Now that the school year is in full swing, I am often asked by parents if they should seek an evaluation for their child to address concerns that either they have or that someone at their child’s school has raised. I have asked a licensed psychologist, Dr. Cynthia Johnson, if she could answer a few questions to help parents determine when, where, and how to go about having their child evaluated.
The Importance of Evaluating a Child for ADHD
If a parent tells you that his or her child is struggling at school, despite getting additional help (i.e., reading group, reminders to pay attention), what role does an evaluation by a psychologist play?
From an overall perspective, determining information related to academic or attention difficulties is like assembling pieces of a puzzle. The comprehensive assessment looks at many areas of student functioning to specify areas of strength and weakness. Each area of functioning is a piece of the puzzle. Once the puzzle is assembled, the information is then used to identify subsequent steps to help a child succeed.
Is there a particular age when it is too early, or that is more ideal for seeking an evaluation?
It depends on the specific child and the situation. A good time to administer an evaluation is when a child is having notable difficulties with some aspect of their functioning. For example, if a child received early intervention services due to a delay in achieving early developmental milestones (i.e., walking, talking, etc.), developmental evaluations are helpful before early intervention services typically end at a child’s third birthday.
In another instance, if there is a family history of reading difficulties, and a four-year-old child is struggling to learn how to rhyme or achieve other early language milestones, it would be the perfect time to have that child evaluated. Some children encounter reading difficulties in 3rd or 4th grade when they transition from “learning to read” to “reading to learn.” An evaluation uncovers underlying phonological difficulties. These children may be bright enough that they learned ways to compensate for these weaknesses, such as memorizing certain words. Yet when reading vocabulary and passage length increases in mid-elementary school, their weaknesses become more evident. From an overall perspective, the earlier interventions are received, the more helpful they are.
Some providers do not evaluate a child with attention/hyperactive difficulties before their sixth birthday. Other providers will evaluate younger children if their difficulties are significant enough to impair overall functioning.
What is involved in the evaluation process?
The evaluation process typically begins with a diagnostic clinical interview with the parents/guardian, where the medical, social, and educational history of the child and the family are discussed. The next step includes multiple assessment sessions with the child and clinician, where specific assessments are administered according to the diagnostic questions discussed during the interview. Sessions typically last one to three hours in duration, and there are typically two to three sessions with the child. During this time, clinicians can directly observe the child completing various tasks.
Depending on the specific information to be gathered, a comprehensive assessment may include activities related to cognitive, academic, executive function, language, memory, and motor abilities. Cognitive tests measure the child’s ability to process different types of information (verbal comprehension, visual-spatial abilities, reasoning abilities, short-term memory, and processing speed), resulting in a pattern of learning style. Academic or achievement tests to assess skill levels in Reading, Math, and Written Expression. Targeted, in-depth reading/writing assessments may also be administered. Tests of executive function measure attention, hyperactivity, as well as a student’s ability to regulate their behavior, emotions, and thought processes. Language tests assess the core and social use of language. Memory tests measure short-and long-term visual and auditory memory. Motor tests assess the fine and gross motor coordination skills necessary for school performance. Comprehensive assessments may also include an emotional and behavioral assessment to check for problems that may be occurring in addition to the diagnostic questions at hand.
Some of the assessments include individual activities, while others include rating scales to measure various aspects of the child’s thoughts, emotions, and behaviors. Scales are often completed by the child, the parents, and teachers. Results may indicate behavior patterns that may differ based on time of day, teacher, or location.
Information gathered from this process represents the different pieces of the puzzle mentioned above. The clinician assembles all these pieces to get a full picture of what may be impeding a child’s academic success.
Following the assessment sessions, the clinician writes a comprehensive report and recommends specific interventions and treatments to support the child in his or her academic efforts. The final step of the evaluation process includes an in-depth feedback session with parents/guardians to discuss test results and recommendations.
OK, I understand how assessment provides relevant information and recommendations for interventions to help a student succeed. But what if a child is having significant emotional or behavioral problems related to their area of difficulty?
Individuals experiencing academic difficulty may also struggle with their emotions. For example, many students with learning disabilities experience anxious feelings. Academic difficulties can also be manifested through behavioral problems in some children. Some clinicians also provide individual therapy to help mitigate any related emotional or behavioral challenges.
If I am bringing my child in for an evaluation, do you have any suggestions on how to best prepare him or her for what he or she will experience? And if my child is on medication, should he or she take as usual or skip for the evaluation?
It is important that a child is well-rested and has had proper nutrition before evaluation sessions. Any medications that the child is taking needs to be discussed at the initial interview session between the parent/guardian and the clinician. Typically, children adhere to their medication protocols. If a child is on ADHD medication, that medication may be postponed for subsequent sessions if a comparison of performance on/off medication is part of the diagnostic question. Any concerns regarding the overall evaluation process can be discussed at the initial interview session.
Rather than telling a child that he or she will be evaluated or is “going for tests,” it is helpful when parents explain to their child that he or she will be doing lots of activities during his or her visits. Some of the activities will be familiar, and others may be new. Many of the activities will be easy, yet some will be harder. Breaks in the sessions are taken as needed. Typically, children find many parts of the sessions to be enjoyable.
Dr. Cynthia Johnson is the owner of StepStone Psychological Assessment and Therapeutic Services in Boulder, CO. [email protected] She is available for consultation.