assessing childhood psychopathology and developmental...

Assessing Childhood Psychopathology and Developmental Disabilities

Assessing Childhood Psychopathology and Developmental Disabilities

Edited by

Johnny L. MatsonLouisiana State University, Baton Rouge, LA

Frank AndrasikUniversity of West Florida, Pensacola, FL

Michael L. MatsonLouisiana State University, Baton Rouge, LA

ISBN: 978-0-387-09527-1 e-ISBN: 978-0-387-09528-8DOI: 10.1007/978-0-387-09528-8

Library of Congress Control Number: 2008931166

© Springer Science + Business Media, LLC 2009All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.

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EditorsJohnny L. MatsonDepartment of PsychologyLouisiana State UniversityBaton Rouge, LA [email protected]

Frank AndrasikDepartment of PsychologyUniversity of West FloridaPensacola, FL [email protected]

Michael L.MatsonDepartment of PsychologyLouisiana State UniversityBaton Rouge, LA 70803

Contents

PART I: INTRODUCTION

Chapter 1. History, Overview, and Trends in Child and Adolescent Psychological Assessment ....................................... 3Robert W. Heffer, Tammy D. Barry, and Beth H. Garland

Chapter 2. Diagnostic Classification Systems ................................. 31Jeremy D. Jewell, Stephen D.A. Hupp, and Andrew M. Pomerantz

Chapter 3. Interview and Report Writing ......................................... 55Amie E. Grills-Taquechel, Rosanna Polifroni, and Jack M. Fletcher

PART II. ASSESSMENT OF SPECIFIC PROBLEMS

Chapter 4. Intelligence Testing ....................................................... 91R.W. Kamphaus, Cecil R. Reynolds, and Katie King Vogel

Chapter 5. Rating Scale Systems for Assessing Psychopathology: The Achenbach System of Empirically Based Assessment (ASEBA) and the Behavior Assessment System for Children-2 (BASC-2) ........ 117Leslie A. Rescorla

Chapter 6. Neuropsychological Disorders of Children ..................... 151WM. Drew Gouvier, Audrey Baumeister, and Kola Ijaola

PART III. ASSESSMENT OF SPECIFIC PYCHOPATHOLOGIES

Chapter 7. Assessment of Conduct Problems .................................. 185Nicole R. Powell, John E. Lochman, Melissa F. Jackson, Laura Young, and Anna Yaros

v

Chapter 8. Evidence-Based Assessment of Attention-Deficit Hyperactivity Disorder (ADHD) ........................................................ 209Paula Sowerby and Gail Tripp

Chapter 9. Assessment of Mood Disordersin Children and Adolescents ... ......................................................... 241C. Emily Durbin and Sylia Wilson

Chapter 10. Assessment of Bipolar Disorder in Children ................ 273Stephanie Danner, Matthew E. Young, and Mary A. Fristad

PART IV. ASSESSMENT OF PROBLEMS DEVELOPMENTAL DISABILITIES

Chapter 11. Academic Assessment ................................................. 311George H. Noell, Scott P. Ardoin, and Kristin A. Gansle

Chapter 12. Behavioral Assessment of Self-Injury ........................... 341Timothy R. Vollmer, Kimberly N. Sloman, and Carrie S.W. Borrero

Chapter 13. Autism Spectrum Disorders and Comorbid Psychopathology ...................................................... 371Jessica A. Boisjoli and Johnny L. Matson

PART V. BEHAVIORAL MEDICINE

Chapter 14. Assessment of Eating DisorderSymptoms in Children and Adolescents .......................................... 401Nancy Zucker, Rhonda Merwin, Camden Elliott, Jennifer Lacy, and Dawn Eichen

Chapter 15. Pain Assessment ......................................................... 445Frank Andrasik and Carla Rime

Chapter 16. Assessment of Pediatric Feeding Disorders .................. 471Cathleen C. Piazza and Henry S. Roane

Index .............................................................................................. 491

vi CONTENTS

List of Contributors

Frank AndrasikDepartment of Psychology, University of West Florida, Pensacola, FL 32514, [email protected]

Scott P. ArdoinDepartment of Psychology, University of South Carolina, Columbia, SC, [email protected]

Tammy D. BarryDepartment of Psychology, The University of Southern Mississippi, Hattiesburg, MS 39406, [email protected]

Audrey BaumeisterDepartment of Psychology, Louisiana State University, Baton Rouge, LA 70803

Jessica A. BoisjoliDepartment of Psychology, Louisiana State University, Baton Rouge, LA 70803

Carrie S.W. BorreroKennedy Krieger Institute Johns Hopkins University Medical School, Baltimore, MD 21205

Stephanie Danner-OgstonThe Ohio State University, Columbus, OH 43210

Catherine Emily DurbinWCAS Psychology, Northwestern University, Evanston, IL 60208, [email protected]

Dawn EichenDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710

vii

Camden ElliottDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710

Jack M. FletcherDepartment of Psychology, University of Houston, Houston, TX 72204

Mary A. FristadResearch & Psychological Services, Division of Child & Adolescent Psychiatry, Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, OH 43210, [email protected]

Kristin A. GansleDepartment of Educational Theory, Policy, and Practice, Louisiana State University, Baton Rouge, LA, [email protected]

Beth H. GarlandBaylor College of Medicine, Department of Psychology, Texas A&M University, TX 77845, [email protected]

Drew GouvierDepartment of Psychology, Louisiana State University, Baton Rouge, LA 70803, [email protected]

Amie E. Grills-TaquechelDepartment of Psychology, University of Houston, Houston, TX 72204, [email protected]

Rob HefferDepartment of Psychology, Texas A&M University, TX 778845, [email protected]

Stephen D. A. HuppDepartment of Psychology, Southern Illinois University, Edwardsville, IL 62026

Kola IjaolaDepartment of Psychology, Louisiana State University, Baton Rouge, LA 70803

Melissa F. JacksonDepartment of Clinical and Forensic Psychology, University of Alabama, Tuscaloosa, AL 35401, [email protected]

Jeremy D. JewellDepartment of Psychology, Southern Illinois University, Edwardsville, IL 62026, [email protected]

List of Contributorsviii

R. W. KamphausCollege of Education, Georgia State University, Atlanta, GA. [email protected]

Jennifer LacyDepartment of Psychology, Duke University Medical Center, Durham, NC 27710

John E. LochmanDepartment of Psychology, University of Alabama, Tuscaloosa, AL, [email protected]

Johnny L. MatsonDepartment of Psychology, Louisiana State University, Baton Rouge, LA 70803, [email protected]

Rhonda MerwinDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710

George H. NoellDepartment of Psychology, Louisiana State University, Baton Rouge, LA 70803, [email protected]

Cathleen C. PiazzaMunroe–Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198

Rosanna PolifroniDepartment of Psychology, University of Houston, Houston, TX 72204

Andrew M. PomerantzDepartment of Psychology, Southern Illinois University, Edwardsville, IL 62026

Nicole R. PowellDepartment of Psychology, University of Alabama, Tuscaloosa, AL

Leslie RescorlaDepartment of Psychology, Bryn Mawr College, Bryn Mawr, PA 19010, [email protected]

Cecil R. ReynoldsTexas A & M University, TX 78602, [email protected]

Carla RimeDepartment of Psychology, University of West Florida, Pensacola, FL 32514

List of Contributors iX

Henry S. RoaneMunroe–Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198, [email protected]

Kimberly N. SlomanDepartment of Psychology, University of Florida, Gainesville, FL 32611

Paula SowerbyDepartment of Psychology, ADHD Research Clinic, University of Otago, Dunedin, New Zealand, [email protected]

Gail TrippDepartment of Psychology, University of Otago, Dunedin, New Zealand, [email protected]

Katie King VogelCollege of Education, University of Georgia, Athens, GA 30602.

