Monday, Aug 5th, 2013
Q: My six-year-old son’s teacher says that he has learning disabilities and wants to have him assessed by a psychologist. What would these tests involve and how will they help?
A: A psychological assessment used to evaluate a child’s (or adult’s) intellectual and academic skills is referred to as a psychoeducational assessment. An assessment invariably includes a test of intellectual ability (IQ) and another test of academic achievement, although tests of other cognitive skills (visual-motor skills, oral language skills, attention, nonverbal reasoning, etc.) are often included as well.
The primary goal of the psychoeducational assessment is to determine if a child’s academic skill levels are consistent with what would be expected for that child considering his or her intellectual ability level/IQ score. This is because a learning disability is defined as a condition in which a child’s success in developing specific academic skills (i.e., reading, writing and/or arithmetic) is significantly lower than would be expected for that child based on his or her intellectual ability level.
In addition to determining whether a child’s intellectual ability and academic achievement levels are consistent, the psycho-educational assessment will also help determine that child’s pattern of cognitive strengths and weaknesses. This is often the most useful aspect of the assessment for the child, as it is using this pattern of strengths and weaknesses that recommendations for improving the child’s learning can be determined. For example, it might be revealed that he or she is more of an auditory learner than a visual learner, expresses his or her knowledge better verbally than through writing, or understands math concepts only when they are expressed via concrete examples.
Although a basic psycho-educational assessment (one incorporating only the IQ and academic achievement testing) is typically sufficient for diagnosing a learning disability, a more comprehensive assessment (such as a neuropsychological assessment) often provides additional information regarding a child’s specific pattern of cognitive strengths and weaknesses. Once that pattern is determined, it can be used to help design the child’s learning plan, which is referred to in the school system as the Individualized Education Plan (IEP). Not every child has or needs an IEP, but it is important for a child with a learning disability, and will typically be created once the results of the psycho-educational assessment have been received by the school.
Q: My eight-year-old is not doing well at school. She is having problems with reading and math. She is also disruptive in the classroom. I am convinced that she has some learning disabilities but her teacher says she’s “just immature.” What should I do?
A: You could first try asking the teacher to have her placed on the waiting list for a school-based psychoeducational assessment. If this does not work, you could take your request directly to the school principal. However, considering the limited number of school psychologists available to conduct these assessments in any given school district, the criteria used by the schools for placing a student on the waiting list for assessments are really quite restrictive. In other words, a child typically must be struggling considerably before he or she is even considered for a school-based assessment.
Aside from waiting to have a student who is struggling assessed by a school psychologist, another option would be, to begin with, a visit to your family physician. This is especially appropriate if the teacher has described her as “immature” and portrays this as being a potential reason for her academic struggles. In such a case, the reported immaturity could potentially be an indication of a neurodevelopmental delay. If this was true, then the child should first be assessed by a physician in order to detect any identifiable medical causes for the immaturity/delay. The family physician is also generally the gatekeeper for referrals for assessments and/or treatment by certain other professionals, such as the assessment teams at BC’s Children’s Hospital, Sunny Hill Health Centre, Surrey Memorial Hospital or a child development centre. However, because of waiting lists and specific referral criteria, these centres will only see certain children. Typically, these are children with more severe and/or more clearly medically-based difficulties.
Other than by going through the school or one of the agencies listed above, there are very few options for obtaining a psychoeducational or neuropsychological assessment without having to pay out-of-pocket—assessments can cost from $1000 to $1500. I am aware of some children in foster care who have had a private psycho-educational or neuropsychological assessment arranged and paid for by the Ministry of Children and Family Development (MCFD). Additionally, I run a program at Royal Colombian Hospital in which I see children for neuropsychological assessments who have been referred through the MCFD Mental Health branch. These children must be mental health clients, and there must be some question of a neurological or a neurodevelopmental disorder contributing to their learning or behavioural problems. Otherwise, a parent who is looking for a psychological assessment for their child may contact the British Columbia Psychological Association referral service (604-730-0522), where they would leave a description of their child’s difficulties and the questions they would like to have answered through an assessment. They would typically be recontacted with the names of three psychologists in their region who conduct such assessments. Many people have extended health plans through their employment which will cover at least part of the cost of a psychological assessment, and some may have access to a psychologist who can conduct an assessment of this nature through their employee assistance program.
Q: I am worried that having a learning disability assessment of my child would permanently and negatively label my son. Have you found this to be the case and can you advise me on ways to avoid that happening?
A: In all honesty, I find that most parents of the children I see have the opposite concern; they are hoping that their child can be “labelled.” This seems to stem from the fact that while it was once common for children identified as having learning problems to be diverted into nonacademic streams or “special classes,” which created anger and anxiety in parents around the possibility of their child’s future prospects being restricted by these labels, this is now much less likely to occur. Rather, the tide has now shifted to the point that a child diagnosed with a learning disability finds it very difficult to obtain any extra attention for his or her diagnosis. There are few nonacademic programs in the school system and it is now almost unheard of for a child to be held back a grade. While these changes are clearly positive in some ways, they have also had the negative effect of depriving some children of the assistance they need in order to develop their academic skills or to develop other important life skills and vocational skills if they are not academically-inclined. The assistance that is still available through the schools for such children is very limited and only the students with the most severe, clearly-identified difficulties will obtain it. Consequently, most of the parents who bring their children to me for assessment are doing so in the hope that I will find sufficient evidence to assign them a “label.”
I believe that the negative connotations of having a student “labelled” developed in a previous generation when such labelling was by itself more likely to limit a student’s future prospects. The “special classes” that such children were often placed in at that time also had a strong negative stigma attached. Currently, however, labelling (or what might be more appropriately termed diagnosis) seems most likely to produce negative consequences when it is applied or interpreted simplistically. That is, medical and psychological diagnoses have been established for important reasons. They provide a shorthand summary of an individual’s core difficulties and help direct treatment or remedial efforts. However, an individual is always more than his or her diagnosis and, of course, has many other important characteristics. Difficulties arise when others ignore this. One of the most effective means of preventing a child’s diagnosis from impacting him or her in a negative way is to obtain a thorough diagnostic assessment that not only provides a clear diagnosis (when this is possible) but also provides an equally clear description of his or her cognitive strengths and weaknesses, as well as the treatment/educational recommendations that arise from them.
Dr. Mark Bailey is a registered psychologist with a specialty in clinical neuropsychology. He works at the Royal Columbian Hospital and has a private practice at ABLE Developmental Clinic in Surrey. He is also an adoptive parent.