Cognitive Assessment, Principles of assessment of aptitude and achievement

Advice for Psychological Evaluation Reports: Write about people, not tests

At its best, the end product of a psychological assessment is that a child’s life is made better because something useful and true is communicated to people who can use that information to make better decisions. How is this information best communicated? I believe that it is by the skillful retelling of the story of the child’s struggle to cope with the difficulties that led to the testing referral.

Not only are humans storytelling creatures, we are also storylistening creatures. We are moved by drama, cleansed by tragedy, unified by cultural myths, and inspired by tales of heroic struggle. Most importantly, through stories we remember enormous amounts of information. Tabulated test results are inert until the evaluator weaves them together into a coherent narrative explanation that helps children and their caregivers construct a richer, more nuanced, and more organized understanding of the problem. Compare the following assessment results.

Explanation 1

On a test in which Judy had to repeat words and segment them into individual phonemes, Judy earned a standard score of 78, which is in the Borderline Range. Only 7 percent of children performed at Judy’s level or lower on this test. This test is a good predictor of the ability to read single words isolated from contextual cues. On a test that measures this ability, Judy scored an 83, which is in the 13th percentile or in the Low Average Range. Reading single words is necessary to understand sentences and paragraphs. On a test that requires the evaluee to read a paragraph and then answer questions that test the evaluee’s understanding of the text, Judy scored an 84, which is in the Low Average Range. This is in the 14th percentile. An 84 in Reading Comprehension is 24 points lower than her Full Scale IQ of 110 (75th percentile, High Average Range). This is significant at the .01 level and only 3% of children in Judy’s age range have a 24-point discrepancy or larger between Reading Comprehension and Full Scale IQ. Thus, Judy meets criteria for Reading Disorder. More specifically, Judy appears to have phonological dyslexia. Phonological dyslexia refers to difficulties in reading single words because of the inability to hear individual phonemes distinctly. This difficulty in decoding single words makes reading narrative text difficult because the reading process is slow and error prone. Intensive remediation in phonics skills followed by reading fluency training is recommended.

Explanation 2

For most 12-year-olds as bright as Judy is, reading is a skill that is so well developed and automatic that it becomes a pleasure. For Judy, however, reading is chore. It takes sustained mental effort for her to read each word one by one. It then requires further concentration for her to go back and figure out what these individual words mean when they are strung together in complete sentences, paragraphs, and stories. It is a slow, laborious process that is often unpleasant for Judy.

Why did Judy, a bright and delightfully creative girl, fail to learn to read fluently? It is impossible to know with certainty. However, the problem that most likely first caused Judy to fall behind her peers is that she does not hear speech sounds as clearly as most people do. It is as if she needs glasses for her ears: The sounds are blurry. For example, although she can hear the whole word cat perfectly well, she might not recognize as easily as most children do that the word consists of three distinct sounds: |k|, |a|, and |t|. For this reason, she has to work harder to remember that these three sounds correspond to three separate letters: |k|=C, |a|=A, and |t|=T. With simple words like cat, Judy’s natural ability is more than sufficient to help her remember what the letters mean. However, learning to recognize and remember larger words, uncommonly used words, or words with irregular spellings is much more difficult for Judy than it is for most children.

Many children with the same difficulty in hearing speech sounds distinctly eventually learn to work around the problem and come to read reasonably well. However, Judy is a perceptive and sensitive girl. These traits are typically helpful but, unfortunately, they allowed her to be acutely aware, from very early on, that she did not read as well as her classmates. She clearly remembers that her friends and classmates giggled when she made reading errors that were, to them, inexplicable. For example, for a while she earned the nickname “Tornado Girl” when she was reading aloud in class and misread “volcano” as “tornado.” She came to dread reading aloud in class and felt growing levels of shame even when she read silently to herself. She began to avoid reading at all costs. She did not read for pleasure, even when the texts were easy enough for her to read because she felt, in her words, “dumb, dumb, and dumb.” Over the next several years, she fell further behind her peers. By avoiding reading, she never developed the smooth, automatic reading skills that are necessary to make reading a pleasurable and self-sustaining activity.

Although Judy’s ability to hear speech sounds distinctly is still low compared to her 12-year old peers, this weakness is not what is holding her back now. Indeed, her current ability to hear speech sounds distinctly is actually better than that of most 6 and 7 year-olds, most of whom learn to read without difficulty. With extra help, Judy can learn to decode words phonetically. However, in order for her to develop her reading fluency and reading comprehension skills to the level that she is capable, she will need to engage in sustained practice reading texts that are both interesting for Judy and are at the correct level of difficulty. She is likely to be willing to read only if she is helped to manage the sense of shame she feels when she attempts to read a book. This may require the collaboration of a reading specialist and a behavior specialist with expertise in the cognitive-behavioral treatment of anxiety-related problems.

Comparing Explanations

I am reasonably confident that most readers would find the second explanation to be much more useful than the first. The second explanation is not better than the first simply because it is more detailed. Explanation 1 could have been supplemented with more details if I had taken the time to fill it with even more information about test results. The second explanation is not better simply because it avoids statistical jargon that is difficult for parents and teachers to understand. Even if the jargon were removed from the first explanation and inserted into the second, the second explanation would still be better.

The second explanation is better because it is more about Judy than about her performance on tests. The narrative explanation of how her reading problem developed and how it was maintained is better because it leads to better treatment recommendations. More importantly, it leads to recommendations that will be understood and remembered by Judy’s parents and teachers. One of the problems with the first explanation is, ironically, that it is not difficult to understand if it is properly explained. Most parents and teachers will nod their heads as they hear it. However, they are likely to forget the explanation as soon as they leave the room. Most of us are not accustomed to thinking about people in terms of sets of continuous variables. Without a narrative structure to hold them together, assessment details slip through the cracks of our memories quickly. It is unfortunate that a forgotten explanation, no matter how accurate, no matter how brilliant, is as helpful as no explanation at all.

This post is an excerpt from:

Schneider, W. J. (2013). Principles of assessment of aptitude and achievement. In D. Saklofske, C. Reynolds, & V. Schwean (Eds.), Oxford handbook of psychological assessment of children and adolescents (pp. 286–330). New York: Oxford.

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