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Comparison of assessments of cognitive skills in children

Comparison of assessments of cognitive skills in children

What test is better in terms of its usability and informativeness - WISC-IV (Wechsler Intelligence Scale for Children) or BAS (British Ability Scales)?


Issues Related to the WISC-V Assessment of Cognitive Functioning in Clinical and Special Groups

Jessie L. Miller , . Lawrence G. Weiss , in WISC-V (Second Edition) , 2019

Abstract

Cognitive assessment has continued to evolve with the growth of psychology and remains relevant in both research and practice. The recently revised Wechsler Intelligence Scale for Children —fifth edition (WISC-V) is frequently used in the cognitive evaluation of children. This chapter reviews the latest research in the cognitive assessment of multiple special groups including children and adolescents identified with intellectual giftedness, intellectual disability, Autism spectrum disorder, attention deficit hyperactivity disorder, traumatic brain injury and disruptive behavior disorder. Following a review of the most recent research in cognitive assessment of these special needs individuals, results from the WISC-V clinical studies are discussed with respect to patterns and trends in cognitive functioning across the domains of the WISC-V battery. WISC-V performance among these special groups is discussed in relation to both the traditional WISC-V paper and pencil administration and the new digital administration available through Pearson’s Q-interactive platform. The chapter concludes with a discussion of the context of cognitive assessment using the WISC-V in typically developing and special populations.


Cognitive Assessments

Discovering that someone in your family may have a learning disorder can generate mixed feelings of relief, concern and stress. If your child or teen has consistently struggled at school, understanding the cause is the first step to helping them reach their full potential. Arranging a cognitive assessment for a learning disorder will help you and your family plan the best way to move forward. Our Neuropsychologists, Dr Kate Elliott, Holly Nelson and Juhi Sanghavi are experienced in conducting cognitive assessments for developmental and learning disorders, and a range of other conditions affecting the brain. We also have several qualified and experienced ASD Assessors who offer Autism assessments for children and teens at Gateway Psychological Services:

Meet our Assessors

Clinical Neuropsychologist Clinical Psychologist

Neuropsychologist | Clinical Psychologist

Kate helps with:

Cognitive assessments to assist with: Bariatric assessment and support Returning to the workplace after an accident Traumatic Brain Injury (workplace accidents, car accidents, victims of crime) Acquired Brain Injury (strokes, cancer recovery, drug use) Intellectual disability testing

Clinical Psychology for: Adult survivors of abuse Family violence survivors Emotional abuse Eating disorders Generalised anxiety Obsessive Compulsive Disorder Panic Disorder Perfectionism Post-natal depression Post-Traumatic Stress Disorder Social Anxiety

When I established the clinic, my goal was to build a team of psychologists who genuinely care about improving emotional wellbeing for children and adults in Perth. As Gateway Psychological Services has grown, we’ve introduced more services for more people. Today, the most rewarding part of my work with cognitive assessments and clinical psychology is seeing the difference we make in people’s lives. Through a combination of empathy and perseverance, we help our clients achieve life-changing breakthroughs.

Qualifications and memberships

Doctorate in Clinical Psychology and Clinical Neuropsychology Master’s degree in Community Development Postgraduate Diploma in Psychology Bachelor of Arts in Psychology (minor in Children and Family Studies)

Clinical Neuropsychologist Registrar

Clinical Neuropsychologist | Registrar

Holly helps with:

Cognitive and diagnostic assessments for: Specific learning disorders (dyslexia, dysgraphia, dyscalculia) Attention-Deficit Hyperactivity Disorder (ADHD) Intellectual disability Giftedness and twice-exceptional Autism Spectrum Disorder (ASD) Williams Syndrome Epilepsy Traumatic brain injury Stroke Cerebral palsy

Holly is passionate about making a positive difference in the lives of individuals with neurodevelopmental conditions and has special interests in the areas of learning disorders, ADHD, giftedness, intellectual disability and Williams Syndrome. Holly is experienced in providing comprehensive assessments and accurate diagnoses, with clinical experience gained across a number of settings in both Sydney and Perth. Through comprehensive assessments of intellectual, academic, memory and executive functioning skills, parents gain a better understanding their child's strengths and weaknesses, and support strategies are provided to help children reach their full potential.

Holly understands that neurodevelopmental conditions and learning disorders can have significant academic, social, behavioural and psychological impacts. She is passionate about providing targeted evidence-based strategies designed to help individuals improve, or compensate for, deficits in a range of thinking skills (such as concentration, working memory and executive functioning) and learning difficulties. Holly enjoys providing assessment and intervention strategies for children, adolescents and adults to support progress at school, university/vocational studies and work. She is experienced in developing individualised support strategies to help overcome areas of weaknesses with the aim of improving independence, confidence and overall quality of life.

Qualifications and memberships Master of Clinical Neuropsychology Bachelor of Science (Honours) with First Class Honours Member of the Australian Psychological Society (MAPS) Member of The Australian Paediatric Neuropsychology Research Network Professional Member of ADHD WA Professional


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Introduction

Mental health professionals use a variety of instruments to assess mental health and wellbeing. Common purposes for psychological testing include: screening for the presence or absence of common mental health conditions making a formal diagnosis of a mental health condition assessment of changes in symptom severity and monitoring client outcomes across the course of therapy.

Screening: Brief psychological measures can be used to ‘screen’ individuals for a range of mental health conditions. Screening measures are often questionnaires completed by clients. Screening tends are quick to administer but results are only indicative: if a positive result is found on a screening test then the screening test can be followed up by a more definitive test.

Diagnosis: Psychological assessment measures can support a qualified clinician in making a formal diagnosis of a mental health problem. Mental health assessment with the purpose of supporting a diagnosis can include the use of semi-structured diagnostic interviews and validated questionnaires. Items in self-report measures used for diagnosis often bear a close correspondence to criteria specified in the diagnostic manuals (ICD and DSM).

Symptom & outcome monitoring: One strand of evidence-based practice requires that therapists use outcome measures to monitor progress and guide the course of therapy. Psychologists, CBT therapists, and other mental health professionals often ask their clients to complete self-report measures regularly to assess changes in symptom severity.


Comparison of assessments of cognitive skills in children - Psychology

Call us

Below is a list of some of the instruments we use in our office for evaluations. If you have any additional questions before scheduling an appointment, please do not hesitate to contact the office.

Please note that tests are chosen based on the reason for the evaluation and your evaluator’s clinical judgment as to which tests will be most appropriate for an individual. In addition to the tests listed, other testing measures may be used.

