Below is a series of “tips” developed by the Diagnostic Assessment
Development Team of the Jerusalem Educational Psychology Service back in 2015.
They have been published here and there in this blog, and are now gathered into
one document.
Try to understand
the story of the child, the family, and the school, and formulate a specific
and clear assessment question
The interviews with the parents, the child and the school staff are not
only opportunities for clarifying the referral question but also opportunities
for intervention and therapeutic work. The very act of asking questions
constitutes an intervention. The parents, the child and the school staff each
have a theory about the source of the child’s difficulties. It is important to
become familiar with these theories and consider them as part of the overall
understanding of the case.
The theories that the parents, the child and the school staff have are
not only about the sources of the child's difficulties and strengths. They are
also about the family system, the school system, the place of the child in each
of these systems, and the interactions between these systems. It is important
to listen and give voice to these different perspectives.
If, at the end of the referral-clarification process, you decide
together with the family and the educational team that a psychological
assessment is the appropriate intervention, try to formulate the assessment
question or questions together with these clients. Try to formulate specific
questions. Such questions will help you focus and plan the assessment process
so that it answers the assessment question, rather than working on “autopilot.”
Ask yourself: What finding would surprise me?
Exercise judgment
regarding the scope of the assessment
When comprehensive information about the child is already available from
the school or from a didactic assessment, it is not always necessary to repeat
the assessment of reading, writing, or arithmetic skills.
To answer many
assessment questions—for example, why a child has difficulty decoding
individual words—begin by focusing on specific tests that may answer the
question. In this example, these would include tests of phonological awareness
and tests of rapid naming. On the basis of the answers obtained from these
tests, decide whether and how the assessment should be expanded.
When you aim to determine whether the child has a learning disability
and, if so, which cognitive mechanism is impaired, it is advisable to assess
all cognitive abilities (fluid reasoning, working memory, processing speed,
auditory processing, visual processing, long-term storage and retrieval, and
crystallized knowledge). It is also important to assess all the cognitive
abilities when the aim is to characterize the child’s stronger and weaker
abilities. However, when the assessment question concerns emotional or
personality functioning, or, for example, readiness or maturity for first
grade, a comprehensive cognitive assessment may not be necessary.
It is sufficient to assess a cognitive ability using two measures. A
third measure should be added only when the first two measures are inconsistent
with one another. There is generally no need to assess the same thing
repeatedly. For example, it is usually unnecessary to assess rapid naming using
pictures, letters, numbers, and alternating categories.
Without
compromising standardization, be flexible in selecting and ordering the tests,
and adapt them to the child’s characteristics
Consider which intelligence test is better suited to the child’s
characteristics. The Wechsler tests require more verbal expression; the CAS may
be appropriate with children from an immigrant family because of low verbal
demand (although interpretive caution is needed with non-verbal tests as well).
Consider asking the child which kind of task they would like to begin
with: a task in which you ask questions, a drawing or copying task, a reading
task, and so forth. The child’s choice is always interesting, and you may ask
about the reason for it. It is always pleasant to begin with a task that will
not cause the child too much frustration. An adolescent once told me that he
preferred to begin with verbal questions because the feedback he had received
following an earlier assessment stated that his visual processing was weak.
This provides valuable information about the adolescent’s self-perception, the
impact of the feedback, his coping methods, and more. This also shows us how careful
we should be when giving feedback.
Without
compromising standardization, conduct a dynamic assessment
Remember that your purpose is not merely to “measure the child’s
performance,” but also to understand how they think and what motivates them. After
completing the standardized administration, return to the test and try, through
a dynamic process with the child, to discover the child’s internal theory that
guided their performance. Ask: “How did you arrive at that answer?”, “How did
you approach this task?”, “Tell me how you thought about it.”, “What did you
understand?” etc. In this way, you may discover the assumptions from which the
child proceeded when answering a question about a text, solving an arithmetic
problem or completing a matrix pattern. Remember, the child always has an internal theory that guides their
work. Revealing this theory will help you understand where the
difficulty lies and what the child needs in order to overcome it.
Work creatively with the child, trying in different ways to determine
what the child needs in order to reach the correct answer or solution, or to
analyze the stimulus more effectively. Does the child need to check the answer?
Do they need simplified instructions? An explanation of words in the text? Help
forming hypotheses and drawing conclusions? Keep a detailed record of this
process, to enable you to reflect on it later.
