Karen Chesnutt, Ph.D

Category: Evaluations

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.

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.

 

Other Intelligence Tests

December 27, 2016 /

Besides the two major tests for intelligence, there are many others that are used, often for specific purposes. These are called “intelligence” tests, but really are tests of cognitive (or learning) abilities. These can be helpful in certain situations, but should not be confused with formal IQ tests.

Group intelligence tests are often used by schools. These serve as benchmarks for educators but have little or no relationship with formal IQ tests. These test results should be used very cautiously. There are many questions surrounding them about what they actually measure and about their accuracy. In fact, I do not use this type of data at all.

There are some other cognitive tests that are given individually.  The Woodcock Johnson Test of Cognitive Abilities or the Cog-Med tests would be examples of this type of test.  These serve specific purposes in schools. Often they may be used to help understand a learning disability or they may be used to determine who should be included in gifted programming. These tend to be tied more to educational theory than they are to psychological ideas about intelligence.

Be Careful

Do not assume that these are IQ tests, even though sometimes they give out results using the term IQ.  These are good tests for their own purpose, but they are not substitutes for a formal IQ.

Here’s where they can be helpful:

  • If your child has had difficulty in school and is currently getting help. These tests can help monitor whether the plan you have in place is working.
  • If your child is experiencing problems in one academic area, in math for example, but is doing well in all other areas. Before beginning an extensive program of testing, some schools may administer one of these tests as a starting point.
  • These tests will give you a snapshot of how your child is doing at the present time.  These will not predict how your child will do in the future.
  • Some schools use them as a way to determine eligibility for gifted programs.

Note to Parents

Make sure you pay attention to the tests that uses and interpret these carefully.  

Adaptive Scales

December 22, 2016 /

This group of tests is one that causes a lot of confusion for parents. It is essential that you understand what these are and what they test. These are needed in New York State any time you look for help through one of the agencies that provide specialized services.

Adaptive Scales do not have anything to do with IQ. They are measures of what a person does in life. How well can they manage on their own?  Can they cook? Can they handle money? These are not tests that can be given in an office, but instead are questionnaires that are completed by people who interact with the patient regularly. Often, there are forms that can be used by teachers as well as caregivers. The profile that we get from these is only as good as the information we are given.

After all the information is gathered, the results are compared to people the patient’s age, so see how they compare.  There are usually four areas that are included: Communication, Socialization, Personal Care and Coping skills. The terms used can vary, but the skills are the same. The results are then compared to other test data for corroboration. For example, if a person is diagnosed with an Autism Spectrum Disorder, we would expect that there would be delays in socialization skills. Sometimes, we find people with strong IQs who are unable to cope with daily life and as a result, score poorly on these tests. Daily living skills and IQ are two very different categories.

There are two major measures of adaptive skills.  One is the Vineland Adaptive Behavior Scale and the other is Adaptive Behavior Scale. These are similar and in New York State, they are both accepted in making determinations about services. These have a wide age range (from 2 ½ through adulthood).

When Do You Need adaptive behavior scales?

  • When you are trying to get services outside of school for your child.
  • When you are trying to make a decision about whether your child is able to live independently, go to college or even go to a sleep away camp.
  • These can be helpful when there is some question about a diagnosis and information about how the child’s difficulties have impacted daily life.
  • You can use this information when you are trying to plan for your child. What skills do you need to focus on, to improve his/her move toward independence.

Help for Parents

Sometimes, parents use these scales to help them have a clearer picture of what their child is actually doing. It is easy to get used to the household routine, without even noticing how much your child is not doing. Many parents have filled out these questionnaires and been shocked by the fact that their child is significantly delayed in independence.

These results can also help parents plan for the areas where they want to focus their attention, what skills they want their child to learn.

Don’t forget that these skills have more to do with life success that even IQ!

“Those Test Scores MUST be Wrong!!”

December 20, 2016 /

I hear this so often from parents. They get a cognitive score or even an IQ score on their child and the number is very different from what they observe at home. Some tell me that their child is reading far above grade level. How can he/she not be scoring in the gifted range?

There is a simple answer. There are NO subtests on an IQ battery that test reading, or math or science. That is not the purpose of an IQ test; testing academic skills requires a different approach.

That is the reason we often do academic testing along with IQ testing. The academic testing is sometimes referred to as “achievement testing” and often includes reading skills (decoding and reading comprehension), math abilities (reasoning and calculation), science knowledge, spelling and writing skills. Some of these tests also include a measure of what they call “fluency.” This indicates how quickly the child can complete the task.

Why are these important?

  • Achievement tests can help in planning academic programs. Where should we provide academic support? Where should we mainstream a handicapped child, based on his/her strengths?
  • This type of test information really helps to measure how effective academic interventions are.  For example, if your child is getting extra reading help on a regular basis, has there been any change in scores?  If not, you will need to go back and modify the program.
  • Sometimes, we compare IQ data with achievement data. Some students score in the average range of IQ but then do poorly on the achievement tests. The question, then, is why is this child not acquiring academic skills at the rate we would expect.  There are many factors that interfere with learning so this situation requires some detective work.
  • Another comparison that is made is between achievement data and grades. Some students are doing poorly on their report cards, but when tested, show good ability. This is another case where we need to look for outside causes that may be impacting the student.
  • These tests give some benchmarks for students. Schools will sometimes measure progress by what goals a student has achieved but there is no way to independently measure progress. These tests give that additional data.

