From Assessment to Intervention Part II: What Do We Assess, and How Do We Help After Assessment?

1. From Assessment to Intervention Part II: What Do We Assess, and How Do We Help After Assessment? By Mike McCall, M.A. School Psychology School Psychologist/Learning Specialist & Sheara Fernando, M.A. School Psychology School Psychologist/Learning Specialist

2. Presentation Outline • Background information on psychological assessment • Criteria for Assessments for Various Disabilities • Description of the Parts of a Psychological Assessment report • Using the Psychological Assessment to Help Students • Case Studies of Psychoeducational Assessments • Questions and Discussion

3. Purpose of Psychological Assessment • The goal of psychological assessment is to describe the client’s functioning in order to do design interventions tailored to the students needs • Part of the goal is to sort students, but that is not enough • Effective assessment guides intervention

4. Purpose of Psychological Assessment Kinds of assessment (Sattler, 2001) • Screening – brief to determine a second course of action • Problem solving – focus on a skill or one area of functioning • Diagnostic – surveys strengths and weaknesses across cognitive, academic, language, and social functioning • Counseling/Rehabilitation – completing daily responsibility • Progress evaluation – monitors intervention success

5. Purpose of Psychological Assessment • 4 Pillars of Assessment (Sattler, 2001) • Norm referenced tests • Interviews • Observations • Informal Assessment Procedures • Good assessment relies on information from all 4 pillars

6. Types of Psychological Assessment • Norm-Referenced Tests • Assess intelligence, achievement, behavior, and social-emotional functioning • Goal – assign a numerical value to client’s functioning • See strengths and weaknesses within the client and compared to peers

7. Types of Psychological Assessment • Interviews • Questioning the client and key individuals who play a role the client’s functioning • Goal – helps determine what to assess by letting us know what the problem behaviors are • May use unstructured, semi-structured, and structured formats

8. Types of Psychological Assessment • Observations • Viewing the client as the behave during testing and in natural settings • Goal – assess behavior as it relates to the client’s skills (e.g. frustration, reaction to failure, persistence, etc.) • If psychologist cannot or will not observe the client, you can complete observation to give to the psychologist

9. Types of Psychological Assessment • Informal assessment • Getting client to engage in naturalistic tasks to further understand strengths and limitations • Goal – better understand the client’s functioning, test intervention strategies • Supplying test scores (e.g. ACT, SAT), GPA, class grades, writing samples

10. Facts of Psychological Assessment • Cost • $100 to $250 dollars per hour • Full assessments take 6-8 hours with the client if done correctly • Reports are going to take 2-4 hours of work • 1 hour of review of the report • Total $1,000 to over $2,000 for a full disability assessment • ADHD screenings cost $300 to $600 dollars

11. Determining Who Needs Assessment • Reevaluation – if a student has had services in the past, his/her testing may be out of date if the testing was over 3 years old • ADHD testing – many students self-refer, if student has trouble completing assignments or staying on task, seems to have average or better skill, coaches notice inattention, repeatedly miss appointments

12. Determining Who Needs Assessment • Specific Learning Disability – if student has average cognitive ability but below average reading, writing, math, or communication skills • Social/Emotional Disability – student has anxiety, depression, bi-polar, schizophrenia, or any other disorder that negatively impacts academic functioning

13. Determining Who Needs Assessment • For everyone who will be newly diagnosed, refer to your disability office’s requirements for services • LD assessments will need less to be less than 3 years old and on adult measures • ADHD – if just wanting to intervene with counseling and medication, student needs an ADHD screening, but disability services may require a full psychological assessment along with a medical doctor’s assessment (testing may need to be only a year old) • Social/Emotional disorders – just recognize the student has dysfunction that seems to be emotional

14. LD Guidelines • Current documentation is defined as three years old or less. Documentation older than this can still be submitted but may not be adequate to determine eligibility for accommodations. • Must be typed, on letterhead • Must include the summary of a comprehensive interview • Comprehensive assessment of aptitude using adult scales. • Comprehensive academic achievement battery using adult scales. • An assessment of specific areas of information processing using adult scales. • Detailed description of how this impairment significantly limits a major life activity in an academic setting. • Report of explanations for academic problems that were ruled out, such as emotional problems, poor study skills, etc. • Should include a detailed description of the disability, including a DSM-IV-TR code. • Should include description of severity and longevity of the condition • The evaluator should include any recommendations he/she has for appropriate accommodations for the student’s specific learning deficits within the context of the university environment.

