stereotyped and monotonous activities, interests, and other activities. ASD children have a rigid fascination for routine (Oh, 2016)Psychiatric Comorbidities will assess emotional and behavior problems in individuals diagnosed with neurodevelopmental disorders. The Child Behavior Checklist will evaluate emotional and behavior complications during preschool, childhood, and adolescence. The evaluations will determine if the child in the referral case has any physiological or psychological comorbidities. 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)
Psychological Explanations in Diagnosis
According to current research, a systematic and holistic assessment of mental health presentations is necessary as a child or adolescents may present with comorbid diagnoses (Ogundele, 2018). Most children and adolescents with neurodevelopmental disorders will develop secondary conditions. Comorbidities are either psychological or physiological and will affect a child’s academic performance. The referral’s inattention, impaired functioning, and disruptive behaviors are present in many mental health diagnoses. However, based on the purpose of referral, the child’s age, and information, the possible psychological justifications may be subsequent diagnoses. The DSM-5 criteria used in the assessment will identify developmental and learning disabilities the child in the referral case is presenting (Boat & Wu, 2015).
Intellectual Developmental Disorder (IDD) is a neurodevelopmental condition that manifests in childhood and is categorized by intellectual difficulties and challenges in theoretical, societal, and practical areas of living (DSM-5). Regarding the referral, the child presents with two mandatory requirements of IDD: deficits in intellectual functioning, including low school performance and inattention, and deficits in adaptive functioning, e.g., 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. 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. 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 theorized to be a response to the poor reaction to unstimulating surroundings such as school, work, and social backgrounds. However, to diagnose intellectual giftedness, it is vital to consider performance in various settings including, 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, Specific Learning Disorder (SLD) is a neurodevelopmental disorder that manifests in school-age children. Children demonstrating challenges in reading, writing, and mathematics, which are critical in determining 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, such as 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, research indicates that one-third of leaners exhibiting learning incapacities are said to be suffering from attention deficit hyperactivity disorder (ADHD) (CDC, 2020). It is a tenacious 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 their seat during class or leaving the classroom and habitually strain organizing responsibilities 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 explaining the baseline functioning in people, the quantification and qualitative account of variabilities in individual functioning, detecting the manifestations of syndromes such as Autism and ADHD, monitoring fluctuations in skills or functioning, perceiving the prevalence of an illness or disease, tracking recovery, developing a diversity of mediation programs, using the current valuation functioning, explaining the cognitive, emotional, and behavioral processes that affect a child’s functioning in school, work, and social situations, endorsing the need for continued management or the provision of alternative environmental accommodation to enhance recovery, and directing parents and guardians on critical decision-making, including issues such as school placement (Woodcock, 2018).
History and Background
Family history and background are a vital part of any psychological assessment in diagnosing neurodevelopmental disorders and learning disabilities. A family history of mental and neurologic disorders is linked to an increased risk of ASD. Information sought includes interactional and relationship data, current family health status, and developmental milestones of the individual in question. In our referral case, there is a need to know if the child achieved the key developmental milestones at the right age. Psychologists will want to know when the presenting symptoms of inattention and disruptive behaviors started and how the child functions in various environments, primarily home and school settings. Details of the child’s life experiences, such as being exposed to traumatic experiences such as divorce, bereavement of a family member, past exploitation, or displacement from home, will be crucial as they can trigger disruptive behaviors. The psychologist will need background 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 medical conditions such as sleep disturbances, poor vision, dietary concerns, and current medical usage. This information will let the psychologist know if any particular concerns or assessment accommodations are required (Nasir et al., 2019).
The psychologist in the referral will use various psychometric assessments to measure the 8-year old’s functioning level based on their intellectual competencies and personality traits. In this case, they include;
The Wechsler Intelligence Scale for Children (WISC) is an independently controlled intelligence test for children ages 6 and 16 to distinguish between IDD, giftedness, and potentially screen for SLD. 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. The referral case in the 8-year-old present’s 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 (Nishiyama et al., 2020)
ADHD diagnosis according to DSM-IV or DSM-5 criteria
DSM-1V 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. DSM-V Criterion is ideal for the diagnosis of neurodevelopmental disorders. Thus, the child in the referral case presents some symptoms of ADHD, namely inattention and disruptive behaviors (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 to point 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 8 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.
Feedback and Management
The following evidence-based intervention strategies will be recommended for the child in the feedback report to improve their attention in class and improve his behavior. Feedback should be based upon assessment data, and prevention and intervention strategies should involve a team approach in several settings. The psychologist should provide reports and outcomes with all parties present, using simple terms to describe the meaning of results so that they don’t misunderstand. The psychologist should describe the general treatment plan to address the psychological distress while accounting for systemic concerns such as ergonomics in schoolrooms and learning materials. Using available test results, decide the best steps for support. Classroom-based interventions include behavior interventions where the teacher focuses on antecedent strategies such as giving3-5 clear rules and expectations for behavior posted in locations noticeable by the child. Instructions should be given clearly and shortly. Teachers and parents should reinforce adaptive behaviors with positive reinforcement in a manner meaningful to the child. Reinforcements could be in the form of gifts or praise. Verbal correction strategies will decrease undesired behavior. Clear and frequent communication between home and school is a vital component of effective classroom behavior management. Academic interventions to address inattention will include assessing the child’s instructional level in every subject and interventions individualized to suit the child’s needs. Increasing task engagement in interesting tasks improves academic performance. Peer tutoring has been proven to improve attention and boost academic performance. Teachers should engage the child in setting goals for work completion, correctness, and time. Peers could reinforce non-classroom-based interventions like lunchroom and play areas where rule infringement occurs frequently. Ensuring organized games are available reduces disruptive behaviors. Home-based interventions will support school performance, such as reading more, limiting TV time, and assisting the child with homework. Progress monitoring and strategy amendments are critical to the victory of any intervention plan (Dolan, 2019).
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 (CDC). (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., Kimura, T., Wang, C., Lin, Y., Ichiyanagi, M., & Hirai, K. (2019). 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. https://doi.org/10.21203/rs.2.12076/v1
Ogundele, M. O. (2018). Behavioral and emotional disorders in childhood: A brief overview for pediatricians. World Journal of Clinical Pediatrics, 7(1), 9-26.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for the 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-psychological-assessment
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