Timothy R. VollmerDepartment of Psychology, University of Florida, Gainesville, FL 32611, vollmera@ufl .edu

Sylia WilsonWCAS Psychology, Northwestern University, Evanston, IL 60208

Anna Yaros

Center for the Prevention of Youth Behavior Problems, Department of Psychology, University of Alabama, Tuscaloosa, AL

Matthew E. YoungThe Ohio State University, Division of Child & Adolescent Psychiatry, Columbus, OH 43210

Laura YoungDepartment of Psychology, University of Alabama, Tuscaloosa, AL

Nancy ZuckerDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, [email protected]

x List of Contributors

Part I

Introduction

1

History, Overview, and Trends in Child and

Adolescent Psychological Assessment

ROBERT W. HEFFER, TAMMY D. BARRY, and BETH H. GARLAND

Systematically evaluating human performance and predicting important outcomes emerged in the far reaches of recorded history. For example, Gregory (2007) described that as early as 2200 BC Chinese emperors developed physical abilities, knowledge, and specific skill examinations for government officials and civil servants. However, assessment of children’s abilities and behavior certainly predates even these distant instances of evaluation of adults.

We contend that child assessment has taken place as long as parents and other adults have observed and tracked changes in children’s develop-ment. Parents notice changes over time within a given child and differences among children in abilities and responses to circumstances. This type of informal evaluation process certainly is a far cry from the empirically based, standardized methods of child and adolescent psychological assessment that have developed over the past 150 years or so, but it is foundational.

The current state-of-the-art of assessing childhood psychopathologyand developmental disabilities is presented in this volume of a two-volume edited series. Each topic and issue covered includes a common core: adults have an interest in understanding, documenting, and predicting the capacities and experiences of children. In addition, these contribu-tions to the literature have an applied slant: that is, interventions designed

ROBERT W. HEFFER, BETH H. GARLAND ● Department of Psychology Texas A&M University, 4235 TAMU College Station, TX 778845-4235.TAMMY D. BARRY ● Department of Psychology, The University of Southern Mississippi, 118 College Drive, 5025 Hattiesburg, MS 39406.

J.L. Matson et al. (eds.), Assessing Childhood Psychopathology 3and Developmental Disabilities, DOI: 10.1007/978-0-387-09528-8, © Springer Science + Business Media, LLC 2009

4 ROBERT W. HEFFER et al.

to influence outcomes emanate from competent assessment. Our psycho-logical assessment approaches have become more sophisticated, but are linked historically to our predecessors’ curiosity about how children grow and learn and what “to do” with this knowledge.

In this chapter, we use the words, “child” or “children” to refer to indi-viduals whose chronological age ranges from birth to late adolescence. Otherwise, we note if a particular description applies specifically to an infant/toddler, preschool-aged young child, a school-aged child, or a teenager. First, we present an overview of some of the key historical events that have shaped child assessment today. We promise not to include every detail from Adam and Eve’s parental observations of Cain, Abel, and Seth to the present! Next, we offer an overview of issues central to child assess-ment methods early in the 21st century. Finally, we suggest overarching trends that we believe are influencing directions for the field of child psy-chological assessment.

SYNOPSIS OF HISTORICAL EVENTS

Thorough and intriguing accounts of the historical underpinnings of psychological assessment and testing may be found in Gregory (2007), Kelley and Surbeck (2004), or Sattler (2008). From parental observations and assessment methods in antiquity, fast forward to the early 19th century, when Jean Marc Gaspard Itard, a physician and educator of children with deafness, wrote of his attempts to understand and intervene with Victor, the “Wild Boy of Aveyron” (Shattuck, 1994). Evidently, Victor lived on his own in the woods near Toulouse, France until perhaps age 12 years when he was discovered without verbal language and typical behavior. Itard’s detailed record in 1807, Reports on the Savage of Aveyron, described sys-tematic assessment and intervention methods to rehabilitate the social behavior and language development of this “feral child.”

Edouard Seguin, who studied with Itard, established the first education program for mentally retarded children in 1837 (Gregory, 2007; Sattler, 2008). He later designed the Seguin Form Board and continued his innovative and pioneering work with developmentally disabled individuals when he emigrated to the United States. Also in France, Jean-Étienne Dominique Esquirol in 1838 distinguished written definitions of mental retardation (idiocy) versus mental illness (dementia) and proposed specific diagnostic criteria for levels of mental retardation (Gregory, 2007; Sattler, 2008).

Other trailblazers in psychology focused primarily on assessment of adult mental processes. For example, Wilhelm Wundt, who founded the first psychology laboratory in Leipzieg, Germany in 1879, and Sir Francis Galton in Great Britain established precise, systematic assessments of psychophysiological and sensory experiences. In the United States dur-ing the late 1800s and early 1900s, psychologists such James McKeen Catell and Robert M. Yerkes instituted research and assessment methods applied to adult mental and intellectual abilities (Gregory, 2007; Sattler, 2008). However, Lightner Witmer’s “Psychological Clinic,” founded at the University of Pennsylvania in 1896, featured intensive case studies of

HISTORY, OVERVIEW, AND TRENDS IN CHILD 5

children—and some adults—from the Philadelphia community. Child cli-ents were assessed and treated by a multidisciplinary team using clinical and research-based methods (Cellucci & Heffer, 2001; McReynolds, 1996). In addition, Granville Stanely Hall, founder of the American Psychological Association in 1892, established the “child study movement” in the United States (Fagan & Wise, 1994), laying the groundwork for the development of child assessment as a subspecialty area.

The work of Itard, Seguin, and Esquirol and the methods established by adult-focused psychologists—along with the concomitant social changes of the time (Habenstein & Olson, 2001)—set the stage for the invention of the first intelligence test, to be used with children, by Alfred Binet and his col-leagues, published as the Binet-Simon Scale in 1905 (Gregory, 2007; Kelley & Surbeck, 2004). Due to laws regarding compulsory school attendance in both France and the United States, assessment methods were needed to identify levels of cognitive abilities and to predict success in various levels of education. In the United States in the early- to mid-1900s, psychologists such as Henry Herbert Goddard, E. L. Thorndike, Lewis M. Terman, Maud Merrill, Florence L. Goodenough, Arnold Gesell, Lucy Sprague Mitchell, and Psyche Cattell established scientific and practical aspects of child psychological assessment upon which current approaches are founded (Kelley & Surbeck, 2004; Sattler, 2008).

Following World War II, the evolution of standardized child assessment continued with the publishing in 1948 of R. G. Leiter’s Leiter International Performance Scale and in 1949 of David Weschler’s Weschler Intelligence Test for Children (Boake, 2002; Kelley & Surbeck, 2004). The Leiter was the first nonverbal, culturally fair test of intellectual abilities, most recently revised in 1997. Further readers will recognize that the WISC evidently “caught on,” because as of 2003, it is in its fourth revision, the WISC-IV. Similarly in 2003, the Simon-Binet Scale of 1905 morphed into its fifth revision as the Stanford-Binet Intelligence Scales-5. Presently, the concept of intelligence in children and methods for evaluating cognitive functioning have diversi-fied and become more intricate, reflecting the advance of child assessment regarding this complicated construct (Benson, 2003a,b,c; Sattler, 2008).

