Child Psychological Report Writing

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Psychological Assessment of Children : 

Psychological Assessment of Children Patricia Heisser Metoyer, Ph.D.

Before You Begin : 

Before You Begin • Why a report? • Answer referral question • Provide useful info • Structured • Objective • In-depth review of client • Clarifies behavior and explains why it occurs • Recommendations • Used by

Basic Guidelines : 

Basic Guidelines • Need for structure • Do not write report by “winging it” • Know the end before you begin • Not all reports will be the same • Consider your audience • The referral question • Include strengths • But don’t forget psychopathology

Basic Guidelines : 

Basic Guidelines • Do not write reports from just one test • Don’t get tied down in social history or behavioral observations • Don’t use jargon, codes or shorthand • Data interpretation is imperative • Don’t overwhelm with statistics • Length and style of report • Timeliness

Other Considerations : 

Other Considerations • The report writer • Computerized testing • Confidentiality and assessment

Organization of the Report : 

Organization of the Report In general: • Title and Demographics • Reason for Referral • Background Information • Behavioral Observations/Mental Status Exam • Psychological Evaluation • Instruments/evaluative procedures • Visuo-spatial functioning

Organization of the Report : 

Organization of the Report Intellectual functioning • Achievement functioning • Personality functioning • Summary • Diagnostic Impressions • Recommendations • Signature

Reason for Referral : 

Reason for Referral • First narrative section • Includes: • Who referred the client • The reason for the referral • This is where the referral question is articulated • Do not change the referral question to meet the findings of the evaluation

Background Information : 

Background Information • Here is where you include information from the clinical interview • Family history • Social history • Sexual history • Physical health

Background Information : 

Background Information • Length of section • Organization of section • Writing style • “Client reported” • Use of other reports

Behavioral Observations : 

Behavioral Observations Mental Status Exam • First description of client • Use Behavioral Observations when the report is short; use Mental Status for longer reports

Psychological Evaluation : 

Psychological Evaluation • List all tests given (e.g., Wechsler Adult Intelligence Scale, Third Edition) and procedures used (e.g., clinical interview with client) • Visuospatial functioning • Results of the Bender • Intellectual functioning • Results of IQ tests • Do not separate tables across pages

Psychological Evaluation : 

Psychological Evaluation • Achievement Functioning • Results of achievement tests • See IQ tests re: tables across pages • Personality Functioning • Start with broader measures and go to finer ones • Interpret all of the measures you have administered

Psychological Evaluation : 

Psychological Evaluation • Developmental history • Education history • Employment history • Alcohol and drug use • Legal history • Financial history • Psychological/emotional History • Suicide Assessment

Slide 15: 

• Not copied • Nothing in the results that has not been presented in the body • Can use to synthesize and draw conclusions • Summary is brief and highlights client’s psychological state • If the reader wants more, he/she can look in the body of the report • Serves as a preamble to the Diagnosis and Recommendations sections

Recommendations : 

Recommendations • Addresses • REFERRAL QUESTION • Immediate needs of the client • Hospitalization for suicidal/homicidal ideation • Psychological Interventions necessary • Individual, group, family therapy • Include goals for each type of intervention • Be as specific as possible • Though try to avoid saying one type of therapy is better than another

RECOMMENDATIONS : 

RECOMMENDATIONS • Evaluate for medication • You are not physicians, cannot make medical diagnoses or prescribe medications • Other services needed • Classroom modifications (big for next year) • Occupational Therapy, Recreational Therapy, Tutoring, Assertiveness Training, Vocational Rehabilitation, Study Skills Classes, etc. • Anything else

Recommendations : 

Recommendations • List from most important to least important • Answering the referral question is always the most important • Try to keep them short and sweet • Should be explicit, specific, realistic and, when possible, written in behavioral terms

Purpose of Psych. Assessment : 

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 : 

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 : 

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 : 

Psychological Assessment Main types of assessment Norm-referenced tests Interviews Observations Informal assessment procedures Non-norm referenced tests

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 : 

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

Slide 25: 

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 “Normal” or “Bell” curve

Norm-Referenced Tests : 

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 : 

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 : 

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 : 

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 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 : 

Examiner Nonverbal Behavior

Other Testing Issues : 

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 : 

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 : 

Establishing Rapport Use of communication skills Acknowledgements Descriptive Statements Reflections Praise Periodic Summaries Elaboration Clarification

Establishing Rapport : 

Establishing Rapport Avoid: Lack of interest or not attending Sarcasm Lecturing Interrupting Commands No eye contact Criticisms

Interviewing : 

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 : 

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 : 

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 : 

Example Developmental Interview History of presenting problem Prenatal, perinatal, and early postnatal history Medical history Acquisition of age-related milestones School history Personality, social, emotional, behavioral history Family history Expectations about assessment visit

Example Developmental Interview : 

Example Developmental Interview 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 : 

Example Developmental Interview Prenatal, perinatal, and early postnatal history Pregnancy Labor and delivery Birth weight Apgar scores Complications post-birth

Example Developmental Interview : 

Example Developmental Interview Medical history Across all ages Accidents & injures Major illnesses Ear infections Neurological conditions Congenital and genetic conditions Hearing and eyesight

Example Developmental Interview : 

Example Developmental Interview Acquisition of age-related milestones Motor Language Toileting 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 : 

Example Developmental Interview 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 : 

Example Developmental Interview Family history Parental history: marriage(s), # children Demographics, ages, education, occupation, SES Siblings: ages, problems, school history Medical, genetic, developmental, psychological, abuse problems Expectations about assessment visit

Developmental Considerations : 

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 : 

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 : 

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 : 

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 : 

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 : 

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 : 

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 : 

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 : 

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 : 

Informal Assessment Self-monitoring records Report cards Personal documents Diaries, poems, stories Role playing

Multimodal Assessment : 

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 : 

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 : 

Final Steps in Assessment Develop intervention strategies and recommendations Write a report Provide feedback Follow-up

Key Ingredients : 

Key Ingredients Successful assessment requires knowledge of: Psychological tests Psychopathology Interviewing Statistics Development Hypothesis testing Your self