This is a question that many parents ask themselves at one point or another as they try to raise their children. New parents often worry if a behavior is concerning or if it is just a normal part of childhood development. A psychological assessment can help to understand and explain behavior and feelings
Have you ever wondered if your child’s tantrums are normal?
Have you ever questioned if your child is speech delayed?
Have you ever worried if your child is still having accidents?
Have you wondered why your child is having nightmares or anxiety?
Have you wondered why your child is acting out?
Have you wondered if your child’s anger is normal?
All of these are very valid questions that, we as parents, ask. Aliisa Breisch, a Psy. D. or Doctor of Psychology for Mindful Therapy in Seattle, also reminds us...
“Sometimes, behavioral issues are a symptom of a cognitive and/or language deficit. For example, a child might have slow processing speed or delayed language skills that result in frustration and behavioral outbursts when they try to respond to a request from a caregiver, teacher, or authority figure. Psych assessment can help ascertain if this is the case.”
If it is a worry, taking your child in for a psychological assessment is a great first start to getting answers to your questions and possibly working toward a solution. It is always better to be safe than sorry as an earlier diagnosis can lead to better results later on.
The next question is what kind of testing is there…
What kind of psychological testing and assessments are available?
There are many types of psychological assessments and tests that are available to find the right treatment. Often, the first step in this process is getting a referral from your pediatrician so you know what the exact concerns and approaches that would benefit your child. Many of these assessments and tests are used in conjunction so the psychologist is receiving the most in-depth information and the patient is, in turn, receiving the best treatment. Some of these tests and assessments include:
One of the first and most simplistic of the assessments is the clinical interview. This is simply where the psychologist asks the patient questions so they can see how the child thinks, reasons, and interacts with others. This type of assessment may also include those that closely work with the child such as parents, relatives, teachers, or care providers.
There are also “norm-referenced tests” meaning only that the test has been standardized so that the test taker is evaluated by the same standards no matter where they live or who administers the test. These tests will often rank the child against other children of a similar age range or grade to see how they are performing. This test, developed and evaluated by researchers, is very effective for measuring a certain trait or disorder
There are also informal and formal interviews, informal tests and surveys, school and medical records, medical evaluations and observational evaluations. The psychologist will often determine what to use based on the question being asked, such as: Does the child have a learning disorder.
Those are some of the most common methodologies that psychologist will use, but often that is only the beginning to evaluate and see how the child is doing compared with their peers. There are also other tests and assessments that may be performed based on each child’s particular diagnosis. These may include:
Autism Diagnostic Interview, Revised (ADI-R)
Autism Diagnostic Observation Scale, Second Edition (ADOS-2)
Wechsler Preschool & Primary Scale of Intelligence, Revised (WPPSI-R)
Beery test of Visual Motor Integration (VMI)
Projective Drawings (DAP, KFP, & H-T-P)
Vineland Adaptive Behavior Scales
3 Behavior Rating Scales
All of the above tests and evaluations may be performed in conjunction with others to see the best results. As a child, for example, that has ADHD or Autism may also have other behavioral issues that need to be improved upon. The testing and evaluations are just one of the many steps. If these determine that your child, does indeed, have a mental or behavioral disorder who do you turn to?
Who provides psychological assessments for children?
Parents usually are referred to a psychologist, they need to ask and clarify with the person referring the child what they are being referred for so the therapist knows what the next steps need to be
Historical data is very important, grades, teacher reports from conferences, etc. This helps to decide what types of testing to conduct.
Typically a psychologist will meet with the parents first, on the intake to determine history and development, school history, and familial history.They will review any records and the psychologist will recommend the proper testing.
Psychological assessments may only be performed by a licensed psychologist who has been specially trained and experts in their field. They will work with your child and may administer different testing or assessments that will help, not only the child, but also the parents to cope with the child’s behavior or emotions.
When finding someone to work with your child you should:
Find a licensed professional that specializes in children
Make sure that both you and your child are comfortable with them
Make a list of behaviors that concern you
Make sure that they have experience dealing with your child’s issue
Ask if they collaborate with any medical teams if medication is needed
After the initial testing is complete the psychologist will review any records that are available and the will recommend the proper testing. After the test is complete the psychologist will score the test and analyze the data for a diagnosis.
They will go over the report and any recommendations with the parents. At this point, the psychologist will refer the child for treatments and interventions and how to proceed. Typically, this will be a referral to therapists, occupational therapist, speech and language pathologist, for a medication evaluation with a psychiatrist, or psychiatric nurse practitioner
The specific referrals really help to target the main issues whether it be behavioral, academic, emotional, social, or intellectual. It is also very important to never test someone you are already seeing, as you can’t be truly objective.
What can I expect from treatment?