Based in part on developmental theorists’ work (e.g., Piaget, 1970, 1971) “the emphasis [in child assessment in the mid-1900s]:shifted from intelligence testing to the study of personality, social, and motoric factors related to general functioning” (Kelley & Surbeck, 2004, p. 6). For exam-ple, in 1959 Anton Brenner published his Brenner Developmental Gestalt Test of School Readiness to evaluate children’s preparedness for entering first grade. In 1961, the Illinois Test of Psycholinguistic Ability, in its third revision as of 2001, was published by S. A. Kirk and J. J. McCarthy as an individually administered test of language ability in children (Sattler, 2008). Over this time period, Edgar Doll (whose work spanned from 1912 to 1968) and colleagues used the Vineland Social Maturity Scales, first published in 1936 and revised in 2005 as the Vineland Adaptive Behavior Scales-II, to assess social, communication, and daily living skills in infants to older adults (Sattler, 2008).

Changes in education practices, United States federal laws, and society in general, gave rise from the 1960s to the 1980s to a range of standardized


tests of child cognitive abilities and development (Kelley & Surbeck, 2004). For example, in 1967 David Weschler published his downward extension of the WISC, the Weschler Preschool and Primary Scale of Intelligence (WPPSI). The WPPSI is in its third revision as of 2002. In 1969, Nancy Bayley published the Bayley Scales of Infant Development, which was revised as the Bayley-III in 2005. In addition, Dorothea McCarthy published her McCarthy Scales of Children’s Abilities (MSCA) in 1970/1972 (Sattler, 2008). The MSCA is a hybrid of intelligence and developmental tests that evaluates verbal, perceptual-performance, quantitative memory, and motor abilities in young children.

Assessment of child behavioral, emotional, and personality functioningblossomed in the 1990s, from its humble beginnings with Florence Good-enough’s Draw A Man Test in 1926 and subsequent permutations by John Buck in 1948 and Karen Machover in 1949. Specifically, in 1992 a version of the Minnesota Multiphasic Personality Inventory was designed and normed for 14- to 18-year-olds, the MMPI-Adolescent, by James Butcher and colleagues. Also in 1993, the Millon Adolescent Clinical Inventory (MACI) was published by Theodore Millon. Both the MMPI-A and the MACI continue to experience widespread use in research and applied settings as extensive, self-report measures of psychological functioning (Vance & Pumariega, 2001).

A welcome addition to the burgeoning body of literature on the Personality Assessment Inventory (PAI; Morey, 1991, 1996, 2003) is the PAI-Adolescent (Morey, 2007). Les Morey adapted the PAI-A for use with individuals aged 12 to 18 years and reported that it demonstrates comparable psychometric properties, practical strengths, and the solid theoretical foundation as its adult-normed predecessor. In addition, between 1998 and 2001, William Reynolds published a self-report measure for individuals aged 12 to 19 years, the Adolescent Psychopathology Scale (APS), that provides multidimensional assessment across a range of psychopathology, personality, and social-emotional problems and competencies (Reynolds, 1998a,b, 2000, 2001). Also between 1995 and 2001, David Lachar and colleagues introduced their revision of the Personality Inventory for Children (PIC-R), the Personality Inventory for Youth (PIY), and the Student Behavior Survey (SBS) as a comprehensive assessment system of psychological functioning of children and adolescents, based on self-, parent-, and teacher-report (Lachar, 2004).

During the late 20th century to the present, Thomas Achenbach and colleagues developed the Achenbach System of Empirically Based Assess-ment (ASEBA; Achenbach & Rescorla, 2000, 2001) and Cecil Reynolds and Randy Kamphaus developed the Behavior Assessment System for Children, 2nd Edition (BASC-2; Reynolds & Kamphaus, 2004). The 2003 version of the ASEBA and the 2004 version of the BASC-2 are exemplars of multido-main, multimethod, multi-informant assessment systems (Kazdin, 2005) for assessing childhood psychopathology and other domains of behavio-ral, emotional, and school-related functioning (Heffer & Oxman, 2003). For continuity in life-span research and applications into adulthood, the BASC-2 offers norms for persons aged 2 through 25 years and the ASEBA includes norms on persons aged 1.5 to 59 years.


At present, myriad child assessment methods have sprouted to address almost any psychological process or construct that the reader can imagine (Sattler, 2006), as evidenced by the chapters in this volume. For example, researchers and practitioners alike may find ample resources regarding assessing and screening preschoolers (Campbell, 2002; Nuttal, Romero, & Kalesnik, 1992); interviewing children, parents, and teachers and conducting behavioral observations (LaGreca, Kuttler, & Stone, 2001; Sattler, 1998); using a “therapeutic assessment approach” with children and adolescents (Handler, 2007); family functioning (Heffer, Lane, & Snyder, 2003; Heffer & Snyder, 1998; Snyder, Cavell, Heffer, & Mangrum, 1995); psychopathy in adolescence (Edens & Cahill, 2007); and evaluating quality of life (Varni, Limbers, & Burwinkle, 2007a; 2007b) and other child health/pediatric psychology issues (Rodrigue, Geffken, & Streisand, 2000). Child assessors may focus on school-based assessments (D’Amato, Fletcher-Janzen, & Reynolds, 2005; House, 2002; Shapiro & Kratochwill, 2000; Sheridan, 2005) or primarily clinical diagnostic or categorical evaluations (Kamphaus & Campbell, 2006; Rapoport & Ismond, 1996; Shaffer, Lucas, & Richters, 1999). In fact, even “comprehensive assessment-to-intervention systems” are modeled for child assessors who intend to link assessment to intervention to process/outcome evaluation (Schroeder & Gordon, 2002).

Assessment of child psychopathology and developmental disabilities certainly has come a long way from informal parental observations and case studies of feral children. We turn your attention next to an overview of the current state-of the-art in child assessment and then to trends for future directions of the field. Where we have been, where we are, and where we are going are the themes.

OVERVIEW OF “STATE-OF-THE ART” IN CHILD ASSESSMENT

Ethical–legal issues and requirements of education laws demarcate child assessment from adult assessment. Of course, professional standards and guidelines generated to promote competent and ethical psychological assessment and research apply equally to evaluations conducted with individuals across the life-span. However, unique characteristics central to child assessment create interesting “twists” for psychologists (Lefaivre, Chambers, & Fernandez, 2007; Melton, Ehrenreich, & Lyons, 2001). Furthermore, as the field of clinical child psychology continues to grow, so does the number of assessment tools available (Mash & Hunsley, 2005). Many of these tools serve to advance research in the broader field of child and adolescent clinical psychology, whereas a large number also become available assessment methods for use by practitioners and researchers. In this section, we describe some of the ethical and legal challenges in child assessment and proffer suggestions for managing such conundrums. Then, we review six “state-of-the-art” approaches in child assessment, several major issues to be considered in the use of such approaches, and a few trends in the resultant outcomes of these approaches to child assessment.


Professional Standards and Guidelines

Each reader should be keenly aware that psychology as a profession has historically paid considerable attention to defining and promoting ethical behavior and standards for professional behavior (American Psychological Association, 1950, 1953, 1959; Hobbs, 1951). For example, the most recent version of “The Code,” Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002a), provides aspi-rational goals and prescriptive directives regarding a range of research, assessment, intervention, teaching/training, consultation, and business activities of psychologists. Furthermore, the APA’s Record Keeping Guide-lines (American Psychological Association Committee on Professional Practice and Standards, 1993) have application to both child-focused and adult-focused practitioners and trainers of clinical, counseling, or school psychologists.

