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Everything You Always Wanted to Know About Psychoeducational Assessments...(and don’t be afraid to ask!) !

Dr. Scott HamiltonLicensed Clinical Psychologist

Board Certified in School NeuropsychologyAsst. Head of School for AcademicsThe Howard School (Atlanta, GA)

Disclosures• The Howard Institute• I do not receive compensation for endorsing any products, services

or tests mentioned today• “Cover Band” citing and synthesizing existing research

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What does “psychoeducational assessment” actually mean?

Depends on whom you ask!

Scores and the Normal CurveCONFIDENCE INTERVALS(95%)

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The Evils of Age & Grade Equivalents

• AE and GE are not what you think!

• Ahmed (1st grade) • Jane (3rd grade) • Pat (5th grade)

Raw Score of 16

G.E. = 3.0

Basic Report Structure

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Domains/skill areas that can be evaluated

Caveat: overlap!

Assessment of Intelligence

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Attempts to Define Intelligence

•No agreed upon definition•Definitions usually center around the ability to think

abstractly, or to learn from the environment, profit from experience, and adapt quickly and efficiently•Will vary to some degree from test to test

Intelligence: One Factor or Many?“g”

versus multiple independent factors

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What Does “Intelligence” Measure?

INTELLIGENCE

AbstractThinking

Ability toLearn

ProblemSolving

AdaptabilityTo

Environment

Creativity

AcquiredKnowledge

LanguageAbility

QuantitativeAbility

Memory

ProcessingSpeed

ProcessingSpeed

Memory

QuantitativeAbility

LanguageAbility

AcquiredKnowledge

Creativity

AdaptabilityTo

Environment

ProblemSolving

Ability toLearn

AbstractThinking

INTELLIGENCE

Cattell-Horn-Carroll (CHC)

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Alternative Theories of Intelligence

Caution about Full Scale IQ Scores

• Just samples (Confidence Intervals)•They measure slightly different constructs, and as such, IQ scores are not always interchangeable•Emotional and motivational factors• Speed bias•Remaining cultural bias

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Examples of Current Intelligence Tests

•Wechsler (WPPSI-IV, WISC-V, WAIS-IV)

•Differential Ability Scales (DAS-II)•Woodcock-Johnson Tests of Cognitive Abilities (WJ-IV)• Stanford Binet-5•Kaufman Assessment Battery for Children 2nd Edition (KABC-II-NU)

Crystalized (verbal) Abilities (Gc)•WISC-V = Verbal Comprehension Index (VCI) • knowledge base/fund of information• vocabulary knowledge• verbal abstract reasoning (e.g., “In what way are a phone and a radio alike?”)

•Analogy: The Skillful Librarian

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Weak verbal/crystalized abilities: What does it potentially look like at school?

• Poor comprehension (oral and reading)•Weak factual knowledge•Weakness with the vocabulary of math• Impaired word usage and grammar in writing•Concreteness in thinking

Fluid Reasoning (Gf)• WISC-V = Fluid Reasoning Index (FRI) • problem solving: how we respond to a novel task• concept formation (e.g., identifying a “rule”

governing a series of observations)• analytical skills (separating a problem

into its component parts)• ability to generate and test

hypotheses mentally• making inferences

• Analogy: The Detective

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Weak fluid reasoning: What does it potentially look like at school?• Difficulty…• drawing inferences from text or set of data• identifying the main idea• seeing a familiar pattern in a story problem and knowing what operation

to select to solve it• appreciating relationships between numbers• generalizing problem solving strategies from

one context to another• comparing/contrasting ideas

Visual Processing (Gv)•WISC-V = Visual-Spatial Index (VSI) • perceive and remember spatial relationships and shapes • perception of spatial orientation e.g., relative size, position, and

angles)•matching of and memory for visual details• ability to analyze (break down) and synthesize

(put together) visual-spatial information

• Analogy: The Architect

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Weak visual-spatial skills: What does it potentially look like at school?• difficulty reading maps, charts, graphs

• difficulty writing-allocating enough space, consistent letter sizes, margins• misaligned numbers in arithmetic

• geometry, geography, art

• certain aspects of science (e.g., chemical elements)

• being able to mentally rotate shapes, imagine them from a different perspective

• taking proper angles in sports, driving

• being able to put IKEA furniture together J

Working Memory(Gsm)• WISC-V = Working Memory Index• Hold a finite amount of information in the mind while performing some sort of

mental operation with this information and producing an output with it• Includes the ability to sustain attention, concentrate, and exert mental control

over information in the mind• Measured: can be verbal (e.g., digit span) or visual (caution about the WISC-V)

Analogy: The General Manager

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Weak working memory: What does it potentially look like at school?