  • Differential Abilities Scale – 2nd Edition
  • Kaufman Assessment Battery for Children – 2nd Edition
  • Ravens Colored Progressive Matrices
  • Reynolds Intellectual Assessment Scales
  • Wechsler Adult Intelligence Scale – 4th Edition
  • Wechsler Intelligence Scale for Children – 5th Edition
  • Wechsler Intelligence Scale for Children – 5th Edition – Integrated
  • Wechsler Intelligence Scale for Children – 4th Edition – Spanish
  • Wechsler Preschool and Primary Scales of Intelligence – 4th Edition
  • Batería III Woodcock-Muñoz, Pruebas de Aprovechamiento
  • Gray Oral Reading Test, 5th Edition
  • Kaufman Survey of Early Academic Language Skills
  • Kaufman Test of Educational Achievement, Third Edition
  • Nelson-Denny Reading Test
  • Scholastic Abilities Test for Adults
  • Woodcock Johnson, Tests of Achievement – 4th Edition
  • Wechsler Individual Achievement Test, 3rd Edition
  • Batería III Woodcock-Muñoz, Pruebas de Habilidades Cognitivas
  • Bilingual Verbal Ability Tests
  • Comprehensive Assessment of Spoken Language
  • Comprehensive Test of Phonological Processing – 2nd Edition
  • Expressive One-Word Vocabulary Test – 4th Edition
  • Peabody Picture Vocabulary Test – 3rd Edition
  • SCAN–3:C Test for Auditory Processing Disorders in Children–Revised
  • Test of Problem Solving – 3, Elementary
  • Test of Problem Solving – 2, Adolescent
  • Wide Range Assessment of Memory and Learning – 2nd Edition
  • Woodcock-Johnson IV, Tests of Cognitive Ability
  • Woodcock-Johnson IV, Tests of Oral Language
  • Developmental Test of Visual-Motor Integration – 6th Edition
  • Developmental Test of Visual Perception – 6th Edition
  • Developmental Test of Motor Coordination – 6th Edition
  • Children’s Color Trails Test Category Test
  • Controlled Oral Word Association Test
  • Delis Kaplan Executive Functioning System
  • Finger Oscillation Test
  • Grip Strength Test
  • Grooved Pegboard Test
  • Integrated Visual and Auditory Continuous Performance Test
  • Wechsler Memory Scale – 4th Edition
  • NEPSY Developmental Neuropsychological Assessment – 2nd Edition
  • Reitan-Indiana Aphasia Screening Test
  • Reitan-Klove Lateral Dominance Exam
  • Reitan-Klove Sensory Perceptual Exam
  • Rey Osterrieth Complex Figure
  • Seashore Rhythm Test
  • Speech Sounds Perception Test
  • Stroop Color and Word Test
  • Tactual Performance Test
  • Trail Making Test
  • Wisconsin Card Sorting Test
  • Children’s Apperception Test
  • Children’s Inventory of Anger
  • Conduct Disorder Scale
  • House-Tree-Person Projective Drawings
  • Kinetic Family Projective Drawings
  • Kovac’s Children’s Depression Inventory – 2nd Edition
  • Millon Adolescent Clinical Inventory
  • Millon Clinical Multiaxial Inventory –4th Edition
  • Minnesota Multiphasic Personality Inventory- 2nd Edition, Restructured Form
  • Myers-Briggs Type Indicator
  • Revised Children’s Manifest Anxiety Scale – 2nd Edition
  • Robert’s Apperception Test
  • Rorschach Inkblot Test
  • Sentence Completion Test
  • Social Anxiety Scale
  • Suicide Probability Scale
  • Thematic Apperception Test
  • Trauma Symptom Checklist for Children
    *Additional charge if extensive emotional testing is requested
  • Behavior Assessment System for Children – 3rd Edition
  • Behavior Rating Inventory of Executive Function
  • Children’s Problem Checklist
  • Sensory Profile Questionnaire
  • Developmental Indicators for the Assessment of Learning – 4th Edition
  • Battelle Developmental Inventory, 2nd Edition
  • Bayley Scales of Infant and Toddler Development, 3rd Edition
  • Autism Diagnostic Interview – Revised
  • Autism Diagnostic Observation Schedule – 2nd Edition
  • Childhood Autism Rating Scale – 2nd Edition
  • Pervasive Developmental Disorder Behavior Inventory
  • Social Communication Questionnaire
  • Social Responsiveness Scale – 2nd Edition
  • Review of School Records
  • Review of Past Evaluations and Medical Records
  • School Observation
  • Telephone contact with teachers, professionals, other relevant individuals

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1. Using Working Memory

Working memory is the part of your brain that hosts all your cognitive skills. It’s widely accepted that your working memory can only hold a certain amount of information in any one period of time (somewhere between 4 and 9 things at once). Go ahead: try to hold 10 random unrelated facts in your mind in one single period of time. It’ll be hard, I assure you!

2. Ranking

When new information enters our working memory we often have to rank it. Our mind may rank the information by importance, size, weight, danger, or any other of the hundreds of spectra you could think of. Sorting usually involves creating some sort of hierarchy in order to make your life easier. The most basic hierarchy is danger. Something that is extremely dangerous is also extremely important for our minds to pay attention to. So, if something enters the mind that’s dangerous, our mind may focus all its cognitive resources to that thing and deciding how to react.

3. Classifying

We may also need to classify new information that enters the mind. While ranking involves placing things upon a spectrum, classifying may not. We can classify things into categories like “colors”, “animal species”, “plant species”, “types of clothing” or … well, just about anything!

4. Recognition

Recognition is a skill that requires you to recall memory from your mind. When new information enters the mind, it subconsciously scans for information (cognitive schemata) that already exist within the brain. If the memory of the thing that has just entered your mind is already stored in the mind somewhere, your brain will try to recall that information. When we recognize something, we can use our memory as well as our current experience to better process what we’re seeing. For example, if your only prior experience of a cow was a bad one (the cow bit you!?), your current experience of the cow will be impacted by your past experience… you may not give cows a second chance!

5. Contextual Recall

Contextual recall involves using peripheral or related pieces of information to make sense of new information in front of us. Have you ever had the experience where someone asks you to remember a shared memory but … you just can’t find it in your brain? Then, they start giving you context such as something that happened during the same period of time as that memory: “Remember … you wore your red dress that day” … “Remember, that afternoon we went out for burgers” … “Remember, it happened on the way to the fair”. Suddenly, the memory comes flooding back!

6. Associative Recall

‘Contextual recall’ and ‘associative recall’ are related cognitive skills. Associative recall involves remembering something by associating it with something else. It can be a great strategy to get your memory working. I use this thinking strategy all the time as a teacher. I’ll meet a new student whose name is Lilly. To remember her name, I might say “Lilly” … “Like a flower. Lilly like a flower.” Next time I see her, I have two ways of remembering her name. Maybe her name will come straight to my head. Or, maybe the more general word “flower” comes to my mind … and then I can go “Ah, you’re Lilly like a flower!”

7. Long-Term Memorization

Long-term memorization often requires us to be exposed to something regularly. It seems that the more we are exposed to something, the more the brain realizes that this information is important. So, the brain shifts that ‘thing’ that we’re coming across in our daily lives from short-term to long-term memory. Once something’s in long-term memory, it’s harder (but not impossible) to forget.

8. Perspectival Thinking

When we are young, we are egocentric. This means that we can only really see things from our own perspective. Cognitive psychologist Jean Piaget called our inability to see other perspectives “centration”. Somewhere between 7 and 11 years of age, we develop several cognitive skills, including the cognitive ability to start seeing things from perspectives other than our own. In other words, we develop the skill of perspectival thinking.

9. Paying attention

At a very young age, babies have many cognitive skills. They certainly don’t know how to pay attention. In fact, they literally have to train their eyes to ‘focus’ in the first few months of life. Even by the time a child reaches school age their ability to direct their attention is significantly weaker than when they’re in adolescence. That’s why, if you walk into an early childhood classroom, the teacher is doing a lot of physical, play-based learning. I mean, try asking a 5 year old to maintain attention on something that’s not fun, physical and … even funny!

