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.

CHC Theory, Cognitive Assessment, Principles of assessment of aptitude and achievement

Needing Glasses for the Ears: Explaining Phonological Dyslexia to Parents

ME: Tell me about why you decided to be evaluated.

ADULT CLIENT: I think I might have HDHD and dahlexia.

ME (unsure): You think you might have ADHD and dyslexia?

ADULT CLIENT (embarrassed): Right, ADHD…but I think I have dahlexia, too.

Auditory processing problems are among the hardest problems to explain. If you were to give parents a simple, technically correct definition of auditory processing (e.g., the ability to perceive patterns in sound), you are likely to be misunderstood. Parents know that “auditory” has something to do with hearing and are likely to think that their child has a hearing problem or has difficulty understanding speech. Auditory processing is the ability that I spend the most time explaining so that I do not cause confusion. If a child has auditory processing problems, I say something like this to the parents:

Auditory processing is not the ability to hear. Your daughter can hear just fine. The problem that she has is difficult to explain so I am going to start by comparing her problem to vision problems (She does not have a vision problem, either. I am just comparing the two problems.). Near-sighted people are not blind. Up close, they see well. Things that are far away, however, are blurry. Making lights brighter does not help; near-sighted people need glasses. In the same way that someone who is near-sighted is not blind, your daughter is not deaf; she is not even hard of hearing. However, for her, speech sounds are a little blurry for her. It is as if she needs glasses for her ears, to make sounds clearer. Unfortunately, no such thing exists. A hearing aid would not help because it is not the volume of the sound that is the problem.

The problem is that the sounds in words are hard for her to distinguish. I’ll explain what I mean. Words are made of different sounds blended together. We usually think of the word cat as one big blob of sound – /cat/. However, whenever we need to, we can break cat into three separate sounds – /c/ /a/ /t/. With a word like cat, this is easy to do and even your daughter does not have much trouble with it. However, when she hears a long word or a word with a lot of consonants bunched together, it is hard for her to break the word into individual sounds. For example, the word strength has only one syllable but it has six sounds – /s/ /t/ /r/ /e/ /ŋ/ /θ/. With cat there are three letters, one for each sound. With strength it gets complicated because the n and the g form a single sound /ŋ/ and the t and the h make the sound /θ/. If I pronounce both the n and the g separately – /stren/ /g/ /θ/ – it sounds strange. With a word like strength, your daughter can hear the first sound and the last sound but gets lost in the middle and starts leaving sounds out or guessing wrong sounds.

Now, if you say the word strength out loud, she can hear it and she understands it. She is not confused. She can even pronounce the word correctly. Why? I’ll make another comparison to vision. When you are driving and you see a road sign from far away, you might not be able to see every letter on the sign distinctly. However, you might be able to make out the shape of the word and because you know what different signs are likely to say, you can tell someone what the word on the sign is. This is sort of like what you daughter can do. She hears the word and can say what it is based on the overall features of the word. However, she has difficulty hearing each of the sounds as distinct from each other.

If the only thing that were wrong was that she could not split words into different sounds, there would be no cause for concern. However, it turns out that this ability to hear the sounds in words as distinct rather than as big blobs of sound is really important to learn to read. If you can hear the different sounds in words, you can hear why the words are spelled as they are (if they are words with regular spelling). If you are reading and you come across a new word, you can sound it out like they do on Sesame Street.

Children who have difficulty hearing speech sounds distinctly, often have trouble learning to spell and to read. Most children learn their letters and the sounds they make and then can figure out how to read and spell most words (at least the ones with regular spelling). Without the ability to sound out a word, learning to read and spell depends mostly on memorizing each word one-by-one. New words have to be taught explicitly to the child. Some children with this problem figure out how to work around it; some have help. When children with this problem fall behind in their ability to read, we call the problem dyslexia.

I want to be clear what dyslexia is and what it is not. You may have heard that dyslexia is when children see words backwards. This is not true. I have been doing this for a long time and I have seen many children with dyslexia. Not one of those children saw anything backwards. However, many of them jumble their letters and, like younger children, sometimes they write their letters backwards. This is not due to seeing things backwards. Instead, these mistakes are due to ordinary memory errors. If you give me a long list of groceries to buy, I might remember most of the items on the list but I might not remember them in the right order. When children with dyslexia learn a new word, they might remember which letters were in the word but might forget their order. They will probably remember the first and last letters but might mix up the middle letters. If they could sound out the words, they would be able to see that the order was wrong but that does not happen as often as it otherwise would.

The reason that young children often write letters backward is that letters are very unusual. Most things have the same name no matter what angle we view them from [I demonstrate with a pen, rotating it and turning it]. This pen is called a pen no matter what I do with it. Letters are not like that. The letter b changes its name, depending on how it is rotated or flipped. It can be a d, a p, or even a q. A backwards j does not even have a name. This is weird for children and it takes a while for them to get the hang of it. Children with dyslexia have a bit of a problem remembering which sounds go with which letters and thus continue making these sorts of errors longer than do most children. The problem is blurry sounds, not backwards vision.

Of course, I would probably not say all this in one long speech but try to make the discussion more interactive.

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.

CHC Theory, Cognitive Assessment, Principles of assessment of aptitude and achievement

Explaining the difference between vision and visual-spatial processing to parents.

Vision is the ability to see something and visual-spatial processing helps you make sense of what you see.

Vision is the ability to see what is there. Visual-spatial processing is the ability to see what is not there, too, in a sense. With good vision you can see what something looks like; with good visual-spatial processing you can imagine what something would look like if you turned it around or if you were standing somewhere else or if something else was covering part of it.

With good vision you can see objects; with good visual-spatial processing you can see how they might fit together.

With good vision you can see a bunch of lines and splotches of colors; with good visual-spatial processing you can see how those lines and splotches of color form meaningful patterns.

This is the ability that sculptors, painters, designers, engineers, and architects need. It comes in pretty handy for the rest of us too.

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.