How Diagnostic Clinical Assessment can be Helpful
by Debra B. Resnick, PsyD, Licensed Clinical Psychologist
President and Clinical Director, PSHDC, Inc.

Diagnostic clinical assessment has been available for many years. Many times, simply talking to your clinician in the initial intake evaluation will provide sufficient information to determine a diagnosis (or provisional/working diagnosis) in order to develop goals and an effective treatment plan. At other times however, your intake clinician or your ongoing therapist may speak with you about utilizing more formalized measures to fine tune your diagnosis or answer questions that cannot be determined by a clinical interview or history alone. Also, patients can ask their intake clinician or therapist for more formalized testing evaluations if they have a particular interest, even if formal evaluation has not yet been recommended.

The following information can be determined through an interview:

  • How the person sees their problem
  • History, including developmental, history, health, school and work
  • Client's current level of functioning
  • Current life stressors
  • Assessment of support system
  • Client's nonverbal behavior
  • Substance abuse history
  • Assessment of orientation to person, place and time
  • Obtaining previous records
The following information can be obtained from formal psychological testing but not interview:
  • Baseline functioning
  • Normative information
  • Age and group comparisons
  • Client's response to a structured situation
  • Quantification and statistical measures
  • Availability of comparisons over time with previous testing
  • Functional analysis of data
  • Cognitive (formal IQ) determination
How to make a decision together with your therapist as to when, or whether more formal psychological testing should be pursued:

Formal measures of psychological testing can roughly be divided into two areas: an assessment of cognitive and learning capabilities and personality or emotional measures although there is an overlap between the two. Although there may be times when a comprehensive evaluation is the most useful (evaluating both cognitive and personality measures), there are times when certain elements can be investigated by themselves.

Psychological testing is extremely valuable in a number of cases. Specific instances when formal testing is indicated would include times when a determination of cognitive, IQ or learning capabilities are necessary, such as in assessing for educational needs the possibility of learning disabilities or learning differences. Formal psychological testing is also extremely important in an evaluation of Attention Deficit Hyperactivity Disorder (ADHD), as studies show that a certain percentage of children and adolescents who present with ADHD may also have learning disorders. Cognitive testing can also assess whether memory or related functions have declined.

Cognitive testing can also be combined with measures of job interest in order to determine whether the person's skills are well matched to their capabilities. Various career, occupational and interest inventories are available in order to assess an individual's future goals in this area.

Evaluation of emotional and personality functioning can be useful in order to determine more complex diagnoses, particularly when an individual has already been in treatment and is not experiencing the type of progress that might be expected. At other times, personality assessment can be extremely helpful in ruling out a particular type of disorder, when such a disorder cannot be clearly determined either by interview, family history or therapy alone. Having a more accurate determination of the diagnosis may also have implications for medication, should psychiatric medication management be necessary.

While cognitive and learning tests tend to be more specific and structured in nature, some personality and emotional tests may be more open-ended, broad band or unstructured in nature, giving the individual an opportunity to insert his or her thoughts, feelings and perceptions. The unstructured nature of many personality tests enables the examiner or clinician to better understand their client's way of thinking, feeling and organizing their world. Other personality tests are termed "semi-projective", in which they are partially structured and then ask the client to complete items or to answer questions of a true or false, "like" or "dislike" nature.

In summary, the purpose of any more formal psychological testing is to yield a more comprehensive and accurate understanding of the individual, to enable more effective goal setting and treatment planning to occur. The results are typically written in a formal report, which can also be communicated to other professionals.

What should I do if I have questions about formal psychological testing?

Discuss the possibility of testing with your intake clinician, therapist or psychiatrist. Try to determine what type of questions you would like the psychological testing to address or answer for you. If you have questions that you would like answered, please feel free to contact Dr. Debra Resnick, Psy.D. at: (215) 540-5860 or via e-mail at resnick@pshdc.com.

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