Specialized Achievement Tests

In addition to the batteries, there are some tests that provide a more detailed look at specific subjects. The most frequently used are the tests that assess reading. There is a wide variety available. Some look at reading comprehension. Others target oral reading ability. There are a number that evaluate a student’s ability to sound out, or decode words.

There are also several good tests that assess math abilities. These will help with progress both in math calculation skills as well as measuring math reasoning, as would be found in algebra.

Writing is another academic area that has gotten attention recently. There are tests that are sensitive to the organization of writing, the vocabulary used in written work, and the quality of the themes expressed.

Much less testing attention is focused on science or social studies. I suspect this is because people assume that reading and math are the foundational skills on which science and social students are built.

Don’t forget—achievement testing is important in planning educationally for your child!

The Stanford Binet Intelligence Scales

December 8, 2016 /

In 1916, two French psychologists, named Binet and Simon, were asked by the government to figure out a way to determine which children were below average in intelligence.  These men developed a test based on age and what would be expected at each age. So, if your child is five and can do all the items in the five year old scale, he/she would be considered “normal.” If your five year old wasn’t able to do any of the items on the five year old scale, he/she would be considered delayed. In this way, they could determine who should be placed in institutions for retarded children and who should not. Obviously, a lot has changed since then! (information from Stanford Binet IV manual)

Since then, the testing they developed has evolved and has been updated many times. In the more recent editions, they don’t focus as much on age criteria. They have developed a theory about a general foundation of intelligence that they call “g.”  They really can’t describe it well and they have theorized about what it might include. For example, they have called one factor “Fluid Intelligence.” They then have tested this in a wide number of children and have figured out what would be considered average, above average or below average. This is all done using complicated statistics.

Here’s a little about the test:

  • There is only one Stanford Binet test and it is used for ages 2-late adolescence/early adulthood
  • The names on the subscales are different from on other tests and can’t be directly compared

Why chose the Stanford Binet?

Age is also a factor when choosing a test. The Stanford Binet was the only test that was able to be used with 2 year old children for a long time. People working in Early Intervention programs would use the Stanford Binet for this reason. They understood that an IQ for a 2 year old was not particularly accurate, but that they were able to compare one child’s development with another in order to provide help, if needed..

Sometimes, psychologists may choose specific tests because of the nature of the tasks themselves. Some materials are more appealing to certain ages of children. Some subtests are difficult to administer.
My personal preference is not to use the Stanford Binet except for young children.  I prefer a test that has some specific connection with tasks that a child will have to actually accomplish. For example, I like to use a test that has some pencil and paper tasks, since those are definitely a part of a child’s school experience. I also like to use a test that has a test of complex language where a child has to explain things. This gives me some idea of how he/she will do in the language rich environment at school. Whenever possible, I like to have a test that will give more than a number, one that will help me develop a treatment strategy for the child I have tested.

What About a WPPSI?

December 6, 2016 /

Many parents ask me about a test called a WPPSI. What is it? What is it for? How accurate or valid are the results?  The WPPSI (Weschler Preschool and Primary Scale of Intelligence) is a test that is becoming more widely used. It is designed to begin measuring children’s abilities at about 2 ½ years of age and goes up to 6 years of age.

It is called an intelligence test, but this is one place that parents will need to be careful. It is a test of where a child falls relative to his/her peers. It is not the kind of test that will allow us to predict how a child will do in the future. We find it to be helpful in determining if a child needs some intervention in preschool. It also can be helpful in designing a specific program for a child. For some, we emphasize working with visual materials, because their profile seems to be too focused on language tasks. For some children, the opposite is true.

For psychologists, one of the important things to consider is not necessarily the names given to the subtests, but what the items really measure.  There are many variables that can change a score.  For example, on the WPPSI III, which is the current publication, there is a subtest that measures the ability to make a block design. What if a child doesn’t have the fine motor skills needed. His/her score will be lower but his ability to work with patterns may be unimpaired. With young children, as a colleague of mine used to say, “it is hard to get a fix on a moving target.” Young children are hard to assess.

A second consideration is how many items are given to a child. There are times when a child can only complete a few items. For example, when doing block patterns, maybe the child can complete one or two of the designs. How much confidence should we have in the results of just two items? Psychologists are very hesitant to draw conclusions based on such limited data.

You can imagine how difficult it is just to get a two or three year old to cooperate with testing, no matter how interesting it is. The session has to be short. The child’s concentration will vary. It is a new setting and probably a new person to the child. All these things will impact the child’s score. As a result, the WPPSI is helpful, but is not as accurate as we would like. We usually wait until a child is at least six years old before we begin to feel confident with test scores.

