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A Parent’s Guide to Cognitive Assessment

11/7/2018

 
Stella Franzese, Psychologist
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We can all agree that the ‘school world’ children live in today is completely different to ours ‘back in the day’. There are notable differences in the subjects studied, classroom layout (assigned desks vs flexible learning spaces), interests (outdoor cricket vs Minecraft), jargon used (“the bomb” vs “lit”), technology available and teaching methods provided to students (blackboards and paper vs interactive whiteboards and iPads). Consistent with these changes, there has been a shift in the way we think about and assess children’s progress, thinking and learning in school settings.
Imagine that you have a son named ‘Johnny’ in Grade One. He is a vivacious and affectionate boy who loves sports and enjoys going to school. His teacher has completed her usual assessments to determine Johnny’s progress in fundamental subjects (reading, writing and maths). From Johnny’s previous school reports, you’re concerned that he’s performing below standard and don’t want him to fall behind further. One day, Johnny’s teacher and Assistant Principal sit you down and ask you to sign a consent form as they believe that given Johnny’s difficulties he may benefit from a Cognitive assessment and/or Oral Language assessment. At this point you’re thinking, my son would benefit from what? Why? How is this going to help him?

The ‘What’. What are they talking about? ​

First off, let’s define cognition.
Cognition is our mental process of not only acquiring information, but making sense of it.
​

Do these assessments have a name or is it just ‘cognitive assessment’? ​

The most commonly used cognitive assessments in Victorian schools are:
  • Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) for children aged 2.6 to 7.7
  • Wechsler Intelligence Scale for Children (WISC-V) for children aged 6.0 to 16.11
For children in Years 11 and 12 there is the Wechsler Adult Intelligence Scale (WAIS-IV) for individuals aged 16.0 to 90 years 11 months. However, it is rare that cognitive assessments at this age are administered for educational purposes.
Cognitive assessments (or intelligence tests/IQ tests) are used in school settings to assess a child’s level of overall cognitive (aka mental) ability, learning capacity and identify their cognitive strengths and weaknesses (for example, does your child thrive with visual information? Are they good at problem solving? Do they better deal with verbal information?).

What do these assessments measure?

These assessments measure cognitive abilities within 5 primary indexes, or ‘areas’ of intelligence:
  • Verbal Comprehension: A child’s ability to not only understand verbal information, but use their own long term knowledge and vocabulary to accurately express themselves.
  • Visual Spatial: A child’s visual/spatial/non-verbal reasoning abilities.
  • Fluid Reasoning: A child’s ability to think flexibly to solve a new problem using problem solving, planning and their own skillset. The ability to detect underlying relationships between concepts and ‘rules’ in a task to solve this novel problem (aka, can they pick up on what the pattern/ rule is and what strategies they need to tackle a novel visual/abstract problem?). It involves seeing the “bigger picture”, figuring out how things relate to each other and how everything works.
  • Working Memory: a child’s ability to pay attention, take in multiple bits of information, mentally work with it and hold onto it long enough to produce an outcome (the best example of this is trying to memorise the digits of a phone number by repeating them over in your mind until you can write it down).
  • Processing Speed: A child’s speed and accuracy of visual scanning, mental processing, motor coordination and visual decision making.
  • The Full Scale IQ: Your child’s IQ score and overall estimate of their cognitive abilities based on their performance across the indexes.
There are many other ‘ancillary’ or ‘other’ indexes that can also be calculated, however it’s not a ‘need to know’ for now. If relevant to your child’s case the Psychologist can explain it to you.