Other documents have been published specifically to guide profes-sional activities and promote standards for psychological assessment and use of psychological tests. Examples of these documents include Stand-ards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 1999), Code for Fair Testing Prac-tices (American Psychological Association, 2003), Code of Fair Testing Practices in Education (National Council on Measurement in Education, 2004), and Guidelines for Test User Qualifications (American Psychological Association, 2000; Turner, DeMers, Fox, & Reed, 2001).

Similar documents elaborate on particular aspects of competent assessment such as Guidelines for Computer-Based Test and Interpreta-tions (American Psychological Association, 1986), Psychological Testing on the Internet (Naglieri et al., 2004), Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (American Psychological Association, 1990), Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (American Psychological Association, 2002b), Statement on Disclosure of Test Data (American Psychological Association Committee on Psychological Tests and Assessment, 1996), and Rights and Responsibilities of Test Takers: Guidelines and Expectations (American Psychological Association Joint Committee on Testing Practices, 1998).

At least one professional guidelines document specific to child assess-ment is Guidelines for Child Custody Evaluations in Divorce (American Psy-chological Association Committee on Professional Practice and Standards, 1994). Additional information about psychological tests and testing as a practice and research enterprise may be viewed at http://www.apa.org/science/testing.html.

Interplay of Ethical and Legal/Forensic Issues

Most psychologists understand that ethical and competent profes-sional behavior ideally is completely compatible with legal behavior. How-ever, from time to time a dynamic tension erupts when a given state law,


for example, creates a dilemma for a child assessor (Anderten, Staulcup, & Grisso, 2003). Evaluation of children evokes unique developmental, systems, and ethical issues that may inconsistently seem congruent with what a given law requires (Heffer & Oxman, 2003). The chronological age of the child, his or her developmental/cognitive capacity, the fam-ily, school, and/or medical system that is requesting the evaluation, and the purposes for which the evaluation will be used may evoke compli-cated problem-solving to balance ethical and legal expectations (Rae & Fournier, 1999). For example, issues of assent and consent for services, confidentiality of communications and records, consulting with extra-family systems (e.g., school or medical personnel), and state abuse reporting laws distinguish child assessment from adult assessment.

Ethical–legal challenges in child assessment abound, which make it such an exhilarating enterprise. Psychologists currently have resources to assist as they wrestle with ethical delimmas. Of course, we already have provided a number of references for professional standards and ethical behavior for psychologists. In addition, publications such as Bersoff (2003), Fisher (2003), and Nagy (2003) allow psychologists to “flesh out” issues that emanate from application of the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002a). Furthermore, publications often exist that elucidate mental health laws specific to a given state. For example, Hays, Sutter, and McPherson (2002) and Shuman (2004) provide such references for psychologists in Texas.

For psychologists involved in service delivery roles, current informa-tion regarding the Health Insurance Portability and Accountability Acts (HIPPA) of 1996 (Bersoff, 2003) may be viewed at http://www.apapractice.org/apo/hipaa/get_hipaa_compliant.html#. Effectively navigating child assessment activities in the schools vis-à-vis the Individuals with Disabil-ities Education Improvement Act of 2004 (National Association of School Psychologists, 2007) may be facilitated by information at http://www.ed.gov/about/offices/list/osers/osep/index.html or http://nasponline.org/advocacy/IDEAinformation.aspx. Other resources are explicit to forensic evaluations of children or other evaluative activities that may interface with the legal system (American Psychological Association Com-mittee on Psychological Tests and Assessment, 1996; Schacht, 2001; Schaffer, 2001).

Assessment Approaches

Although we do not include an exhaustive list of current and exemplary assessment approaches, we do highlight six recent and important advances in child assessment. First, the evolution of our understanding of brain and behavior relationships has been mirrored by growth in neuropsychological assessment (Williams & Boll, 1997). Once used primarily for understand-ing significant psychopathology and traumatic brain injury, neuropsycho-logical assessment is now increasingly utilized to better disclose subtle differences in children presenting with a range of disorders, including Attention-Deficit/Hyperactivity Disorders (ADHD) and learning disabilities


(Williams & Boll, 1997). Neuropsychological assessment instruments are well suited to meet these increasing demands as the field of neuropsychology continues to assimilate knowledge from other disciplines, including those pertinent to child assessment, such as developmental psychology (Williams & Boll, 1997).

Furthermore, input from other fields has allowed the application of previously adult-oriented neuropsychological techniques to be more readily applied to child populations (Korkman, 1999), thus leading to the expan-sion of child-specific neuropsychological test batteries. Such batteries range from focusing on a circumscribed area of neuropsychological func-tioning, such as the Children’s Memory Scale (Cohen, 1997), to encom-passing a comprehensive neuropsychological examination that can be tailored to the client’s needs, such as the NEPSY-II (Korkman, Kirk, & Kemp, 2007). A complete neuropsychological evaluation certainly is not implicated for every child referral.

However, the availability of these tools and the tremendous expansion of the subdiscipline of clinical neuropsychology (Heilbronner, 2007) provide abundant opportunities to employ these state-of-the-art approaches when indicated. Whereas neuropsychological assessment can provide informa-tion linking brain functioning and a child’s behavior, conceptualizing the child within a broader, contextually based framework is imperative (Heffer, Lane, & Snyder, 2003). As such, a second progression in child assessment has been the inclusion of an ecological/systems approach in the process (Dishion & Stormshak, 2007; Mash & Hunsley, 2005).

Data from a broader perspective better informs assessment and can be integral to treatment planning. Thus, assessment approaches should seek an understanding of not only the individual child’s functioning but also should assess domains of influence on the child, such as the parent–child dyad, broader family context, peer relations, school and academic func-tioning, and domains of influence on the family itself, such as life stress, community resources, or medical involvement (Brown, 2004; Dishion & Stormshak, 2007; Mash & Hunsley, 2005; Roberts, 2003). Although con-text affects functioning at any age, children are particularly dependent on external regulatory systems and are more strongly influenced by context than are adults (Carter, Briggs-Gowan, & Davis, 2004). Furthermore, parent–child interactions are often reciprocal in nature, with certain parenting behaviors and other characteristics of the parent serving as either risk or protective factors for the child’s functioning (Carter et al., 2004). Hence, it is critical to understand the child’s functioning within a contextual frame-work, especially given that such understanding can inform treatment deci-sions (Dishion & Stormshak, 2007).

Whereas both neuropsychological assessment and ecological/systems assessment broaden the amount of data gleaned about a child, a third trend in current assessment approaches allows for more specific, objective measurement in the assessment of individual childhood disorders (Mash & Hunsley, 2005). Fueled largely by the popularity of the use of time-efficient and cost-effective behavior rating scales in the assessment process (Kamphaus, Petoskey, & Rowe, 2000), this problem-focused assessment approach is particularly attractive to cost-focused healthcare systems that


require practical symptom-based assessment, which lends itself to con-tinuous monitoring of outcomes (Mash & Hunsley, 2005). Furthermore, a problem-focused approach to assessment fits cohesively with research on both assessment and treatment of disorders and can allow the practitioner or researcher to map symptoms directly on to DSM-IV-TR criteria (Mash & Hunsley, 2005). Indeed, although omnibus ratings scales, such as the ASEBA (Achenbach & Rescorla, 2000, 2001) and BASC-2 (Reynolds & Kamphaus, 2004) will likely remain effective in years to come, tremendous growth in specialized or more problem-specific measures for childhood disorders is occurring. Both research and practice have moved toward the use of brief problem/disorder-specific measures and batteries (Mash & Hunsley, 2005).