Have an open, unstructured conversation with the child in order to
become acquainted with them. Such a conversation is an essential part of the
assessment process.
Base every
conclusion on the broadest possible range of data and observations
When drawing conclusions about a particular cognitive ability, you have
at your disposal the child’s scores, your clinical impression of how the child
performed the tasks that assess that ability, and your observations of how the
child performed other tasks in which the same skills were expressed. Your aim
is to integrate all these sources of information. Be especially cautious about drawing conclusions on the
basis of a single finding or “translating” subtest scores into specific
statements. A single subtest does not provide a sufficient basis for
conclusions about the child’s abilities.
For example, suppose you have three scores from tests assessing
crystallized knowledge. Do not write: “Jonathan's vocabulary is below average
(Vocabulary subtest = 6). Jonathan has difficulty understanding everyday life
situations (Comprehension subtest = 7). His general knowledge is also low
(Information subtest = 8).” Instead, write: “Jonathan’s level of crystallized
knowledge is low. Although his syntax and grammar are intact, his vocabulary is
limited. Jonathan is unfamiliar with many words and expressions in texts
intended for his age group, such as ‘myth,’ ‘affliction,’ and ‘destroying
everything in its path.’ When expressing himself orally and in writing, Jonathan
used simple, everyday language and slang. Jonathan had difficulty understanding
complex instructions and questions, but understood them better when I rephrased
them using words from a less formal register. Although Jonathan’s performance
on a task requiring the retrieval of general knowledge fell within the normal
range, his performance on other assessment tasks indicated that he lacked
background knowledge that could have helped him learn. For example, Jonathan
had difficulty understanding a text about alcoholism, partly because he did not
understand concepts such as ‘blue-collar workers,’ ‘the middle class,’ and
‘Western society.’”
This passage
demonstrates the integration of evidence-based information regarding
crystallized knowledge—the scores on the three tests indicating low
crystallized knowledge—with clinical information obtained from the assessment
of reading comprehension, oral and written expression, and comprehension of
instructions.
Prefer to draw conclusions at the level of broad abilities rather than
narrow abilities. In all cases, do not draw a conclusion from a single subtest.
Base your conclusions on an integration of the data, your clinical impressions,
and the teachers’ reports. Do
not follow the test data blindly, but do not engage in purely impressionistic
assessment either.
For example, when drawing conclusions about the child’s fluid reasoning
ability, consider the results of tests that assess fluid reasoning. However,
also examine the child’s ability to think abstractly and form concepts, draw
inferences from a text about matters not stated explicitly, tell TAT stories
that are not merely “tied” to and descriptive of the picture, but include
imagination, tell TAT stories with a coherent and logical sequence, provide
generalized definitions of words and concepts, understand complex instructions,
identify the central elements in the Rey Complex Figure and integrate its parts
into a coherent whole, think flexibly and benefit from feedback, plan and
monitor their work, avoid perseverations and automatic responses. Also consider
the teachers’ reports regarding the child’s capacity for thought and
understanding, the child’s ability to take initiative and to work in a
controlled and planned manner.
When there is a marked discrepancy between the test data, your clinical
impression, and the teachers’ reports, exercise judgment and common sense in
determining whether the ability is intact. Also try to understand the reason
for the discrepancy. Remember that it is not always possible to reach an
unequivocal conclusion. We are dealing with human beings, and therefore not
everything will always “fit together.” When you are uncertain or questions
remain, it is preferable to describe your uncertainty and suggest ways of
resolving it rather than write something with which you are not comfortable.
Think in terms of abilities rather than tests
Do not think: “I am going to use the Wechsler, the TAT, the Trail Making
Test" and so forth. Tests are a means, not an end. Instead, try to think: “Which cognitive abilities and
skills do I need to examine in depth in order to answer the assessment
question?”, “Which impaired abilities or skills might account for the specific
difficulties experienced by this particular child?”, “How can I assess
these abilities or skills?” Impairments in cognitive abilities contribute to
difficulties in academic functioning. They also affect the child’s social and
emotional functioning, just as emotional difficulties affect the child’s
cognitive functioning. Therefore, you should become familiar with the
relationship between cognitive abilities and different kinds of difficulties in
reading, writing, arithmetic, and social-emotional functioning.