• Reading comprehension•Decoding multi-syllabic words•Writing (errors in one domain)•Math (multi-step algorithms)•Oral language (retelling stories; word finding)•Difficulty following multistep directions•Note taking

Processing Speed (Gs)•WISC-V = Processing Speed Index• Speed to mentally process simple or routine information without making

errors • More working memory and attention can be allocated to problem solving

if not bogged down by slow execution of basic processes• Handling more incoming information at a time• Fluency is a specific application of processing

speed, such as reading rate or speed with completing math fact problems

• Analogy: assembly line worker

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Weak processing speed: What does it potentially look like at school?• Sometimes, but not always, slow oral or silent reading, affecting comprehension

(but can be accurate)• Sometimes, but not always, math facts are not automatic (but can be mostly

accurate)• Difficulty coming up with ideas for writing• Slow processing of incoming information, burdening working memory

Assessment of Language

• Articulation• Verbal Fluency• Receptive and Expressive Vocabulary• Semantic Understanding and Use• Syntactic Understanding and Use• Pragmatic Understanding and Use• Higher Order/Abstract Language

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Examples of Language Assessments•Comprehensive: CELF-5, OWLS-II, TOAL-4, TACL-3

•Narrow: WIAT-III, KTEA-II achievement tests

Weak language: What does it potentially look like at school?• Difficulty with understanding complex sentences (e.g., “The boy the dog

watched ate the pancake made by the chef”)• Asks for things to be repeated often• Difficulty with words with multiple meanings (“At the appropriate date, she

gave her date a delicious date”)• Difficulty putting thoughts together “on demand” (e.g., when called on in

class)• Frequent grammatical errors in speech• Difficulty telling stories or elaborating• Limited vocabulary• Difficulty with higher order language (e.g., figures of speech; idioms)

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Assessment of Memory

• Visual versus verbal• Paired associations• Immediate versus delayed (not quite long term)•Meaningful/contextual versus rote/abstract

Weak memory: What does it potentially look like at school?• Requires multiple repetitions to grasp something• Note taking gaps• Remembering to turn in homework• Performance on comprehensive exams• Answering questions about factual information• Out of sight, out of mind with math (frequent re-teaching needed)• Difficulty accessing background knowledge to support new learning• Math facts (accuracy)• Difficulty with specific types of writing tasks (e.g., compare/contrast;

persuasive)

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Memory TestsVerbal MemorypCalifornia Verbal Learning Test: Child

Version (CVLT-C)pChildren’s Memory Scale (CMS)pKABC-II: Number Recall, Word OrderpNEPSY-2: Sentence Repetition, Narrative

MemorypTest of Memory and Learning (TOMAL-2) pWRAML2 : Story Memory, Verbal

Learning and Sentence MemorypChild and Adolescent Memory Profile

(ChAMP)

Visual Memoryp Children’s Memory Scale (CMS)pKABC-II : Face RecognitionpNEPSY-2: Memory for Faces,

Memory for DesignspTOMAL-2pWRAML2 : Design Memory and

Picture MemorypChAMP

Sensorimotor Functions

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Sensorimotor

Sensorimotor

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What does weak sensory-motor functioning look like at school?

• Fine motor tasks are difficult (e.g., scissors; tying shoes; buttoning)•Unusual gait• Poor balance• Sensitivity to sound, noise, light, touch• Poor handwriting (pencil grip, pressure)•Atypical activity level, either sensory seeking/avoiding

Tests of Motor Functioning

• Beery VMI-6• Bender-Gestalt•Dean-Woodcock Sensory Motor Battery•Wide Range Test of Visual-Motor Integration•NEPSY-II : Design Copying, Fingertip Tapping, Imitating Hand

Positions, Manual Motor Sequences, Visuomotor Precision•Grooved Pegboard Test•Manual Finger Tapping Test

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Assessment of Executive Functions•Collection of cognitive processes that are responsible for

guiding, directing, and monitoring thinking, emotions, and behavior, especially in novel problem solving situations

• Simply put, executive functions enable people to adapt to and interact successfully with the environment. Executive Functioning can be strong or weak in a variety of domains, such as the student’s interaction with school materials, or socially/behaviorally