Nevertheless, comorbidity in child functioning must be considered because target problems are often quite heterogeneous (Achenbach, 2005; Kazdin, 2005). A fourth approach to child assessment, building steadily over the past few decades, is multidomain, multimethod, multi-informant assessment techniques (Kazdin, 2005). Given the wide utility of assess-ment, the heterogeneity of functioning, and the rates of comorbidity among disorders, consideration of multiple domains in the assessment of child functioning is indispensable (Kazdin, 2005). Even if the presenting prob-lem is specific and narrowly defined, evaluating multiple domains to ascer-tain a comprehensive representation of the child is important. Domains may include not only dysfunction, but also how well a child is perform-ing in prosocial adaptive areas (Kazdin, 2005). Thus, any state-of-the-art assessment of a child should incorporate evaluation of multiple domains of functioning, based on multiple sources of information, using multiple assessment methods/measures (Kazdin, 2005).

Because any one measure likely fails to capture the entirety of a clinical concern, it is imperative that child assessment include multiple measures. In addition, even within the same mode of assessment (e.g., behavioral rat-ing forms), practitioners and researchers may use various instruments to better gauge the complexities of a given problem. For example, a referral to evaluate for ADHD may include completion of parent, teacher, and child rating forms assessing for behavioral symptoms of inattention, hyperac-tivity, and impulsivity (e.g., BASC-2, Reynolds & Kamphaus, 2004), atten-tional difficulties (e.g., Conner Rating Scales-Revised, Conners, 2001a), and, at a more broad level, cognitive aspects of the problem (e.g., Behavior Rating Inventory for Executive Function, BRIEF; Gioia, Isquith, Guy, & Ken-worthy, 2000). Likewise, different modes of assessment for the same clini-cal problem—such as use of a continuous performance test to measure sustained attention and behavior rating forms to assess “real life” atten-tion problems—yield richer data than either mode alone.

Finally, assessment of a child’s functioning based on multiple inform-ants (e.g., parents, other caregivers, teachers, practitioners, self-report) is critical, given that each informant adds a unique perspective and captures variations across settings (Achenbach, 2005; Kazdin, 2005). The need for multi-informant assessment is underscored by a lack of uniform agree-ment commonly found among various raters of child social, emotional, and behavioral functioning (Kamphaus & Frick, 2005). In addition, some


childhood disorders (e.g., ADHD) require documentation of impairment across more than one setting (American Psychiatric Association, 2000).

Fifth, functional assessment, including experimental functional analysis, has made robust advances in child assessment (Matson & Minshawi, 2007). These procedures, which allow antecedents, measurable actions, consequences, and contextual variables of child behavior to be evalu-ated in controlled settings, inform individualized interventions. Functional assessment and analysis approaches are becoming even more prevalent in applied settings (Horner, 1994; Matson & Minshawi, 2007), includ-ing homes (Moes & Frea, 2002), schools (Watson, Ray, Turner, & Logan, 1999), residential care settings (Field, Nash, Handwerk, Friman, 2004), and medical rehabilitation centers (Long, Blackman, Farrell, Smolkin, & Conaway, 2005), among others.

Through these procedures, environmental variables can be manipulated, which can further inform the practitioner of the function of target behaviors and, thus, identify what may be causing or maintaining an unwanted behav-ior (Watson et al., 1999). Furthermore, functional assessment and analysis link directly to intervention, which typically involves manipulation of envi-ronmental variables identified through the assessment (Watson et al., 1999). That is, the intervention can focus not only the behavior itself but also its function in an effort to improve treatment efficacy (Horner, 1994).

Functional assessment has widely been implemented with children with developmental disabilities, such as intellectual disabilities (Swender, Matson, Mayville, Gonzalez, & McDowell, 2006) and autism spectrum dis-orders (Moes & Frea, 2002). In addition, these procedures are increasingly used to assess children presenting with a range of other concerns, such as ADHD (Stahr, Cushing, Lane, & Fox, 2006), behavioral and academic problems (Kamps, Wendland, & Culpepper, 2006), and primary pediatric problems, for example, acquired brain injury (Long et al., 2005).

Sixth and finally, with progression in the field of child assessment and corresponding research, state-of-the-art assessment will need to embrace—or at least come to terms with—evidence-based practices. Whereas applied child psychology has long focused on evidence-based treatments (EBT) for childhood disorders, only recently has an emphasis been placed on evidence-based assessment (EBA; Mash & Hunsley, 2005). EBA is used to describe “assessment methods and processes that are based on empirical evidence in terms of both their reliability and validity as well as their clinical usefulness for prescribed populations and purposes” (Mash & Hunsley, 2005, p. 364).

In short, an EBA battery should be specific to the presenting prob-lem and should provide incremental validity in measuring the presenting problem and its associated symptoms. That is, a measure included in an EBA battery should help predict the set of target behaviors and symptoms above and beyond that already assessed by other measures included in the battery (Mash & Hunsley, 2005).

Finally, EBAs should aid the practitioner in forming a case conceptu-alization, determining a DSM–IV–TR diagnosis, and generating subsequent treatment recommendations (Mash & Hunsley, 2005). These goals help to evaluate whether a given assessment meets the qualifications for EBA. That is, it is these purposes of assessment that distinguish EBA simply


from a measure that demonstrates evidence of its psychometric properties and usefulness (Kazdin, 2005).

This final assessment approach is one that should sustain continued attention and interest for many years to come, because development of clear guidelines and policies to conduct EBA for specific disorders is greatly needed (Mash & Hunsley, 2005). It is complicated, however, in that no “gold standard” exists by which to validate assessments (Kazdin, 2005, p. 548). Efforts, however, have begun to establish EBA guidelines for myriad child and adolescent disorders, including anxiety (Silverman & Ollendick, 2005), depression (Klein, Dougherty, & Olino, 2005), bipolar disorder (Youngstrom, Findling, Youngstrom, & Calabrese, 2005), ADHD (Pelham, Fabiano, & Massetti, 2005), conduct problems (McMahon & Frick, 2005), and learning disabilities (Fletcher, Francis, & Morris, 2005), among others.

EBA should take into consideration key demographic characteristics of the child (e.g., gender, ethnicity, age) that may influence performance on a given measure, as well as to adequately evaluate both primary and sec-ondary targets of assessment, particularly given the high rates of comor-bidity among disorders (Kazdin, 2005; Mash & Hunsley, 2005).

Further development of EBA guidelines will need to balance being comprehensive but also flexible to meet the assortment of purposes of applied and research assessment, including case conceptualization, early identification, prognostic predictions, and treatment planning, monitor-ing, and evaluation (Kazdin, 2005; Mash & Hunsley, 2005). Likewise, other assessment parameters, such as the optimal amount and duration of assessment and the need for follow-up assessment, will require atten-tion in future EBA research (Mash & Hunsley, 2005).