15. ADHD Guidelines • Current documentation is defined as three years old or less. Documentation older than this can still be submitted but may not be adequate to determine eligibility for accommodations. • Must include 2 parts: • Letter from MD with qualifications listed • Diagnostic interview (should include any evidence of early impairment, evidence of current impairment, developmental history, family history of ADHD, relevant medical/medication history, description of current educational limitations) • Ruling out of alternative diagnosis (mood, neurological, other disorders) • Any prescribed medications for ADD/ADHD and the specific symptoms they help to control or manage for the student (i.e., inattention, hyperactivity, etc.) • Specific DSM-IV-TR diagnosis and code • Detailed description of how this impairment significantly limits a major life activity in an academic setting • Suitable rating scales that might be included in the report are: Wender Utah Rating Scale, Brown Attention-Activation Disorder Scale, Beck Anxiety Inventory, Hamilton’s Depression Rating Scale, Connor’s Parent/Teacher Rating Scales • Suitable tests of attention including: Continuous Performance Test (such as Connor’s or IVA), Test of Variables of Attention (TOVA), STROOP, Trailmaking Test • Tests should be completed using adult scales/versions.

16. ADHD Guidelines Continued • Psychoeducational evaluation • Evaluation conducted by a psychologist or other appropriately credentialed psychoeducational professional • Should include any recommendations for accommodations in the classroom setting • Suitable tests for the Aptitude portion include: WJ-III Tests of Cognitive Ability, WAIS-III, or Kaufman Adolescent and Adult Intelligence Test • Suitable tests for the Achievement portion include: Subtests from the WIAT, WJ Tests of Achievement, or Detroit Tests of Learning Aptitude-03 (or DTLA-A). • Tests should be completed using adult scales/versions.

17. Social Emotional Disorders • Current documentation for psychiatric disabilities is defined as 6 months old or less due to the nature of psychiatric disabilities and medications for psychiatric disabilities. Documentation older than this can still be submitted by may not be adequate to determine eligibility for accommodations. • Must state qualifications of doctor • Must state the disability including a DSM-IV-TR code. Your doctor will be familiar with this. Should also include the date of diagnosis. • Must describe how this impairment significantly limits a major life activity/activities in general and in an academic setting. • Must include a detailed description of the disability. • Must include a DETAILED description of the student’s current condition and how this condition interferes with or impacts the ability to participate in the educational process. • If applicable, should include medical information relating to the impact of medication and/or treatment on the student’s ability to participate in all aspects (classroom, extracurricular activities, dorm life) of the academic environment • The doctor should include any recommendations he/she has for appropriate accommodations within the context of the university environment.

18. Process of Referral • Use one or a few psychologists who are trusted by disability services • Using the same people consistently can help build a working relationship so assessments happen in a timely fashion and are useful • Ideally, programs may need to hire services of a licensed professional at least on a part time basis

19. Process of Referral • Expect full assessments to take 4-8 hours of face time • ADHD assessments may take 1-2 hours of face time • Students will get better results early in the day when they are not exhausted • May need to find psychologist who can assess on weekends • Reports take several hours to write, so there may be a week to a month delay from testing to when the report is ready

20. Athletic Department’s Role • Send a packet of screening data to the psychologist • Write a description of the student’s behaviors that you are concerned about • Give a copy of the university’s disability criteria to the psychologist • Make sure the student agrees to complete the testing • Send a list of services that disability services and your office can provide

21. Description of the Assessment Parts • The report should be understandable to a parent, advisor, disability services, and most importantly the student • The report should have objective data, but should also include subjective discussion of what may help the student • There are 9 essential parts to the assessment

22. Description of the Assessment Parts • Identifying Information • List of Assessment Instruments • Reason for Referral • Background Information • Observations During the Assessment • Assessment Results and Clinical Impressions • Summary • Recommendations • Signature

23. Description of the Assessment Parts • Identifying information • Name • Date of assessment • Date of birth • Age • Sex • Year in school • Names of anyone who contributes to the report (e.g. interviews, observations, ratings scale data) • Name/Contact information of place sponsoring the testing • Examiner’s contact information

24. Description of the Assessment Parts • List of instruments for the assessment • Formal and informal assessments should be listed • The list is important so that readers can know exactly what was completed with the child in one quick look • Reason for Referral • Who referred and why • A description of problem behaviors and screening data that warrant testing • Goal of the assessment

25. Description of the Assessment Parts • Background information • Interview information from student, parents, coaches, or anyone else who may speak to the psychologist regarding the student’s difficulties • Previous testing results • High school grades and standardized scores • Demographic information about high school and home town • Description of family life and history of parents and siblings • Medical history as relevant (e.g. concussions or hospitalizations) • Statement of current functioning

26. Description of the Assessment Parts • Observations during an assessment • Description of the student’s effort • Description of students reaction to challenges • Discussion of language usage, rapport, and attitude to self • Statement of the validity of the results

