Diagnostic Testing 101
When I was twelve, my mother showed me some vocational tests she used in her volunteer work with seniors. I was fascinated. I loved math, puzzles, and analyzing behavior. I had found my perfect vocation. Later, I majored in psychological testing at college. The rest is history.
For more than 30 years, I’ve been an educational diagnostician. Daily, I administer psycho- educational tests to kids and adults. For me, testing is like playing bridge; instead of using cards, I ask questions, present blocks and problems, pencil and paper. Every “hand” is a different, new puzzle to solve.
Why Test? Most people want a diagnosis. The results of diagnostic testing determine placement, access to services such as special education or therapy, and insurance reimbursement (or denial).
Rule: Decide whether you need a diagnosis, or are more interested in what is causing the learning and/or behavioral issues. While good diagnostic testing is multi-faceted and can pinpoint underlying causes, test scores alone simply identify symptoms.
Who Tests? Psychologists, neuro-psychologists, neurologists, counselors, reading specialists, tutors and special educators administer aptitude and achievement testing. Anyone with basic inter-personal skills can test children according to the rules. Many can quickly put a child at ease, and make it fun. Few can take scaled scores, percentiles, and critical clinical observations and make sense out of them. Testing is an art, not a science.
Rule: Find someone with good “people skills” who evaluates the whole child, and does not provide therapeutic services. Psychologists ﬁnd emotional issues, OTs ﬁnd motor problems, tutors note academic lags, and neurologists speculate about how the brain is wired. “When you’re a hammer, everything looks like a nail.” I remember a tutor who gave six reading tests to a second grader who couldn’t read. Guess what she recommended? Reading tutoring! I want to know why that child can’t read.
What Tests? The lucrative testing industry markets hundreds of instruments to measure every possible aspect of learning and achievement. Aptitude tests are the best way to get information about a child’s abilities. It would take days of observation and interviewing to gather the data a WISC yields in an hour. Aptitude tests measure vocabulary, reasoning skills, abstract thinking, attention, sequencing, long- and short-term memory, visual spatial understanding, social savvy, organization and endless other skills, relative to age norms. Achievement tests describe a child’s mastery of curriculum in different subjects, relative to age norms or grade levels. When a child is ready to move from special ed into the mainstream, for example, standardized achievement scores indicate an appropriate grade placement.
For children with developmental delays, standardized tests may not be ideal. When we know that a child is delayed, and are interested in his progress, an informal developmental scale could be more useful. If last year he made horizontal and vertical lines, for example, and this year he can make an X, he has gained about a year in ﬁne motor skills. All tests yield more than scores. While the student works, good examiners observe. What hand does he use? Where is the non-dominant hand? What strategies does he use when stuck? Does he think aloud? Stare in space? Ask for assistance? Give up in defeat? Clinical observations are often more valuable than standard scores.
Rule: Ask the examiner what tests she administers and why. Avoid “standard” test batteries. A good examiner should be ﬂexible, have a wide choice of tests, and use the ones that will best solve the puzzle of your child.
When and where? Ask yourself, “Why now?” Is this a critical transition period? Are diet or medications stable? Is the family dynamic supportive? Is my child better in the morning or afternoon? Is he well rested? Testing is a tiny sample of a child’s behavior at a given point in time. If the child is not acting typically, for whatever reason, results may be misleading. Will your child respond better to an institutional setting, or an informal home office? You can’t always avoid clinical settings, as good clinicians often work there.
Rule: Make sure that biological, psychological and environmental factors are as close to ideal as possible. Postpone appointments if not. Take a ﬁeld trip to evaluate how the setting ﬁts your needs. After a career evaluating children, I now rely less on tests and more on history-taking and informal observations. Parents know what is causing their kids’ issues, but may not have the conﬁdence or expertise to act on their intuition. DDR is committed to ﬁnding the best diagnosticians in all ﬁelds. Let us know who, what, where and when has worked for you.
[New Developments: Executive Director’s Column, Winter 2001 – 2002]