Issues in the Implementation of Child Assessment Approaches

When conducting child assessment, it is insufficient solely to imple-ment a state-of-the-art approach. Child assessors must also consider important issues that influence the assessment process. Interpretations of assessment data must be filtered accordingly. Although an exhaustive list of implementation issues is beyond the scope of this chapter, four key issues are highlighted. First, an individual child must be assessed within the context of broader developmental theory, taking into account both the continuities and discontinuities of development (Achenbach, 2005). Indeed, the subdiscipline of developmental psychopathology has exerted tremendous influence in how a child assessor formulates child psychopa-thology and disability within a developmental framework (Yule, 1993).

A second contextual issue that may affect a given child’s psychological functioning involves health and medical conditions. Increasingly since the late 1960s, psychologists with interests and training in working with children and families have developed innovative assessment and intervention strat-egies to serve families challenged by pediatric chronic illness and disabil-ity (Spirito & Kazak, 2006). Since Logan Wright’s (1967) seminal article defined the pediatric psychologist as a unique subspecialty within applied psychology, the field of pediatric psychology or child health psychology has


expanded to include greater numbers of scientist-practitioners, who are working in a larger variety of settings (Goreczny & Hersen, 1999).

Assessing children who experience acute illness, developmental delay or disability, or catastrophic, life-threatening injury or disease requires an appreciation for challenging life circumstances and a developmental and ecological/systems approach (Brown, 2004; Roberts, 2003). For example, understanding and operating effectively as a child assessor in a medical care system is a must for pediatric or child health psychologists (Drotar, 1995). Central features affecting the professional role of a pediatric psy-chologist include: (a) service provision and research depend strongly on collaboration among psychologists and physicians, (b) the families and children served typically are not psychiatrically disordered, and (c) assess-ment and intervention strategies are family-focused. Becoming familiar with the experiences of medically involved and developmentally disabled children and their families equips the savvy child assessor to place assess-ment data in its appropriate ecological context (Fletcher-Janzen & Rey-nolds, 2003; Graziano, 2002).

Third, throughout the assessment process, child practitioners and researchers must take into account the role of cultural and ethnicity vari-ables (Achenbach, 2005). Many practical considerations of assessing a child from a different cultural and/or linguistic background are reviewed later in this chapter. However, at a broader level, individual differences within the context of cultural and ethnic diversity, even among subcul-tures within the United States, should be infused into every step of the assessment process (Canino & Spurlock, 2000; Gopaul-McNicol & Tho-mas-Presswood, 1998). It is also important to recognize that this process is especially intricate because “culture” is dynamic and often changes in response to other demands and needs for adaptation (Carter et al., 2004). The importance of considering diversity cannot be overstated; indeed, cul-ture and ethnicity may not only be considered as possible subtle influ-ences, but also may have major impact on assessment decisions, such as cut-points in EBA (Achenbach, 2005).

Fourth and lastly, improvements in assessment have resulted in earlier identification, and subsequent treatment, of problems in childhood (Carter et al., 2004). Early identification follows directly from advances in devel-opmental psychopathology research, which allows us to understand the complexities of teasing apart psychopathology from typical developmen-tal processes. Such research has also identified trajectories for various developmental processes and how early onset of problems differs from problems with a later onset. One example is the well-established differ-ences between childhood-onset and adolescent-onset Conduct Disorder, the former of which is preceded by an early onset of aggression and irri-tability and often a previous diagnosis of Oppositional Defiant Disorder (Loeber, 1990). Early identification also has been aided by the expansion of standardized, norm-referenced measures for younger populations. Many child and adolescent instruments have been downwardly extended for use with younger ages and it is becoming common for newly developed meas-ures to include a preschool version, such as the BRIEF-Preschool Version (BRIEF-P; Gioia et al., 2000).


Nevertheless, early identification of child psychopathology faces many challenges, including rapid developmental shifts in very young children’s functioning and abilities, as well as the hesitance of many practitioners or parents to label young children with a psychological diagnosis (Carter et al., 2004). Yet, the preponderance of literature suggests that psychological problems in young children are typically not transient and are usually associated with a continuation of later problems, underscoring the impor-tance of early identification (Briggs-Gowan, Carter, Bosson-Heenan, Guyer, & Horwitz, 2006).

Trends in Child Assessment

We have overviewed a historical perspective and issues germane to the current state-of-the art in child assessment. Now, we direct the reader to our peering into the “crystal ball” of the future for assessing children within their ecological context. Where will our Delorean take us … to new horizons or back to the future? We suggest three trends for the upcoming road-trip of child assessment: (a) the use of technology in assessment administration and scoring/interpretation, (b) the impact of taxometric statistical tech-niques on diagnoses, and (c) cultural/linguistic considerations.

Use of Technology in Child Assessment Administration

For the past few decades, computer technology has affected several aspects of assessment practices including test administration and scor-ing/interpretation of test results. With ever-changing and improving technology and security concerns, research has begun to consider these impacts on psychological assessment. Software has been developed for a number of assessment instruments to allow computerized self-adminis-tration. For example, the Parenting Stress Index -3rd Edition (PSI-3; Abidin, 1995), the ASEBA (Achenbach & Rescorla, 2000, 2001), and the MMPI-A (Butcher et al., 1992) are measures of emotional–behavioral functioning that can be answered at a computer by parents, children, or teachers. In addition, a majority of continuous performance tests for the diagnosis of problems with inattention and impulsivity are computerized, such as the Conner’s Kiddie Continuous Performance Test (Conners, 2001b), the Test of Variables of Attention (TOVA; visual version) and TOVA-A (auditory version; Greenberg, Leark, Dupuy, Corman, & Kindschi, 2005), and the Wisconsin Card Sorting Test: Computer version 4 (Heaton, 2005).

Several authors have discussed advantages of computerized admin-istration, such as cost effectiveness (Rew, Horner, Riesch, & Caurin, 2004), increased speed of administration and scoring (Singleton, Horne, & Thomas, 1999), and precise response times for timed subtests (Luciana, 2003). From a data collection perspective of the practitioner or researcher Rew and colleagues (2004) suggested that computerized administration avoids certain assessment process problems possible with paper and pen-cil methods, such as marking two responses to an item or skipping an item in error. Computerized versions of tests of achievement, cognition, and comprehensive neuropsychological functioning are less common and


likely will remain so (Camara, Nathan, & Puente, 2000; Mollica, Maruff, Collie, & Vance, 2005). Comprehensive and frequently used assessments, such as the WISC-IV, WPPSI-III, NEPSY-II, or the Woodcock-Johnson Tests of Achievement (Woodcock, McGrew, & Mather, 2007) are developed strictly for face-to-face administrations, replete with opportunities for informative behavioral observations.

Only a few studies have evaluated computerized measures of achieve-ment, intellectual, and neuropsychological tasks. For example, Single-ton et al. (1999) studied computerized assessment of mathematics ability and literacy and reported good psychometric properties of the computer-ized version as well as a moderate to good relation with literacy scores obtained by traditional methods 12 months later. Hargreaves, Shorrocks-Taylor, Swinnerton, Tait, and Threlfall (2004) likewise studied compu-terized assessment of children’s mathematics ability and demonstrated similar scores on a computerized version and a traditional pencil and paper test. Luciana (2003) noted strong psychometric properties of the Cambridge Neuropsychological Testing Automated Battery (CANTAB; http://www.cantab.com) in a pediatric sample. Although Luciana (2003) stated that the use of the CANTAB does not replace a human assessor in neuropsychological testing, the use of the computerized assessment does allow for excellent standardization procedures that are not confounded by administrator influences.