The assessment within a whole process

The cognitive assessment itself is actually NOT the only thing Psychologists do when they conduct a cognitive assessment. Here is a brief dot point summary of the process:
  • Parent Consultation: To gather developmental history, to gather information about the child’s current functioning, build relationships with the parents and gain an understanding of parent concerns/specific requests of the parents.
  • School Consultation: To gather history of difficulties, gain a thorough understanding of the child’s academic functioning.
  • Behavioural Observation: To see the child ‘in action’. How do they respond to task instructions? Can they keep up with the demands of the class? Do they experience difficulty in one subject? How do they socialise with other kids? How does the child’s quality of work compare to their peers?
  • Cognitive Assessment Behavioural Observations: Here we observe and take note of your child’s behaviour during the assessment itself. For example, do they make sufficient eye contact? Do they use concrete language? Can they participate in an interactive conversation? How do they describe school/home life? Can they respond to instructions? Can they pay sufficient attention to meet the assessment demands? How do they tackle tasks? How do they self-soothe when they find a task challenging? Can they be encouraged if they are overwhelmed? Are the child’s results impacted because the child is unmotivated or tired? < These observations are invaluable and are a part of the reason why I have managed to make quality recommendations to schools.>
  • Cognitive Assessment: Involves non-academic, interactive activities (particularly for the younger children). The Psychologist and child build rapport and most commonly complete 10 subtests (or presented as “fun activities” to the child).
  • Feedback Session with the parents: Meeting with the child’s parents/school to discuss the results and what it means for the child.
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Now, depending on the unique situation of your child, there may be other things that occur alongside this ‘standard process’. For example, if you’re looking to obtain funding through the school system for Intellectual Disability, a Psychologist would have to complete other assessments AS WELL as this and write a separate funding report.

Cognitive assessment, part of a formula

It is quite often that the entire cognitive assessment process (from parent consult onwards) is paired with other standardised assessment for different referral questions. Here is a brief snapshot.
Intellectual Disability: Cognitive Assessment + Adaptive Functioning Assessment
Language Disorder: Cognitive Assessment + Language Assessment 

Specific Learning Disorder: Cognitive Assessment + Achievement Assessment (sometimes memory assessment and phonological awareness testing is also included)
Giftedness: Cognitive Assessment ​
+ Gifted Rating Scales or other information gathering

The ‘does this ring a bell?’ game

A good way to understand the abilities that cognitive assessments measure is to know what the “strengths and weaknesses” in these skills actually look like in school aged children. Have a look at this table and see if any of these ‘ring a bell’ or ‘ring true’ to your child.
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Now that we understand what it measures, how do I make sense of these results?

A lot of scores come out of cognitive assessments, however I feel that parents should be knowledgeable of two things:

​Percentile Ranks

Percentile ranks reflects how a child performed compared to children the same age. Let’s say we lined up 100 boys the same age as Johnny in order of ‘ability. The little boy sitting at position 1 would be the worst performing and 100 the best. If I told you that Johnny was sitting at the 50th percentile, it means that he is RIGHT in the middle and performing as he should be for his age OR that he is performing better than 50% of children his age. With cognitive assessments, the Average Range falls within the 25th to the 75th percentile.

Standard Scores
Put simply, standard scores are these converted scores that Psychologists use to determine where Johnny’s cognitive abilities lie in comparison to other children his age and what range of ability he falls under. You’ll see ranges associated with standard scores for the indexes and Full-Scale IQ. As an example, any standard score between 90 and 109 falls within the Average Range.
​

Here is a general scoring guideline table for quick reference:
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What do schools do with cognitive assessment results?

Psychologists make recommendations that teachers can use to develop a personalised learning plan for the child. These recommendations are made based on your child’s strengths and weaknesses. As a very simple example, Johnny might have a personal strength with visual-spatial skills but weaknesses in working memory.

The psychologist might then recommend that all instructions provided to Johnny in the classroom be concise, clear and provided to him one at a time. The psychologist might also recommend that instructions or demonstrations in the classroom be highly visual in nature when being delivered to him or that verbal instructions are paired with visual stimuli.
​

Depending on the reason for the referral, these results and the report might be passed onto a paediatrician or submitted as evidence for a funding application within the Victorian school system.

The cognitive assessment process is a highly rewarding one. It provides educators and parents with the opportunity to better understand the learning needs of the child involved, and also to address your concerns as parents about why they are falling behind academically.

At Hopscotch and Harmony, we have a team of Psychologists including myself who are highly experienced in conducting cognitive assessments and thoroughly enjoy collaborating with parents and educators to achieve the best outcomes for children.
To make an appointment, please don’t hesitate to ring the Werribee Clinic on (03) 9741 5222.
​

I have developed a “Guide to cognitive assessment: A cheat sheet” as a resource for schools and parents. This provides a brief snapshot of the contents in this blog post. I hope you find it useful!

