Health and Psychology

Evaluations are as minimal as a good clinical interview and as complex as a 12-20 hour testing battery.  An evaluation is as complex or as simple as what is required to answer a referral question.  

I teach psychological testing, but it's not always indicated as a requirement for an evaluation.  Some people want to know if they have a specific diagnosis.  In many cases the symptoms they have do NOT match the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition).  Those are easy cases.  The answer is "no you don't."  But then some people want to know what they can do about their symptoms and what their symptoms might mean in terms of a diagnostic label.  That will require a clinical interview, a review of treatments to date, and maybe psychological testing.

A good clinical interview and full mental status examination can provide a wealth of information.  This is what psychiatrists generally do to reach a diagnosis.  A few of them may give a psychological questionnaire or two that they have learned about and found useful, others will refer out for psychological testing, but many rely on a history and mental status alone.  Some have good training in psychotherapy others primarily do medication management.  

I notice a lot during a clinical interview.  There are often questions that do not get asked, that I ask.  I was seeing a young girl that had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).  She had been prescribed medication.  She was doing better on medication.  So far so good.  Except she was doing some things I wasn't expecting from a medicated person with ADHD. Like repeating herself.  Like past-pointing.  Like losing track of the conversation.  So I started asking all the standard questions I ask for neurological symptoms.  Any history of head injury or seizures?  Yes to both.  Any history of neurological symptoms like musical hallucinations?  Yes.  Any history of the experience of "coming to" and not knowing how you got where you are?  Yes.  Okay, this is now a condition that will first require a neurological evaluation, and then maybe neuropsychological testing.  She had been diagnosed with ADHD by a school teacher (they aren't able to make the diagnosis).  She was medicated by a primary care physician who used a questionnaire and didn't rule out other causes of attention difficulties like anxiety, seizures, hearing loss, etc.  

In general people want to spend as little as possible to get the question answered about diagnosis and treatment.  I agree with that.  In some cases the "standard" for testing is set by an outside agency that will ultimately be reviewing the report.  In other cases it's just for the person.  In some cases someone has already made a decision about the diagnosis and wants testing to confirm that.  That's often the case with ADHD and bipolar disorder.  There are popular books on the topic.  In many of those cases a careful history can rule the diagnoses in or out and testing is a simple matter of providing confirmation of what the history already documents.  Those cases can be tricky because people want to believe they are right, even when formal testing shows they aren't.  So when testing contradicts their ideas, they want to know about false negative rates of testing.  

False positive rates mean the test finds a condition when it shouldn't.  False negative means the test fails to find the condition when it should.  There are small percentages for each of these.  Most test makers are content to have about a 5% error rate.  It's why multiple tests are used to show the same findings across tests and to increase certainty.  If I can't match the diagnosis in history and a test fails to show it, I have an answer.  You don't have the diagnosis.  

When testing is set by an outside agency they have specific criteria they expect to see in testing reports.  This can be for social security disability, documentation for the need for accommodations in school and work, documentation of learning disorders, or documentation of psychological or neuropsychological conditions.  These types of reports are more lengthy and require longer test batteries according to standards set by the outside agency or provider.

If you are interested in an assessment please feel free to contact our office.