Let’s Talk About Psychological Assessment
Somewhere along the way the term psychological evaluation started getting used very loosely. Let me be very clear… a couple of rating scales, a brief intake, and a quick diagnostic impression are not a psychological evaluation. That is a screening. A potentially life altering label of an Autism Spectrum Disorder, learning difference, or even executive dysfunction requires a comprehensive assessment by a qualified and specially trained professional.
A true comprehensive psychological evaluation takes its time on purpose. It begins with listening and specific questions about developmental history, school patterns, medical factors, family dynamics, trauma exposure, personality style, strengths, cultural context, sleep, stress levels, coping tools and on and on.
Human beings are layered and nuanced and symptoms rarely exist in isolation. If the clinician isn’t mapping out the full landscape, they are working with a partial picture and partial pictures lead to partial answers, inaccurate diagnostics, inappropriate treatment planning, and poor care.
Intentional Choices-Intentional Testing
Appropriate psychological assessment isn’t good just because a lot of instruments are used and it is definitely not one size fits all. It’s about selecting the right tools for the specific referral questions. If someone, hopefully a licensed psychologist, is evaluating for an attention disorder (ADHD) that doesn’t mean you just administer an ADHD rating scale and call it a confirmed diagnosis. To accurately diagnose an attention disorder a client needs cognitive testing, executive functioning measures, emotional functioning assessment, academic data, possible academic achievement evaluation, behavioral observations, and observer reports. At this point you may ask, Why? Why do we need all of this information and I say Because!!! Because anxiety can look like ADHD. Depression can impact a person’s ability to concentrate. Trauma can mimic inattention. Giftedness can mask learning challenges, and Autism can look like so many other things.
Differential Diagnosis - Where The Work Happens
Differential diagnostic work is the part that clients don’t see, but it’s where the integrity of the evaluation truly lives. Differential diagnostic work occurs in competent comprehensive evaluations and asks deep and difficult questions. A comprehensive differential asks what else could explain this presentation? What diagnoses can and do overlap here? What diagnoses can we rule out? Is there more than one issue occurring at the same time? In my experience it is rarely a simple yes or no answer. It’s looking for patterns across multiple data sources and that requires training, supervision, and experience.
Scores Don’t Diagnose - Psychologists Do
Most testing instruments yield numerical data, numbers are data, they are not in themselves conclusions. Standardized scores must be interpreted in context with behavioral presentation, history, cultural background, motivation, effort, medical history, family background and so forth. Two people can have the same score and have very different stories. An experienced psychologist integrates this data and is specifically trained to administer measures so the numbers are as correct as possible and then integrates all the information into a meaningful whole.
Let’s Talk Reports
A comprehensive psychological report should explain many things including: the referral question, background and history, tests administered and why, behavioral observations, results across domains, diagnostic reasoning, strengths and protective factors, and specific, actionable, personalized recommendations. A report should read like someone really, truly understands you. And.. you should have a feedback session where the results are explained, clearly, respectfully, and thoroughly.
Training Matters; Not Every License and Degree is the Same
Psychological assessment is a specialty competency. It requires doctoral-level education, supervised training regarding standardized assessment and statistical properties, and ethical responsibility around scope of practice. Not every mental health provider is trained in comprehensive assessment. That’s not a criticism, it’s simple reality. Assessment and therapy are overlapping but comprehensive psychological assessment is a distinct skill set. If you are seeking a psychological evaluation I encourage you to ask questions about your providers license, formal training, continuing education, evaluation process, report, and feedback process. You are allowed to ask questions and feel comfortable with the answers. True evaluation is a collaborative process.
So Why Does It All Matter? Geez, Why is Dr. Vincent on a Soapbox tonight?
Diagnoses are a big deal and they can impact a lot of things including education plans, workplace accommodations, medical treatment, insurance coverage, employment ability, identity, and even self-understanding. Diagnoses are not casual conclusions or hunches, and shouldn’t be given out willy nilly without mindful processes, differential integrity, and due diligence. An evaluation should feel rigorous, compassionate, scientific, and human. You deserve an evaluation that treats your brain and story with respect and captures the true nuance of the concerns and questions that are present. You deserve a provider that holds these standards high and provides ethical and quality care.
