For many of us, the word “assessment” conjures up negative associations.
In reality, though, the fact of the matter is that even though from the outside psychological assessments might prompt a fear of judgment or an image of subjective evaluation, the exact opposite is true: Psychological professionals use assessments to gather objective information in order to find the best way to help an individual grow.
Let’s take a closer look at what psychological assessments entail, common biases to note, and the best way for you to think about psychological assessment.
What Is Psychological Assessment?
The notion of psychological assessment defines an individualized, holistic information-gathering process. It’s not something that can be summarized in a single sentence: there are as many different ways to perform a psychological assessment as there are individuals.
Although there is diversity in how assessments are performed, there is a general method that is consistent across different realms of psychology and different types of disorders. This method involves integrating the results of a variety of different psychological tests in order to create a balanced, objective view of the psychological profile of an individual
Multiple Sources of Information
A psychological professional generally integrates multiple sources of information when coming to a conclusion. This will generally include observation of the person (e.g., interview), historical information (e.g., grades), and the results from multiple tests hopefully done by multiple people. For example, when diagnosing Attention-deficit/Hyperactivity Disorder (ADHD) our clinic will gather information from teachers, parents, and the child. We would rule out various learning difficulties and emotional/behavioural challenges.
Is the Issue A Disorder?
Tests are norm-referenced, which means that an individual’s performance is compared against the average performance of a group of people. For example, a height measurement is a kind of test – it provides a single, discrete measurement of a physical characteristic (not a psychological characteristic). But an individual’s height is only meaningful if it is compared to others; for instance, a child’s height compared to the norms for his or her age group. This can let you know if there is an issue with the child’s growth.
Finding Important Factors that are Hard to Observe
It may be clear that a person is having difficulty managing life. However, the real issues may be harder to see. They may be difficult to see because the person is hiding it, or because they are just not aware. Children, for example, often benefit from psychological assessments because they don’t know how to describe the issues they are facing.
It’s not just children who may not be aware of their issues. For example, a client may be consuming a large amount of alcohol, which is causing anger and relationship problems. This alcohol problem is more obvious and is the issue that attracts the attention of family and friends. A psychological assessment my show that this the alcohol use is an issue, but it may also show that their level of anxiety is very high. This combination of issues may suggest that the individual is using the alcohol to manage their anxiety difficulties. A recommendation of therapy or using an anti-anxiety medication may be the result of this type of assessment. Treating the anxiety may then help the person to stop the alcohol abuse.
Multiple Tests to Rule out Other Potential Issues
Psychological assessments aren’t there to just measure one symptom. The tests chosen are also there to ensure that other issues may not be causing the problem. For example, in an ADHD diagnosis, it is important to know that the observed attention problem is not a symptom of a different disorders.
In the case of ADHD, the primary pharmacological treatment is a stimulant. However, bipolar can look like hyperacitvity and a stimulant medication can make bipolar worse. Psychological assessments are there to make an accurate diagnosis to avoid making mistakes that can lead to months or years of extra pain and confusion.
Tests Can only Be Used With Certain Groups
It’s important when interpreting the results of an individual test to notice the assumptions that the test makes about its subject population. Every individual is different, and it’s dangerous to oversimplify these differences by measuring the averages of a group of people.
Psychological tests are generally meant for specific populations. When these rules are broken, the results may not be accurate. For example, a test that was developed with North American’s may not be accurate with people who grew up in India. Although psychologists sometimes break these rules because no better test is available, clinical judgement is important in interpreting the results.
How to Approach Psychological Assessment
One helpful way to think about psychological assessment is to approach as you would a trip to the doctor’s office.
In both cases, whether it’s a medical professional running a blood test to check for signs of a physical illness, or a psychological professional performing a mental health evaluation to check for signs of a psychological disorder, the basic idea is the same. A professional with the patient’s best interest at heart is simply gathering information in order to inform themselves as to the best next steps.
