Psychological Testing and Diagnosis
- Article by Ms. Anju Mathur (Head Care Centre at Veer Bhagat Singh International School)
Testing and diagnosis play an important role in the treatment of an emotional or behavioural problem. A school counsellor relies a lot on psychological testing while working on a case. A School Counsellor is a qualified professional with a Master’s degree in Psychology and with specialization in either Clinical Psychology or Counselling Psychology. The person would be have a deep understanding of human behaviour in relation to physical, social, mental and emotional development.
When a case is referred to a counsellor, the counsellor needs to thoroughly understand the problem or the difficulty that the child is facing, to be able to help him/her. More information about the child is required before he/she can start with the treatment. The counsellor’s first task is to construct a scientific biography or ‘case history’ of the child. A detailed and relevant account of the personal history is obtained by interviewing the child and from any other appropriate source, such as parents, friends and teachers.
Accurate information gathering and objective notes are essential for psychological assessment. The process typically starts with the chief complaint or the presenting problem.
The following information is obtained from the parents, teachers and the child–
Identifying information – This includes name, age, sex, class, etc.
Chief complaint (presenting problem)– The reason for referral.
History of present problem– The onset of the signs and symptoms that comprise the current problem.
Past medical and psychological history– Thorough history of past illnesses, hospitalization, previous psychological assessments or treatment.
Personal history– Information on the patient’s entire life - including prenatal history, birth history, developmental milestones, family relationships, behavioural issues and academic history.
Family history– Information related to any physical or mental illnesses in the family and also the family interactions.
Mental status examination (MSE) - This assesses the child’s mental state, and begins by evaluating:
- Behaviour- abnormal movements, hyperactivity and eye contact with the interviewer
- Speech- fluency, rate, clarity, and tone, all of which may indicate the child’s mental state. Speech can also reveal a physical or psychological impairment.
An important area of counselling or clinical psychology is psychological testing. A psychological test is essentially a standardized measure of a sample of behaviour and has ‘diagnostic’ and ‘predictive’ value. Such evaluation is usually done to gain insight into and forming hypotheses about psychological or behavioural problems. The results of such assessments are usually used to create generalized impressions or a diagnosis and to lay out a plan of action. A test may be given to determine the level of educational achievement, another to determine the level of intelligence, a third to measure certain personal, emotional and behavioural traits. These tests are standardized tests with established reliability and validity and the psychologist is trained to administer these tests. Each test comes with a manual which provides guidelines on how to administer the test, carry out the scoring, and interpret the scores obtained according to the norms provided.
Methods of testing include standardized tests, interviews, reviewing past records and observation.
Following are some of the tests used by Counsellors with school going children:-
Intelligence and achievement tests:
These tests are designed to measure certain specific kinds of cognitive functioning (IQ). These tests, such as the Wechsler’s Intelligence Scale for Children (WISC), measures such traits as general knowledge, verbal skill, memory, attention span, logical reasoning, and visual/spatial perception. Some other tests of intelligence may be the Seguin Form Board, Kamat-Binet Test of Intelligence and the Goodenough Draw-A-Man test.
Tests of personality aim to describe patterns of behaviour, thoughts, and feelings. They generally fall within two categories: objective and projective.
1. Objective tests (Rating scale): Objective tests have a restricted response format, such as allowing for true or false answers or rating using an ordinal scale, which allow for computation of scores that can be compared to a normative group. Prominent examples of objective personality tests include the Minnesota Multiphasic Personality Inventory, Children’s Personality Questionnaire (CPQ), Eysenck’s Personality Inventory and the Beck Depression Inventory.
2. Projective tests (Free response measures)
Projective tests allow for a much freer type of response. Projective tests allow for open-ended answers, often based on ambiguous stimuli, presumably revealing non-conscious psychological dynamics. An example of this would be the Rorschach test, in which a person states what each of ten ink blots might be. Many practitioners continue to rely on projective testing, and some testing experts suggest that these measures can be useful in developing therapeutic rapport. Other projective tests include the House-Tree-Person Test, Children’s Apperception Test (CAT), Sack’s Sentence Completion Test and the Draw-a Person Test (D-A-P).
Direct observation tests:
Clinical psychologists are also trained to gather data by observing behaviour. Although most psychological tests are “rating scale” or “free response” measures, psychological assessment may also involve the observation of people as they complete activities. This type of assessment is usually conducted with children in a classroom. The purpose may be clinical, such as to establish a pre-intervention baseline of a child’s hyperactive or aggressive classroom behaviours or to observe the nature of a parent-child interaction in order to understand a relational disorder.
By combining the biographical information gathered earlier with the scores on these tests, the counsellor is better able to evaluate the child’s strengths and challenges, and understand the reason for his/her behaviour in light of his past performance. A counsellor needs to understand the problem thoroughly before starting with the course of treatment; hence a diagnosis of the problem is essential. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a publication of the American Psychiatric Association is used by psychiatrists, psychologists, counsellors, social workers, nurses and other health and mental health professionals for diagnosing mental disorders.
This manual provides a classification of all the mental disorders, their diagnostic features, prevalence, familial patterns, prognosis, the diagnostic criteria for the disorder and the differential diagnosis. The DSM-IV thus provides a specific classification and diagnosis of disorders, which can be commonly understood by all health and mental health workers and aids communication between them. All disorders related to children are classified under the category ‘Disorders usually first diagnosed in infancy, childhood or adolescence’.
The DSM-IV follows a multi-axial system for diagnosis. A multi-axial system involves assessment on several axes, each of which refers to a separate domain of information that may help the clinician plan treatment and predict outcome. These are the five axes included in the DSM-IV multi axial classification-
Axis I: Clinical disorders, including major mental disorders, as well as developmental and learning disorders
Axis II: Underlying pervasive or personality conditions, as well as mental retardation
Axis III: Acute medical conditions and Pphysical disorders.
Axis IV: Psychosocial and environmental factors contributing to the disorder
Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale for children under the age of 18 (on a scale from 100 to 0)
Once the counsellor has reached a diagnosis for a case, he/she can plan out the course of treatment, the specific area he/she is going to focus on while working with the child, the method and material he/she will use for this, and the support that s/he is going to incorporate from the parents and teachers.
The counsellor might again feel the need for further testing during the course of therapy if he/she comes across a block or if through the sessions, new information is revealed which would require further testing to be verified. For example, while working with a child on his impulsive behaviour, the counsellor might discover presence of unexpressed hostility towards the mother, and in order to help the child resolve it, the counsellor might want to understand it better by administering a projective test like Children’s Apperception Test (CAT), which might throw light on the child’s family dynamics.
Thus, psychological testing, during the course of casework is an ongoing process, but needs to be used judiciously, and only when it is essential for either diagnosis or prognosis, or if the need is felt after a further review of the case.