It All Goes Together

The current fashion in diagnostic practice is to isolate the emotional from the personal, and both of these from the spiritual or meaning-of-life.  Mostly, the personal and spiritual/meaning-of life issues are ignored, and the focus is mainly on the emotional.  So, for example, a patient may be diagnosed as depressed or bipolar, without further elaboration of their personality functioning or their spiritual or meaning-of-life issues.  We see this in medication advertisements on television, and in the way that diagnosis is usually done.

 

In fact, while diagnosing people in this way may be better than nothing, because it might lead to treatment decisions that might help with the emotional parts of disorders, it falls far short of a more comprehensive approach to understanding and treating human beings in distress.  In order to understand a human being more completely, we need to understand her/his emotional (“affective”) functioning, personality functioning, and spiritual or meaning-of-life orientation and issues.  And we need to place this understanding within the context of two stories:  the story of the person’s life, and the story of the situation or problem that brought them into counseling/therapy.

 

Now, understanding these issues doesn’t mean that they must be completely understood; that would be the work of a lifetime.  They just have to be understood well enough for treatment to take place.  And gathering this information, this “data,” is itself part of the treatment, for it encourages the patient/client into sustained reflection on her/his life and self, and builds rapport between counselor/therapist and client/patient.

 

Nine Criteria For Usefulness in Evaluations of Learning and Attention Issues

(As consulting psychologist, I am asked to review private evaluations of learning and attention issues in students, and explain them to administrators, teachers, and even the parents whose children have been evaluated.  Since the quality and usefulness of evaluations varies, I prepared this memo as a guide for parents, as consumers, and evaluators, as providers.)    

This memo is prepared for parents who are considering seeking evaluation of learning and attention issues in their children, and also for potential providers of such evaluations.
Methods for evaluating learning and attention issues and disorders, and for reporting on evaluations, have evolved over the years, not necessarily in a consistent or integrated way. Professionals from several fields, with varied backgrounds, have entered the marketplace as evaluation providers. As a result, we have seen evaluations of varying quality and usefulness. Here are nine criteria that characterize a more useful evaluation:

1A specific problem statement provides the focus for the evaluation. It tells the readers what this evaluation is about, and why it is important for this child to be evaluated for this problem at this time.

2. A detailed case history places the referring problem within the context of the child’s developmental and family history. Part of understanding a learning and/or attention disorder is understanding its history in this child’s life, and whether it might also be reflected in this child’s family history.

3. Information from the school, from teachers and other staff who may have useful information to report, tells readers how the school sees the child and the referring problem. Detailed descriptions by teachers and staff help to clarify the the referring problem. Observations by the evaluator of the student in school can also shed light on the referring problem, especially where classroom behavior is contributing to the referring problem.

4. Information from other sources, which may include therapists, tutors, former teachers, etc., who can contribute to the evaluator’s, and the readers’, understanding of the child.

5. Behavioral observations of the child during the evaluation process, with specific reference to the referring problem. The evaluator’s astute observations of the child’s behavior can contribute to the evaluator’s, and the readers’, understanding of the child.

6. Selection of tests that are specific enough and comprehensive enough to address the referring problem. Selecting tests that focus on the child’s cognitive functioning with reference to the referring problem will help the evaluator and readers understand the child’s cognitive functioning with regard to the referring problem. Where multiple explanations of a child’s problem are possible, it can be important to have testing across different areas in order to rule some out and establish others as associated with the problem.

7. Report of test results, including all scores. Reporting all scores supports the evaluator’s conclusions and provides professional readers with the information necessary to understand the basis of those conclusions.

8. Discussion of all the foregoing information leads to an impression about why the child is having the referring problem, in the context of his or her developmental history and cognitive processes, including a diagnosis, if appropriate. By discussing all the foregoing information, the report makes sense of the child’s referring problem, and helps readers make sense of it also.

9. Recommendations that are specific to the referring problem, the specific child, and the child’s situation, will help insights in the report find integration and application in the child’s educational program. When multiple recommendations are included in a report, prioritizing recommendations helps educators and parents determine the most appropriate next steps in supporting the child’s education.