This comparison also illustrates how one should prepare for the assessment: You wouldn’t study for a blood test. When you go to the doctor, the goal isn’t to present yourself as perfectly healthy and to ignore the physical ailments that are bothering you. How would that help?
Instead, the goal should be to open up lines of honest communication between you and the professional devoted to your care and well-being. With both medical and psychological assessments, you want to be as completely honest as possible, even if you feel afraid or embarrassed. The individual trained to help you is on your team, and will help as best they can.
In conclusion, psychological assessments are an information-gathering process performed by psychological professionals in a number of different contexts. While the process is open to some amount of human bias, if approached like a medical examination, the process of psychological assessment can be a helpful part of psychological care for individuals in all situations.
By Dr. Syras Derksen,
Eabon, M. F., and Abrahamson, D. (2016). Understanding psychological testing and assessment. American Psychological Association. Retrieved from www.apa.org.
We all know individuals who are of a more melancholy disposition than others. In A. A. Milne’s popular set of children’s stories, the friends of Winnie-the-Pooh include both Tigger – the bouncing, happy tiger; and Eeyore – the somber, plodding donkey. Even from a young age, we all understand that it is completely acceptable for individuals to have their own unique dispositions and levels of emotional valence.
However, when a friend or loved one’s general tendency towards being blue seems to worsen, and perhaps begins to impair day-to-day functioning, it is exceptionally difficult to assess the seriousness and potential danger of the situation. In particular, it can be hard to know when a period of melancholy crosses the line into untreated major depression.
Depression Can Be Misdiagnosed
A recent study published in the JAMA Internal Medicine journal by the American Medical Association indicated that in the United States, a large proportion of individuals seeking attention for depression-related symptoms are misdiagnosed. The study surveyed over 46,000 US adults aged 18 or older in 2012-2013.
Using an established scale to measure depressive symptoms, the study established that around 8.4% of the participants in the sample had depression. However, only 28.7% of those individuals had received treatment. Meanwhile, of those who were undergoing treatment for depression (either psychotherapy or antidepressant medication), only 29.9% screened positive for symptoms of major depression.
This means that there are some serious challenges associated with the correct identification of depression, and diagnosis and treatment is not necessarily always straightforward.
In an effort to widen the scope of research into the prevalence of depression misdiagnosis, another study conducted a meta-analysis of 118 different studies assessing the accuracy of depression diagnoses. The final analysis contained data from more than 50,000 patients across 41 different studies, in countries including the United States, Canada, and various European countries, among others.
In the end, the study suggested that for every 100 cases of potential depression seen by a primary care physician, 15 cases are false positives (treatment was prescribed when there was no real depression), 10 cases are missed (treatment is not prescribed when there is real depression), and 10 cases are correctly identified (treatment is provided for real, identified depression).
One reason for this pattern of diagnosis is the difficulty in ascertaining the difference between depression and psychological distress. The AMA study described in the previous section measured the difference between depression and serious psychological distress, and found that among adults who were undergoing treatment for major depression, 29.9% had depression and 21.8% had serious psychological distress.
In addition, factors such as age, culture, and available medical resources can impact diagnoses. In general, the studies concluded that developing a relationship with a mental health care professional and undergoing multiple diagnostic visits over a longer period of time can substantially increase diagnostic accuracy.
Signs to Look For
To address the complexity of depression diagnosis, there are several mnemonics that have been developed in an effort to make the symptoms of depression more memorable. The mnemonic below, published by Blenkiron, 2006, lists 10 symptoms of depression aligning with the 10 letters of the word. Here we present the list and supplement each item with a brief description.
As was apparent from the list above, each symptom presented must recur in an individual for a period of multiple days before it should be considered a possible indicator for major depression. Generally speaking, until multiple of the symptoms above are present much of the time for a sustained period lasting around two weeks, there should not be major cause for concern.
However, anyone with any concern over the mental health or safety of a friend or loved one should consult with a mental health professional. Individuals who fear for anyone’s immediate safety should contact emergency services.
By Dr. Syras Derksen,
Blenkiron, P. (2006). A mnemonic for depression. BMJ: British Medical Journal, 332(7540), 551.
