“Perhaps you should have him/her tested." These are often the words that make parents’ hearts sink with worry or pounce with alarm at the thought that there may be something wrong with their child. Parents usually hear these words from professionals knowledgeable in child development, such as daycare educators, teachers and pediatricians. In fact, most of the parents I see often report that their first concerns about their child were raised by one of these professionals.

Parents react to a recommendation for testing in a number of ways. They are surprised, worried, upset, angry, or sometimes even relieved, as if they knew something was not quite right but their concerns had always been minimized and dismissed by well-meaning family and friends. Even when parents suspect something may be wrong, they may not voice it even to themselves but quietly hope that their child will “catch up” or that things will change with time.

All of these reactions are completely understandable but parents are often also left with many questions such as how to go about getting their child tested, what testing will involve, how it will help their child, and what implications testing may have on their child’s future. This article is intended as a general guide for parents who are concerned about their pre-schoolers or school-aged child’s development, behavior, or learning.

When to have your child evaluated by a psychologist:

A parent is advised to obtain a psychological evaluation when:

1) they, themselves, as the best expert on their child, have observed their child and suspect their child may have a delay or a problem;

2) any professional be it a teacher, a daycare educator, a speech and language therapist, or pediatrician (among others) who is a developmental expert and has training in detecting red flags in a child’s development recommends it;

3) child is clearly behind his/her same-aged peers in attaining developmental milestones or in acquiring academic skills;

4) child is behaving differently from his/her same-aged peers (e.g., is not responding to his/her name, not having friends, or not following class routines and rules).

During infancy and toddlerhood, parents should look for red flags such as delays in attaining developmental milestones (e.g., in crawling, walking or in saying first words, or speaking in 2- to 3-word phrases), hitting and biting, poor attention during circle or story time, moving or talking too much, poor learning of colours and shapes, poor eye contact, lack of interest in or aversive reactions to peers, poor play with toys (e.g., repetitive play, sensory examination of toys such as smelling or visual inspection) and excessive time spent in repetitive behaviours or in pursuit of unusual interests (e.g., in opening and closing drawers, or interest in fans or lights).

One of the most prominent myths about child testing is that infants and toddlers are too young to be tested. This is simply not true. There is a vast amount of research on infant and toddler development and on early identification of developmental problems. There are standardized tests and measures by which we can obtain estimates of an infant’s and toddler’s developmental status. What we are short on is professionals trained in infant and toddler assessment. Early assessment of risk, or early diagnosis, is critical to early intervention.

In turn, early intervention maximizes the possibility of developmental gains. Among pre-school and school-aged children, common red flags that merit attention and testing include struggling to learn the alphabet or numbers, knowing these one day and forgetting them the next, persistent confusions among or reversals of letters (e.g., b and d, p and q), difficulty learning the days of the week, the months and the seasons and confusing the names of days with those of the months, difficulty learning to read, difficulty mastering spelling, poor understanding of read material, poor grades that do not reflect the many hours put into studying and effort or else adequate grades with extraordinary effort, poor attention, difficulty forming letters, sloppy handwriting, disorganization with school materials or forgetfulness, being the class clown, frequent peer conflicts or difficulty making friends, avoidance of school work, anxiety and distress in the face of school work.

Who can assess your child:

Developmental or pediatric psychologists and neuropsychologists have the qualifications, training and expertise to assess children presenting with developmental, behavioural, emotional, social or learning problems. Parents are sometimes confused as to whether they need to see a neuropsychologist or a psychologist. Both psychologists and neuropsychologists can assess neuropsychological disorders of childhood. Neuropsychology is a specific branch of psychology and neuropsychologists are typically graduates of neuropsychology programs. Both neuropsychologists and psychologists are licensed by the Order of Psychologists of Quebec (OPQ), and both are reserved titles.

What is essential is that parents ensure that the professional that they consult has training and experience in the assessment of child neuropsychological conditions, such as ADHD and learning disabilities. Parents have the right to question professionals on their qualifications and the depth and breadth of their experience with child development, childhood developmental disorders and child psychopathology. It is important that professionals, either psychologist s or neuropsychologists have the necessary certification for administration of some specific tests, such as the tests required for autism evaluations.

What to expect:

Child evaluations begin with a parent or family interview. During the interview, the child’s medical, genetic, developmental, behavioural, and psychosocial history is obtained. If the child is present he/she can get familiar with the psychologist’s office, meet the psychologist and hence be better prepared for, or less anxious about the subsequent testing sessions. In the case of younger children, the psychologist can observe the child in free play and informally interact with the child during this interview. In the case of older children, they can participate to varying degrees in the interview.

An assessment plan is usually proposed to parents, with some explanation of what aspects of the child’s functioning will be assessed and why, and a brief description of the tests may be given. Testing sessions with the child usually involve anywhere from one to three appointments, depending on the scope of the issues involved, the age of the child, and the number of the tests needed to be administered towards specific diagnoses.