Treatment can come in many different forms and many different methods. Also, not all “bad behavior” necessarily means that there is a problem. Many children go through normal stages of childhood development where they may not only act out but may seem to regress to a former stage. For example, a fully toilet trained child may revert if they have a younger sibling. For those that do proceed on to receive treatment for behavioral issues, it is important to note that early intervention is key. Diagnosing and treating a problem earlier can lead to better progression and make it easier to correct some behavior before it becomes ingrained. These treatments may include:
Psychotherapy or talk therapy. There are many different approaches to this type of therapy and it may also be used in a structured manner to directly address a specific condition.
Medication which should be used in tandem with psychotherapy. What types of medications will depend on the diagnosis but may include mood stabilizers, antidepressants, stimulants, and others
Family counseling may be used to include parents and other family members in the treatment process so they better understand how a child’s particular challenges may affect the relationships within and other family dynamics.
Support for the parents is also vitally important. This may include group or individual sessions that include training and the opportunity to interact with other parents that are facing the same struggles. The psychologist can also offer tips for talking to schools
Aliisa will tell you that the value of testing is that parents can get different ideas from doctors, nurse practitioners, therapist, and/or teachers. Diagnostics are important to clarify the diagnosis, as many will overlap. For example, anxiety can look like ADHD or vice versa. A clear diagnosis will allow for a tailored treatment plan in the school and clinical setting allowing for accommodations so that the child can succeed.
What results can be expected?
Now that treatment and therapy sessions have been started most parents want to know what kind of results that they can expect. Unfortunately, this question is rarely easily answered. For one, each child is an individual and will progress at their own speed.
For others, it is the question of what the diagnosis is and where they would fall on the spectrum of that diagnosis. This is an important question to bring up with the psychologist because there should be a defined plan of action in place and goals and benchmarks that the child should be working towards. There should be some sort of measurable information to show how much progress the child is making.
For some with ADHD, it is going to be finding the right medication or therapy to redirect their focus. For some with autism, it could be working toward being able to live on their own with occupational therapy, or working on speaking with speech therapy, as nearly 1 in 3 people diagnosed with autism are non-verbal.
It is always important to be supportive of their therapies and try to get treatment as soon as possible for the best results if suspect a problem. With all of the diagnosis out there, many parents don’t know what they are or the symptoms that they should be looking for.
Aliisa also noted that “A lot of the time we focus on the deficits or the weaknesses the children may possess but testing also reveals their strengths, and that gives everyone something to focus on instead of just the negative.”
The most common mental and behavioral disorders and symptoms
Most parents should be aware that other than ASD, which is diagnosed as early as possible, most “disorders” are not diagnosed until around the age of five.
These include obsessive-compulsive disorder, post-traumatic stress disorder, social phobia, separation anxiety, and generalized anxiety disorder. Some worry is normal, however, in these children, the anxiety starts to affect their lives.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Symptoms of ADHD include hyperactivity, difficulty paying attention, and impulsive behavior. This may include one or all three categories. Though there is a growing movement that looks at ADHD as an identity with its own unique benefits and not a disorder.
Autism Spectrum Disorder (ASD)
Symptoms appear in early childhood, around three, while symptoms vary they always include the child’s ability to speak and interact with others.
Oppositional Defiant Disorder
Symptoms may include consistent patterns of angry outbursts, arguments, and disobedience. Most of the defiance is directed toward people in positions of power (parents, teachers) but can include siblings and other family members.
Depression is a mood disorder. Symptoms may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.
This is an umbrella term that covers many singular disabilities. Learning disabilities are classified as neurologically-based processing problems. These processing problems can interfere with learning basic skills such as reading, writing and/or math. They include:
Auditory Processing Disorder
Language Processing Disorder
Nonverbal Learning Disabilities
Visual Perceptual/Visual Motor Deficit
Sensory Processing Disorder
SPD is a neuro-physiologic condition in which sensory input either from the environment or from one’s body is poorly detected, modulated, or interpreted and/or to which atypical responses are observed.
These are some of the most commonly found in younger children though there are many more. As the children get older and enter their teenage years depression, eating disorders, bipolar disorder and schizophrenia become more common.
What Can I Do?
For many parents finding out that there is a workable problem for their child is a relief. Take for instance the story of David Baldwin from the Seattle Area. When he and his wife receive the diagnosis for their son ‘Squirreley’ he writes,
“So curious as it may sound, The Squirrelly's diagnosis came as something of a relief to us. The Queen and I have been devouring books on autism ever since the pediatrician seconded the daycare lady's suspicions, and by the time we brought him to the UW we were already convinced that he had some form of ASD. But hunches aren't enough to seek treatment. To gain access to the ABA clinics, you need an official diagnosis; once we had one we could start arranging for intervention.”
As the psychologists suggest, the earlier the intervention and treatment schedule, the better the results will be. Be consistent and supportive but also do not fail to protect your own mental health. Work actively with your child to improve their mental or behavioral disorder but take the time to join a support group and to reach out, whether to other parents or your own therapist, so that you know that you are not alone.