Mitchell, A. J., Vaze, A., & Rao, S. (2009). Clinical diagnosis of depression in primary care: a meta-analysis. The Lancet, 374(9690), 609-619.
Olfson, M., Blanco, C., & Marcus, S. C. (2016). Treatment of Adult Depression in the United States. JAMA Internal Medicine, 176(10), 1482.
“We have demonstrated that the validity of psychological tests is comparable to the validity of medical tests” –Meyer et al.
How accurate are psychological tests? Are they accurate enough to use in diagnosis? Sometimes psychological tests don’t seem as accurate because they don’t feel the same as a blood test or a brain scan. However, a thought-provoking study evaluated the accuracy of psychological tests in comparison to common medical tests.
Psychological Assessment Validity
A group of researchers, led by Gregory Meyer, gathered data from more than 125 pieces of research that looked at the accuracy of different psychological and medical tests. Each test was evaluated by the relationship between the test and the disease or disorder that test is trying to measure. For example, you could evaluate the relationship between a positive mammogram finding and actual instances of breast cancer. Although mammograms are intended to accurately find breast cancer every time, they don’t always succeed. The more often the mammogram is successful, the greater the tests accuracy.
Tests I Use IN My Psychological Assessments
I was interested to see the strength of some of the psychological tests I use in my practice and how they measured up to familiar medical tests. The MMPI is a common personality test that I often use to help with diagnosis of different psychological disorders like depression, anxiety, schizophrenia etc. This test was more accurate than a home pregnancy test.
Another common test that I use is the WAIS, which is an IQ test for adults. I often give this test to adults who are wondering if they have a learning disorder or perhaps as part of an adult ADHD assessment. It turns out that this test is about as accurate as a dental x-ray looking for cavities.
I sometimes use neuropsychological tests, which are good for screening for issues like dementia. It turns out that these tests were more accurate in identifying dementia than using an MRI.
Importance of Accurate Diagnosis
Psychological tests are important because it is often very challenging to provide an accurate diagnosis. It is difficult because many disorders have many of the same symptoms, it can be hard to be aware of all potential symptoms, and it can be hard to figure all of this out and explain it in a short medical appointment.
One of the reasons an accurate diagnosis is important is because the medical treatments for different psychological issues can be very different. For example, ADHD can often be confused with Bipolar. Unfortunately, if you give someone with bipolar an ADHD medication, they have have a negative reaction.
The importance of these psychological tests is reinforced for me every time I make an unexpected discovery. It is surprising how many individuals are surprised to discover that they have issues with anxiety. Others may have struggled with ADHD since they were young, never knowing the cause of school, work, and relationship issues. It is not just the patients who are surprised. Even after years of seeing different issues, psychological tests can show results that surprise me and make me grateful I am not relying solely on clinical interviews.
By Dr. Syras Derksen
Meyer, G., et al., (2001). Psychological testing and psychological assessment: A review of evidence and issues. American Psychologist, 128-165.
The serious impact of cyberbullying on its victims are well documented in our news today. The tragic stories of Rehteah Parsons and Amanda Todd have inspired changes in national laws and sparked many policies and prevention strategies in schools. Instances of cyberbullying continue, however, and have become a regular concern in the lives of many adolescents.
Bullying in general has historically been even more of a challenge for those whom other children and teens perceive to be different from themselves and their friends. Individuals with disabilities, whether physical or mental, are more prone to becoming targets. And as bullying experts will tell you, it is not uncommon for people who are victims to then become the bully in an effort to regain self-worth and power. Therefore, bullying, both direct and online, are significant concerns to parents and teachers of students with learning and behaviour difficulties.
Heiman, Olenik-Shemesh, and Eden (2015) investigated cyberbullying involvement among teens with ADHD and how it relates to feelings of loneliness, self-esteem, and social support. In their study, which is consistent with other research, adolescents with ADHD are more likely to be involved in bullying behaviour overall, as a perpetrator, a victim, or a witness. Those who are victims reported higher levels of loneliness, and were less likely to believe in their capabilities and also report less social support. This is not surprising, but the study also found that even teens with ADHD who witnessed cyberbullying felt lonelier and less confident about themselves.