27. Description of the Assessment Parts • Assessment Results and Clinical Impressions • Describes test results in relation to peers and to ability to function in current environment • IQ is based on age • Achievement should be compared to college peers (since they function in a college environment) • Description of strengths and weaknesses • Diagnostic impressions

28. Description of the Assessment Parts • Summary • Reviews and integrates the important information from the results and should lead to recommendations • It is the big point(s) from each test and any relevant background information • Recommendations • Statement of diagnosis (if there is one) • Statement of intervention strategies • Who should be involved with carrying out the interventions

29. Using the Report to Help a Student • If they qualify for disability services, you need the report to register them, but disability services won’t be enough • Many students need more than extra time and books on tape or note takers • Use the recommendations of interventions such as alternative study strategies, memory strategies, reading comprehension strategies

30. Using the Report to Help a Student • Slow processing speed – help students better estimate and manage time so they can finish their work • Weak working memory – train students in various memory strategies (e.g. flash cards, elaboration, schemas, mnemonics) • Weak verbal skills – practice vocabulary, practice describing, have students discuss problem solving aloud, use visual aids to pair with verbal descriptions • Weak perceptual skills – pair pictures and diagrams with words

31. Using the Report to Help a Student • Weak decoding and fluency skills – practice phonics and phonemic awareness skills, practice reading aloud, reread passage to reduce errors, practice reading fun material, train key vocabulary words to become sight words so they will recognize them on the test • Weak comprehension – auditory and visual presentation of reading (e.g. Kurzweil), teaching students how to create questions to answer while reading, teaching to read small parts and then reflect on the part, create visual representations of the material

32. Using the Report to Help a Student • Weak writing – practice brainstorming, teach outlining, practice describing, have students talk aloud about what to write, use word processors, programs that record oral language in word processing programs, review grammar skills, journal writing, have students read good writing • Weak Math – use calculators, review math facts and processes, teach them to write out steps of problem solving, verbally and visually describe the problems

33. Using the Report to Help a Student • ADHD – segment student time into smaller segments that are less taxing to focus, teach use of a planner, organize notebooks and folders, teach student how to find a good study environment, teach student how to monitor their own behavior

34. Using the Report to Help a Student • These are just some strategies to help students with various problems • If the report indicates a weakness, the psychologist should recommend a solution • If the psychologist does not recommend an intervention, call them and consult with them • A psychologist’s responsibility is to assess and design interventions, which involves consultation

35. Questions & Discussion • RTI on the horizon • Communication with Disability Services • Working with a Psychologist • Others?

36. References • Sattler, J. (2001). Assessment of children: Cognitive applications (4th ed.). La Mesa, CA US: Jerome M Sattler Publisher.

37. Presenter Contact Information • Mike McCall , School Psychologist/Learning Specialist mccallmw@sc.edu 803 – 777 - 3581 • Sheara Fernando, School Psychologist/Learning Specialist fernando@mailbox.sc.edu 803 – 777 - 3581

38. DSM-IV-TR (2000) Criteria for Students with Learning Disabilities Diagnostic Criteria for 315.00 Reading Disorder A) Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person’s chronological age, measured intelligence, and age-appropriate education. B) The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require reading skills. C) If a sensory deficit is present, the reading difficulties are in excess of those usually associated with it.

39. Characteristics of Attention-Deficit/Hyperactivity Disorder (ADHD) • Three subtypes - Combined (314.01) - Predominantly Inattentive type (314.00) - Predominantly Hyperactive-Impulsive Type (314.01) • Inattention manifests across situations (e.g. school, practice, free time, etc.)

40. Characteristics of Attention-Deficit/Hyperactivity Disorder (ADHD) • Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder • Either (1) or (2): • six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:Inattention • often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities • often has difficulty sustaining attention in tasks or play activities • often does not seem to listen when spoken to directly • often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) • often has difficulty organizing tasks and activities • often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) • often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) • is often easily distracted by extraneous stimuli • is often forgetful in daily activities

41. Characteristics of Attention-Deficit/Hyperactivity Disorder (ADHD) • six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:Hyperactivityoften fidgets with hands or feet or squirms in seat • often leaves seat in classroom or in other situations in which remaining seated is expected • often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) • often has difficulty playing or engaging in leisure activities quietly • is often "on the go" or often acts as if "driven by a motor" • often talks excessively • Impulsivity (g) often blurts out answers before questions have been completed(h) often has difficulty awaiting turn(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

42. Characteristics of Attention-Deficit/Hyperactivity Disorder (ADHD) • Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. • Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home). • There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. • The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

43. Interpretation of Discrepancy and Disability