Introduction to

Psychological
Assessment of Children
Purpose of Psych.
Assessment
Goal Driven
• Broad Screening versus
Focused/Problem-Specific
• Diagnostic
– Differential and Comorbid Conditions
• Therapy Oriented
– Identify target problems
– Develop preliminary intervention plan
• Progress evaluation
– How well are ongoing interventions working?
Testing vs. Assessment
• Both involve
– Identifying areas of concern
– Collecting data
• Psychological Testing
– Administering tests
– Focuses solely on collection of data
• Psychological Assessment
– More broad goals
– Involves several clinical tools
– Uses clinical skill to interpret data and
synthesize results
Psychological Testing
• Require standardized procedures for
behavior measurement
– Consistency and use of the same
• Item content
• Administration procedures
• Scoring criteria
– Designed to reduce personal
differences and biases of examiners
and other external influences on the
child’s performance
Psychological Assessment
• Main types of assessment
1. Norm-referenced tests
2. Interviews
3. Observations
4. Informal assessment procedures
5. Non-norm referenced tests
Norm-Referenced Tests
• Tests that are standardized on a clearly
defined group
– Normative versus clinical reference groups
• Goal: quantify the child’s functioning
• Scores represent a rank within the
comparison group
• Examples
– Intelligence
– Academic skills
– Neurocognitive skills
– Motor skills
– Behavioral and emotional functioning
Norm-Referenced Tests
• Psychometric properties
– Demographically representative
standardization sample
– Reliability
• Internal consistency, test-retest stability
– Validity
• Correlation with other tests measuring same
construct
• Ecological
• Psychological tests are imperfect
– Examiner, the child, and the environment can
affect responses and scores
 “Normal” or “Bell” curve

• Most attempt to be normally distributed

• Standard deviation: Commonly used measure of the
extent to which scores deviate from the mean
• In a Normal distribution, 68% of cases fall between 1
SD above the mean and 1 SD below the mean
• The threshold for meeting “clinical significance”
varies across tests, typically > 1 to 2 SDs above or
below mean
Norm-Referenced Tests
• Percentile ranks
– Determines child’s position relative to the
comparison group
– Example: What does it mean when a child is
in the 35th %tile on an Intelligence test??
• Age-Equivalent and Grade-Equivalent
scores
– Frequently used on academic achievement
tests
– Sometimes questionable validity
Variables Affecting Test
Scores
• Demand characteristics
– Child may give a certain type of
response in order to obtain a desired
outcome
• Response bias
– Child’s response to one item may
influence how they respond to
subsequent items
• Social desirability
– Tendency to present one’s self in a
positive light
Variables Affecting Test
Scores
• Misinterpretation of Items
– Misunderstanding directions
• Format of instructions
– Oral vs. written
• Response format
– True-false, written, oral, timed, untimed
• Setting variables
– Location, time of day, medication status
• Previous testing experience
– Practice effects
Variables Affecting Test
Scores
• Reactive effects
– Assessment procedure affects responses
• Timed, anxiety provoking
• Examiner-examinee variables
– Individual characteristics may affect
responses (e.g., gender, age, warmth)
– Research suggests that children of low
SES and/or ethnic minorities are more
affected by examiner characteristics
• Familiar vs. unfamiliar examiner
Administering Tests
• Administering psychological tests to
children requires specific skills
– Flexibility: breaks, time to warm up,
establishing rapport
– Vigilance: attend to child’s behavior
while still correctly administering the
test
– Self-awareness: how do children
typically react to your style, body
language, mannerisms
 Examiner Nonverbal Behavior

