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christian counseling today
Vol. 20 no. 2
this conclusion. Many adults whose children have been diag-
nosed also have the disorder themselves. Counselors may end
up giving suggestions for management of an ADHD child to
a parent who may not be managing his or her own condition
effectively and, consequently, may not be able to implement
needed recommendations.
Learning disabilities can occur in many areas related
to achievement. A child with a learning disability typically
has a significant gap between potential (e.g., intelligence)
and performance (e.g., achievement), which is caused by a
processing difficulty that is brain-based. Depending on the
state in which one lives, guidelines to qualify for special educa-
tion services can vary. However, that does not mean a child
cannot have a diagnosed learning disability such as dyslexia;
rather, it means the student does not qualify for services. As a
result, other mental health practitioners may end up providing
support to the child and his or her parents.
Autism Spectrum Disorder diagnoses, including
Asperger’s, are also on the rise. The rate of diagnosis of chil-
dren on the autism spectrum has escalated significantly in
recent years (now one in 88 children). Likewise, anxiety and
depression can interfere with learning even though they are
not learning disorders. They must be considered, however,
when determining why a child is having difficulty learning.
Cognitive Disability is one of the least prevalent diagnoses.
Children with mental impairments will function well below
average in all, or almost all, areas of functioning.
Proper Psycho-educational Evaluation is Critical
for Treatment and Intervention Planning
If misdiagnosed, there can be a worsening of symptoms
or complications, such as wrong medications, inadequate
prescribing, inappropriate treatment planning, or a setback
in progress.
I interviewed Dr. Mary Burch, Licensed Clinical
Psychologist who practices in Virginia. Dr. Burch, like myself,
has worked with children and adolescents for more than 25
years. She indicated one of the first things parents want to be
assured of in treatment is that something effective can be done
for the child/family. The initial diagnosis is key, and coun-
selors, as well as psychologists, must form a comprehensive
treatment plan.
Treating symptoms without the correct diagnosis can
lead to wrong or inadequate treatment and complications. A
counselor should first ensure that other difficulties or disor-
ders are not causing some of the child’s learning problems. For
instance, has the child had a normal eye exam within the past
year? Many problems can be rectified with a proper pair of
eyeglasses. Motor delays and fine/gross motor deficits should
be referred to an occupational or physical therapist. Similarly,
speech and language issues should be addressed by a trained
speech pathologist. Finally, a full physical exam by the child’s
physician should rule out any medical basis for the presenting
issues.
Once other etiologies have been addressed and ruled out, a
psychological basis for the problem must then be considered.
Here are some things to keep in mind:
Experience/Expertise:
Counselors need someone
with experience and assessment expertise in doing child and
adolescent evaluations of their clients. Not all psychologists
concentrate their professional practice on testing—many
prefer to do therapy. Seek an appropriate referral if necessary.
Professional colleagues, and especially physicians, often know
who is competent in doing evaluations. Pediatricians will
likely not refer a second time to someone who fails to conduct
a thorough and timely assessment of their patients.
Communication:
Counselors should find someone who
will communicate with them effectively and consistently.
Dr. Burch commented, “Many clients who had previously
been evaluated and then came to me for therapy had never
received any feedback regarding assessment results. Reports
went to the treatment provider (I assumed they went), but
I always provide my own feedback.” Parents need to hear
results—they need and want to know what is going on with
their children.
Accuracy in History:
Parents should also be given the
report to read and review in the presence of a trained profes-
sional to ensure that it is correct—especially regarding the
history. This process benefits the counselor if the psycholo-
gist is ensuring accuracy. The therapist should also rule out
whether the child’s problems are caused by a parenting issue.
A good family history is critical—for instance, has the parent
been diagnosed with a learning issue or received a psychiatric
hospitalization? Once this is determined, an evaluation should
go forward and a review of school records and an interview
with the teacher(s) should take place.
Testing Components
What will a psychologist be assessing? Intellectual functioning
with assessment instruments appropriate for the child’s age,
emotional status and personality, attention and memory,
educational achievement, and other processing tests will be
given based upon the presenting symptoms and the specific
referral questions. Every assessment looks a little different. If
educational problems are being considered, you need to ensure
the evaluator is covering educational tests in his or her assess-
ment. The following are important evaluation components:
Memory Processing:
These tests are critical if the
child has attention/retention issues, yet does not have an
ADHD diagnosis. The student may be accused of being a
daydreamer. He or she may struggle with increased memory
demands in transitioning from middle school to high school.
Marginalization may occur if the student is gifted, but cannot
remember his or her material.