    Get your Cognitive Assessment Cheat Sheet!

Download now, AND receive our monthly blog update!
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Stella Franzese is a Hopscotch & Harmony Psychologist who is particularly passionate about working with children with Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder and children with academic difficulties. Her love for working with children is fuelled by her belief that quality early intervention significantly improves a child’s functioning and sets children up for their future.

Child-Centred Therapy with Pre-Schoolers

9/10/2017

 
Evrim Ulusoy, Psychologist
Play therapy Child Psychology
Interested to know how therapy works with pre-schoolers?
In child centred therapy, the child is provided with a safe and supportive environment to join with the psychologist to explore challenging issues. Children express their concerns and needs and also learn helpful ways to manage emotions in therapeutic play.

​What does the therapy room look like for young kids?
My therapy room includes different play sites for kids. In one corner you may notice a dollhouse and human figurines. In another corner you will find a sandtray with miniature figures such as animals. There is also paper based activities, social stories, puppets and soft toys, and other toys appropriate for sensory play, constructive play and pretend play. Most play sites are based on the floor or mats and the tables and chairs are child friendly. 
What happens in the therapy room with young kids?
There are two rules in the therapy room; we will keep each other safe and we will take care of the toys in the room. Parents are welcome to the therapy room to observe play therapy techniques and to track their child’s progress in sessions with the psychologist.

Young kids are encouraged to bring their favourite toy to their initial session as a source of comfort and are free to explore the play room with curiosity and openness. In the therapy room, young kids will have the opportunity to learn about emotion expression and regulation, turn-taking and problem solving with play! Parent participation in session and between sessions is always encouraged. Mindful parenting strategies relating to the treatment goals can also be discussed and practiced in sessions.

What other sources of information can be helpful in the early stages of therapy?
Parents can bring copies of health professional reports or letters from educators to the initial parent appointment. It is valuable for the psychologist to gather information about the child’s developmental, medical and family history. The psychologist may also conduct a kinder observation to refine the treatment goal after initial information is collected with signed consent by the parent.

What are some reasons why parents may consider to make an appointment with a psychologist for their young child?
  • Excessive clinginess/fear of separating from parent
  • Excessive anxiety around other adults/children
  • General/specific anxiety or traumatic experiences
  • Ongoing complaints of headaches, stomach aches
  • Behavioural issues at kinder/home
  • Anger management challenges
  • Attention/hyperactivity challenges
  • Limit setting/discipline challenges
  • Tantrums/meltdowns
  • Fussy eating behaviours
  • Night time fears
  • Communication challenges
  • Life transition challenges

​Who can I speak to so I can ask for a referral for my young child?
No referral is needed to see a psychologist. Please keep in mind that if you are interested in a service with Medicare rebates you will need to provide a signed referral letter from a paediatrician or G.P. Your child may be eligible for a Medicare rebate for up to 10 sessions per calendar year. Alternatively, your child can attend Hopscotch and Harmony as a private client.
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Evrim Ulusoy is a psychologist at Hopscotch and Harmony, and her work involves play-based therapeutic interventions with preschool aged and primary school aged children. Evrim provides a supportive and engaging environment for children to share their challenges and the impact on their personal wellbeing and relationships. Call 9741 5222 to make an appointment with Evrim at Hopscotch & Harmony's Werribee practice.

Child Behaviour: The importance of figuring out WHY in order to cease the negative and encourage the positive

23/8/2017

 
Leanne Smith, Psychologist
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What is behaviour?
 
Behaviour is the way someone acts or conducts themself, especially toward or around others. When discussing children’s behaviours, we often find ourselves using the terms positive and negative behaviour or appropriate and inappropriate behaviour.
 
Difficult Behaviours and why we act so quickly around them
 
Children may at times display negative or inappropriate behaviour. As parents and adults, our first thought is to react to this behaviour straight away to try to cease it, because it is not considered appropriate in the current situation. The behaviour may be having negative effects on other people or their thoughts about the child or about us!
 
Why do behaviours occur?
 
