Cap Psych Pod Episode 7: Psycho-Educational Assessments

Today we're joined by Sarah Mackrell. Sarah is our head psychometrist. Today she will be sharing some information on the different types of assessments that we offer as well as when to tell if you or your child may need an assessment and what to do once the assessment is complete.

The first question that I think we should start with is how to tell if you or your child may need an assessment?

S:  Signs that a child might require an assessment often depends on the age; so early on, it can often be prompted by family physicians. For example, are kids meeting appropriate developmental milestones for things like motor skills or speech, are they developing expectedly in terms of their social skills from things like eye contact, social play, etc. Once kids are older in the daycare and in school years, it can be prompted by teachers or daycare providers who may express concerns about their behavior or learning skills, especially compared to their peers. Also, parent intuition; are you concerned about something in their developments? Are you seeing them struggle more than expected in terms of their development or academic skills? And if you're not sure, talking to a doctor or friends or teachers can be helpful.

Typically, what age do children need or generally complete an assessment?

S: So, often when we're looking at assessment timing, important transitions in developmental can help prompt us for when we might look at when we want to do those. For example, as I mentioned, starting daycare or elementary school are big transitions for kids so it's common for kids to have some trouble with that adjustment as they’re settling into a new environment or new routine. Think about “Is there difficulty excessive” so, are you seeing a lot of behavioral challenges? Is it causing them a lot of mental health difficulties for a longer period than expected? Are they having a lot of social challenges that, again, are not typical for the usual adjustment trouble that they might have a new environment? And a big part for that is thinking about where they are developmentally, so is anyone else concerned? Again, as I mentioned, we expect some adjustment difficulty, but is it above and beyond what’s typical in terms of the intensity and duration of those challenges and where are they at relative to their peers? For example, when we're talking about starting school, you might have a child who's born in December versus a child born in January and we would expect some development variation there in terms of their adjustments. Keeping in mind, is it appropriate for where they’re at for their age and where they are relative to their peers?

As far as teacher prompting that's a big one from learning disabilities and attention issues as those tend to be noticed in the classroom. Academically, around grades 2/3 is usually when we do assessments the first time around for reading, writing, and math challenge. Attachment issues tend to come out more then too as kids are in a more structured academic environment. Sometimes, we see those troubles more often because there’s greater demands on staying seated or listening to instructions. For kids who do relatively well in earlier grades, we often do assessments around that middle school- high school range as there's more demands on attention skills like planning, organization, homework, increased independence that tends to be a time were especially bright kids they can't really coast by anymore on their intellect, they start having more demands that look for more of those higher order skills versus their aptitude for a task. Then the final time for kids is usually that reassessment often needed for college or university to maintain supports.

K: Okay that makes sense, so it really just varies depending on every kid, really.

S: Yeah, and there's expected transition points where there are shifts in the curriculum and that can make things more or less difficult for different kids depending on the areas they struggle with.

Right, okay. So, so far, the focus has been on children but adults sometimes also require an assessment. What are some signs that an adult may want to seek out an assessment?

S: For adults typically, the main prompt is difficulty in the workplace. For people finding that they’re having a lot of trouble focusing on their job tasks, people who are consistently having trouble meeting workplace deadlines, mental health challenges can also prompt needing an assessment done. For adults, the mental health challenges might be also an issue in the workplace but often it’s prompted by physicians who want a formal diagnosis to help guide pharmacological treatment to see what's the diagnosis they fit best into, what medications might help, or if there's multiple diagnoses because that can affect the combination of medications and might be important information for a physician.

Another type of assessment often done for adults is for people have been in some type of accident. For example, car accidents, or people have had some have injury from activity like a concussion. In that case, someone might need an assessment to formalize support for workplace or for accessing services through their insurance company.

Okay, perfect. Starting the assessment process can seem like a daunting task for some people. Can you explain the different types of assessments that there, are and how each type of assessment can be helpful?

S: Yep, so as I mentioned, psychological assessments are one type of assessment and that's usually then formalized a mental health diagnosis; that can be used for guidance for physicians. It could also be used for guidance for therapist, so if someone's working with therapist and feels that a formal diagnosis can help guide treatment, that can be useful. Also, this can be used in the workplace and people need accommodations around their condition or support or things like extra time for work or any time off, things like that.

ADHD assessments are another type of assessment. Again, often those are used for accommodations in school and the workplace, formalizing supports, also for physician guidance for medication if needed.

Psycho-educational assessments are used in the education world especially, so school accommodations for things like extra time, access to technology for students, and formalizing supports in the workplace too. If someone might have a long term academic challenging for things like reading, you might need accommodations in the workplace for things like technology.

Gifted testing is often used just to confirm a student meets criteria for entrance into gifted programming offered through the schools because that tends to be limited, so that's more confirming that they meet criteria in that case.

For Autism Assessments, again providing guidance from parents, teachers, physicians just best support the child for other practitioners who involved in care. Assessments are also often required in order to access funding services available. So, the assessment can help open up access to services and provide more information on how to best support children and adults.

Neuropsychological assessments again guidance for physicians, accessing funding through insurance, workplace and for children also in the school.

Okay perfect! Can you tell us about the process of getting a child in for an assessment and just kind of some general timelines that people can expect?

