Karen Chesnutt, Ph.D

Month: January 2017

Do we Ever Test Adults?

January 17, 2017 /

Most of the time, when we think about testing, we think about testing children.  In fact, we often have opportunities to test adults. There are many reasons that adults need to have an IQ test done.  Here are a few of them:

  • We often use IQ tests as part of a battery when there are medical problems that are being explored.  For example, when there is a question of dementia or memory loss.  After strokes or head injuries, adult IQ tests can be very helpful in determining deficits but also in identifying strengths.
  • When adults return to college or when they are exploring the possibility of a new career path, they often want to get a good picture of their skills.  Sometimes testing will help them make a decision about what kinds of supports they may need or about their ability to pursue a particular vocational path.
  • Sometimes people come in just to have some of their own personal questions answered.  They want to know if they have ADD/ADHD for example, or whether they have an undiagnosed learning disability.
  • This type of testing is often useful when people are concerned about whether they are showing cognitive change.

We usually use a test called the Weschler Adult Intelligence Scale (WAIS) for this type of testing.  It takes about 1 ½ hours to complete and involves a number of subtests. Some of the subtests are verbally based and measure vocabulary. Others are visual and look at how we you can copy block patterns or how well you can make designs. There are some memory scales as well.

After all the data has been collected, the psychologist will look for patterns in the scores to help describe your cognitive profile.  Because these tests have been given to thousands of other adults, we have some idea of the “normal” pattern of scores.  Your pattern is then compared to this norm and we look for differences. A little bit of difference is expected—we all are different!  But when there is a large discrepancy, we want to look at it more closely. Sometimes more testing is suggested so that we can get more information about why your scores are so different (Don’t forget, they could be both higher or lower than we expect!).

The next step always is to apply the results to the “real world.”  How do these scores impact your daily life?  Should you use different strategies to help you remember? Should you “talk yourself through” a difficult task so you can use your best skills in that area? Sometimes people find that they have lived their lives feeling that they weren’t “smart enough,” only to find out that they have one small area of weakness but that otherwise, they are fine!  For some of the patients I have worked with, this revelation has been very freeing for them, allowing them to try new things or move in new life directions.

Remember, though, that IQ tests only measure certain types of tasks. They NEVER should be used to judge your value as a person, or your ability to be successful.  They just give us a snapshot of specific tasks; our lives a so much more complex than that. So don’t overvalue IQ scores! Use them for what they are intended to do.

When your Child is Worrying (Part 2)

January 12, 2017 /

In an earlier blog, I discussed anxiety in children.  Most of us don’t want to think about the fact that children can worry. It’s not our idea of childhood.  Parents’ innate responses are to comfort and protect.  The way to handle childhood fears is actually the opposite of that.  As I explained earlier, firm parenting is key to addressing your child’s fears.

Here are some more suggestions about what to do:

  • It is important to remember that anxiety often has a ruminating quality to it and it can dominate your child’s thoughts. You should not foster this by constantly talking with him/her about it.  Put limits on the conversation,  so you can help your child learn how to do that.  You might say, “I understand that you are worried about flying, but that is not happening for two months, so I will not talk with you about it now” and then don’t.
  • Our general treatment for specific fears is to have children face these fears. That is the only way they can get past them, so the fears don’t have an ongoing impact on their lives. Since this is a stressful process, I usually suggest that you only use this technique when other areas of your child’s life are relatively stable. And you will want to do it in a step-wise fashion. For example, for children who are afraid to go upstairs by themselves, I have them practice walking upstairs first with a parent present. They start with 5 steps and then increase daily. When they finally get upstairs, I have a parent at the bottom of the stairs. The child starts by staying upstairs and counting to five. Then I have parents increase the task until the fear is totally overcome. The important thing is to do only a small step at a time.  In this way, your child can overcome a specific fear, but at the same time feel very successful.
  • Obviously, using punishment or shaming will make anxiety worse, not better.
  • If your child’s sleep is disrupted for more than 2 weeks, I recommend seeing a therapist soon.  For my patients, I use this as a red flag that the anxiety is reaching a point where a  professional opinion is needed.

 

Your Child is Worrying! What Should a Parent Do? (Part 1)

January 10, 2017 /

All of us worry at some point in our lives. Most of the time, parents are surprised when their children, even preschoolers start worrying. We have this idea that childhood should be carefree, but that isn’t the reality for some children.

So where does this anxiety come from?  We inherit a predisposition to how we respond to stress. Some of the tendency to be anxious may run in the family and then be triggered by some kind of stress. In other children, it can be a direct result of trauma. We usually don’t think about trauma as occurring in children, but we are becoming much more aware of it. Things such as accidents, medical procedures, family disputes and obviously abuse all can trigger anxiety in children.

You can see anxiety in your children for a number of reasons. Sometimes, specific events are frightening for them, like thunderstorms or having to ride in an elevator. Other children are shy and have difficulty in new or public situations. Some worry about everything, starting most sentences with, “What if…” I often find that a bright child can come up with many “What ifs.”  They also can develop fears as a result of news coverage of a tragedy or natural disaster. Some develop stomachaches, some have difficulty leaving home, some are clingy to adults and others have problems sleeping.

My concern is that the family response is often the opposite of what needs to happen. Parents feel sorry when they see their child suffering so much. They want to comfort and protect their child. This is a natural response, but one that will not help stop the cycle of anxiety. In fact, it will make it worse.