This study gives some insight into the everyday effects of cyberbullying in teens. Most surprising perhaps is the changes in feelings of loneliness and self-confidence of those who are just witnessing the events. They may be feeling empathy for the victim, they may be reminded of times when they were the victim, or perhaps they have an understanding of how the negative words are isolating peers from each other.
It is important to note that despite the negativity in the findings above, compared with other teens, the study also found that those with ADHD were more likely to ask bullies to stop or to report the instances to parents or teachers. They are able to see that something is not right and are willing to make steps to stop the bullying. While these teens experience some significant emotions around cyberbullying, they also have great potential to create change in online social culture.
Understanding the emotional impact of cyberbullying in teens with ADHD can help to start conversations with them about their interactions with peers, and also be a way to encourage them to be agents of positive change.
By Kristi MacDonald
Heiman, T., Olenik-Shemesh, D., & Eden, S. (2015). Cyberbullying involvement among students with ADHD: Relation to loneliness, self-efficacy and social support. European Journal of Special Needs Education, 30(1), 15-29. Doi: http://dx.doi.org/10.1080/08856257.2014.943562
The start of a new school year brings many different emotions for students and their families. Positive feelings such as hope for a new start, anticipation of seeing old friends, and excitement of new back-to-school clothes can be mixed with anxiety of a new school, dread of a difficult course load, or sadness at saying goodbye to summer freedom. For students with academic or behavioural challenges, the negative feelings can overshadow any positive ones.
It is well documented that students with ADHD can experience school problems in a number of ways. Recent research has identified that ADHD is directly related to school discipline such as being suspended or expelled due to unacceptable behaviour, and it is also related to difficulty completing schoolwork (Martin, 2014a). In addition to these problems, students with ADHD often struggle with learning disabilities and social relationships. Put together, it’s no wonder that the start of September is a stressful time for many students. So how can parents, teachers, and students themselves prepare for the next ten months? What can be done to end a cycle of trips to the office and bad report cards?
Rather than hope for the best and wait until problems arise, it is important to focus on how we can prepare our teens and young adults for success at school. There are many research studies on the problems that students experience, particularly when they have a diagnosis such as ADHD, but research is starting to focus on how students are succeeding despite adversity they may face.
Andrew Martin describes the idea of “academic buoyancy” as “students’ capacity to successfully overcome setbacks and challenges that are typical of the ordinary course of everyday academic life” (Martin, 2014b). Basically, he looks at how students deal with day-to-day problems in school such as deadlines, timed tests, and tough assignments. Characteristics of academically buoyant students include seeing themselves as capable, having a plan for their work, persisting despite difficulty, and having lower anxiety about schoolwork. Martin found that students with ADHD (as well as students without) who show academic buoyancy have better outcomes at school for their achievement, enjoyment, and participation.
Here are some ways to promote academic buoyancy:
It’s natural to be sad about saying goodbye to sunny beach days and warm evening campfires, but starting a new school year can be an exciting beginning and by preparing students for facing challenges, this can be the most successful one yet.
By Kristi MacDonald
Martin, A. (2014a). Academic buoyancy and academic outcomes: Towards a further understanding of students with attention-deficit/hyperactivity disorder (ADHD), students without ADHD, and academic buoyancy itself. British Journal of Educational Psychology, 84, 86-107. doi:10.1111/bjep.12007
Martin, A. (2014b). The Role of ADHD in Academic Adversity: Disentangling ADHD
Effects From Other Personal and Contextual Factors. School Psychology Quarterly, 29(1), 395-408. doi: 10.1037/spq0000069
Memory is a broad term with many sides to it. Simply put, it is generally accepted that the process of memory involves experiencing information with our senses, encoding it into our minds, storing it, and then retrieving it. To forget something means there was a disruption somewhere along the way.