Computer-Assisted Survey Interviewing (CASI) is a trendy application of computer administration for interviewing that may be applied to child assessment. CASI allows for presentation of all items in a measure or an altered presentation based on a decision tree formula to prompt follow-up information if a certain item is endorsed. Use of CASI provides a standardized presentation of items and preliminary background information and evaluation data, which then allows for face-to-face follow-up with a human assessor to refine the interview regarding specific areas of concern (McCullough & Miller, 2003).

CASI users report less embarrassment and discomfort with the computer-administered interviews compared to face-to-face interviews, especially if sensitive topics are covered, such as sexual behavior, drug/alcohol/sub-stance use, or health-risk behaviors (McCullough & Miller, 2003; Newman, et al., 2002). Romer et al. (1997) demonstrated that adolescents reported more sexual experience and more favorable responses toward sex, after controlling for reported experience, on a computerized survey than when interviewed face-to-face. Davies and Morgan (2005) reported that the use of CASI designed for “vulnerable” youths in foster care provided a sense of empowerment and confidence to express their ideas, opinions, and concerns about foster home placements. In addition, Rew and colleagues (2004) used headphones to present an audio recording of items and also presented items visually in words on a computer screen, which allowed for non-English speakers and children with lower reading skills to participate. Valla, Bergeron, and Smolla (2000) also considered the issue of potential reading difficulty among young children and devised a diagnostic com-puterized interview with pictures and audio in different languages. They reported adequate to good psychometric properties for methods in which the interview was presented pictorially and aurally.


Several studies suggest that children prefer a computerized admin-istration format over a face-to-face interview with an adult. In an evalua-tion of a program applied to forensic interviewing, children reported that they preferred the computerized interactive interview over the face-to-face interview (Powell, Wilson, & Hasty, 2002). Children may prefer the novel—or now more familiar to many children—medium to gather information. In particular, the use of animation and graphics may be a more entertaining method of collecting information relative to an adult interview.

Research findings do not, however, suggest universally positive outcomes of computerized administration of interviews. Connolly (2005) reported that face-to-face interviews elicited more statements that were also selected by participants for further discussion in later sessions. Although Connolly suggested that games and questionnaires often included in computer-assisted interviews might aid in increasing rapport, “They do not replace the need for direct communication with professionals” (p. 412).

Another CASI, designed to measure children’s recall of a classroom event, found that most children reported correct responses on recall and were equally verbose in responses to the computer and to an adult inter-viewer (Donohue et al., 1999). This recall task also tested the children’s reporting of a “secret” that occurred during the event. Children did not report the secret more frequently on the computer than with the adult, suggesting that the use of the computer may not create a more comfort-able milieu in which to discuss sensitive or personal topics.

Use of Technology in Child Assessment Scoring and Interpretation

More frequently utilized by child assessors—compared to computer administration software—are desktop software or online scoring and inter-pretation services for many types of assessment (e.g., achievement, cog-nitive, neuropsychological, behavior, social–emotional). Computer-based test interpretation (CBTI) generally includes programs that use actuar-ial assessment programs, based on statistical equations, and automated assessment programs. CBTI reports are generated using an “if-then” for-mula by expert practitioners based on research and experience (Lichten-berger, 2006). Authors have recently noted several important benefits and limitations with CBTI, which predict a further expansion and adaptation of their use in the future.

One advantage of CBTI is the immediacy of receiving data both for individual clients as well as for group data used in research (Davies & Morgan, 2005). These software programs operate very quickly in compari-son to personally calculating and looking up scores in tables and manu-als. In addition to speed of data availability, the use of CBTI may increase divergent thinking about alternative assessment hypotheses and provide “virtual access to expert practitioners,” who wrote the software reports (Harvey & Carlson, 2003, p. 99). In addition, Snyder (2000) offered a sum-mary of benefits from existing literature, including reduction of errors in scoring, minimization of a practitioner’s subjectivity or bias in an interpre-tation, and the ability to store entered information for later research use.


In spite of these benefits, authors have noted several important limi-tations to using CBTI. First, results produced by CBTI should be detailed enough to have already ruled out several hypotheses, but still be inclusive of possible hypotheses. In a review of several studies, Butcher, Perry, and Atlis (2000) concluded that CBTI reports are similar to results derived from a practitioner. However, CBTI reports should include a level of spe-cificity and detail to avoid the Barnum Effect of giving overly generalizable descriptions that could apply to many people in general. This effect, they report, stems from a line of literature suggesting that people are more likely to report higher levels of accuracy with statements that are nonspe-cific, especially if those statements are given by an authority figure.

A second major limitation to the use of CBTI is variable validity and reliability evidence to support computer-generated interpretations. Garb (2000) noted that writers of the interpretive reports generated by computers do not always collect criterion information to empirically influence results. He argued that interpretations may come from clinical experience, rather than research findings, to make predictions about behavioral outcomes and generate hypotheses. Also, CBTI reports should be scrutinized for the validity of their report, for example, regarding the comparison group used by the software program and relevant demographic characteristics. Such demographic information may include cultural, linguistic, and economic variables, which are not always accounted for in the computer-generated interpretations (Butcher, et al., 2000, McCullough & Miller, 2003; More-land, 1985; Snyder, 2000; Harvey & Carlson, 2003).

A lack of psychometric data for many CBTI applications calls into ques-tion the trustworthiness of the interpretation for some clinical or research uses. Therefore, proper caution and study is imperative before accepting the results of a given CBTI report. For a more detailed review of validity and reliability issues related to CBTI, please see Snyder (2000).

Both Garb (2000) and Lichtenberger (2006) provided recommenda-tions for CBTI software. Garb (2000) asserted that computer-generated reports are not inappropriate to use, but suggested several recommen-dations to improve a system of CBTI. For example, information with the highest validity should be considered initially for statistical predictions. In addition, statistical-prediction rules can improve with more collection of criterion information, such as behavior sampling, other psychological testing, and structured interviewing. Lichtenberger (2006) suggested find-ing an optimal balance between practitioners’ need for efficiency due to time limitations and their reliance on CBTI reports. She recommends four considerations for practitioners as they evaluate narrative summaries pro-vided by CBTI to create a psychological report:

1. When evaluating all major hypotheses in a CBTI narrative consider additional data collected for evidence that might support or refute the CBTI hypothesis.

2. Consider alternate hypotheses in addition to those presented in the CBTI narrative. As in Step 1, determine if other evidence from the assessment supports or refutes hypotheses.

3. Review written notes from the assessment and clinical interview to avoid reliance on personal memory, which is subject to bias.


4. When available, use computer-based programs or other prediction formulas to evaluate additional data collected during the assess-ment that was not considered in the CBTI narrative (Lichtenberger, 2006, pp.27–28).

Lichtenberger (2006) adds that although computer-generated reports can provide important information, the human assessor must respect the uniqueness of the person being evaluated and her or his situation and consider all variables in generating—or concluding about—hypotheses.

Most research suggests a clear trend toward the use of CBTI and tech-nological advances in computerized scoring and interpretation of data. Many potential benefits exist, but proper education about the validity and reliability of these programs is crucial to accurate assessment. In particu-lar, compared to adult-focused assessment, even less is known about CBTI for frequently used child assessment measures. An important direction for future research will be the adaptation of computerized assessments with children and the continuing evaluation of the scoring and interpretation programs for child assessment measures.

