CHAPTER 20 Interpreting Psychoeducational Testing Reports, Individualized Family Service Plans (IFSP), and Individualized Education Program (IEP) Plans Mary C. Kral, PhD Introduction According to the Centers for Disease Control and Prevention (CDC), 1 in 5 youth in the United States is diagnosed with a developmental disability.1 Primary pediatric health care professionals are often first-line professionals who identify developmental, learning, social, and behavioral challenges and are uniquely poised to advocate for appropriate supports. To accomplish this goal, primary pediatric health care professionals need to work concertedly with a multidisciplinary team of school psychologists, special educators, social workers, and other allied health professionals to provide a road map for comprehensive care, including appropriate educational programming and referral for related services, such as occupational, physical, and speech/language therapies. In this context, it is critical that primary pediatric health care professionals understand psychoeducational evaluation procedures and federal guidelines concerning the provision of services to children and adolescents from birth through 21 years of age. This chapter provides an overview of psychoeducational evaluation and federally funded services for youth with developmental-behavioral disorders. Evaluation of Cognitive Functioning and Academic Achievement Many psychoeducational evaluation reports will cross the desks of primary pediatric health care professionals who need to understand how to interpret them in order to best advocate for the needs of their patients. This understanding includes up-to-date knowledge of commonly used instruments in psychoeducational evaluation, proficiency in the interpretation of quantitative data yielded by psychometric instruments, and communication of the results of psychoeducational evaluations in terms accessible to families. Psychoeducational Evaluation Psychoeducational evaluation involves the assessment of cognitive skills, academic achievement, social-emotional functioning, and behaviors that influence academic performance. Certified school psychologists and other licensed psychologists possess the necessary training, expertise, and credentialing to conduct psychoeducational evaluations. When concerns arise at school within the academic or behavioral domains, a child is referred to one of these professionals, who selects a battery of psychometric instruments to determine the source of these difficulties. Assessment of neurodevelopmental abilities may include intellectual functioning, language skills, and motor skills. Performance in these areas helps explain a child’s academic achievement, which also is assessed in psychoeducational evaluation. Commonly used psychometric instruments in psychoeducational evaluation appear in Table 20.1. Often, parent- and teacher-completed behavior rating skills, clinical interviews, and classroom observations are also completed to assess functioning in adaptive behavioral, social-emotional, and behavioral domains. Psychometrics 101 When selecting a battery of instruments to assess the cognitive, academic, social-emotional, and behavioral concerns for a particular child, the psychologist chooses an instrument with acceptable psychometric properties. The instrument’s psychometric properties offer an objective indication that the observed sample of behavior obtained during the assessment is representative of the child’s general behavior. Selection of psychometric instruments that are well standardized is key. Standardization refers to uniformity of content, administration, and scoring. Uniform administration of a psychometric instrument includes adherence to detailed administration procedures, such as clearly delineated rules regarding presentation of test materials, time limits, specific oral directions, teaching or demonstration during sample items, queries permitted, and methods of handling questions. Standardization reduces measurement error.
Table 20.1. Examples of Commonly Used Instruments in Psychoeducational Evaluation | ||
Cognitive Domain | Assessment Instrument | Age Range |
Intellectual Function | Assessment of Infant and Toddler Cognitive Development Bayley Scales of Infant Development, Third Edition3 Mullen Scales of Early Learningb | 1-42 months birth-68 months |
Assessment of Intelligence in Young Children Differential Ability Scales, Second Edition, Early Years Batteryc Wechsler Preschool and Primary Scale of Intelligence, Fourth Editiond | 2:6-6:11 years 2:6-7:7 years | |
Assessment of Intelligence in School-aged Youth Differential Ability Scales, Second Edition, School-Age Batterye Stanford-Binet Intelligence Scales, Fifth Editionf Wechsler Adult Intelligence Scale, Fourth Editiong Wechsler Intelligence Scale for Children, Fifth Editionh | 7:0-17:11 years 2:0-85+ years 16:0-90:11 years 6:0-16:11 years | |