10. Focus (Sustaining attention)

Once a child has learned to direct their attention, the next skill they need to master is sustaining that attention. The difference in focus between younger and older children is also very stark. Ask any early childhood teacher how long a lesson will last and they might say 10 – 20 minutes. After that, you’ve totally lost the children’s attention – they don’t have the cognitive skills to go on. You’ll need something new to get them back and focused again. Fast-forward 10 years and walk into a classroom full of the same children – except now they’re adolescents. Their teacher might ask them to do mathematics worksheets for 45 minutes straight in preparation for an exam. These adolescents have clearly developed their cognitive skills, including the ability to focus over the past 10 years of their lives.

11. Selective attention

Humans also need to develop the skill of selective attention. Selective attention involves being able to selectively block out some stimuli while focusing on other new information. This is a necessary skill when working in overstimulating environments. It’s why you can listen to your friend talking to you in the middle of time square rather than being distracted by all the neon lights. I tend to be best at selective attention when watching sports. Good luck trying to call my name or ask me to do something when I’m engrossed in the final quarter of a football game.

12. Divided attention

Divided attention involves the cognitive ability to multitask, or pay attention to two things at once. Most of us would believe that women are better at cognitive skills like divided attention than men, although science seems to disagree with this old trope. When we divide our attention, we can absorb new information from two sources at once: like feed our baby and talk on the phone, or sweep the floor and watch the football game.

13. Inhibiting Response

Response inhibition is the cognitive ability to suppress reactions to stimuli in our environments. We have automatic response inhibitors that work at a high processing speed, such as not flinching when someone claps in front of their face. We also have conscious response inhibition, which involves the capacity to filter our reactions to stimuli through processes of logic, reasoning and contextual mediation. For example, it is inappropriate to yell in exasperation at colleagues, despite our desire to do so.

14. Emotional Self-Regulation

Emotional self-regulation involves the ability to employ our response inhibition mechanism to manage our emotional lives. But it’s not simply the ability to “turn an emotion off”. Rather, emotional self-regulation requires a person to continue to use logic and long-term perspective when analyzing a situation. In layman’s terms, emotional self-regulation involves the ability to keep a cool head and react proportionately to a moment in which emotions are high.

15. Metacognition

Metacognition is the ability to think about thinking. It involves being able to reflect on your thought processes and using strategies to improve those thought processes. Humans are one of the only species (alongside monkeys and dolphins, in small ways) who have exhibited the capacity to use metacognition. Reflection on one’s own thought processes involves strategies like using reflection after an event, using in-time reflection to change practice in the moment and thinking about which learning strategies you are using while learning.

16. Spatial Awareness

Spatial awareness involves the ability to identify distance, location and proximity of objects to one another. We need to develop the cognitive capacity to recognize and navigate three dimensional spaces from childhood in order to move about our environments. In adulthood, spatial awareness is necessary for operating tools (such as using a hammer and nail) as well as in everyday situations like driving cars (distance from the car in front, distance to stopping, etc.).

17. Logical Reasoning

Logical reasoning involves the ability to come to conclusions based on a coherent set of truth principles. A person who uses logic does not rely on superstition or unfounded assumptions to reach their conclusions. There are two primary types of logical reasoning: deductive and inductive.

18. Visual Processing

Visual processing is a cognitive skill involves being able to receive, interpret and understand messages that enter the brain through our eyes. Some people consider themselves to be more adept at visual processing than other forms, like audio or language processing. For example, people may be drawn more to the meaning in art or cartoons than through musical meaning-making. If you’re a visual learner, you might need a visual aid to get your memory working in the morning!

19. Audio Processing

Audio processing is another one of the cognitive skills we use to interpret our surrounds. It involves the ability to receive, interpret and understand messages that enter the brain through the ears. People who excel at audio processing not only understand noises well, but also have the capacity to discern subtle differences in tone, cadence and pitch (such as people with ‘perfect pitch’). The processing speed of our brains to interpret audio signals is very high.

20. Language Processing

Language processing is a cognitive skill that involves the ability to hear and interpret man-made communication codes such as spoken, written and sign languages. Children tend to develop most of the fundamental spoken language and cognitive skills required to communicate by the age of 5 through cultural absorption. Neurologist Paul Thompson argues that up until age 11, children’s brains are designed to rapidly absorb languages. Beyond this age, language processing speed slows and learning a language becomes more difficult.

21. Ethical Thinking

Ethical thinking is a cognitive skill that involves applying a values, beliefs and moral frameworks when forming ideas, actions and developing conceptual relationships between concepts. A person who applies ethical thinking must use cognitive abilities like empathy, spirituality and morality to filter good ideas from bad ideas. The use of ethics as a cognitive framework helps people to come to conclusions about how to act in complex ways and interpret ‘moral grey areas’ around topics such as abortion and how to solve refugee crises.

22. Estimation

Estimation requires the capacity to model and predict future events based upon incomplete information in the present. Estimation does not require someone to be able to predict the future perfectly, but rather make guesses based on the best current information.

23. Abstract Thinking

Abstract thinking is a cognitive skill that involves thinking about concepts that are beyond the obvious surface features of an idea. To think abstractly is to think logically about concepts that are not immediately clear or observable. An abstract thinker needs to use their working memory to hypothesize about possibilities of, relationships between and consequences of ideas and actions that are theoretical rather than simply practical.


Discussion

Recent guidelines strongly recommend the systematic screening of developmental delay in young children, in order to provide early beneficial interventions to the child and family. 24 In light of this, it appears relevant to question the accuracy of diagnoses of those identified with developmental concerns. This is especially so if a diagnosis of a GDD is put forward.

The paucity of studies assessing this particular issue probably reflects the relative novelty of the concept of GDD. 8 Retrospective studies have detected evidence of early childhood developmental delays in children affected with specific learning disabilities. 25, 26 However, the specific subject of cognitive delay has not yet been addressed in the GDD population as a whole.

Shevell et al. 27 have prospectively assessed the functional and developmental outcomes of a cohort of GDD patients, using the Battelle Developmental Inventory and the Vineland Adaptive Behavior scale. On follow-up evaluation, 96% of their cohort still met criteria for GDD and 70% showed functional impairments in at least two domains. Only 17% of the children attended a regular class without an aid. Interestingly, the degree of initial delay was not found to be predictive of later developmental outcome.

Our study addressed the specific topic of cognitive delay in children meriting a concurrent diagnosis of GDD. Our aims were twofold: (1) to explore the relationship between initial language and fine motor scores and cognitive performance and (2) to determine the overall distribution of cognitive scores in a cohort of young children with confirmed GDD.

We found no statistically significant correlation between a combination of fine motor, expressive vocabulary, and receptive language scores and the results of cognitive testing. However, a trend was evident towards a possible correlation (p value of 0.06) and thus we would not completely exclude this combination in the evaluation of possible cognitive impairment. This would be better assessed in a larger prospective cohort of children with GDD.

The poor predictive value of the combined scores may also be related to an inherent defect of our definition of GDD. It appears that evidence of significant delay in at least two areas of fine motor, expressive vocabulary, or receptive language is not predictive of cognitive performance in our population. This seems contrary to what was found with respect to the developmental and functional outcomes of children with GDD. 27 The answer to this apparent conundrum may be that cognitive performance is not equivalent to developmental performance or functionality in a child, and thus all three should be considered as distinct, and thus potentially complementary, outcome measures.

Although we were unable to assess personal/social, gross motor, and activities of daily living domains in a more comprehensive standardized fashion, significant delays in these areas were found during the initial evaluation and were included in the diagnostic process. Hence, most of our participants met more than the present minimum criteria for impairment in at least two domains.