IQ Tests

November 29, 2016 / / 0 Comments

Those dreaded words, “It’s a test!” Even after being out of school for many years, the idea of a test still makes us nervous.  So, if it has been suggested that your child needs to have an IQ test done, here are some things that you need to know.

What are they?

There are all kinds of IQ tests.  Each type has some strength in terms of what they measure and some weaknesses. Often, a psychologist will ask you to outline your concerns and then will pick the test that will best answer your questions.  In a separate blog, I will review a number of these tests to give you an idea of what each one is like.

The tests themselves are made up of sub-tests.  What psychological researchers and test developers have done is to identify each kind of “cognitive” skill (meaning thinking skill).  Then they have analyzed school success and determined the most important cognitive skill that is related to good school performance. Then, they try to find tasks for those cognitive skills and include them in the battery. Parents often ask me specifically how each task relates to schoolwork, and the truth is that it is a statistical relationship. IQ tests don’t test reading or math, for example. Sometimes, parents are confused by this and don’t realize that the tests are developed to predict overall school success. For example, an IQ Test could be used to predict how well a student will do overall in high school.

On some of the IQ tests, we can look at some patterns in the sub-test scores and answer some other questions about how your child learns.  Some of them can help us identify if your child is a verbal learner or a visual learner.  On some, we can measure how efficiently your child works on specific kinds of tasks.  Some of the newer tests have included more sections on reasoning.

The sub-tests that are included are designed to give us information about how successful your child is likely to be in school.  Remember, they do not measure life success.  This is a common misconception.

What information can we get from them?

IQ tests help us get a general idea of what our expectations should be about school performance.   Other factors may be involved, but IQ test data can help us make good academic choices for our children.

Students with ADD sometimes have a specific pattern of sub-test scores that helps make that diagnosis.  IQ tests can identify some specific types of learning disabilities.

What can’t an IQ test do?

It can’t diagnose reading disabilities, dyslexia or math disabilities.  Other tests, in addition to an IQ test, are needed.  It can’t diagnose autism or autism spectrum disorders.  It can’t diagnose emotional difficulties such as depression or anxiety.

So, if your child needs an IQ test, no worries!!

  • Most of the time, children think they are playing “games.” It is far less stressful than the tests you remember.
  • The results should help you plan for your child. They provide a road map for school services, not a “life sentence” of any sort.  I advise parents to use this data only for what it was designed to do—to plan for school.

DON’T FORGET!

      IQ tests can’t predict life success.  IQ data must never be used to judge a child’s value.  Even though in popular use, it is implied that high IQs are better or more valuable, that just is not true.  Your child’s worth should never be linked to a number!

“I Think My Child is Gifted”

November 24, 2016 / / 0 Comments

Many parents come to me with their young children who have shown a pattern of precocious development. These young people have reached milestones at a younger age than expected. Many have huge vocabularies and seem to understand concepts that are far above their age level.

Parents want to know if they should schedule some testing for their children, to determine if they are truly superior in intelligence. There are some things that you may want to consider before moving ahead with testing.

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We do have intelligence tests that start at about 2 ½ years of age.  We usually use the Stanford Binet Intelligence Battery (SBIB) or the Weschler Preschool and Primary Scales of Intelligence (WPPSI).  For school age children, we use the Weschler Intelligence Scale for Children (WISC).  (In a separate blog, I will discuss more details about each of these).  The result of this kind of testing will be a number that is labeled “IQ.” These numbers are often misused. Some parents look at the results and think that this number represents a firm intelligence level, one that will persist as the child gets older. That is not true. Some of the early tests tend to overestimate IQ and there can be a great change in these scores over time.  A child who scores in the superior range at 4 years of age is likely to score in the average range at 9.  The opposite can also be true. Be careful in interpreting IQ scores in young children.

Children show great variability in their developmental patterns. Some children show a pattern of growing very quickly at first, and then leveling off.  Other children show the opposite pattern, starting slowly but then showing spurts of development as they grow up. So, if you test your child at one point, can you count on that information to make predictions about the future?  No, you can’t. You don’t have any information about your child’s future development pattern.

The other consideration relates to brain development. There are many skills that we cannot measure until the brain itself matures. For example, if you want to get an estimate of your son or daughter’s reasoning, you will need to wait until adolescence to have that type of skill tested.

So, are there times that testing can be helpful?  Yes. Here are some general rules of thumb about when to get testing.

  • One time that testing is warranted is when you are trying to design a behavior program for your child. The test results will tell you what is happening NOW, and that is what you need to know so you can tailor the program to your child.
  • I like to test the younger children if they come to me for treatment of anxiety. Children who seem to be bright often can perceive things intellectually that they can’t deal with emotionally. The test results can help determine if this is what is happening and this helps me in my treatment of their anxiety.
  • Sometimes, testing is required to access particular academic-type programs.

What should parents do? I would suggest not pursuing testing unless it has some current application, especially if your child is young. Many parents are hopeful that their child will be found to be gifted. It is far more important that parents focus on providing for their children’s emotional, social and also intellectual needs as they are now. In that way, you can be sure you are meeting all your child’s needs.

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