Influence of Taxometric Statistical Techniques on Diagnoses

Taxometric research examines the discrete, rather than the continu-ous, nature of a trait or psychological disorder (Meehl, 1995). Meehl (1995) discovered a particular taxon, schizotaxia, which led to the diagnosis of schizophrenia in a certain subset of people evaluated.

Although Meehl’s methods have experienced limited application in child assessment research, Beauchaine (2003) noted three important areas for future taxometric research. First, taxometrics could be useful in the early identification of children at risk for psychopathology. For example, studies have demonstrated links of family history of psychiatric symptoms and a temperament trait of behavioral reactivity as indicators of psychopathology later in childhood or adulthood.

For example, Woodward, Lenzenweger, Kagen, Snidman, and Arcus (2000) reported a High Reactivity (HR) taxon in young infants that showed qualitative differences measured by time spent crying, back arching, hyperextension of limbs, and leg movements. Later behavioral differences (e.g., smiling less, and less spontaneous comments to an unfamiliar adult) at 4.5 years were found for infants who were classified in the HR taxon. An empirical determination of these taxa could aid in early intervention tech-niques to target the onset and severity of a possible psychological disorder in a person’s developmental history.

Second, taxometric research could aid in determining subtypes of cur-rent diagnoses, such as childhood-onset and adolescent-onset depression. Another example might involve the nature of Autistic Disorder, Pervasive Developmental Disorder, and Asperger’s Disorder as discrete diagnoses versus a continuum known as Autism Spectrum Disorders with various subtypes. An additional example might include further empirical validation of the discreteness of the three subtypes of Attention-Deficit/Hyperactivity Disorder, in particular distinctions between ADHD, Combined Type and ADHD, Predominately Inattentive Type. Two groups of researchers have


reported a rejection of a categorical representation of the core symptoms of ADHD (Frazier, Youngstrom, & Angle, 2007; Haslam, Williams, Prior, Haslam, Graetz, & Sawyer, 2006); however, further research is still needed to replicate these findings. Taxometric research may also clarify variations over the past several decades in the use of diagnoses such as childhood schizophrenia, childhood psychosis, and childhood bipolar disorder.

Lastly, Beauchaine (2003) noted that adult research has demonstrated discrete taxa for schizotypy, dissociative experiences, and psychopathology. However, he argued that currently the research literature is insufficient to determine the viability of a sensitive period when these traits first emerge. Although very few taxometric studies have been completed with children, two studies demonstrated the presence of taxa related to antisocial behavior based on self-report measures. These taxa indicated broad, long-term antisocial behavior as well as psychopathy (Skilling, Quinsey, & Craig, 2001; Vasey, Kotov, Frick, & Loney, 2005). Taxometic research could elucidate time periods in development for these emerging traits, with benefits being earlier, more effective, and more precisely tailored interventions.

Cultural/Linguistic Considerations in Child Assessment

An important trend in the best practices of assessment involves research and resources regarding assessment of a child who is bilingual and/or has limited English proficiency. One assessment approach with these children, especially those from different cultures or who speak Eng-lish as a second language, has been to translate versions of the assessment instrument in a child’s first language or to complete the English version assessment with an interpreter present. Valencia and Suzuki (2001) and Kamphaus (1993) argued these translations/interpretations may produce assessments that are not clear in the second language (poorly translated/interpreted), may measure different constructs than the English version, and may not consider or provide appropriate regional dialects for various languages. Most importantly, newly constructed assessments—even if they are translations from English versions—should still be held to the rigor of psychometric evaluation. One may not assume that a translated version demonstrates the same psychometric properties of the English version. In addition, Fives and Flanagan (2002) asserted that although several of the well-studied, verbal intelligence tests have demonstrated limited test bias for special populations even in translated forms, intelligence testing with populations of limited communication abilities may yield more a measure of English proficiency than intelligence per se.

Current recommendations for assessing multilingual children are addressed by Ochoa (2003). For academic achievement assessment, child assessors are encouraged to use multiple methods of alternative assess-ment, such as school records, observations, performance assessments, and samples of the child’s work or portfolio. For intellectual assessment, Ochoa (2003) suggests that current standardized measures of intelligence (e.g., WISC-IV; Wechsler, 2003), frequently given in English, should only be


administered if the student demonstrates an acceptable Cognitive Academic Language Proficiency (CALP) in English.

Alternatives to verbally loaded intellectual assessment are tests of nonverbal intelligence, such as the Universal Nonverbal Intelligence Test (Bracken & McCallum, 1998) and the Leiter International Performance Scale-Revised (Roid & Miller, 2002), which focus on less verbally loaded, performance-based assessment. Proponents (e.g., Bracken & Naglieri, 2003; McCallum, Bracken, & Wasserman, 2001; Naglieri, 2003; Roid, Nellis, & McLellan 2003) of nonverbal measures of cognitive abilities argue that a de-emphasis on verbally loaded directions and items creates tests appropriate for special populations who may not understand spoken language or be able to use verbal communication. In addition, these assessments are judged to be less culturally weighted because they use universal pictorial images in items and universal signs of nonverbal communication (e.g., shaking head from side to side to indicate a negative response or “no”) in directions.

However, a major weakness for some of these nonverbal tests is that although the participant may respond nonverbally to the task, the directions—and sometimes the items—are administered verbally, meaning receptive language is necessary for understanding the task. For children who have learned English as a second language or who are hearing- or speech-impaired, the validity of obtained scores may be questionable because the verbal directions were not clear to the child. Such assessment practices may result in misdiagnosis or inappropriate placement into certain service or education programs (Fives & Flanagan, 2002; McCallum et al., 2001; Valencia & Suzuki, 2001). In addition, some controversy exists regarding the nature of intellectual abilities measured by these nonverbal tests. Some researchers argue that these instruments measure a separate construct known as nonverbal intelligence or nonverbal abilities (Kamphaus, 1993; McCallum, et al., 2001). However, other researchers argue that whether tested verbally or nonverbally (or with both methods) measures of intelligence tap into the same general ability (Naglieri, 2003). This trend in intellectual assessment will likely continue in a controversial fashion.

Another trend in the assessment of bilingual children is the creation of the Bilingual Verbal Ability Test (BVAT; Munoz-Sandoval, Cummins, Alvar-ado, & Reuf, 1998). The BVAT incorporates three subtests of verbal abil-ity that are first administered in English. Items answered incorrectly are later presented in the child’s native language, with credit being earned if the child correctly answers the item. The combined score yields a measure of bilingual verbal ability. In addition to this score, the BVAT can be used to obtain a CALP and an aptitude score that can be compared to collected measures of achievement (Rhodes, Ochoa, & Ortiz, 2005). However, continued research regarding the psychometric properties of the BVAT is needed. Interested readers in this trend are encouraged to review Bracken (2004), Barona and Garcia (1990), Tho-mas and Grimes (1990), and Rhodes et al. (2005). Cultural competence of child assessors clearly will be emphasized for some time to come (Ecklund & Johnson, 2007)


EPILOGUE

Continuing research into the development of childhood disorders will shed light on future versions of the Diagnostic and Statistical Manual–IV–TR (American Psychiatric Association, 2000) and on less diagnosis-focused assessment (Kamphaus & Campbell, 2006). Of course a goal of such research will be to enhance the accuracy, utility, and predictive quality of assessment of child psychopathology and developmental disabilities. The future of child assessment seems bright, indeed. Certainly, the chapters that follow in this volume will shine and illuminate your path as a child assessor.

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assessing childhood psychopathology and developmental...

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