Scores on cognitive testing were somewhat widely distributed. However, most children fell within the low average to mild deficiency range. This is in keeping with recent estimates establishing that 90% of individuals with mental retardation* * UK usage: learning disability.
/intellectual disability function within the mild range of impairment. 10, 28-30 Surprisingly, a small proportion of our participants scored in the high average range. This is again in contradiction to the common assumption of equivalence between GDD and cognitive limitation. It appears that a non-trivial proportion of children with GDD have average intelligence (e.g. 20% of our cohort). This finding may not be completely foreign to the developmental and functional outcomes found by Shevell et al. 27 Indeed, one may hypothesize that the subgroup of their cohort attending regular classes without aid (17%) may have had somewhat close to average overall intellectual performance. Thus there may be two subsets of children with GDD those with and without cognitive impairment.

Another issue pertains to the significant number of participants with autistic features in our subject population. It may be that children with autistic spectrum disorders are less amenable to valid developmental testing as toddlers, increasing the risk of overestimating delay initially. Children with autistic spectrum disorder may perform better at later cognitive testing, especially with nonverbal cognitive subcategories. This could be an explanation for the wide distribution of IQ scores obtained. It also raises the question whether children with autistic features should be consistently excluded from studies involving GDD cohorts, as their cognitive profile is likely to differ from children with GDD alone.

Taken in isolation, expressive vocabulary and fine motor scores accurately predicted verbal IQ scores and performance IQ scores, respectively. This further supports the validity and inference of the expressive vocabulary and fine motor scales that we used. Since cognitive testing relies heavily on language-associated tasks, it is not surprising to find a significant association between expressive vocabulary deficits and global IQ scores. This has interesting implications for prognosis in GDD. It may be that children with GDD with higher expressive vocabulary scores are more likely to have a favorable cognitive outcome. This remains to be studied further in a systematic prospective fashion.

Fine motor performance was also predictive of global IQ, which probably relates to the important overlap between fine motor performance and cognition in the pre-school child as assessed by present developmental assessments.

Surprisingly, we found no correlation between receptive language scores and verbal IQ, which contradicts the general assumption that language comprehension predicts cognition, specifically verbal IQ. This could be partly related to the scales used for receptive language assessment. However, this is unlikely as both the Reynell and the Clinical Evaluation of Language Fundamentals – Preschool 2 (CELF) tests have been validated for assessment of receptive and expressive language in a population of preschool children. However, it may be that the receptive language function assessed through these scales is not directly implicated in verbal IQ function, a hypothesis that has never been explored. Thus, verbal IQ may depend on aspects of cognition other than language comprehension alone and could not be predicted with these scales.

Inherent to our study was the possibility of variations in the status of delay in our participants between the initial evaluation and slightly later cognitive testing. Some children may have improved significantly, while others may have plateaued or worsened (i.e. gap widening) relative to age-equivalent norms. Since our aim was to determine the nosologic value of our initial diagnosis, we do not consider this variation as a bias, but as evidence of the wide variety of developmental profiles of children with GDD. A corollary to this is the possibility of the child’s benefiting from rehabilitation resources between the initial assessment and cognitive evaluation. This is likely to have had no impact on the overall results, because of the lengthy average waiting time for rehabilitation resources in our community (most children would have been assessed cognitively before any actual rehabilitation intervention being provided).

One limitation of the study is its retrospective design. However, we believe that the overall structure of the Developmental Progress Clinic, the clinical source of all our study participants, limits potential biases, as all patients undergo the same standardized evaluations, recorded in a predetermined uniform format. We reviewed the charts of all participants presenting to the Developmental Progress Clinic within a selected defined time interval. A review of the 47 children with GDD not analyzed because of lack of cognitive assessment revealed comparable demographics and developmental profiles with our study group: hence, potential selection biases are likely to be limited.

Most of the children assessed had no identifiable cause for their GDD and few had associated medical conditions. This is probably representative of the majority of patients seen in developmental pediatrics and community pediatrics settings. Locally, children with associated neurologic impairment appear to be preferentially referred to hospital-based child neurology clinics. Patients with obvious causes for delay or significant associated medical conditions may have very different developmental and cognitive profiles, with a different referral pattern (e.g. child neurology clinic evaluation), which we could not assess because of the nature of recruitment in this particular study.

GDD remains a symptom complex with an as yet undefined nosologic profile and implications. Our study found no correlation between a combination of developmental scores and cognitive scores in children with GDD. However, fine motor and expressive vocabulary scores taken in isolation were predictive of global cognitive scores, which could have important implications for accurate diagnosis and eventual prognosis.

A previous study has shown persistence of developmental and functional impairments at age 7 in children diagnosed with GDD as young children. 27 According to recent consensus, mental retardation/intellectual disability is defined as significantly sub-average functioning existing concurrently with related limitations in at least two applicable adaptive skill areas. 10 Adaptive skills were not assessed in our cohort we cannot, therefore, comment on the proportion of our participants meeting current criteria for diagnosing mental retardation/intellectual disability. Even so, we believe our results shed some doubts on the validity of the assumption of GDD–mental retardation/intellectual disability equivalence.

Prediction of outcome of GDD should take into consideration intellectual performance, developmental performance, and, most importantly, functional performance. The current definition of GDD likely needs to be revisited, to better embrace the now well-established variety of profiles of children with several areas of delay apparent at a young age and an apparent impairment dichotomy in children with GDD with reference to actual associated cognitive profile.


Of particular importance to the specialty of clinical child and adolescent psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, developmental processes, mental and behavioral disorders and developmental psychopathology, behavioral adaptation, and health status of children and adolescents.

The specialty of clinical child and adolescent psychology involves the study, assessment, and treatment of a wide range of interrelated biological, psychological, and social problems experienced by children and adolescents. These include but are not limited to the following:

  • Treating psychological, cognitive, emotional, developmental, behavioral issues.
  • Biological vulnerabilities.
  • Behavioral, psychologial, mental, emotional, developmental, and family problems.
  • Cognitive deficits.
  • Trauma and loss.
  • Health related problems.
  • Stress and coping related to developmental change.
  • Problems in social context.

What an IQ Test Measures

The traditional kinds of IQ tests have not changed overmuch as time has passed. However, there are a number of tests that attempt to use different methodology to measure intelligence. Most IQ tests concentrate on concrete concepts as opposed to abstract reasoning questions. These include arithmetic problems, memorization tests, vocabulary questions, and spatial reasoning problems. Depending on the age of the person being assessed, a test might be visual, verbal, or written, or a combination of all three. IQ tests are most often used as a way to measure a person’s capability, as well. For instance, most IQ tests will measure:

Spatial ability is the understanding of how objects occupy space. Often this ability is measured using physical puzzles or tangram tests to see how the individual being tested can anticipate spatial dilemmas or manipulate shapes and objects to solve thos dilemmas.

Mathematical ability testing usually takes the form of standard arithmetic problems, but it is very common for the test administrator to introduce logic problems and puzzles into the test to discover the test taker’s logical reasoning skills.

Who doesn’t love a good old fashioned game of memory? This part of an IQ test usually uses visual aids to determine the test taker’s recall abilities. These can include a sensory board or picture cards.

This part of an IQ test will usually measure a person’s ability to identify words, sentences, and phrases once the letters have been removed or rearranged, or require the test taker to rely on etymological knowledge to identify completely unfamiliar words.

As we stated, there are multiple types of IQ tests, as many psychologists and statisticians have attempted to build a better test to measure IQ. The Cattell-Horn-Carroll test, for instance, will focus on fluid and crystallized typed of knowledge, while Guilford’s Structure of Intellect attempts to place the test taker in one of 120 multiple intelligences.