Assessment of Nonverbal Intellectual Functioning Leiter International Performance Scale, Third Editioni | 3:0-75 years | |
Language Functions | Clinical Evaluation of Language Fundamentals, Fifth Editionj Comprehensive Test of Phonological Processing, Second Editionk Expressive Vocabulary Test, Second Editionl Oral and Written Language Scales, Second Editionm Peabody Picture Vocabulary Test, Fourth Edition11 Preschool Language Scales, Fifth Edition“ | 5:0-21:11 years 4:0-24:11 years 2:6-90+ years 3:0-21:11 years 2:6-90+ years birth-7:11 years |
Motor Functions | Developmental Test of Visual-Motor Integration, Sixth Editionp Bender Visual-Motor Gestalt Test, Second Editionq Peabody Developmental Motor Scales, Second Editionr | 2:0-99:11 4:0-85+ years birth-5 years |
Academic Achievement | Assessment of Academic Readiness Skills in Young Children Bracken Basic Concept Scale, Third Edition: Receptive and Expressive5 Young Children’s Achievement Test* | 3:0-6:11 years 4:0-7:11 years |
Assessment of Academic Achievement in School-aged Youth Wechsler Individual Achievement Test, Third Edition11 Woodcock-Johnson IV Tests of Achievementv | 4:0-50:11 years 2:0-90+ years | |
Adaptive Behavioral Functioning | Adaptive Behavior Assessment System, Third Editionw Vineland Adaptive Behavior Scales, Third Editionx | birth-89+ years birth-90 years |
a Bayley N. Bayley Scales of Infant and Toddler Development. 3rd ed. San Antonio, TX: Harcourt; 2006
b Mullen EM. Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Service Inc.; 1995
c Elliott CD. Differential Ability Scales, Second Edition, Early Years Battery. San Antonio, TX: Psychological Corporation; 2007
d Wechsler D. Wechsler Preschool and Primary Scales of Intelligence. 4th ed. San Antonio, TX: Psychological Corporation; 2012
e Elliott CD. Differential Ability Scales, Second Edition, School-Age Battery. San Antonio, TX: Psychological Corporation; 2007
f Roid GH. Stanford-Binet Intelligence Scales. 5th ed. Itasca, IL: Riverside Publishing; 2003
g Wechsler D. Wechsler Adult Intelligence Scale. 4th ed. San Antonio, TX: Psychological Corporation; 2008
h Wechsler D. Wechsler Intelligence Scale for Children. 5th ed. San Antonio, TX: Psychological Corporation; 2014
i Roid GH, Miller L J, Pomplun M, Koch, C. Leiter International Performance Scale. 3rd ed. Wood Dale, IL: Stoelting Co.; 2013
j Wiig EH, Semel E, Secord WA. Clinical Evaluation of Language Fundamentals. 5th ed. San Antonio, TX: Pearson; 2013
k Wagner R, Torgesen J, Rashotte C, Pearson NA. Comprehensive Test of Phonological Processing. 2nd ed. Austin, TX: Pro-Ed, Inc.; 2013
l Williams KT. Expressive Vocabulary Test. 2nd ed. San Antonio, TX: Pearson; 2007
mCarrow-Woolfolk E. Oral and Written Language Scales. 2nd ed. San Antonio, TX: Pearson Assessments; 2011
n Dunn LM, Dunn D M. Peabody Picture Vocabulary Test. 4th ed. San Antonio, TX: Pearson Assessments; 2007
o Zimmerman IL, Steiner VG, Pond RE. Preschool Language Scales. 5th ed. San Antonio, TX: Psychological Corporation; 2011
p Beery KE, Buktenica NA, Beery NA. The Beery-Buktenica Developmental Test of Visual-Motor Integration. (BEERY VMI). 6th ed. Bloomington, MN: Pearson; 2010
q Brannigan GG, Decker SL. Bender Visual-Motor Gestalt Test. 2nd ed. Itasca, IL: Riverside; 2003
r Folio MR, Fewell RR. Peabody Developmental Motor Scales. 2nd ed. Austin: Pro-Ed; 2000
s Bracken BA. Bracken Basic Concept Scale: Receptive and Expressive. 3rd ed. San Antonio, TX: Pearson Assessments; 2006
t Hresko W, Peak P, Herron S, Bridges D. Young Children’s Achievement Test. Austin: Pro-Ed; 2005
u Wechsler D. Wechsler Individual Achievement Test. 3rd ed. San Antonio, TX: Pearson; 2009
v Schrank FA, Mather N, McGrew KS. Woodcock-Johnson IV Tests of Achievement. Rolling Meadows, IL: Riverside; 2014
w Harrison PL, Oakland T. Adaptive Behavior Assessment System. 3rd ed. Torrance, CA: Western Psychological Services; 2015
x Sparrow SS, Cicchetti DV, Saulnier CA. Vineland Adaptive Behavior Scales. 3rd ed. Minneapolis, MN: Pearson; 2016
Selection of an instrument that is well normed also is critical. Normatization of a psychometric instrument involves the selection of a large, representative sample of individuals for whom the measure is designed. Adequate norms permit comparisons of an individual’s performance to the representative group, or standardization sample, so that objective statements can be made about a child’s level of performance in comparison to his or her peers. In addition, norm-referenced scores permit the comparison of a child’s performance on one test or domain to their performance on another test or domain. When choosing a psychometric instrument, the examiner also considers whether the characteristics of the normatization sample are comparable to the demographic characteristics of the child.