The act of learning happens in the same process. Take for example, learning how to play a new song on the piano. You experience it by hearing it and playing it for the first time. Then you encode it into your mind by rehearsing or listening to it again. It’s stored in your memory and then next time you sit down at the keyboard, you can play it at least a little bit better than you could after the first time you heard it.
The similarity makes memory an essential process to look at when diagnosing and understanding learning disabilities. One area of memory is verbal learning; that is, remembering spoken information. Oyler, Obrzut, and Asbjornsen (2012) examined verbal memory in adolescents with learning disabilities in order to better understand the way their brain processes information and what parts of their memory might be making reading difficult for them.
The researchers used the memorizing of word lists to investigate the different parts of memory mentioned above, such as inputting words into memory, storing them, and then being able to recall as many as possible. The results of their study revealed that students with learning disabilities (particularly in reading), had most difficulty in the initial learning of the words, as opposed to being able to retrieve them from their memory. So when it comes to learning, teens with learning disabilities are having more difficulty with getting information into their memory.
Often we think that our kids with learning disabilities just need to “catch up” in reading or math, but studies such as this one show that there are parts of the learning process that may need to be different. This study in particular suggests a few ways to help teens to have good strategies for learning.
For some teens, learning a new concept is a difficult task, but studies like this tell us that by being creative and flexible in our approach to memory, they can be confident that learning is possible.
By Kristi MacDonald
Oyler, J. D., Obrzut, J. E., & Asbjornsen, A. E. (2012). Verbal learning and memory functions in adolescents with reading disabilities. Learning Disability Quarterly, 35(3), 184-195. Retrieved from http://search.proquest.com/docview/1114699703?accountid=14569
Cities like Winnipeg seem to come alive in the summer. As soon as spring hits, we jump at the chance to wear sandals and put away our down-filled parkas. Gradually, the sidewalks and fields dry out and we dust off the running shoes and bikes, anxious to enjoy every moment of warm sunshine. The Canadian Physical Activity Guidelines recommend 150 minutes a week of moderate-to-vigorous activity per week for adults and 60 minutes per day for children and adolescents. There are many physical benefits to activity and exercise, as well as emotional and mental health benefits.
A number of studies have investigated the impact of exercise on focus and attention, finding that regular exercise has a positive impact on children’s ability to attend to new information (also known as working memory). Working memory and attention are areas of thinking that are core difficulties for children and teenagers with ADHD. A recent study by Ziereis and Jansen (2015) looked at the effect that physical activity has on children with a diagnosis of ADHD and whether it changed their performance on working memory tasks.
Children aged 7 to 12 were assigned to three groups, a control group (who were on a waitlist for the program), a group who participated in various activities such as swimming, climbing, and gymnastics, and a group who did focussed skills such as balance training, throwing and catching, and juggling. The latter two groups participated in activities once a week for 12 weeks. The researchers measured working memory/attention performance before and after the programs and found a significant improvement for those who participated in either physical activity program, but no difference for children in the control group.
The study tells us three important things:
1. Physical activity has a positive effect on attention-related skills in children with ADHD. Getting out and doing a sport or training for just an hour each week was enough to boost working memory ability. Working memory is essential for remembering new information and also for understanding it.
2. The type of physical activity doesn’t seem to matter; that is, kids don’t necessarily need specific skill training in order for it to improve their working memory. Some kids enjoy the drills and practices of soccer camp, others might prefer to splash around in the pool, but either will be a benefit to their ability to learn.
3. It is important for exercise to be continuous. Ziereis and Jansen did look at whether attention improved after just one week and found that it was the same as prior to the activity. So it’s more than just going for a run before a test, make physical activity a regular and continuous habit to reap the most benefits.
Summer is a great time to get started with new activities and sports, and continuing into fall and winter will give kids with ADHD a big advantage when they get back to school.
By Kristi MacDonald
Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Research in Developmental Disabilities, 38, 181-191. doi:10.1016/j.ridd.2014.12.005