What’s a Comprehensive Assessment and How Could It Help My Child?

Katherine Quie

 Attention Magazine December 2019

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My last year in my doctoral program to become a clinical psychologist, I applied for a fellowship in pediatric neuropsychology. I had focused on child development, assessment, and health psychology during school. I wanted to learn even more about the assessment of cognitive skills linked to brain functioning, like memory, attentional functioning, processing speed, and fine-motor speed and dexterity. I would have the opportunity to assess children with complex medical backgrounds, like seizure disorders, brain cancer, and traumatic brain injuries.

This decision nearly pushed my husband over the edge (“More training, are you kidding me?”), but it was one of the best decisions I’ve ever made.

Here’s why: I learned how valuable it is to understand a child’s learning style.

I’ll never forget one of the first children I assessed during my fellowship. He was six years old and explosive at school. It was through him that I began to understand what we refer to as “uneven skills” in the field. During testing, when I asked him to define the word shoe, he pointed to his foot. When I pressed him to share more, he kicked my desk. Hard.

Not once had his language functioning been in question, at least during the parent interview or within the documentation provided by the school. His language functioning had not even been assessed, as his behavioral challenges were deemed the primary problem.

Here’s the thing. This same child cooperated beautifully when I asked him to replicate block designs. He even hummed to himself while he worked. Instead of slouching in his seat, he sat proud with his shoulders back as he built nearly every design in the booklet.

So what does all of this mean? It meant that this child was a highly visual learner. It also meant that he needed help strengthening his coping and language skills. While this may seem like a no-brainer, catching nuances in a child’s learning isn’t as easy as it sounds, particularly when a child’s behavior is so hard to manage.

Does a neuropsychologist need to conduct the testing? The simple answer is no. My added training in neuropsychological assessment prepared me to assess children with complex medical backgrounds. However, comprehensive testing, such as the testing mentioned above, is often conducted by clinical psychologists who specialize in assessment. School psychologists conduct assessments, as well, although they are often limited in their ability to make medical diagnoses, and in the amount of testing they can perform based on financial and time constraints.

Here are five potential ways that comprehensive testing could help your child thrive.

  1. Testing can help identify your child’s learning style and mental health needs.
    During testing, psychologists test various aspects of a child’s learning, such as expressive vocabulary development, spatial reasoning, working memory, processing speed, fine-motor speed and dexterity, reading, writing, and math skills.Based on these findings, the evaluator can better understand your child’s specific learning style. For example, if your child is great with hands-on tasks (such as replicating block designs), yet struggles with language-based tasks (such as defining words, reading, writing), the psychologist will likely recommend hands-on learning opportunities for your child in school to supplement verbal instruction (writing out words in sand or shaving cream and sounding out each letter along the way, for example).Psychologists also assess your child’s mental health. For example, if your child rates high in anxiety relative to kids his or her age, and shares about frequent worries during the clinical interview, the psychologist will talk with you and your child about ways to address this (therapy, relaxation exercises, parent guidance).Believe it or not, many kids don’t tell their parents the things they tell psychologists, as they don’t want to worry their parents! Comprehensive testing provides your child with an opportunity to talk with an impartial person about how he or she truly feels, which can be a real gift.Here’s a picture of my desk at the office mid-evaluation during my lunch break. Psychologists like to have fun, too! Make sure you tell your child there will be toys to play with during breaks. Most psychologists give kids rewards for their hard work, too.
  2. Psychologists make school-based and private recommendations.
    For example, if a child performs within the well below average range in expressive and receptive language (such as defining words and tracking directions), I may recommend a private speech and language evaluation to gather more information about your child’s language skills. Speech and language therapy may be necessary to strength your child’s expressive and/or language skills. This can make a huge differencein many aspects of your child’s development, even socially.Think about it. If your child struggles to express himself, he may frustrate easily with peers or withdraw from kids altogether.Psychologists also help with school-based recommendations. For example, if a child has slow processing speed and can’t get through homework within a normal time-frame, which is super common in kids with ADHD, like my own son, I may recommend modified homework assignments (allowing the student to complete every third math problem, for instance) and added time for testing.
  3. Psychologists follow your child’s learning over time.
    This one is so important. Parents often tell me that they find great comfort in having me update their child’s testing every few years. While this is not necessary for all children with ADHD, for many kids, given their uneven learning (memorizing history facts is a piece of cake, while learning math facts is torture!), updating testing can provide tremendous support for the child and family.For example, if your child struggles with reading, the psychologist can identify the specific challenge(s) your child is experiences in reading, like difficulty blending sounds or poor phonemic awareness. Then, the neuropsychologist can tailor recommendations for the reading specialist. In one to two years, when testing is updated, the neuropsychologist can check your child’s reading progress. If it’s minimal, interventions should be tweaked.
  4. Psychologists are a strong referral source.
    Psychologists work with many different specialists, like occupational therapists, speech and language therapists, psychiatrists, psychiatric nurse practitioners, neurologists, play therapists, social workers, psychologists, in-home therapists, and more.That being said, we get to know who does a great job, and who doesn’t, which is “gold” if your child needs specialized support.
  5. Psychologists also help with educational decisions and planning.
    Let me give you an example. As a parent who has raised a son with ADHD, I used to fret about his transitions between elementary, middle, and high school. Having my son tested was very helpful in guiding his educational transitions, such as from middle to high school.Psychologists also help teens prepare for college. Just this year alone, I’ve helped at least five teens connect with disability services in college settings to develop plans on how to access adequate support.

So, in summary, there are five potential ways comprehensive testing could help your child thrive.

  1. Testing clarifies a student’s unique learning and mental health needs.
  2. Testing guides private and school-based recommendations.
  3. Psychologists can track your child’s learning over time.
  4. Psychologists are well-connected with the community, which helps with referrals to specialists.
  5. Psychologists help with educational decisions, such as which schools may or may not be a good fit for your child.

Katherine Quie, PhD, LP, recently founded ADHD&U as an outlet for her passion in supporting youth and families impacted by ADHD (https://kqadhdandu.com). She is a licensed psychologist and author of the memoir, Raising Will: Surviving the Brilliance and Blues of ADHD (Wise Ink, 2019). She is a mother of two, an avid knitter and yoga lover, and lives with her husband in Saint Paul, Minnesota.