A sound psychometric instrument also must be reliable and valid. Reliability means that the results a test yields are repeatable and consistent. For example, a child will obtain comparable scores on two different administrations of a test, barring compromise of cognitive functioning, if the measure is highly reliable. A psychometric instrument is reliable if it is free from measurement error and yields an individual’s “true score.” Some degree of measurement error is inevitably involved in psychoeducational evaluation. Therefore, scores are usually presented along with “confidence intervals.” The confidence interval is based on the standard error of measurement (SEM) statistic. The SEM is an estimate of the amount of error associated with an obtained score and is directly related to a test’s reliability (ie, the lower the reliability, the higher the SEM). Confidence intervals are usually reported as 90% or 95%, meaning a child’s “true” score would be found 90% or 95% of the time within that range, or the statistical chances are 5 or 10 in 100 that a child’s “true” score lies outside of the confidence interval.
Validity means that the psychometric instrument measures the construct (ie, specific cognitive ability) that it purports to assess. A valid psychometric instrument permits the examiner to draw inferences about a child’s performance. For example, a well-validated measure of language enables the examiner to make statements about a child’s ability to express ideas with words. Statistical procedures, such as confirmatory factor analysis, provide evidence for the validity of specific test instruments.
Psychoeducational evaluation involves quantifying behavioral samples by transforming raw test scores into norm-referenced scores. Raw scores have little meaning and cannot be used to compare a child’s performance to typically developing peers. In contrast, norm-referenced scores permit comparison of a child’s performance to the performance of children in the normatization sample. The collective performance of children in the normatization sample forms a distribution of scores that is typically bell-shaped. This normal distribution has a range of scores, the majority of which fall in the center of the distribution. In a normal distribution, one-half of the scores fall below the average, or mean, and one-half of the scores fall above the mean. Figure 20.1 provides a graphic depiction of the normal distribution.
The statistical properties of the normal distribution permit transformation of raw scores into norm-referenced scores such as percentile ranks, standard scores, and T-scores. Percentile ranks indicate the relative position of a child’s performance when compared with the standardization sample. Percentile ranks provide results that are easily understood; however, percentile ranks may be confused with percentage correct. For example, a score at the 50th percentile does not mean the child achieved 50% of the items correctly; rather, the child performed as well or better than 50% of children in the standardization sample. In this case, the child’s performance also could be described as falling in the average range. In addition, percentile ranks are problematic in as much as they over-emphasize differences in scores in the middle of the distribution and underemphasize differences in scores at the extremes of the distribution. Figure 20.1 provides a graphic illustration of this problem.
Standard scores and T-scores are norm-referenced transformations that express raw scores in terms of standard deviation units from the mean. The standard deviation refers to the amount of variability in the distribution of scores around the mean. When the average standard score is 100 with a standard deviation of 15, approximately 68% of children in the standardization population obtained scores within one standard deviation above and below the mean (ie, 85 to 115; see Figure 20.1). Standard scores also may be presented as “scaled scores” with a mean of 10 and a standard deviation of 3. T-scores are yet another norm-referenced transformation that is a common metric of behavior rating scales. T-scores have a mean of 50 and a standard deviation of 10. Because standard scores, scaled scores, and T-scores occur on an interval scale, one of these scores can be transcribed into another metric. For example, a standard score of 100 equals a scaled score of 10, which equals a T-score of 50. These equivalent scores facilitate comparison of performance across different tests and domains. Figure 20.1 graphically displays the relative position of various norm-referenced scores within the normal distribution.
Figure 20.1. Normal distribution and norm-referenced scores.
Assessment of academic achievement also involves transformation of raw test scores into norm-referenced scores, such as standard scores and scaled scores. Some academic achievement instruments provide for transformation of raw test scores into age equivalents and grade equivalents. These equivalents reflect at what age or grade the average person in the standardization sample received the same score as the examinee. These scores are problematic because they do not suggest that the child has acquired all of the knowledge of a child in that grade or at that age. Also, age equivalents and grade equivalents are ordinally derived norm-referenced scores and cannot be used to assess progress. In general, if a child obtained a grade or age equivalent above his or her current grade or age, the child is probably performing better than other children of his or her age or grade in that particular area.
Interpreting Psychoeducational Test Results
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