Discussion

Recent guidelines strongly recommend the systematic screening of developmental delay in young children, in order to provide early beneficial interventions to the child and family. 24 In light of this, it appears relevant to question the accuracy of diagnoses of those identified with developmental concerns. This is especially so if a diagnosis of a GDD is put forward.

The paucity of studies assessing this particular issue probably reflects the relative novelty of the concept of GDD. 8 Retrospective studies have detected evidence of early childhood developmental delays in children affected with specific learning disabilities. 25, 26 However, the specific subject of cognitive delay has not yet been addressed in the GDD population as a whole.

Shevell et al. 27 have prospectively assessed the functional and developmental outcomes of a cohort of GDD patients, using the Battelle Developmental Inventory and the Vineland Adaptive Behavior scale. On follow-up evaluation, 96% of their cohort still met criteria for GDD and 70% showed functional impairments in at least two domains. Only 17% of the children attended a regular class without an aid. Interestingly, the degree of initial delay was not found to be predictive of later developmental outcome.

Our study addressed the specific topic of cognitive delay in children meriting a concurrent diagnosis of GDD. Our aims were twofold: (1) to explore the relationship between initial language and fine motor scores and cognitive performance and (2) to determine the overall distribution of cognitive scores in a cohort of young children with confirmed GDD.

We found no statistically significant correlation between a combination of fine motor, expressive vocabulary, and receptive language scores and the results of cognitive testing. However, a trend was evident towards a possible correlation (p value of 0.06) and thus we would not completely exclude this combination in the evaluation of possible cognitive impairment. This would be better assessed in a larger prospective cohort of children with GDD.

The poor predictive value of the combined scores may also be related to an inherent defect of our definition of GDD. It appears that evidence of significant delay in at least two areas of fine motor, expressive vocabulary, or receptive language is not predictive of cognitive performance in our population. This seems contrary to what was found with respect to the developmental and functional outcomes of children with GDD. 27 The answer to this apparent conundrum may be that cognitive performance is not equivalent to developmental performance or functionality in a child, and thus all three should be considered as distinct, and thus potentially complementary, outcome measures.

Although we were unable to assess personal/social, gross motor, and activities of daily living domains in a more comprehensive standardized fashion, significant delays in these areas were found during the initial evaluation and were included in the diagnostic process. Hence, most of our participants met more than the present minimum criteria for impairment in at least two domains.

Scores on cognitive testing were somewhat widely distributed. However, most children fell within the low average to mild deficiency range. This is in keeping with recent estimates establishing that 90% of individuals with mental retardation* * UK usage: learning disability.
/intellectual disability function within the mild range of impairment. 10, 28-30 Surprisingly, a small proportion of our participants scored in the high average range. This is again in contradiction to the common assumption of equivalence between GDD and cognitive limitation. It appears that a non-trivial proportion of children with GDD have average intelligence (e.g. 20% of our cohort). This finding may not be completely foreign to the developmental and functional outcomes found by Shevell et al. 27 Indeed, one may hypothesize that the subgroup of their cohort attending regular classes without aid (17%) may have had somewhat close to average overall intellectual performance. Thus there may be two subsets of children with GDD those with and without cognitive impairment.

Another issue pertains to the significant number of participants with autistic features in our subject population. It may be that children with autistic spectrum disorders are less amenable to valid developmental testing as toddlers, increasing the risk of overestimating delay initially. Children with autistic spectrum disorder may perform better at later cognitive testing, especially with nonverbal cognitive subcategories. This could be an explanation for the wide distribution of IQ scores obtained. It also raises the question whether children with autistic features should be consistently excluded from studies involving GDD cohorts, as their cognitive profile is likely to differ from children with GDD alone.

Taken in isolation, expressive vocabulary and fine motor scores accurately predicted verbal IQ scores and performance IQ scores, respectively. This further supports the validity and inference of the expressive vocabulary and fine motor scales that we used. Since cognitive testing relies heavily on language-associated tasks, it is not surprising to find a significant association between expressive vocabulary deficits and global IQ scores. This has interesting implications for prognosis in GDD. It may be that children with GDD with higher expressive vocabulary scores are more likely to have a favorable cognitive outcome. This remains to be studied further in a systematic prospective fashion.

Fine motor performance was also predictive of global IQ, which probably relates to the important overlap between fine motor performance and cognition in the pre-school child as assessed by present developmental assessments.

Surprisingly, we found no correlation between receptive language scores and verbal IQ, which contradicts the general assumption that language comprehension predicts cognition, specifically verbal IQ. This could be partly related to the scales used for receptive language assessment. However, this is unlikely as both the Reynell and the Clinical Evaluation of Language Fundamentals – Preschool 2 (CELF) tests have been validated for assessment of receptive and expressive language in a population of preschool children. However, it may be that the receptive language function assessed through these scales is not directly implicated in verbal IQ function, a hypothesis that has never been explored. Thus, verbal IQ may depend on aspects of cognition other than language comprehension alone and could not be predicted with these scales.

Inherent to our study was the possibility of variations in the status of delay in our participants between the initial evaluation and slightly later cognitive testing. Some children may have improved significantly, while others may have plateaued or worsened (i.e. gap widening) relative to age-equivalent norms. Since our aim was to determine the nosologic value of our initial diagnosis, we do not consider this variation as a bias, but as evidence of the wide variety of developmental profiles of children with GDD. A corollary to this is the possibility of the child’s benefiting from rehabilitation resources between the initial assessment and cognitive evaluation. This is likely to have had no impact on the overall results, because of the lengthy average waiting time for rehabilitation resources in our community (most children would have been assessed cognitively before any actual rehabilitation intervention being provided).

One limitation of the study is its retrospective design. However, we believe that the overall structure of the Developmental Progress Clinic, the clinical source of all our study participants, limits potential biases, as all patients undergo the same standardized evaluations, recorded in a predetermined uniform format. We reviewed the charts of all participants presenting to the Developmental Progress Clinic within a selected defined time interval. A review of the 47 children with GDD not analyzed because of lack of cognitive assessment revealed comparable demographics and developmental profiles with our study group: hence, potential selection biases are likely to be limited.

Most of the children assessed had no identifiable cause for their GDD and few had associated medical conditions. This is probably representative of the majority of patients seen in developmental pediatrics and community pediatrics settings. Locally, children with associated neurologic impairment appear to be preferentially referred to hospital-based child neurology clinics. Patients with obvious causes for delay or significant associated medical conditions may have very different developmental and cognitive profiles, with a different referral pattern (e.g. child neurology clinic evaluation), which we could not assess because of the nature of recruitment in this particular study.

GDD remains a symptom complex with an as yet undefined nosologic profile and implications. Our study found no correlation between a combination of developmental scores and cognitive scores in children with GDD. However, fine motor and expressive vocabulary scores taken in isolation were predictive of global cognitive scores, which could have important implications for accurate diagnosis and eventual prognosis.

A previous study has shown persistence of developmental and functional impairments at age 7 in children diagnosed with GDD as young children. 27 According to recent consensus, mental retardation/intellectual disability is defined as significantly sub-average functioning existing concurrently with related limitations in at least two applicable adaptive skill areas. 10 Adaptive skills were not assessed in our cohort we cannot, therefore, comment on the proportion of our participants meeting current criteria for diagnosing mental retardation/intellectual disability. Even so, we believe our results shed some doubts on the validity of the assumption of GDD–mental retardation/intellectual disability equivalence.