S: The first step is calling the main office to see what the wait times are. Unfortunately, there's a lot of demand right now and wait list can be extensive at a lot of offices. So, calling the office, getting your name on the wait list and see what the expected wait times are, which can vary depending on the time of year and demand at the time. The next step is to speak with your family doctor and insurance companies; check if you have coverage and if you need a doctor’s referral letter. We don't need a doctor’s referral letter for you to access our services, but some insurance companies do require a doctor’s letter saying that you require an assessment to provide coverage for the process.

Once you come up on the wait list, someone from the office will call you to set up an intake meeting. For parents of children, that meeting’s done just with parents to review the child's medical history, social, emotional, and academic history. For adults, work history is also applicable. After that, we will book times for you to come into the office to do testing; the assessment measures are completed in the office. After that's completed, we will score all the test materials and prepare a draft report. This is written by the Psychometrist and Psychologist involved in the assessment. Once that's done, we complete a feedback session where we review any diagnoses and then talk about recommendations which is the most important part in order to see how to help with areas of challenge. Finally, we send you a copy of the report to review and that's an opportunity go through it in more detail and ask us any follow up questions.

What kind of information is included in the final report?

S: The final report typically involves a review of background history that we get at the intake meeting, the second part of the report is looking at the testing results, so a summary of all the testing completed in office, and then the final, most important part is the recommendation section. The way the report’s broken up for that part is it's usually in headings for the areas of difficulty, and in that section, we’ll talk about accommodations and recommendations for what can be done to address those challenges. For students, it could be in class support (classroom modifications, technology access) it can be referrals for other professionals that might be able to help work with those areas more specifically like an occupational therapist or a therapist for emotional challenges, and adjustments for evaluations in the workplace or school setting.

Okay, and then once the final feedback appointment is completed and parents have the report with all those recommendations, what should they do with it?

S: The first thing parents should do is contact your child's school and let them know that you have completed an assessment, you have the report, and would like to set up a meeting to review the recommendations and set up an Individual Education Plan (IEP) and that's just to formalized supports in the school. [The IEP] is basically a condensed document that summarizes any diagnoses, areas of strengths, areas of challenge, and then has required supports for environmental accommodations in the classroom, assessment accommodations required for tests and exams, and instructional accommodations required by the teacher as far as how they communicate your child for their needs. Once a feedback appointment is completed, another thing that might be required too is additional paperwork. This depends on the case; for the majority of people, the report is enough for school, but in some cases if you're looking at things like funding access there might be additional paperwork that we need to fill out. At that point parents can also let us know if there's any documents they need us to complete to help support an application for funding support.

Just a couple more questions and these are questions that we typically get from parents or from people that are having assessments done. One is how to explain the process to a child – for some it can be kind of scary and if you tell a child they are going to see a doctor, I know a lot of the time they expect to be getting needles at our office, which is not accurate. How would you suggest that people explain the whole process to a child?

S: Often, we’ll recommend using the child’s own words. Usually by the time people are looking at an assessment, kids are aware of what they're struggling with so whether it be reading or attention or difficulty with their peers, they’re usually expressing to their parents that they're struggling either if they’re [feeling] more sadness, they’re more anxious about things, or they're just really frustrated. We usually recommend using their own language back to them, so “Remember when you mentioned you were having trouble?” or “You're feeling left out and you're not really sure why.” or “That reading homework we've been doing, you’ve been getting really frustrated.” or “Do you feel like you're listening in class but people are telling you that you're not paying attention or you're not working hard enough?” Using their own frustrations and saying, you know “You've expressed that you're really having a challenge in this area. We want to make it easier for you.” Using their experience can be useful because then it makes sense to them why, and it’s also validating their experience and explaining that this is supposed to make your life easier and that's why we're doing it.

One last question: is the outcome of this going to limit them from being successful in the future?

S: Yeah, so that’s often a common concern from parents is if they do meet criteria for some kind of diagnosis, whether it be learning or attention or something else. The fear that this identification is going to hinder them in some way or that their challenges are going to stop them from achieving your goals or being successful and this is not true at all. It’s not uncommon for students have the biggest difficulty in these areas in the school-age time, so elementary school to high school. Unfortunately, there's not a lot of flexibility at this age; you have to be in school for a set amount of time, you have to sit at a desk for a certain amount of time, you're taking courses that are required despite your interest level in some cases, and this tends to be less of an issue overtime. Towards the end of high school students get a lot more choice, they're picking things that they're interested in, they naturally will self-select into a skill area and especially as they go into the college or university time, they’re picking something they’re going to be doing as a career- something they're motivated to do, something they’re interested in, something they’re good at, and they’re going to be surrounded by peers who have similar interests. So, the impact tends to be less and less overtime. It's not to say that their challenges won’t affect them in those careers, but the motivation and their skill will compensate in a lot of ways, and people don't have to pick a job if they're not good at it. You can pick a job that you're interested in, you can pick careers that are on a topic you’re related to that minimize impact your challenges. Someone with attention issues might not want to sit at a desk all day and be staring at a computer screen; they might want something more dynamic where you're talking to people and they’re able to change what they're doing day to day. There are ways to be successful in careers that were going to minimize the impact as an adult and that's something that's going to improve overtime.

I think that was all the questions that we had. Thanks so much for joining us today Sarah that was very helpful. I'm sure I'm sure it'll be great for a lot of people who are questioning where to get started with assessments.

S: It can be a daunting process but it's really helpful I find, for a lot of people having some type of information about why they're struggling and guidance on how to overcome [it].

Thank you so much again to Sarah Mackrell for joining us today. If anyone would like more information on assessments within our office, please feel free to call us at 613-599-7709 or visit our website at www.capitalpsychological.com.