Child and adolescent mental health is a complex area of clinical practice that different types of professionals seek to address in their everyday practice. From pediatricians to Licensed Clinical Social Workers (LCSWs), school guidance counselors, doctoral-level Psychologists, and pediatric Neurologists and Psychiatrists, these are some examples of the types of professionals that deal directly with the myriad mental health disturbances that impact an estimated 15 million children, adolescents, and their families at this moment. When a parent/caregiver brings a child/adolescent into the office of a mental health professional, determining an accurate diagnostic formulation and effective course of treatment typically relies on the individual mental health professional’s own educational and clinical training experiences. One valuable resource that mental health professionals consult to assist with the identification and categorization of mental health symptoms to determine the most applicable diagnoses is the American Psychiatric Association (APA) publication of the Diagnostic And Statistical Manual For Mental Health Disorders-Fifth Edition (DSM-V). However, research has identified the most valuable approach to assessing and informing treatment for mental health disorders as a comprehensive psychological evaluation. This comprehensive approach to assessing for the presence of applicable psychiatric diagnoses utilizes scientifically-validated assessment tools, along with the consideration of other data sources (e.g., clinical observations, review of collateral records such as a child’s academic records, interviews with relatives and third party professionals, and the list goes on). By examining multiple valid data sources (and identifying consistencies and inconsistencies across these key sources of information), hypotheses may be generated and tested, and subsequently discarded or applied.
There are several different types of psychological evaluations that can be administered to any given child or adolescent to determine the most accurate diagnostic formulation applicable. When one hears the term, “psychological evaluation,” many images might come to mind. Unfortunately, many consumers of mental health evaluation and treatment services maintain the inaccurate belief that mental health practitioners specializing in the diagnosis and treatment of mental health disturbances in children and adolescents possess a “Crystal ball” of sorts. This tendency to mystify the practice of psychological assessment can unfortunately, give rise to a whole host of inaccurate beliefs and assumptions regarding what psychological test measures and other assessment tools can tell us about a child or adolescent’s mental health functioning. In this blog, information regarding several of the most commonly sought psychological evaluations specific to the assessment of mental health disturbances in children and adolescents shall be described, with the goal of increasing awareness of the significant importance that a sound, comprehensive psychological evaluation can have on facilitating an overall best practices approach to informing treatment.
The title, “comprehensive psychological evaluation” can give rise to various ideas and beliefs regarding what such assessments may be able to uncover with respect to a child or adolescent’s mental health functioning and treatment needs. Perhaps the most basic operational definition of a “comprehensive psychological evaluation,” involves a multi-faceted approach to the assessment of mental health conditions that incorporates use of psychometric test data, review of collateral data sources, and subjective/qualitative data obtained from self and third party report. This data, when considered together (i.e., in a comprehensive fashion), can delineate certain inconsistencies which in turn, can highlight significant risk factors and protective variables. The primary goal of a comprehensive psychological evaluation of a child or adolescent may be thought of as determining the most appropriate/accurate diagnostic formulation specific to the examinee, determining the most effective treatment goals, objectives, and modalities, and, assisting those responsible for ensuring a child/adolescent’s best interests are consistently maintained with ensuring proper decision-making. In its broadest conceptualization, a comprehensive psychological evaluation would describe that assessment process, by which, diagnostic clarification can occur, and through which, the most relevant and effective treatment services can be identified.
In certain instances, a child or adolescent’s referral for a psychological evaluation may involve more specific referral questions. For instance, suppose that a child/adolescent suddenly exhibits a rapid deterioration in academic performance, or perhaps a teenager whose parents recently separated/divorced is suddenly struggling to remember simple information, or to adequately focus/attend to information in a classroom setting. In many cases, a general psychological evaluation (such as the description previously noted) may not be sufficiently specialized to determine the answers to more specific questions guiding the child or adolescent’s referral for an evaluation. Thus, it is pertinent to describe several more specialized psychological evaluations, which can assist with diagnostic clarification, clinical recommendations, and facilitate more general aspects of clinical decision-making when a child or adolescent is presenting with a unique set of circumstances and or symptoms that in some cases, confounded previous clinical assessments.
Perhaps two of the most commonly sought specialized psychological evaluations consist of psycho-educational evaluations, and neuropsychological assessments. Although both of these evaluations tend to incorporate many of the same assessment methods and procedures, these two types of evaluations differ in several important respects. For instance, a psycho-educational evaluation tends to focus primarily on delineating an examinee’s academic achievement, and to specifically ascertain whether a diagnosis of a specific learning disability or Attention-Deficit/Hyperactivity Disorder (ADHD) may be applicable. These same focal points of assessment are included in most comprehensive neuropsychological evaluations, which retain a more narrow focus on delineating an individual’s cognitive strengths and weaknesses. Unlike a psycho-educational evaluation, a comprehensive neuropsychological evaluation typically goes a step beyond the assessment of specific learning disabilities and/or ADHD, and actually seeks to identify more subtle, albeit, still important cognitive factors (e.g., executive functioning and memory), and tests of emotional and personality functioning may also be included in a comprehensive neuropsychological evaluation to determine the need for further psychological assessments/to identify situations where a child/adolescent’s acting out behaviors may be attributed to an underlying cognitive impairment or other organic condition.
Additional specialized, and more narrowly focused psychological evaluations may be sought to clarify very specific diagnoses on a differential basis. Since we oftentimes see similar symptoms overlapping several diagnostic categories (e.g., symptoms of ADHD representing an underlying anxiety-based disturbance or trauma/stressor-related disorder), or considering cases where there is a question of whether a diagnosis of an intellectual disability is most fitting rather than a separate or comorbid diagnosis of Autism Spectrum Disorder (ASD), there are a range of test measures that can specifically be administered, and still considered along with the more general data sources previously mentioned. In this way, the specific/specialized formal test measures are selected on a case-by-case basis, and are then considered along with other clinical and objective data. The labels given to these assessment processes are largely determined by an individual child or adolescent’s primary presenting problem(s), and oftentimes, a hybrid/customized approach to the assessment of child and adolescent mental health concerns is most fitting (rather than a pre-determined and consistently chosen battery of individualized, standardized tests).
Regardless of the ultimate questions or concerns that any parent/caretaker may be experiencing regarding a child or adolescent’s unique symptoms and presentation, it is important to seek professional consultation regarding available assessment approaches that are specific to evaluating those constructs of concern. A one-size-fits-all approach to evaluating mental health concerns applicable to children and adolescents can invariably overlook important, and oftentimes, underlying processes that can uncover those aspects of a child or adolescent’s functioning that account for most problems exhibited. By contrast, knowing that the professional you seek to perform an evaluation of a child or adolescent will begin with a thorough consultation and interview, will inform the selection of specific test measures and other assessment procedures, and get you on the right track to obtaining the answers needed, and to identify the services most appropriate and fitting for each child/adolescent’s unique needs.