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ODD: Why an Assessment is Necessary |
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(Use landscape mode to print out this article) James D. Sutton, EdD, Consulting Psychologist This article is excerpted from the program, What Parents Need to Know About ODD. For information about a 108-page, downloadable e-book of this title, click here.
Hardly a week goes by that I don’t receive several dozen emails from parents, grandparents and teachers. They note that their child, grandchild or student is definitely ODD (Oppositional Defiant Disorder). When I ask how the youngster was diagnosed, I’m often told that they, the parent, grandparent or teacher, made the diagnosis themselves based on the observable symptoms and behaviors. If only it were this easy. I’ve always held to the notion that effective intervention must follow accurate assessment. Otherwise, a condition could be treated as one thing when it is actually something else. In such a case not only will interventions not be effective, appropriate diagnosis and treatment are overlooked. This could cause the real problem to fester and worsen. There are a number of childhood conditions that present much the same symptoms and behaviors as ODD. These include depression, anxiety disorders, ADHD, stress disorders, bipolar conditions, emerging personality disorders, medical conditions and other concerns. An evaluation and diagnosis of ODD must consider all of these and determine that they are not the child’s primary condition or disorder, or that two or more conditions coexist (comorbidity). An accurate evaluation of ODD must also determine the severity and impact of the child’s symptoms and behaviors over time, exactly how the behaviors affect others, and the overall clinical significance of the disorder as it could affect the growth and development of the youngster. In short, an effective evaluation is a complete mapping of an uncharted region … the inner workings of a child.
Components of a Comprehensive AssessmentI’m clear on the fact that there is no one way to do an evaluation. (I’m referring to the terms assessment and evaluation and being the same thing.) What is listed here is a model for a process I used for years. It represents what I consider to be the basics. (Because of my writing and speaking schedule, I rarely do evaluations anymore.) I normally do not repeat parts of an assessment that have been done recently, such testing at school. If the reports and records contain the information I need, I use them. This can save time and it’s easier on the child, not to mention the benefit to the parents’ pocketbook. Review of available records and reports: Unless we take a look, information valuable to treatment can remain buried. I once evaluated a fourth grade girl whose medical background indicated that she had reduced hearing in one ear and no hearing in the other. The teacher did not know this. The child was seated in the back of the room with her best ear to a wall. Behaviorally she looked indifferent, uncooperative and noncompliant. She did an abrupt turnaround with a little preferential seating. Interviews with parents and teachers: This can be done in writing, in person, or both. I generally ask parents and teachers to write down their concerns in order of priority … on one sheet of paper (this keeps it quick, focused and concise). I ask them to also briefly list the youngster’s three best strengths or qualities. If a child has several teachers, I prefer that they all do a page on the child. It’s amazing how this little activity can quickly differentiate between problem and non-problem areas at home and school. If we don’t have to “fix” everything, the job is easier. Perceptual-motor assessment: Some examiners would leave this one out of the assessment. I consider it to be essential with an ODD youngster because the child either doesn’t want to answer your questions initially, or they are apt to tell you what they think you want to hear (especially if they think they’re in trouble). By giving a couple of drawing tasks that require no speaking at all, I positively disrupt what the child is expecting. Also, distinct patterns of oppositional and defiant behavior can be uncovered on these instruments, often without the child even knowing it. Assessment of academic functioning: Why is this child not completing school work? Is the work too difficult (always a possibility), or is the child too difficult? This part of the assessment doesn’t have to be all that deep, but it does need to settle the issue of potential versus performance. Assessment of intellectual functioning: IQ testing can signal areas of interest, strengths and needs, learning modalities and potential for insight, all of which are helpful in developing intervention. Extremes in intellectual functioning can present difficulty. Mentally retarded oppositional and defiant youngsters are resistant to change; they have trouble developing insight into their behavior (they have to experience consequences instead of considering “What if …” as motivation to change behavior). Of course, if a child is seriously deficient in intellectual skills, you probably already know it. Really bright youngsters, on the other hand, already know they’re smarter than the adults; they stay a jump ahead of everyone. Projective assessment: Projective assessment consists of questions and challenges that have no right or wrong answers. This assessment serves to evaluate how youngsters structure their responses to the tasks. Assessment instruments include the famous “ink blot” cards, sentence completion questions and open-ended thematic (story) cards. The examiner looks for content and patterns of responses that can lend insight into the child’s emotional and psychological state. Since youngsters typically have little experience with projective assessment, this part of the evaluation is difficult for the child to “fake” or manipulate. For the same reason, it’s a part of the assessment that can make them uncomfortable. But even this discomfort is diagnostically valuable; it shows how youngsters handle situations they cannot control. Diagnostic Interview: I put the diagnostic (clinical) interview at the end of the assessment because it can affect rapport. However, in the hands of a skilled and compassionate interviewer, it can deepen rapport. It just depends. I use an interview I wrote; it consists of 155 questions that sample a child’s perception of how they operate in the essential “Life Fields” of school, home and community, peers and self. The interview is extremely comprehensive, covering everything from relationships to drug/alcohol use to depression to suicidal thoughts or gestures. (Obviously, I don’t use the whole interview with young children.) The interview not only collects valuable information in the child’s own words, it lets the child consider their needs and priorities for intervention. What better place to start counseling or therapy than with an issue the child already sees as pertinent?
What it Means, Where to Go, What to Pay Any psychologist will tell you that the most difficult part of an assessment is the challenge of making sense of all the information collected. This involves pulling together all the pieces and parts into a narrative interpretation of the assessment, providing a diagnosis (if appropriate), and offering plenty of practical recommendations for treatment and intervention at home and school. A comprehensive assessment is usually done by a psychologist, but it can be done by anyone having the training and certification or licensure to do so. I recommend that parents find someone who specializes in children and adolescents. A referral from a pediatrician would be a good place to start, as would the psychology or special education departments of a local university. Large counties, especially those with large cities, often have a psychological association; members can be accessed through a referral line. Also, child psychiatrists sometimes have a psychologist on staff or available to do assessments. Fees vary, but generally run between $500 and $1500, depending on customary fees in the area and, quite frankly, the reputation and track record of the assessment professional. These expenses are usually covered, at least in part, under health insurance.
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