Positive Behaviors Negative Behaviors

Good eye contact Avoiding eye contact,
staring or peering
Body posture—leaning Body posture - laid back,
towards child feet propped up
Interested, natural voice Interrupting child often
Not engaging in distracting Looking at watch, chewing
gestures gum, running hands
through hair, etc.
Taking minimal notes while Taking excessive notes and
continuing to make seldom looking at child
frequent eye contact
Other Testing Issues
• Introducing yourself to child
• Explaining what the child will be doing
• Letting them know where their parent will
be during the assessment
• Providing adequate expectations
• Developmental considerations
– Younger children
– Older children
• Praising effort NOT performance
• Setting limits on behavior
Establishing Rapport
• “the sense of mutual trust and
harmony that characterizes a good
relationship”
• Good rapport =
– child/family perceives the clinician as
caring, interested, competent, and
trustworthy
– Clinician feels positive regard,
genuineness, and empathy
• Necessary condition
Establishing Rapport
• Use of communication skills
– Acknowledgements
– Descriptive Statements
– Reflections
– Praise
– Periodic Summaries
– Elaboration
– Clarification
Establishing Rapport
• Avoid:
– Lack of interest or not attending
– Sarcasm
– Lecturing
– Interrupting
– Commands
– No eye contact
– Criticisms
Interviewing
• Types of interviews:
– Unstructured—allow child/parent to “tell their
story”
– Semi-structured—provide flexible guidelines,
a starting point
– Structured—most often used to make
diagnoses or in research studies,
standardized
• May interfere with rapport
• Does not provide info on family interactions or a
functional analysis of behavior
– Which types of interview require the most
clinical skill??
Explaining Confidentiality
• Parents sign releases of information
• Review concept of confidentiality and its
limits early in clinical interaction
• Limits to confidentiality:
– Specific threat to someone else (homicidal
ideation)
– Self-harm is threatened (suicidal plan/intent)
– Sexual and physical abuse (history or current)
– Insurance requests
– Courts
– Generally referral source
Interviewing Techniques
• Establishing rapport is crucial
• Moving from open-ended to closed-ended
questions (general to specific)
– Tell me about why you’re here today?
– What about school is most difficult for you?
– Are you failing math because you didn’t hand
in your homework….not studying……didn’t
understand the material?
• Avoid
– Double-barreled questions (“and”, “or”)
– Long, multiple questions
– Leading questions
– Psychological jargon
 Example Developmental
Interview
A. History of presenting problem
B. Prenatal, perinatal, and early postnatal
history
C. Medical history
D. Acquisition of age-related milestones
E. School history
F. Personality, social, emotional, behavioral
history
G. Family history
H. Expectations about assessment visit
 Example Developmental
Interview
A. History of presenting problem
– Parental description of problem
– Child’s view of problem
– Onset
– Duration
– Interventions attempted
– Prior assessments
– Parents sense of effects of problem,
and sense of child’s understanding
 Example Developmental
Interview
B. Prenatal, perinatal, and early
postnatal history
– Pregnancy
– Labor and delivery
– Birth weight
– Apgar scores
– Complications post-birth
 Example Developmental
Interview
C. Medical history
– Across all ages
– Accidents & injures
– Major illnesses
– Ear infections
– Neurological conditions
– Congenital and genetic conditions
– Hearing and eyesight
Example Developmental
Interview
D. Acquisition of age-related milestones
– Motor
– Language
– Toileting
E. School history
– Preschool experiences to present – Settings
– Achievement, grades, strengths and weaknesses
– Behavioral, emotional, social functioning
– IEPs, 504 Plans, accommodations, modifications
– What teachers think
 Example Developmental
Interview
F. Personality, social, emotional/mood,
behavioral history across development
– Temperament as an infant and toddler
– 2.5-5 years: Development of play, aggression,
interests
– 5-11 years: Hobbies, activities, friendships, family
relationships
– 11 to adolescence: Development of interest in
opposite sex, dating and sex, activities, drug and
alcohol use, family relationships, self-concept,
goals and aspirations
 Example Developmental
Interview
G. Family history
– Parental history: marriage(s), # children
– Demographics, ages, education,
occupation, SES
– Siblings: ages, problems, school history
– Medical, genetic, developmental,
psychological, abuse problems
H. Expectations about assessment visit
 Developmental
Considerations
• Young children tend to think in concrete
ways, while teens may reflects more on
feelings and motivations
• While age is an obvious indicator of
developmental level, language and
cognitive levels may also vary with age
• Interview format should be adjusted to the
individual child’s level
– Open vs. Closed questions
 Developmental
Considerations

• 6 year olds might be asked about the

difference between preschool and
kindergarten
• Young teens might be asked about
the transition to individualized
school schedules and homework,
and peer pressures.
• Older teens might be asked about
college, vocational plans, or
separating from parents
Format of the Interview
• Who will be interviewed is often a
question with young patients
– e.g., Children under 6 typically are
generally interviewed with parents, then
sometimes parents are seen alone
– e.g., Older children and adolescents are
often seen as a family first and then
later may be interviewed alone
– Sex abuse may be an exception
Format of the Interview
• If the clinicians sees family together
it allows for:
– Observation of interactional patterns
– Areas of agreement and disagreement
• Tell family how their time will be
structured
– Allow them to know if they can save
sensitive topics for when they are alone
Closing the Interview
• Summarize what has been learned
– Make sure you understand what the
interviewee has reported
– Helps determine what additional
information might be needed
• Ask the child/family if they have
questions
• “Is there anything else I didn’t ask
about that you think it would be
important for me to know?”
Behavioral Observations
• Psychological assessments always
include observations about the patient’s
behavior during the assessment
• Collected throughout the assessment
• Areas assessed/observed:
– Orientation (person, place, time)
– General appearance and behavior
• Gait, posture, dress, personal hygiene, activity level
– Speech and thought
• Coherence, speed, open vs. guarded
Behavioral Observations
• General response style
• Mood and affect
– Euthymic vs. dysthymic
– Labile, blunted, etc.
• Reactions to being evaluated
• Response to encouragement
• Attitude towards self
• Unusual habits, mannerisms,
vocalizations
Behavioral Observations
• How child relates to parent?
• How child relates to examiner?
• How child reacts to test materials or
toys?
• Is the child age appropriate in
behavior?
• How is the child’s concentration?
Behavioral Observations
• Are tantrums seen?
• Does the child cooperate?
• What is the extent of child’s
responses?
– short vs. elaborate
• How is the child’s speech and
language development?
Informal Assessment
• Self-monitoring records
• Report cards
• Personal documents
– Diaries, poems, stories
• Role playing
Multimodal Assessment
• Obtaining information from several
sources
– Integrate information from several
sources
– Recognize limitations of any one
source
• Using several assessment methods
• Assessing several areas of
functioning
– Strengths and weaknesses
Interpreting Results
• Are test results congruent with other
information obtained?
• How can you account for
discrepancies in teacher, parent,
child reports?
• Do findings appear to be reliable and
valid?
• INTEGRATING results from multiple
sources is a critical clinical skill
Final Steps in Assessment
• Develop intervention strategies and
recommendations
• Write a report
• Provide feedback
• Follow-up
Key Ingredients

• Successful assessment requires

knowledge of:
– Psychological tests
– Psychopathology
– Interviewing
– Statistics
– Development
– Hypothesis testing
– Your self