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Assessment 101 is a series of three articles about developmental assessments by Dr. Aida Khan, clinical psychologist and neuropsychologist and Lecturer in the Department of Brain and Cognitive Sciences at the Massachusetts Institute of Technology.
Types of Evaluations
Assessments Provide a Roadmap
Assessment professionals try to understand how your child thinks, reasons, and processes information. A formal evaluation should give you a clearer understanding of your child. An evaluation should also offer strategies for addressing your child’s needs. A good evaluation creates a road map about what to anticipate as your son or daughter gets older and expectations increase at school and elsewhere.
Assessment or testing are other terms for evaluations. In an assessment, the evaluator works with a student using paper and pencil tasks and other activities to figure out your child’s skill levels in different areas. The evaluator’s observations of a child’s behavior and problem solving style also provide information about individual difficulties and strengths.
The larger goal of the assessment process is to provide a big picture view of your child’s vulnerabilities—and resources. This information helps guide your decisions about education, behavior, and other areas.
Neuropsychological evaluation is the most time-consuming and comprehensive of the assessment options. A neuropsychological assessment will provide a snapshot of your child’s functioning and developmental profile today.
This evaluation describes your child’s strengths and weaknesses as a thinker and learner. It tells you how your child’s skill levels compare to his peers.
Neuropsychologists are specialized psychologists with a doctoral degree in psychology or a related field. You may see Ph.D., Ed.D., or Psy.D. listed after their names. They usually have done a postdoctoral fellowship in clinical neuropsychology after getting their doctoral degree.
What do neuropsychologists do? They try to understand how a child’s underlying temperament interacts with life and school experience. These experiences shape a young person’s learning style, personality, and overall functioning.
Temperament refers to the intellectual ability, learning style, and personality traits your child came into the world with—the foundation. Experiences in life and at school will further shape a child’s natural temperament. These experiences will influence who your child becomes as she moves through her development.
A neuropsychologist does a battery of tests to assess many areas of your child’s functioning, including:
The assessment takes four to six hours of your child’s time. The evaluator may spend another two or more hours to talk with you to learn your child’s history and share impressions of your child. Neuropsychologists review a range of records and may observe your child at school. Usually, a neuropsychological evaluation takes place over two to four meetings.
The report the neuropsychologist writes after the assessment should include:
Neuropsychologists cannot look in-depth at every area. The goal is to identify the big picture of your child’s strengths and weaknesses and to integrate this picture into an understanding of the whole child.
The neuropsychologist may refer your child for additional evaluations if there are areas of weakness that need to be better understood. Additional evaluations are often recommended to provide more information about: a) language skills, b) academic skills, c) fine or gross motor abilities, or d) emotional functioning.
If a child’s language skills are not developing as expected, he should receive a referral for a speech/language evaluation. This is usually about a three to four-hour commitment for a family.
Speech/language pathologists have master’s degrees. They assess:
Speech/language pathologists look at five main areas:
1. They want to see how well your child understands the language spoken by others (directions, stories read to her, teacher lecture, classroom discussion).
2. They want to see how well he expresses herself in language (expresses needs, thoughts, and ideas verbally).
3. They want to see if your child grasps the underlying structure of language. The structure of language means how well she understands aspects of language such as grammar, vocabulary, word usage, and how words go together to form sentences.
4. They assess how well a child uses language to meet his own needs and navigate the social world.
5. They evaluate whether your child has acquired the foundation of skills needed in order to learn to read and write in early elementary school.
Psycho-educational evaluations focus on your child’s intellectual ability and academic skill levels. These evaluations take about four hours.
One goal of psycho-educational evaluations is to figure out whether your child is performing in reading, spelling, writing, and math at grade level and at his intelligence level.
Professionals with master’s degrees or doctoral degrees in education or psychology do these evaluations.
Psycho-educational evaluations can provide useful information but they are not as comprehensive as a neuropsychological evaluation.
If this is your child’s first evaluation, a neuropsychological evaluation is likely to provide more useful information. In my opinion, you should get an initial neuropsychological evaluation, then if needed a psycho-educational evaluation as a follow-up a year or more later to track your child’s rate of progress over time.
Think of it this way. The neuropsychological evaluation provides an initial detailed map of the terrain. The psycho-educational evaluation tracks progress, developments, and changes in that terrain over time.
If your child is falling behind her peers in academic skills, an academic or educational evaluation will reveal whether your child's skills are at grade level in academic subjects. This usually takes about three hours of your time.
It is important to know if your child is behind equally in all areas or if she shows clusters of difficulties that suggest a pattern of weaknesses in learning. Does she have trouble in language arts, but is strong in math? Is the pattern the opposite?
Educational evaluators usually have master's or doctoral degrees in education or psychology. Sometimes special education teachers do these evaluations.
Occupational Therapy Evaluations
Young children are expected to learn many complex fine motor activities. They draw, copy, write, and pick up and manipulate small objects.
Verdana, Arial, Helvetica, sans-serifIf your child has trouble with these skills, she is likely to need a referral for an occupational therapy evaluation. This evaluation takes about two to four hours. The evaluator is a professional with a master's degree.
Occupational therapists evaluate hand skills and sensory motor abilities. This refers to the ability to manipulate things with the hands, the ability to write smoothly and control a pencil or scissors, and the ability to plan and carry out drawing and other visual motor tasks.
Occupational therapists also assess the child’s ability to track things visually. They may assess your child’s strength, range of motion, and balance. Knowing how your child’s skills affect her ability to carry out tasks of daily life, like brushing her teeth, can also be part of an occupational therapy evaluation.
Personality or Projective Evaluations
Doctoral-level psychologists do personality assessments, which are also known as projective evaluations. This assessment can take between two and four hours. The goal is to understand your child’s inner emotional life and psychological preoccupations.
Is his thinking disturbed or not connected to reality? Are her social perceptions accurate or faulty? How does your child think about relationships with family and friends?
Figuring out how resilient your child is emotionally is an important part of this evaluation. How does she handle emotions and upset feelings? How does she cope with unpleasant feelings? How does he manage the stress and strain of life in the real world?
These evaluations should identify areas of distress as well as the emotional tools and coping strategies the child already has for managing life’s difficulties.
The word projective means the evaluator gives your child ambiguous test materials and asks her to respond to them. Without saying it explicitly, the evaluator is asking your child to project her own thoughts and feelings onto the materials. Examples of ambiguous materials include pictures of interpersonal situations or the well-known inkblots of the Rorschach test.
In sharing what she sees in these ambiguous materials, we presume your child is projecting her own beliefs and psychological preoccupations onto the materials. The evaluator interprets the meaning of your child’s projections and offers insight into her psychological state and internal emotional life.
About the Author
A clinical psychologist and pediatric neuropsychologist, Aida Khan, Ph.D. trained at the University of Massachusetts-Amherst and Harvard Medical School. She has held academic appointments at Harvard Medical School and Tufts University School of Medicine. Dr. Khan is currently in private practice in Massachusetts and is a Lecturer in the Department of Brain and Cognitive Sciences at the Massachusetts Institute of Technology.
Dr. Khan welcomes comments and can be reached at: aidakhan<at>msn<dot>com
Copyright © 2013 Aida Khan, Ph. D.