Prediction of outcome of GDD should take into consideration intellectual performance, developmental performance, and, most importantly, functional performance. The current definition of GDD likely needs to be revisited, to better embrace the now well-established variety of profiles of children with several areas of delay apparent at a young age and an apparent impairment dichotomy in children with GDD with reference to actual associated cognitive profile.


What an IQ Test Measures

The traditional kinds of IQ tests have not changed overmuch as time has passed. However, there are a number of tests that attempt to use different methodology to measure intelligence. Most IQ tests concentrate on concrete concepts as opposed to abstract reasoning questions. These include arithmetic problems, memorization tests, vocabulary questions, and spatial reasoning problems. Depending on the age of the person being assessed, a test might be visual, verbal, or written, or a combination of all three. IQ tests are most often used as a way to measure a person’s capability, as well. For instance, most IQ tests will measure:

Spatial ability is the understanding of how objects occupy space. Often this ability is measured using physical puzzles or tangram tests to see how the individual being tested can anticipate spatial dilemmas or manipulate shapes and objects to solve thos dilemmas.

Mathematical ability testing usually takes the form of standard arithmetic problems, but it is very common for the test administrator to introduce logic problems and puzzles into the test to discover the test taker’s logical reasoning skills.

Who doesn’t love a good old fashioned game of memory? This part of an IQ test usually uses visual aids to determine the test taker’s recall abilities. These can include a sensory board or picture cards.

This part of an IQ test will usually measure a person’s ability to identify words, sentences, and phrases once the letters have been removed or rearranged, or require the test taker to rely on etymological knowledge to identify completely unfamiliar words.

As we stated, there are multiple types of IQ tests, as many psychologists and statisticians have attempted to build a better test to measure IQ. The Cattell-Horn-Carroll test, for instance, will focus on fluid and crystallized typed of knowledge, while Guilford’s Structure of Intellect attempts to place the test taker in one of 120 multiple intelligences.


Issues Related to the WISC-V Assessment of Cognitive Functioning in Clinical and Special Groups

Jessie L. Miller , . Lawrence G. Weiss , in WISC-V (Second Edition) , 2019

Abstract

Cognitive assessment has continued to evolve with the growth of psychology and remains relevant in both research and practice. The recently revised Wechsler Intelligence Scale for Children —fifth edition (WISC-V) is frequently used in the cognitive evaluation of children. This chapter reviews the latest research in the cognitive assessment of multiple special groups including children and adolescents identified with intellectual giftedness, intellectual disability, Autism spectrum disorder, attention deficit hyperactivity disorder, traumatic brain injury and disruptive behavior disorder. Following a review of the most recent research in cognitive assessment of these special needs individuals, results from the WISC-V clinical studies are discussed with respect to patterns and trends in cognitive functioning across the domains of the WISC-V battery. WISC-V performance among these special groups is discussed in relation to both the traditional WISC-V paper and pencil administration and the new digital administration available through Pearson’s Q-interactive platform. The chapter concludes with a discussion of the context of cognitive assessment using the WISC-V in typically developing and special populations.


1. Using Working Memory

Working memory is the part of your brain that hosts all your cognitive skills. It’s widely accepted that your working memory can only hold a certain amount of information in any one period of time (somewhere between 4 and 9 things at once). Go ahead: try to hold 10 random unrelated facts in your mind in one single period of time. It’ll be hard, I assure you!

2. Ranking

When new information enters our working memory we often have to rank it. Our mind may rank the information by importance, size, weight, danger, or any other of the hundreds of spectra you could think of. Sorting usually involves creating some sort of hierarchy in order to make your life easier. The most basic hierarchy is danger. Something that is extremely dangerous is also extremely important for our minds to pay attention to. So, if something enters the mind that’s dangerous, our mind may focus all its cognitive resources to that thing and deciding how to react.

3. Classifying

We may also need to classify new information that enters the mind. While ranking involves placing things upon a spectrum, classifying may not. We can classify things into categories like “colors”, “animal species”, “plant species”, “types of clothing” or … well, just about anything!

4. Recognition

Recognition is a skill that requires you to recall memory from your mind. When new information enters the mind, it subconsciously scans for information (cognitive schemata) that already exist within the brain. If the memory of the thing that has just entered your mind is already stored in the mind somewhere, your brain will try to recall that information. When we recognize something, we can use our memory as well as our current experience to better process what we’re seeing. For example, if your only prior experience of a cow was a bad one (the cow bit you!?), your current experience of the cow will be impacted by your past experience… you may not give cows a second chance!

5. Contextual Recall

Contextual recall involves using peripheral or related pieces of information to make sense of new information in front of us. Have you ever had the experience where someone asks you to remember a shared memory but … you just can’t find it in your brain? Then, they start giving you context such as something that happened during the same period of time as that memory: “Remember … you wore your red dress that day” … “Remember, that afternoon we went out for burgers” … “Remember, it happened on the way to the fair”. Suddenly, the memory comes flooding back!

6. Associative Recall

‘Contextual recall’ and ‘associative recall’ are related cognitive skills. Associative recall involves remembering something by associating it with something else. It can be a great strategy to get your memory working. I use this thinking strategy all the time as a teacher. I’ll meet a new student whose name is Lilly. To remember her name, I might say “Lilly” … “Like a flower. Lilly like a flower.” Next time I see her, I have two ways of remembering her name. Maybe her name will come straight to my head. Or, maybe the more general word “flower” comes to my mind … and then I can go “Ah, you’re Lilly like a flower!”

7. Long-Term Memorization

Long-term memorization often requires us to be exposed to something regularly. It seems that the more we are exposed to something, the more the brain realizes that this information is important. So, the brain shifts that ‘thing’ that we’re coming across in our daily lives from short-term to long-term memory. Once something’s in long-term memory, it’s harder (but not impossible) to forget.

8. Perspectival Thinking

When we are young, we are egocentric. This means that we can only really see things from our own perspective. Cognitive psychologist Jean Piaget called our inability to see other perspectives “centration”. Somewhere between 7 and 11 years of age, we develop several cognitive skills, including the cognitive ability to start seeing things from perspectives other than our own. In other words, we develop the skill of perspectival thinking.

9. Paying attention

At a very young age, babies have many cognitive skills. They certainly don’t know how to pay attention. In fact, they literally have to train their eyes to ‘focus’ in the first few months of life. Even by the time a child reaches school age their ability to direct their attention is significantly weaker than when they’re in adolescence. That’s why, if you walk into an early childhood classroom, the teacher is doing a lot of physical, play-based learning. I mean, try asking a 5 year old to maintain attention on something that’s not fun, physical and … even funny!

10. Focus (Sustaining attention)

Once a child has learned to direct their attention, the next skill they need to master is sustaining that attention. The difference in focus between younger and older children is also very stark. Ask any early childhood teacher how long a lesson will last and they might say 10 – 20 minutes. After that, you’ve totally lost the children’s attention – they don’t have the cognitive skills to go on. You’ll need something new to get them back and focused again. Fast-forward 10 years and walk into a classroom full of the same children – except now they’re adolescents. Their teacher might ask them to do mathematics worksheets for 45 minutes straight in preparation for an exam. These adolescents have clearly developed their cognitive skills, including the ability to focus over the past 10 years of their lives.