Appointments are usually held in the mornings since children are usually rested and “fresh”. Morning appointments usually result in more valid assessments, however, older children or adolescents who are more resistant to fatigue may also be tested in the afternoons. The duration of each appointment can vary (depending on the child’s age, cooperation, or attention) from one hour to three hours. Children can be given short breaks as necessary. Younger children such as infants and toddlers can be tested in the presence of their parents whereas preschoolers or older children are typically tested alone.

The presence of the parents can dramatically influence the child’s behaviour. Moreover, an important part of many evaluations consists of assessing a child’s emotional and social maturity which includes the capacity to handle and tolerate the separation from the parents and how they manage to relate to and meet the demands of the examiner in the absence of their parents. However, for some tests like the Autism Diagnostic Observation Schedule (or ADOS) the presence of the parents is essential since key elements such as the child’s social initiatives and social referencing towards parents need to be observed. Parents should expect their psychologist to employ the most recent standardized tests (rather than outdated tests and outdated norms) and to follow recommended guidelines regarding test batteries, methods and procedures for specific conditions or diagnoses (e.g., the OPQ has published guidelines regarding autism and ADHD evaluations).

Apart from direct, standardized, testing with children in the psychologist’s office, evaluations may also involve an observation of a child in free-play or parent-child play sessions (in the office), or observations in daycare or in school, as well as completion of clinical questionnaires by the parents, educators and teachers. At our clinic we have also asked parents to submit home video recordings of their child in their natural environments (such as at home or at social events). During the course of an evaluation, the psychologist may also refer the child for complementary testing, such as a hearing test, or a speech and language evaluation, the results of which may be very pertinent to making a diagnosis.

The psychological evaluation is usually concluded with one or more feedback meetings where parents are presented with the test results, the conclusions that can be drawn about their child’s functioning and a written report of the assessment which should include recommendations regarding the child’s developmental, learning, schooling or intervention needs. The value of the evaluation and the report is in the clinical impression or conclusion and the recommendations; an evaluation that consists simply of test results is futile. Parents need to ensure that their psychologist will provide an evaluation and a report that will help move them forward in their care for their child (e.g., provide a conclusion regarding the referral question or concerns, and provide recommendations regarding schooling and intervention).

Where to get testing done:

Psychological testing services are available in the public sector, for example in hospitals, CLSCs, and schools. Parents can inquire about these and see if they are eligible given the concerns they have about their child and how they can get on the waiting lists for these public sector evaluations. However, some obstacles parents may encounter in the public sector include limited evaluations (e.g., only intellectual testing can sometimes be offered in schools rather than complete learning disability or ADHD testing), or the more typical obstacle is a long waiting list. In the private sector, the waiting time is usually short and comprehensive evaluations are conducted towards arriving at a diagnosis and access to services (e.g., public therapy services, government funding or tax credits, etc…). While private evaluations are not covered by medicare, and parents pay out of pocket initially, they can get reimbursed either partially or in full, depending on their insurance plan. They can also claim psychology services as a medical expense on tax returns.

And finally Why should you get your child tested:

There are many reasons why testing is a valuable process:

1) Because testing is critical to intervention; in the words of one of my own best teachers, Dr. Rex Kline, Ph.D. “there can be no good intervention without good assessment." Just like in the medical field where doctors test before they prescribe, psychological testing is key to applying the best intervention;

2) Because you love them;

3) Because you want to do whatever you can to help them, to make sure that you act as early as possible in order to maximize their progress, to get them as much back on track as possible in terms of their development, their learning, their well-being, their future.

I am sure parents can come up with their own best reason for having their child tested. Parents who go through with this process are some of the strongest parents I have ever met. They deal with their own anxieties and fears in order to put their child’s needs first. Most of the parents I have met are often initially nervous about what the testing will reveal, what implications it will have for their child, and ask questions such as “if this is ADHD, will he have to be on medication”…“if this is dyslexia, can it be treated”…”will my child be labeled for life” and even “if this is autism, will he be able to have a normal life."

Important, valid and difficult questions to ask, and when asked reflect tremendous courage to face the truth instead of hoping that a terrible fear will go away on its own, and courage and determination to do the best by their child. I firmly believe that it is equally important during the process of a child evaluation to tend to how the parents are coping. This is why, when I deliver test results, explain all that I can about what is going on with a child, and answer their questions, one of my final and most important questions to parents is how are YOU doing with all this? Parents are a child’s best advocates. How they cope with test results and with their child’s diagnosis is critical to their child’s progress.

Finally, it is important to mention that testing may actually at times bring relief, it may actually re-assure parents that there is no problem, or that the problem is not as bad as their deepest fears, or it may actually finally provide parents with the understanding, the tools and resources that enable them to move forwards towards helping their child effectively.

If you are a parent who is considering having your child assessed, please contact Dr. Tsonis at www.votrepsylaval.com for a free consultation in which you can have your specific questions answered.