Parents want their child to understand that there is nothing to worry about, so they spend a great deal of time discussing why thunderstorms or elevators aren’t dangerous. Sometimes, parents try to avoid the frightening situation or try to protect their child (“It’s OK, you don’t have to talk to the waiter. I’ll order your meal”).

Children who are afraid don’t need explanations. Fears are emotional, not rational. No rational explanation will help. The first step for parents is to realize that indulging their child’s fears will not help at all. In fact, it just reinforces them. A child might think, “If Mom thinks there is a reason to be afraid and we avoid the elevator, it must be really dangerous.”

Here’s the first step to take:

  • The most important thing you can do is to establish firm parenting. Your child needs to realize that you are stronger than his/her thoughts. You are the one who is in charge of life. For example, your child does not need to worry about someone breaking into the house, because security is your job and you are quite good at it.  You, as parents, are the ones who decide if a weather situation is dangerous or not. Basically, you relieve their fears by being the ones in charge and making the decisions.

This firm parental presence is the best way to reduce a child’s anxiety. It should not just occur in a specific situation but should be an overall approach to parenting.

In my next blog, I will review some other ways to help your child cope with anxiety but strong parenting is the foundation of all the rest.

Psychological Testing—All tests are NOT created equal

January 5, 2017 /

One of my favorite parts of my practice was when I could do evaluations. I liked trying to figure out ways to get good data, even when the situations were complicated. It was like solving a puzzle, putting all the parts together to get a picture of how someone worked with information. Then, I could start to figure out what could be done to help.

Many times, parents would bring in reports to me that had received from other psychologists. Even though the results were clear to me, many parents said they had no understanding of what all the numbers meant. They also didn’t know how to use the information to help with planning for their child. So, I decided to write a series of blogs to help sort out the confusion.

There are many kinds of tests and more are coming out every day. Psychologists sort through all these and usually use only the ones that have two important characteristics.

First, it is important to be sure that the results are consistent.  If a child is tested one day, will the results be similar the next time. The question is, can we count on the test results. One way to be sure about this is to have given the test many times, to many different groups of students. Even though this kind of research is not interesting to non-psychologists, it is crucial if you are going to base treatments on the results.

Second, does the test really assess what it says it does. If a test is developed to identify the presence of an Attention Deficit Disorder, for example, is it really able to sort out what is ADD behavior from what is “squirmy boy” behavior, or sensory seeking behavior, or just normal behavior for that age. How can we be sure? They all can look similar. So, research is needed on a large number of children, from different areas, different backgrounds to make sure that the test is really valid. In general, the more children in the sample groups and the more care in studies, the more accurate we can be.

I know many parents don’t worry too much about these factors, but in my opinion, they should. I have seen tests used to label or categorize children when the tests themselves were of questionable value. Unfortunately, I have also seen times when the choice of tests was made to give a desired result, usually to deny services to a child.

So, I have written a series of blogs where I try to outline to variety of tests available so that parents can be sure that they are getting the best assessment possible for their child. In defense of the testors, it is important for parents to know that buying the test kits is extremely expensive so most independent psychologists don’t have a wide variety. Instead, they choose the ones that they have the most use for.

What should a parent do either when testing is recommended or when you feel your child needs an assessment?  

  • Make sure the questions to be answered are clear.  Do you need to know about your child’s overall ability or are their specific questions about his/her vocabulary development, for example.
  • Look at the lists of tests in the next blogs to be knowledgeable when you talk to the psychologist.  Ask what tests will be used.
  • Carefully review the results, to be sure you understand what the results indicate about your child.

Tell Me the Test For: ADD/ADHD

January 3, 2017 /

Many parents come in to my office and ask about testing for ADD/ADHD.  Most hope there is a test that clearly identifies this disorder. Unfortunately, there is no one test that can make this diagnosis. Let me tell you the process that helps us sort out ADD/ADHD from other patterns.

One type of test that we use is a questionnaire, like the Vanderbuilt Scales, the Connors scales or the Achenbach scales. Some doctor’s office will use these so parents can give some feedback about what actually happens at home. Some of the questionnaires are designed for teachers to complete. The goal is to get a better picture of all areas of life. The data from questionnaires is only as good as the observations of the person completing them, so we need other information as well.

The second kind of test that is used is what we call a “continuous performance” test. These are tests made up of routine tasks (ones that really are not interesting to ADD/ADHD persons). Usually, they are given on computers that constantly monitor if you are paying attention.  For example, you would be asked to click every time you saw a specific letter. The computer, then, would track how long you could stay focused on the task. It would be able to tell if you had been distracted or gotten sidetracked. The amount of time for each task is variable, some as short as a minute or two.

These continuous performance tests give us some interesting information but it is not enough. A lot of people don’t like doing this type of task, but not all of those people have ADD/ADHD. We can learn something about attention span, but it is not enough to make a diagnosis.

We also can use the WISC V to help with the diagnosis. There is a pattern on this test, where certain subtests tend to be lower with people with ADD/ADHD. The tests that are the most sensitive are the Digit Span subtest and the Coding subtest. Both seem to be lower in people with ADD/ADHD.  Is this enough to make a diagnosis?  Not yet.

It is important to get a good description of behavior in a variety of situations. We also need to rule out other problems that can mimic ADD/ADHD, like thyroid problems or anxiety. It is only when we have a good history, and good data that this diagnosis can be made.

 

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