11. Selective attention

Humans also need to develop the skill of selective attention. Selective attention involves being able to selectively block out some stimuli while focusing on other new information. This is a necessary skill when working in overstimulating environments. It’s why you can listen to your friend talking to you in the middle of time square rather than being distracted by all the neon lights. I tend to be best at selective attention when watching sports. Good luck trying to call my name or ask me to do something when I’m engrossed in the final quarter of a football game.

12. Divided attention

Divided attention involves the cognitive ability to multitask, or pay attention to two things at once. Most of us would believe that women are better at cognitive skills like divided attention than men, although science seems to disagree with this old trope. When we divide our attention, we can absorb new information from two sources at once: like feed our baby and talk on the phone, or sweep the floor and watch the football game.

13. Inhibiting Response

Response inhibition is the cognitive ability to suppress reactions to stimuli in our environments. We have automatic response inhibitors that work at a high processing speed, such as not flinching when someone claps in front of their face. We also have conscious response inhibition, which involves the capacity to filter our reactions to stimuli through processes of logic, reasoning and contextual mediation. For example, it is inappropriate to yell in exasperation at colleagues, despite our desire to do so.

14. Emotional Self-Regulation

Emotional self-regulation involves the ability to employ our response inhibition mechanism to manage our emotional lives. But it’s not simply the ability to “turn an emotion off”. Rather, emotional self-regulation requires a person to continue to use logic and long-term perspective when analyzing a situation. In layman’s terms, emotional self-regulation involves the ability to keep a cool head and react proportionately to a moment in which emotions are high.

15. Metacognition

Metacognition is the ability to think about thinking. It involves being able to reflect on your thought processes and using strategies to improve those thought processes. Humans are one of the only species (alongside monkeys and dolphins, in small ways) who have exhibited the capacity to use metacognition. Reflection on one’s own thought processes involves strategies like using reflection after an event, using in-time reflection to change practice in the moment and thinking about which learning strategies you are using while learning.

16. Spatial Awareness

Spatial awareness involves the ability to identify distance, location and proximity of objects to one another. We need to develop the cognitive capacity to recognize and navigate three dimensional spaces from childhood in order to move about our environments. In adulthood, spatial awareness is necessary for operating tools (such as using a hammer and nail) as well as in everyday situations like driving cars (distance from the car in front, distance to stopping, etc.).

17. Logical Reasoning

Logical reasoning involves the ability to come to conclusions based on a coherent set of truth principles. A person who uses logic does not rely on superstition or unfounded assumptions to reach their conclusions. There are two primary types of logical reasoning: deductive and inductive.

18. Visual Processing

Visual processing is a cognitive skill involves being able to receive, interpret and understand messages that enter the brain through our eyes. Some people consider themselves to be more adept at visual processing than other forms, like audio or language processing. For example, people may be drawn more to the meaning in art or cartoons than through musical meaning-making. If you’re a visual learner, you might need a visual aid to get your memory working in the morning!

19. Audio Processing

Audio processing is another one of the cognitive skills we use to interpret our surrounds. It involves the ability to receive, interpret and understand messages that enter the brain through the ears. People who excel at audio processing not only understand noises well, but also have the capacity to discern subtle differences in tone, cadence and pitch (such as people with ‘perfect pitch’). The processing speed of our brains to interpret audio signals is very high.

20. Language Processing

Language processing is a cognitive skill that involves the ability to hear and interpret man-made communication codes such as spoken, written and sign languages. Children tend to develop most of the fundamental spoken language and cognitive skills required to communicate by the age of 5 through cultural absorption. Neurologist Paul Thompson argues that up until age 11, children’s brains are designed to rapidly absorb languages. Beyond this age, language processing speed slows and learning a language becomes more difficult.

21. Ethical Thinking

Ethical thinking is a cognitive skill that involves applying a values, beliefs and moral frameworks when forming ideas, actions and developing conceptual relationships between concepts. A person who applies ethical thinking must use cognitive abilities like empathy, spirituality and morality to filter good ideas from bad ideas. The use of ethics as a cognitive framework helps people to come to conclusions about how to act in complex ways and interpret ‘moral grey areas’ around topics such as abortion and how to solve refugee crises.

22. Estimation

Estimation requires the capacity to model and predict future events based upon incomplete information in the present. Estimation does not require someone to be able to predict the future perfectly, but rather make guesses based on the best current information.

23. Abstract Thinking

Abstract thinking is a cognitive skill that involves thinking about concepts that are beyond the obvious surface features of an idea. To think abstractly is to think logically about concepts that are not immediately clear or observable. An abstract thinker needs to use their working memory to hypothesize about possibilities of, relationships between and consequences of ideas and actions that are theoretical rather than simply practical.


Comparison of assessments of cognitive skills in children - Psychology

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Below is a list of some of the instruments we use in our office for evaluations. If you have any additional questions before scheduling an appointment, please do not hesitate to contact the office.

Please note that tests are chosen based on the reason for the evaluation and your evaluator’s clinical judgment as to which tests will be most appropriate for an individual. In addition to the tests listed, other testing measures may be used.

  • Differential Abilities Scale – 2nd Edition
  • Kaufman Assessment Battery for Children – 2nd Edition
  • Ravens Colored Progressive Matrices
  • Reynolds Intellectual Assessment Scales
  • Wechsler Adult Intelligence Scale – 4th Edition
  • Wechsler Intelligence Scale for Children – 5th Edition
  • Wechsler Intelligence Scale for Children – 5th Edition – Integrated
  • Wechsler Intelligence Scale for Children – 4th Edition – Spanish
  • Wechsler Preschool and Primary Scales of Intelligence – 4th Edition
  • Batería III Woodcock-Muñoz, Pruebas de Aprovechamiento
  • Gray Oral Reading Test, 5th Edition
  • Kaufman Survey of Early Academic Language Skills
  • Kaufman Test of Educational Achievement, Third Edition
  • Nelson-Denny Reading Test
  • Scholastic Abilities Test for Adults
  • Woodcock Johnson, Tests of Achievement – 4th Edition
  • Wechsler Individual Achievement Test, 3rd Edition
  • Batería III Woodcock-Muñoz, Pruebas de Habilidades Cognitivas
  • Bilingual Verbal Ability Tests
  • Comprehensive Assessment of Spoken Language
  • Comprehensive Test of Phonological Processing – 2nd Edition
  • Expressive One-Word Vocabulary Test – 4th Edition
  • Peabody Picture Vocabulary Test – 3rd Edition
  • SCAN–3:C Test for Auditory Processing Disorders in Children–Revised
  • Test of Problem Solving – 3, Elementary
  • Test of Problem Solving – 2, Adolescent
  • Wide Range Assessment of Memory and Learning – 2nd Edition
  • Woodcock-Johnson IV, Tests of Cognitive Ability
  • Woodcock-Johnson IV, Tests of Oral Language
  • Developmental Test of Visual-Motor Integration – 6th Edition
  • Developmental Test of Visual Perception – 6th Edition
  • Developmental Test of Motor Coordination – 6th Edition
  • Children’s Color Trails Test Category Test
  • Controlled Oral Word Association Test
  • Delis Kaplan Executive Functioning System
  • Finger Oscillation Test
  • Grip Strength Test
  • Grooved Pegboard Test
  • Integrated Visual and Auditory Continuous Performance Test
  • Wechsler Memory Scale – 4th Edition
  • NEPSY Developmental Neuropsychological Assessment – 2nd Edition
  • Reitan-Indiana Aphasia Screening Test
  • Reitan-Klove Lateral Dominance Exam
  • Reitan-Klove Sensory Perceptual Exam
  • Rey Osterrieth Complex Figure
  • Seashore Rhythm Test
  • Speech Sounds Perception Test
  • Stroop Color and Word Test
  • Tactual Performance Test
  • Trail Making Test
  • Wisconsin Card Sorting Test
  • Children’s Apperception Test
  • Children’s Inventory of Anger
  • Conduct Disorder Scale
  • House-Tree-Person Projective Drawings
  • Kinetic Family Projective Drawings
  • Kovac’s Children’s Depression Inventory – 2nd Edition
  • Millon Adolescent Clinical Inventory
  • Millon Clinical Multiaxial Inventory –4th Edition
  • Minnesota Multiphasic Personality Inventory- 2nd Edition, Restructured Form
  • Myers-Briggs Type Indicator
  • Revised Children’s Manifest Anxiety Scale – 2nd Edition
  • Robert’s Apperception Test
  • Rorschach Inkblot Test
  • Sentence Completion Test
  • Social Anxiety Scale
  • Suicide Probability Scale
  • Thematic Apperception Test
  • Trauma Symptom Checklist for Children
    *Additional charge if extensive emotional testing is requested
  • Behavior Assessment System for Children – 3rd Edition
  • Behavior Rating Inventory of Executive Function
  • Children’s Problem Checklist
  • Sensory Profile Questionnaire
  • Developmental Indicators for the Assessment of Learning – 4th Edition
  • Battelle Developmental Inventory, 2nd Edition
  • Bayley Scales of Infant and Toddler Development, 3rd Edition
  • Autism Diagnostic Interview – Revised
  • Autism Diagnostic Observation Schedule – 2nd Edition
  • Childhood Autism Rating Scale – 2nd Edition
  • Pervasive Developmental Disorder Behavior Inventory
  • Social Communication Questionnaire
  • Social Responsiveness Scale – 2nd Edition
  • Review of School Records
  • Review of Past Evaluations and Medical Records
  • School Observation
  • Telephone contact with teachers, professionals, other relevant individuals

