Childhood Disorders

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Straight Talk about Psychological Testing for KidsReview - Straight Talk about Psychological Testing for Kids
by Ellen Braaten and Gretchen Felopulos
Guilford Press, 2004
Review by Roy Sugarman, Ph.D.
Sep 6th 2005 (Volume 9, Issue 36)

The word nebulous might indeed be applied to our thinking when psychological testing is mooted for anyone, especially a child.  The then-president of the APA, Dr J D Matarazzo gave his plenary address on the topic.  Drawing on his years of research, Dr Matarazzo cautioned psychologists to heed the fact that intra-subtest scatter was a feature of normal presentations, not pathological necessarily; he noted that despite the face value of tests, the construct validity, standard error of measurement, ecological validity, other statistical aspects, all have to be considered when, despite the science involved, a subjective component would have to be added to the final report.

Kevin Walsh, writing of gnomes we should know, noted that so much of the interpretation of tests was a matter of inference and what you test depends on what you know.  Don Stuss, in 1987, went further, and wrote that what you test, is, well, what you get.  Victor Nell, the great South African transcultural expert, warned of cultural universal beliefs and the valuelessness of norms without constructs.  As Thomas Kramer noted, when all you have in your toolbox is a hammer, everything starts to look like a nail.  Shapiro noted in 1967 that most tests have only an indirect relationship with the variables they are supposed to measure.  One often sees IQ tests defined as tests of intelligence, but little harks back to Wechsler's 1944 pronouncement that intelligence was a global, or aggregate capacity, to think rationally, act with purpose, and deal effectively with the environment.  All of this prompted Benton to write in 1987, referring to neuropsychology in particular:

The unfortunate consequences of this combination of ignorance with delusion are numerous, including the inappropriate application of tests to probe for evidence of cerebral abnormality, the uncritical interpretation of test findings, and, most important from the standpoint of the patient or client, the drawing of unwarranted conclusions about the state of his whole brain or some geographically labelled part of it (page 8: Evolution of a clinical specialty.  The Clinical Neuropsychologist, 1, 5-8).

Into this arena comes the welcome and novel addition of a book that seeks to tell parents when, why and how to have the kid tested, what the schools can and should provide, what the magic of numbers means in terms of IQ, development, learning disabilities, behaviour, and how to use the test results with some outcome in mind.

Both of the authors are staff specialists at Mass General Hospital and serve on the faculty of Harvard Medical School's department of psychiatry, good credentials then to take this on in the USA.

Right out from the start, its nice to see little windows added to the pages, as one finds in some texts, the DSM-IV for one, which make it easier to find, for instance, 'questions to ask the psychologist' or 'what should I tell my child about the diagnosis', or definitions of 'criteria' or 'cognition'. 

The first chapter defines what for instance motor, or language skills are, and how they are tested, dividing these up into infant/toddler, preschool, and school age kid, which is a nice, touch, the developmental perspective being what it is.  Learning, behaviour, social skills, all get the same treatment, with some Q and A bits thrown in, also useful. Under chapter two, the private vs. public debate gets immediate treatment, perhaps percepts based on the exact market for this book.  The chapter is largely a Q and A fest again, and very USA-centric, but it all fits just fine for the global market too.  Chapter three kicks off by defining the roles of psychologists, Neuro psychologists and social workers, as well as educational psychologists, psychiatrists and others, very helpful certainly from my experience, and in countries like Australia that are petrified to tell anyone the difference, and where psychologists still qualify with honours degrees and some clinical internships.  The window of note here is one that gives all the combinations of letters that appear after names, what they mean and who has them, a nice touch.  Chapter four defines most of the tests that will be used, a long chapter with lots of good stuff, and then on to Chapter five with an explanation of what the meaning of the magic numbers is that Ch 4 produces.  An example of a neuropsychological exam is given soon in the chapter, after dealing with the Bell Curve and the normal distribution, with a few pithy definitions.  I tend to like their definitions which are clear, very short, and lack any real language that might confuse.  Along the passage of the report example are little windows of commentary, which, like the big ones, clarify where one is going with the report. There is no example given of a less empirical report, such as a clinical psychologist might produce, which is a bit remiss of the authors I think.  In waxing nebulous, clinical psychologists may just reign supreme unless checked.

Part three examines the common disorders for which one might seek assessment, starting off with Dyslexia, and nicely, the tests that might be used to diagnose or clarify the condition.  The what-to-tell-the-child-window is there, treatment options, and so on.  Then in Chapter 7, the ghoulish ADHD, all-time champion of lets get nebulous (or not) depending on what school you emerge from, with controversy its permanent bed-fellow, is dealt with.  It's not a big chapter, and the authors note fairly quickly that they are not going to address the usual and very long list of questions that parents might have, and defer several times to the treating physician.  I don't think many readers are going to be happy with that, given the controversies that still rage around psycho-stimulants, cognitive change and outcome, efficacy and so on in ADHD, and I think this book would really have done better if it dealt with the myriad of entities that might make up the evaluation and outcome in this condition which the authors describe as a common one.  In essence, the chapter is the same length as the Dyslexia one, and I guess the authors are trying to not get over involved here.  In any event there is a good reference list, split into adults, children and teens, with books, video and website addresses for those wanting more.  Nonverbal learning disorders and Asperger's are lumped together, and then Autism and Pervasive Developmental Disorder get their own chapter, quite adequately dealt with and longer than the ADHD chapter by a small margin.  Garnett and Attwood's scale is at least mentioned by the authors, which is nice, given they are Australian.

Mathematics and written expression disorders are dealt with in Chapter 10, mental retardation and giftedness in the next, with the notation that being gifted doesn't necessarily mean happiness and fitting in well, nor does it mean resource is close to hand.

Finally, although missed in many books, depression, anxiety and other psychological disorders are dealt with in much the same way as the rest of the book, such as psychotic disorders, ODD and CD.  Eating disorders and self mutilation are given a tiny reference, mainly seeming to link DSH with sexual abuse by an example, which of course may not always be true, but I would hate to see an uninitiated parent pick up on that.

There are further examples of books that can be read, sites to visit, and a good enough index to complete the book.

As far as common sense goes, it's not always enough when entering the nebulous and often well defended world of testers, assessors and therapists.  It's always a terrible fright to parents to hear that their child is not quite up to scratch in some esoteric way, and whether or not this variance from the norm is common or not is another consideration.  There is after all an indigenous American tribe that do not let their infants touch the earth until one, then they plonk them down, and off the kids walk as if their muscles knew just what to do. I see and hear of countless children who are found to be in need of therapy, with one or other lag dominating, and some 20% of kids seem to be assessed for something or the other. The need for books that tell us when and when not to panic is really huge, and I wonder how this book is to be marketed, and whether or not parents will be given this or advised to purchase it when first told by report or word that something is not quite right? By the time parents find out about this book, the chance is that they will already have had some contact with professionals, so my earnest hope is that this down to earth book is a common sight in doctor's and professional assessors rooms in the right place at the right time, or be useless. The authors have kept it tight, perhaps too tight, but as far as straight talk goes, they have done just fine, and the handbook is worth every cent.


© 2005 Roy Sugarman


Roy Sugarman PhD, Conjoint Senior Lecturer in Psychiatry, University of New South Wales, Australia


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