• Analogy: The Coaching Staff

Weak Executive Functioning: What does it potentially look like at school?• Poor sustained or focused attention• Impulsivity • Hyperactivity• Difficulty planning/organizing tasks• Losing belongings easily• Difficulty with shifting/transitions• Frequent careless errors/poor self-monitoring• Poor regulation of emotions (positive and negative)• Difficulty with task initiation• Difficulty setting goals and persisting

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How to assess for EF?•Clinical history•Rating scales (and limitations of!)• BRIEF-2; Conners CBRS; BASC-3; CEFI

• Examples of specific tests (and limitations of!)•DKEFS (e.g., Trailmaking; Color-Word Interference; Sorting; Tower)•NEPSY-2 (Animal Sorting; Auditory Attention/Response Set)•Wisconsin Card Sorting•Continuous Performance Tests (Conners; Gordon; IVA-2)• TEA-Ch-2

Assessment of Academic Functions: Reading

• Phonological Skills • Rapid Automatic Naming (RAN)• Isolated Word Decoding• Nonsense/Pseudoword Decoding• Comprehension• Fluency (oral, silent)

• Basic: WJ-IV, WIAT-III, K-TEA-III• Expanded: PAL-II, Feifer Assessment of Reading (FAR), WJ Diagnostic

Reading Battery, GORT-5

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Assessment of Academic Functions: Mathematics

• Math Fact Fluency (written or oral)• Computations • Applied Problem Solving• Math Reasoning

• Basic: WJ-IV, WIAT-III, K-TEA-III• Expanded: CMAT, Key Math-3, Feifer Assessment of Mathematics (FAM)

Assessment of Academic Functions: Written Language

• Handwriting• Writing Fluency• Sentence Composition• Longer Composition (essay, narrative)• Spelling (real and nonsense words)• Editing (Syntax)

• Basic: WJ-IV, WIAT-III, K-TEA-III, PAL-II (handwriting, essay)• Expanded: OWLS-II, TOWL-4, TEWL-3

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Assessment of Social-Emotional Functioning

• Anxiety Disorders•OCD•Mood Disorders•Disruptive Behavior Disorders (e.g., oppositional/defiant)• Autism Spectrum Disorder•Other factors (e.g., atypical life stressors; bullying; medical

issues; language and acculturation)Clinical Interview, Review of Records, and Rating Scales

Broad: BASC-3, Conners CBRS, Achenbach, MMPI-ANarrow: Specific Anxiety, Mood, Autism, etc. scales

Diagnoses

•DSM-5 and testing not always in sync• “dyslexia” = Specific Learning Disorder, with Impairment in Reading• ”dysgraphia” = Developmental Coordination Disorder

•No good diagnostic category with certain profiles (e.g., visual spatial; working memory; executive functioning deficits without ADHD)

“Other Specified Neurodevelopmental Disorder”

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Unique Challenges with Diagnosis in Independent Schools

•Rating Scales- overpathologizing•Pressure from parents for accommodations•Absolute versus relative weakness (and functional impairment)•One subtest is not enough for a diagnosis!•The discrepancy model is dead!• The wide range of average

10085 115 13070

Independent Schools:Pathologizing the Normal?

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What makes for a good evaluation?

Good Evals…• Validity statement matches the behavior observations• Background section: Goldilocks zone• Qualitative/process data, in addition to quantitative• Recommendations• Fit the data, not boilerplate• Home and school• Tied directly back to strengths/weaknesses• Don’t insult the intelligence of the educator• Feasible

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Good Evals…

• Diagnosis-match with the data• Diagnosis- never from 1 subtest!• Diagnosis: not too young!• Focus on implications of results, not

just scores• Findings are from multiple sources,

not just test scores (i.e., school input!)

Good Evals…• Broader than IQ and Achievement

tests

• Organized by function, not by test

• Strengths emphasis, not just pathology

• Avoiding “psychobabble”

• Humility

“John showed a deficit in perceiving part-whole relationships and being able to accurately discern a visual gestalt, separating component parts in a figure-ground configuration. He also had difficulty with simultaneous processing of visually complex stimuli and producing a motoric response, mediated by pre-frontal processes.”

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Questions? sbhamilton68@gmail.com

Dr. Scott HamiltonLicensed Clinical Psychologist

Board Certified in School NeuropsychologyAsst. Head of School for AcademicsThe Howard School (Atlanta, GA)