Comprehensive Psychoeducational Assessment: Do we really need all that?
One of the most common questions I’ve gotten on consultation calls for testing is this:
Why does my child need the full comprehensive evaluation? Can’t you just give them assessments of reading after they flagged in a dyslexia screening?
I love these kinds of questions, because they give me the opportunity to share some of the cool information I know about why we do what we do as testing psychologists!
The short answer is: We need lots of data to feel confident that we’ve done our due diligence to confidently diagnose something. Our research, standards, and ethical guidelines dictate and validate this imperative.
For those of you wanting more reasoning and evidence, this blog will focus on increasing your understanding of psychological assessment procedures and ethics, which are the guiding principles psychologists use when creating and conducting evaluations with the goal of diagnosis and recommending appropriate accommodations for you and your child. If you’re not into that, but still curious, let’s talk!
Comprehensive Testing
To make diagnostic decisions, it’s necessary to rule out all possible explanations for a presenting problem. This is the same logic applied to proving something in court “beyond a reasonable doubt” or a medical provider running several types of tests to ensure they’re not missing something before putting you on an expensive medication with heavy side effects. We want our lawyers and doctors to make sound decisions using extensive and validated evidence, don’t we? Psychologists aim to do the same, especially when diagnosis, access to services or treatment, and accommodations or school placement hang in the balance.
In order to prove that a learning disability or other neurodevelopmental or mental health-related condition exists, it is imperative to establish someone’s level of functioning across multiple domains. One of our ethical imperatives as psychologists who specialize in assessment is to select reasonable tests to do that - we even have specific ethical guidelines set forth by the American Psychological Association (APA) about this! They write:
“When conducting assessments and evaluations, psychologists are aware of the responsibility that may be ascribed to them for the appropriate choice of measures that reflect evidence-based practice, sound psychometric properties, and awareness of the context, including patient characteristics, that can impact test results. Careful and informed measurement selection benefits the intended examinees by ensuring valid assessment, fair utility of results, and generation of recommendations that are applicable to the intended context. (APA, 2020).”
This means that it’s my job to use my expertise and the research to select a testing battery (the list of tests I will administer to your child) that is consistent with the data I need to make informed diagnoses and recommendations. The American Educational Research Association (AERA) has been the gold standard for guidance in testing of all kinds since the 1960s. Their Standards for Educational and Psychological Testing are open access, providing an evidence-based foundation for why we do what we do.
Standards for Psychologists
The AERA’s standards recommend that tests of “cognitive abilities, academic achievement, learning processes, visual and auditory memory, speech and language, vision and hearing, and behavior and personality…used in conjunction with other assessment methods— such as interviews, behavioral observations, and reviews of records— [are used] for purposes of identifying and placing students with disabilities” (AERA, 2014, p. 192). Ultimately, regardless of what is specifically being assessed (reading difficulties, attention concerns, anxiety, etc.), thorough evidence is needed so that it can all be judged “in terms of usefulness for designing appropriate programs for students” (AERA, 2014, p.192).
Using these guidelines, it becomes my job to gather data from multiple sources (both during testing and from outside the testing environment from families, historical data, teachers, tutors, and other providers), to identify the interactions between it all to make informed decisions. If I gather too little data, I am at risk for my interpretations becoming highly biased or lacking sufficient evidence (Finn & Kamphuis, 2006, Mather & Schneider, 2023, AERA, 2014). The AERA’s standards remind us that “little, if any, literature exists that describes the validity of interpretations of scores from highly customized or flexible batteries of tests” (AERA, 2014, p. 154). This means that while I have room to choose which of the gold-standard tests are valuable to answering specific diagnostic questions, it’s important for me to incorporate tests from several domains in order to have all the information I need. Without enough evidence, diagnosis should not be made because other concerns or comorbidities (other conditions) haven’t been sufficiently ruled out. This sometimes even means that when I collect data from 15+ different tests and tasks, I am still left with more questions!
In Practice
As an example, recent research from Mather & Schneider (2023) on dyslexia highlights that while cognitive assessment (IQ testing) alone is not enough to diagnose dyslexia, it is highly valuable in identifying verbal abilities to determine strength or weakness in the language-related processes of dyslexia. Additionally, cognitive assessment can give us more information on a dyslexic individual’s compensation strategies. They recommend using a “comprehensive approach that takes into account multiple sources of information” which includes family history, history of learning difficulties, behavioral observation, and data from standardized assessments (Mather & Schneider, 2023).
Ultimately, tests are just tools. However, they help us understand development and behavior to determine what someone needs to be understood and supported in their daily environments. As Meyer et al. (2001) explained, “Tests do not think for themselves, nor do they directly communicate with patients. Like a stethoscope, a blood pressure gauge, or an MRI scan, a psychological test is a dumb tool, and the worth of the tool cannot be separated from the sophistication of the clinician who draws inferences from it and then communicates with patients and professionals” (p. 153).
TL;DR: The types of and amount of tests can be very important in an evaluation, and an expert clinician who wants to understand your whole child is imperative to the processes from beginning to end.
I write this not to convince you to spend thousands of dollars on an evaluation - if you need it, we’ll figure that part out. Really, I want to help you understand why the choice for a comprehensive evaluation is supported by research and validated by years of experience among psychologists. I want your child to be understood for all their parts, and I want you to get the most out of your time, effort, energy, and money during psychological assessment. My approach is grounded in science, wrapped in my deep care for your child, and steeped in my excitement to help you understand them better.
Still have questions? Fill out the contact form on my website, and let’s talk about it.
-Katie
Sources:
American Psychological Association. (2020). Guidelines for psychological assessment and evaluation (PDF). https://www.apa.org/about/policy/guidelines-psychological-assessment-evaluation.pdf
Finn, S. E., & Kamphuis, J. H. (2006). Psychological testing and psychological assessment: A review of evidence and issues. Journal of Clinical Psychology, 62(10), 1325–1345. https://www.researchgate.net/publication/289963910
American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing (2014 ed.). https://www.testingstandards.net/uploads/7/6/6/4/76643089/standards_2014edition.pdf
Mather, N., & Schneider, D. (2023). The use of cognitive tests in the assessment of dyslexia. Journal of Intelligence, 11(5), 79. https://doi.org/10.3390/jintelligence11050079
Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G., Moreland, K. L., Dies, R. R., Eisman, E. J., Kubiszyn, T. W., & Reed, G. M. (2001). Psychological testing and psychological assessment: A review of evidence and issues. American Psychologist, 56(2), 128–165. https://doi.org/10.1037/0003-066X.56.2.128
