Hardly a week goes by that i dont receive emails from parents, grandparents and teachers. they note that their child, grandchild or student is definitely odd ( oppositional defiant disorder ). when i ask how the youngster was diagnosed, im often told that they, the parent, grandparent or teacher, made the diagnosis themselves based on the observable symptoms and behaviors.
If only it were that easy. ive always held to the notion that effective intervention must follow accurate assessment. otherwise, a condition could be treated as one thing when it is actually something else. in such a case not only will interventions not be effective, appropriate diagnosis and treatment would be overlooked. this could cause the real problem to fester and even worsen.
Beware Of Look-Alike Conditions
There are a number of childhood conditions that present much the same symptoms and behaviors as odd. these include depression, anxiety disorders, adhd, stress disorders, bipolar conditions, emerging personality disorders, medical conditions and other concerns. an evaluation and diagnosis of odd must consider all of these and determine they are not the childs primary condition or disorder, or that two or more conditions coexist ( comorbidity ). an accurate evaluation of odd must also determine the severity and impact of the childs symptoms and behaviors over time, how those behaviors affect others and the overall clinical significance of the disorder as it could affect the growth and development of the youngster. in short, an effective evaluation is a complete mapping of an uncharted region... the inner workings of a child or teen.
Components Of The Assessment :
Im clear on the fact that there is no one way to do an evaluation. ( im referring to the terms assessment and evaluation and being the same thing. ) what is listed here is a model for a process i used for years. it represents what i consider to be the basics. ( because of my writing and speaking schedule, i rarely do evaluations anymore. ) i normally do not repeat parts of an assessment that have been done recently, such testing at school. if the reports and records contain the information i need, i use them. this can save time and its easier on the child, not to mention the benefit to the parents pocketbook.
Review of available records and reports : unless we take a look, information valuable to treatment can remain buried. i once evaluated a fourth grade girl whose medical background indicated that she had reduced hearing in one ear and no hearing in the other. the teacher did not know this. the child was seated in the back of the room with her best ear to a wall. behaviorally she looked indifferent, uncooperative and noncompliant. when she was seated with her good ear to the teacher, there was an abrupt turnaround in her attention and behavior.
Interviews with parents and teachers : this can be done in writing, in person or both. i generally ask parents and teachers to write down their concerns in order of priority, and on one sheet of paper ( this keeps it quick, focused and concise ). i ask them to also briefly list the youngsters three best strengths or qualities. if a child has several teachers, i prefer that they all do a page on the youngster. its amazing how this little activity can quickly differentiate between problem and non-problem areas at home and school. if we dont have to fix everything, the job is much easier.
Perceptual-motor assessment : some examiners would leave this one out of the assessment. i consider it to be essential with an odd youngster because the child either doesnt want to answer your questions initially, or they are apt to tell you what they think you want to hear ( especially if they think theyre in trouble ). by giving a couple of drawing tasks that require no speaking at all, i positively disrupt what the child is expecting. also, distinct patterns of oppositional and defiant behavior can be uncovered on these instruments, often without the child even knowing it.
Assessment of academic functioning : why is this child not completing school work ? is the work too difficult ( always a possibility ), or is the child too difficult ? this part of the assessment doesnt have to be all that deep, but it does need to settle the issue of potential versus performance.
Assessment of intellectual functioning : iq testing can signal areas of interest, strengths and needs, learning modalities and potential for insight, all of which are helpful in developing intervention. extremes in intellectual functioning can present difficulty. mentally retarded oppositional and defiant youngsters are resistant to change ; they have trouble developing insight into their behavior ( they have to experience consequences instead of considering what if... as motivation to change behavior ). of course, if a child is seriously deficient in intellectual skills, you probably already know it. really bright youngsters, on the other hand, already know theyre smarter than the adults, they act stay a jump ahead of everyone.
Projective assessment : projective assessment consists of questions and challenges that have no right or wrong answers. this assessment serves to evaluate how youngsters structure their responses to the tasks. assessment instruments include the famous ink blot cards, sentence completion questions and open-ended thematic ( story ) cards. the examiner looks for content and patterns of responses that can lend insight into the childs emotional and psychological state. since youngsters typically have little experience with projective assessment, this part of the evaluation is difficult for the child to fake or manipulate. for the same reason, its a part of the assessment that can make them uncomfortable. but even this discomfort is diagnostically valuable ; it shows how youngsters handle situations they cannot control.
Diagnostic interview : i put the diagnostic ( clinical ) interview at the end of the assessment because it can affect rapport. however, in the hands of a skilled and compassionate interviewer, it can deepen rapport. it just depends. i use an interview i wrote ; it consists of 155 questions that sample a childs perception of how they operate in the essential life fields of school, home and community, peers and self. the interview is extremely comprehensive, covering everything from relationships to drug/alcohol use to depression to suicidal thoughts or gestures. ( obviously, i dont use the whole interview with young children. ) the interview not only collects valuable information in the childs own words, it lets the child consider their needs and priorities for intervention. what better place to start counseling or therapy than with an issue the child already sees as pertinent ?
A written report : any psychologist will tell you that the most difficult part of an assessment is the challenge of making sense of all the information collected. this involves pulling together all the pieces and parts into a narrative interpretation of the assessment, providing a diagnosis ( if appropriate ), and offering plenty of practical recommendations for treatment and intervention at home and school.
Who Can Do An Assessment ?
A comprehensive assessment is usually done by a psychologist, but it can be done by anyone having the training and certification or licensure to do so. i recommend that parents find someone who specializes in children and adolescents. a referral from a pediatrician would be a good place to start, as would the psychology or special education departments of a local university. large counties, especially those with large cities, often have a psychological association ; members can be accessed through a referral line. also, child psychiatrists sometimes have a psychologist on staff or available to do assessments.
Fees vary, but generally run between $500 and $1500, depending on customary fees in the area and, quite frankly, the reputation and track record of the assessment professional. these expenses are usually covered, at least in part, under health insurance.
0 komentar:
Post a Comment