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Of particular importance to the specialty of clinical child and adolescent psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, developmental processes, mental and behavioral disorders and developmental psychopathology, behavioral adaptation, and health status of children and adolescents.

The specialty of clinical child and adolescent psychology involves the study, assessment, and treatment of a wide range of interrelated biological, psychological, and social problems experienced by children and adolescents. These include but are not limited to the following:

  • Treating psychological, cognitive, emotional, developmental, behavioral issues.
  • Biological vulnerabilities.
  • Behavioral, psychologial, mental, emotional, developmental, and family problems.
  • Cognitive deficits.
  • Trauma and loss.
  • Health related problems.
  • Stress and coping related to developmental change.
  • Problems in social context.

Introduction

Mental health professionals use a variety of instruments to assess mental health and wellbeing. Common purposes for psychological testing include: screening for the presence or absence of common mental health conditions making a formal diagnosis of a mental health condition assessment of changes in symptom severity and monitoring client outcomes across the course of therapy.

Screening: Brief psychological measures can be used to ‘screen’ individuals for a range of mental health conditions. Screening measures are often questionnaires completed by clients. Screening tends are quick to administer but results are only indicative: if a positive result is found on a screening test then the screening test can be followed up by a more definitive test.

Diagnosis: Psychological assessment measures can support a qualified clinician in making a formal diagnosis of a mental health problem. Mental health assessment with the purpose of supporting a diagnosis can include the use of semi-structured diagnostic interviews and validated questionnaires. Items in self-report measures used for diagnosis often bear a close correspondence to criteria specified in the diagnostic manuals (ICD and DSM).

Symptom & outcome monitoring: One strand of evidence-based practice requires that therapists use outcome measures to monitor progress and guide the course of therapy. Psychologists, CBT therapists, and other mental health professionals often ask their clients to complete self-report measures regularly to assess changes in symptom severity.


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Cognitive Assessments

Discovering that someone in your family may have a learning disorder can generate mixed feelings of relief, concern and stress. If your child or teen has consistently struggled at school, understanding the cause is the first step to helping them reach their full potential. Arranging a cognitive assessment for a learning disorder will help you and your family plan the best way to move forward. Our Neuropsychologists, Dr Kate Elliott, Holly Nelson and Juhi Sanghavi are experienced in conducting cognitive assessments for developmental and learning disorders, and a range of other conditions affecting the brain. We also have several qualified and experienced ASD Assessors who offer Autism assessments for children and teens at Gateway Psychological Services:

Meet our Assessors

Clinical Neuropsychologist Clinical Psychologist

Neuropsychologist | Clinical Psychologist

Kate helps with:

Cognitive assessments to assist with: Bariatric assessment and support Returning to the workplace after an accident Traumatic Brain Injury (workplace accidents, car accidents, victims of crime) Acquired Brain Injury (strokes, cancer recovery, drug use) Intellectual disability testing

Clinical Psychology for: Adult survivors of abuse Family violence survivors Emotional abuse Eating disorders Generalised anxiety Obsessive Compulsive Disorder Panic Disorder Perfectionism Post-natal depression Post-Traumatic Stress Disorder Social Anxiety

When I established the clinic, my goal was to build a team of psychologists who genuinely care about improving emotional wellbeing for children and adults in Perth. As Gateway Psychological Services has grown, we’ve introduced more services for more people. Today, the most rewarding part of my work with cognitive assessments and clinical psychology is seeing the difference we make in people’s lives. Through a combination of empathy and perseverance, we help our clients achieve life-changing breakthroughs.

Qualifications and memberships

Doctorate in Clinical Psychology and Clinical Neuropsychology Master’s degree in Community Development Postgraduate Diploma in Psychology Bachelor of Arts in Psychology (minor in Children and Family Studies)

Clinical Neuropsychologist Registrar

Clinical Neuropsychologist | Registrar

Holly helps with:

Cognitive and diagnostic assessments for: Specific learning disorders (dyslexia, dysgraphia, dyscalculia) Attention-Deficit Hyperactivity Disorder (ADHD) Intellectual disability Giftedness and twice-exceptional Autism Spectrum Disorder (ASD) Williams Syndrome Epilepsy Traumatic brain injury Stroke Cerebral palsy

Holly is passionate about making a positive difference in the lives of individuals with neurodevelopmental conditions and has special interests in the areas of learning disorders, ADHD, giftedness, intellectual disability and Williams Syndrome. Holly is experienced in providing comprehensive assessments and accurate diagnoses, with clinical experience gained across a number of settings in both Sydney and Perth. Through comprehensive assessments of intellectual, academic, memory and executive functioning skills, parents gain a better understanding their child's strengths and weaknesses, and support strategies are provided to help children reach their full potential.

Holly understands that neurodevelopmental conditions and learning disorders can have significant academic, social, behavioural and psychological impacts. She is passionate about providing targeted evidence-based strategies designed to help individuals improve, or compensate for, deficits in a range of thinking skills (such as concentration, working memory and executive functioning) and learning difficulties. Holly enjoys providing assessment and intervention strategies for children, adolescents and adults to support progress at school, university/vocational studies and work. She is experienced in developing individualised support strategies to help overcome areas of weaknesses with the aim of improving independence, confidence and overall quality of life.

Qualifications and memberships Master of Clinical Neuropsychology Bachelor of Science (Honours) with First Class Honours Member of the Australian Psychological Society (MAPS) Member of The Australian Paediatric Neuropsychology Research Network Professional Member of ADHD WA Professional