In understanding
the case and writing the report, try to move from description to explanation
Do not limit yourself to describing findings in the cognitive
domain, the didactic domain (reading, writing, and arithmetic) and the
emotional-personality domain. Try
to explain how weaker abilities account for the specific difficulties you
observed in reading, writing, or arithmetic, and how intact abilities account
for the child’s areas of intact functioning. Try to explain how emotional and
personality characteristics affect cognitive abilities and how cognitive
abilities affect personality characteristics. For example, a child may
have difficulty integrating details into a whole when presented with complex
visual stimuli. The same child may also have difficulty integrating the persons
and objects in a TAT picture into a single complex story.
Alternatively, an adolescent may may describe the figures in TAT stories
primarily in terms of external or observable characteristics, because they have
difficulty seeing the self and others as psychological beings with complex
motives and experiences. The same adolescent may have difficulty comprehending
written texts when required to attribute intentions to the characters.
The “Five
Sentences” method
Before beginning to write, ask yourself: “What am I trying to say?”, “What
is my main message?” Describe the child to yourself in “five sentences”: One
sentence stating the reason for referral—the assessment question—and the
child’s background. Three sentences presenting your explanation of the child’s
difficulties—the answer you found to the assessment question. One sentence
describing the child’s coping strengths. Then begin writing the report. The
“five sentences” can serve as the central core of the report. They constitute
the nucleus of the arguments you are trying to support through the details
presented in the body of the report. The “five sentences” may appear at the
beginning of the presentation of the results and again in the summary.
As you write, ask yourself: “Does the report express the five
sentences?”, After you finish writing, read the report again and ask: “Would someone reading this report
be able to formulate the five sentences on the basis of the report?”
Write about the
particular child, beginning with a blank document
Do not use a ready-made report template. Do not use prefabricated
sentences. Challenge yourself. Begin with a blank document and write about this
particular child. How did the child cope? What characterizes this child? Because
every child is unique, every report should also be unique.
The theoretical model you use to analyze the data will affect the
report’s structure and content, including its headings, subheadings,
conceptualization of the findings, and manner of presentation. A particular child’s diagnostic
picture may fit one model better than another. Some children’s diagnostic pictures may be best
understood using the CHC model. Other children may be better understood using
the PASS, CPM, or SNP model. Within each model, decide whether to begin
by describing the child’s strengths or difficulties, the emotional condition
and its interaction with the cognitive picture, or the cognitive picture and
its interaction with the emotional condition, and so forth.
Leave the data in
an appendix
Focus the report on the child and the child’s characteristics rather
than on numbers. Try to write in a manner that is clearly grounded in the data
but describes the child rather than the data. Keep the reader or client of the
report in mind, and write in a manner that is clear and respectful.
When there is a
strong basis for doing so, state a clear diagnosis.
Write concisely.
Psychological
assessment is a form of intervention: provide dynamic feedback and think
together with the school team about practical interventions and recommendations
Feedback is not a one-way transfer of information from the psychologist
to the parents, the child, and the educational team. Feedback is not the
unilateral provision of recommendations by the psychologist to the parents, the
school team, and the child. Feedback
is a reciprocal process in which we integrate the theories held by the school,
the parents, and the child with our own theory regarding the sources of the
child’s difficulties and strengths, and attempt to answer the assessment
question.
This reciprocal process leads to joint thinking with the parents, the school
team, and the child about interventions that should be tried at home, in the
classroom, and at school. The interventions must be consistent with the
findings, while also being practical, feasible, and specific. It is therefore advisable to
develop them through joint brainstorming with these clients. Such brainstorming can draw on the teacher’s,
the parent's and the child's ideas about things that have worked with this child
or other children.
The interventions
should address both the treatment of the child’s difficulties and the ways in
which the child’s strengths can be reinforced and emphasized. The interventions
are part of the diagnostic process because the way in which they are
implemented will provide further insights into the child, the school system,
and the family system. It is therefore important to schedule follow-up
meetings in which the interventions can be evaluated and a richer understanding
can be developed, opening new possibilities for helping the child.
Because of the reciprocal nature of the feedback process, it is advisable to write the final
version of the report after the feedback meetings. This version should include
insights that arose during the feedback meetings and integrate the stories or
theories of the psychologist, the parents, the educational team, and the child.
Give feedback to
yourselves as well
Consider how the way in which you conducted the assessment process
affected the results and the conclusions you reached.
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