The word nebulous
might indeed be applied to our thinking when psychological testing is mooted
for anyone, especially a child.  The
then-president of the APA, Dr J D Matarazzo gave his plenary address on the
topic.  Drawing on his years of
research, Dr Matarazzo cautioned psychologists to heed the fact that
intra-subtest scatter was a feature of normal presentations, not pathological
necessarily; he noted that despite the face value of tests, the construct
validity, standard error of measurement, ecological validity, other statistical
aspects, all have to be considered when, despite the science involved, a
subjective component would have to be added to the final report.

Kevin Walsh, writing of gnomes we
should know, noted that so much of the interpretation of tests was a matter of
inference and what you test depends on what you know.  Don Stuss, in 1987, went further, and wrote that what you test,
is, well, what you get.  Victor Nell,
the great South African transcultural expert, warned of cultural universal
beliefs and the valuelessness of norms without constructs.  As Thomas Kramer noted, when all you have in
your toolbox is a hammer, everything starts to look like a nail.  Shapiro noted in 1967 that most tests have
only an indirect relationship with the variables they are supposed to measure.  One often sees IQ tests defined as tests of
intelligence, but little harks back to Wechsler’s 1944 pronouncement that
intelligence was a global, or aggregate capacity, to think rationally, act with
purpose, and deal effectively with the environment.  All of this prompted Benton to write in 1987, referring to
neuropsychology in particular:

The unfortunate
consequences of this combination of ignorance with delusion are numerous,
including the inappropriate application of tests to probe for evidence of
cerebral abnormality, the uncritical interpretation of test findings, and, most
important from the standpoint of the patient or client, the drawing of
unwarranted conclusions about the state of his whole brain or some
geographically labelled part of it (page 8: Evolution of a clinical specialty.  The Clinical Neuropsychologist, 1,
5-8).

Into this arena
comes the welcome and novel addition of a book that seeks to tell parents when,
why and how to have the kid tested, what the schools can and should provide,
what the magic of numbers means in terms of IQ, development, learning
disabilities, behaviour, and how to use the test results with some outcome in
mind.

Both of the authors are staff
specialists at Mass General Hospital and serve on the faculty of Harvard
Medical School’s department of psychiatry, good credentials then to take this
on in the USA.

Right out from the
start, its nice to see little windows added to the pages, as one finds in some
texts, the DSM-IV for one, which make it easier to find, for instance,
‘questions to ask the psychologist’ or ‘what should I tell my child about the
diagnosis’, or definitions of ‘criteria’ or ‘cognition’. 

The first chapter
defines what for instance motor, or language skills are, and how they are
tested, dividing these up into infant/toddler, preschool, and school age kid,
which is a nice, touch, the developmental perspective being what it is.  Learning, behaviour, social skills, all get
the same treatment, with some Q and A bits thrown in, also useful. Under
chapter two, the private vs. public debate gets immediate treatment, perhaps
percepts based on the exact market for this book.  The chapter is largely a Q and A fest again, and very
USA-centric, but it all fits just fine for the global market too.  Chapter three kicks off by defining the
roles of psychologists, Neuro psychologists and social workers, as well as
educational psychologists, psychiatrists and others, very helpful certainly
from my experience, and in countries like Australia that are petrified to tell
anyone the difference, and where psychologists still qualify with honours
degrees and some clinical internships. 
The window of note here is one that gives all the combinations of
letters that appear after names, what they mean and who has them, a nice touch.  Chapter four defines most of the tests that
will be used, a long chapter with lots of good stuff, and then on to Chapter
five with an explanation of what the meaning of the magic numbers is that Ch 4
produces.  An example of a
neuropsychological exam is given soon in the chapter, after dealing with the
Bell Curve and the normal distribution, with a few pithy definitions.  I tend to like their definitions which are
clear, very short, and lack any real language that might confuse.  Along the passage of the report example are
little windows of commentary, which, like the big ones, clarify where one is
going with the report. There is no example given of a less empirical report,
such as a clinical psychologist might produce, which is a bit remiss of the
authors I think.  In waxing nebulous,
clinical psychologists may just reign supreme unless checked.

Part three
examines the common disorders for which one might seek assessment, starting off
with Dyslexia, and nicely, the tests that might be used to diagnose or clarify
the condition.  The
what-to-tell-the-child-window is there, treatment options, and so on.  Then in Chapter 7, the ghoulish ADHD,
all-time champion of lets get nebulous (or not) depending on what school you
emerge from, with controversy its permanent bed-fellow, is dealt with.  It’s not a big chapter, and the authors note
fairly quickly that they are not going to address the usual and very long list
of questions that parents might have, and defer several times to the treating
physician.  I don’t think many readers
are going to be happy with that, given the controversies that still rage around
psycho-stimulants, cognitive change and outcome, efficacy and so on in ADHD,
and I think this book would really have done better if it dealt with the myriad
of entities that might make up the evaluation and outcome in this condition
which the authors describe as a common one. 
In essence, the chapter is the same length as the Dyslexia one, and I
guess the authors are trying to not get over involved here.  In any event there is a good reference list,
split into adults, children and teens, with books, video and website addresses
for those wanting more.  Nonverbal
learning disorders and Asperger’s are lumped together, and then Autism and
Pervasive Developmental Disorder get their own chapter, quite adequately dealt
with and longer than the ADHD chapter by a small margin.  Garnett and Attwood’s scale is at least
mentioned by the authors, which is nice, given they are Australian.

Mathematics and
written expression disorders are dealt with in Chapter 10, mental retardation
and giftedness in the next, with the notation that being gifted doesn’t
necessarily mean happiness and fitting in well, nor does it mean resource is
close to hand.

Finally, although
missed in many books, depression, anxiety and other psychological disorders are
dealt with in much the same way as the rest of the book, such as psychotic
disorders, ODD and CD.  Eating disorders
and self mutilation are given a tiny reference, mainly seeming to link DSH with
sexual abuse by an example, which of course may not always be true, but I would
hate to see an uninitiated parent pick up on that.

There are further
examples of books that can be read, sites to visit, and a good enough index to
complete the book.

As far as common
sense goes, it’s not always enough when entering the nebulous and often well
defended world of testers, assessors and therapists.  It’s always a terrible fright to parents to hear that their child
is not quite up to scratch in some esoteric way, and whether or not this
variance from the norm is common or not is another consideration.  There is after all an indigenous American
tribe that do not let their infants touch the earth until one, then they plonk
them down, and off the kids walk as if their muscles knew just what to do. I
see and hear of countless children who are found to be in need of therapy, with
one or other lag dominating, and some 20% of kids seem to be assessed for
something or the other. The need for books that tell us when and when not to
panic is really huge, and I wonder how this book is to be marketed, and whether
or not parents will be given this or advised to purchase it when first told by
report or word that something is not quite right? By the time parents find out
about this book, the chance is that they will already have had some contact
with professionals, so my earnest hope is that this down to earth book is a
common sight in doctor’s and professional assessors rooms in the right place at
the right time, or be useless. The authors have kept it tight, perhaps too
tight, but as far as straight talk goes, they have done just fine, and the
handbook is worth every cent.

 

© 2005 Roy Sugarman

 

Roy Sugarman PhD, Conjoint Senior
Lecturer in Psychiatry, University of New South Wales, Australia

Categories: MentalHealth, ChildhoodDisorders