Written by Sean Snyder
Noticing that your child is beginning to struggle with their mental and behavioral health can be a hard moment for any caregiver. The challenges that your child is facing may have begun slowly and grown over time, or may have seemed to come up abruptly, with no easy cause or event to blame. It can be paralyzing to watch your child suffer, and to feel the impact on your own family and home, without knowing the next steps you need to take to secure effective support.
The National Center is helping States, Tribes, and territories improve access to child welfare competent mental health services. As part of our efforts to support child-serving systems, we’ve partnered with the Baker Center to create this evidence-based assessment guide to help families and caregivers find care for their loved ones.
There are many kinds of assessments that address different presenting problems and challenges, so let’s break it down to help you identify the assessment that you might need for your child. These different assessments can be useful in their own ways, but it can be overwhelming to figure out the right fit.
Adoption Competent Assessments
Mental health professionals working with children and families who have experienced the child welfare system should ensure that their assessment addresses this unique experience. The assessment process should be used as an opportunity to provide families feedback and psychoeducation to help them shift from blaming the child or themselves to a more realistic understanding of what has happened to the child and the resulting difficulties. Some commonly used assessment measures are:
Achenbach System of Empirically Based Assessment
Includes the Child Behavior Checklist and Youth Self Report
The Child and Adolescent Needs and Strengths (CANS)
This article provides more information about how adoption competent assessments can increase the effectiveness of mental health services.
Neuropsychological Assessments
Neuropsychological assessments are conducted by neuropsychologists, who are specifically trained to carry out testing procedures and understand the relationship between an individual’s behavior and cognition. These evaluations are appropriate for children at least 6 years old, through adulthood, though some evaluations may occur much earlier depending on a child’s presentation and need. A good neuropsychological assessment will start with a referral question and then the neuropsychologist works to identify psychological tests that will help them answer pertinent questions. These questions can be broad and are determined by an individual’s need. For instance, a neuropsychological evaluation can assess questions of intelligence, learning and comprehension, reading abilities, language abilities, concentration, attention, processing speed, memory, fine motor skills, visuospatial skills, executive functioning, and mood/personality.
This kind of testing is often recommended when an individual is experiencing unexplained challenges in day-to-day functioning, particularly struggles at school. This could include difficulty with learning and encoding new information, short term memory, challenges interacting with and communicating with others, speaking or pronunciation challenges, poor attention and concentration, unexplained changes in personality, major challenges with executive functioning skills, and having trouble staying organized or completing tasks, among other things.
Neuropsychological evaluations can help identify things like:
The result of a neuropsychological evaluation is the identification of the above challenges, and recommendations for next steps to support your child through additional services or support in school.
Diagnostic Assessments
If you know your child or teen is struggling, but you’re not totally sure why and they haven’t yet received a psychological evaluation, a diagnostic assessment is a good place to start. A diagnostic evaluation involves a semi-structured interview process in which children and their caregivers are asked about an array of diagnostic areas they might struggle with and specific examples from the child or teens life about how these challenges manifest across settings. The interview will address cultural, social, emotional, behavioral, and mental health concerns for children and adolescents across a wide spectrum. The clinician will address challenges including mood disorders, behavioral disorders, executive functioning, and traumatic stress to consider a broad etiology of factors contributing to the presenting challenges, especially because in youth mental health, the culprit is rarely the cause.
In addition to a semi-structured interview, good diagnostic assessments will also include the completion of clinical questionnaires to corroborate or provide an alternative perspective on functional impairments across settings. This includes having the youth, their caregivers, and other important adults in their lives (e.g., teachers, coaches), completing validated questionnaires about how symptoms do or do not present. Once the interview with child and caregivers are completed and questionnaires are scored, the assessing clinician will hold a feedback session, often complemented with a diagnostic report, outlining clear diagnostic impressions and recommendations for next steps, including treatment and other resources for support.
Examples of diagnostic assessments that are validated and empirically supported are:
Bottom line, a good diagnostic assessment is a good place to start, and should include an interview, questionnaires, and a feedback session to clearly outline the problem and the next steps to address it.
ADOS
For more specific areas of concern, there are specific types of evaluations and tests that you can request to help you answer the questions you have about your child. If Autism Spectrum Disorder is an area of concern, we recommend seeking out a provider who offers ADOS. The Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) is an assessment administered by professionally trained clinicians to evaluate concerns specifically related to Autism Spectrum Disorder. In the evaluation, they will be assessing communication skills, social interaction abilities, and imaginative uses of materials. This assessment is appropriate for kids as young as 12 months into adulthood and, in tandem with the Autism Diagnostic Interview (ADI) or another comprehensive developmental interview, is considered the gold standard for how to evaluate and diagnose autism across the lifespan. We know that early and comprehensive diagnosis for neurodevelopmental concerns such as autism are key to successful treatment and prevention of problems getting worse over time. Therefore, families must be empowered with information on how to assess this concern. A good autism evaluation should consider developmental history, information from informants in the child’s life, and behavioral observations across time and settings.
When you’re deciding where to pursue your evaluation, it’s important to consider what you hope to gain from the assessment. Each of these types of evaluations can provide valuable insight, but you want to make sure that it’s shining a light on the challenges that are most prominent for your child, and that any diagnoses or recommendations given can be actioned based on the information from the assessment.
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