Behaviour occurs for many reasons. The reasons we behave are called functions. There is often a function of every behaviour we see or do. The function is the Why. A person may be trying to gain someone’s attention, seek control of a situation or express their thoughts or feelings, none if which are wrong. The difficulty some children may encounter is in understanding how to use positive and appropriate behaviours instead.
 
Noticing why behaviour is occurring is extremely important. We need to know why behaviour is happening and what a child wants, so that we can assist them to gain this in an appropriate way.
 
When children have not independently clued onto how to behave in a positive manner, to get what they are after, they may continue to use negative behaviour because this is what they are familiar with… and maybe it has been working for them so far!
 
Proactive and Reactive Methods
 
Reacting to behaviour to try to stop or reduce behaviour after it has occurred is surprisingly called… a reactive strategy. Reactive strategies can include giving verbal feedback to a child or a fair and logical consequence occurring.
 
Teaching a child a skill (like how to gain something in an appropriate way) before the child is in a situation is called using a proactive method. Using a proactive strategy gives a child the appropriate behaviour to use, and gives them the best chance to demonstrate a positive behaviour. They then have a better chance of what they want, which will encourage them to use the desired behaviour again.
 
Do we need a more systematic game plan?
 
If you find that a negative behavour is occurring again and again, and you can’t seem to redirect the behaviour to something more appropriate, these tips may help:
 
  1. Take a step back and observe the behaviour for a little while. This will help you to observe what the child is feeling and will give you a moment to make a small plan of how best to manage the behaviour. It also gives you a chance to think before you act!
 
  1. Once you have observed, think about what the child is trying to gain in the situation.
 
- Do they want someone’s attention?
- Do they want to be in the ‘drivers seat’ of the situation?
- Are they trying to communicate a thought or a feeling?
- Are they trying to release frustration?
- Are they trying to regulate themselves or self-soothe?
- Are they trying to avoid something?
 
  1. Once you think you have pinpointed the function (and we are not always right, of course), think about what you can do reactively to respond to the behaviour to reduce it and also support the child in that moment.
 
  1. Now let’s think about what you might do in the near future (proactively) to assist the child to increase their skills for the next time they are in a similar situation. Guide the child toward practicing an alternative behaviour; a positive skill, in preparation for the next similar situation.  
 
  1. Keep in mind that the best method is to be Proactive. What skills can you teach to your child before the moment to assist them to feel confident, heard and happy?!
 
Knowing how to respond to behaviour, to encourage positive skills, and discourage negative behaviour is a tricky task. Every child is extremely different and will be encouraged and discouraged with varying methods of adult responses. If you have noticed difficult behaviours and would like some assistance to increase your child’s skills and to encourage positive behaviours, please contact us - we are here to help. 

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Leanne Smith
Leanne is a Hopscotch & Harmony Psychologist who has a special interest in helping young children develop social skills and emotional regulation. She supports parents and children with Autism Spectrum Disorder, including Aspergers, to learn life skills and improve well-being.

Cognitive Development - The stages of growth and change

2/4/2016

 
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​Does it blow you away when you see your little one master a new skill? Are you fascinated by how your child learns?

Understanding a little about cognitive development gives you an insight into how little minds work. Cognitive development refers to the process of growth and change in intellectual abilities such as how a person perceives, thinks, and gains understanding of his or her world.  By learning what is typical and appropriate for general age groups, behaviour can be considered in the context of a child’s cognitive development. 

You might learn behaviour that’s bothering you is a typical part of development and this knowledge may ease any accompanying frustration you feel.  You might even feel relieved knowing you don’t need to try to change your child. You don’t have a ‘naughty’ child nor are you a ‘bad’ parent.

Piaget (1936) was an influential psychologist and his theory of cognitive development continues to shape our understanding of child development. His four proposed stages are outlined below:

Sensorimotor Stage

From birth until about 2 years, infants are busy discovering relationships between their bodies and the environment. The child relies on their senses of seeing, touching, sucking and feeling to learn.
 
Object permanence is an important part of this stage. If you cover a toy with a blanket and your baby stops showing interest then it is likely that he hasn’t mastered object permanence yet. He thinks that the object doesn’t exist anymore as it cannot be seen. If your baby actively looks for the toy under the blanket then you can be confident that your little one understands that the toy still exists even though it can’t be seen. 
 
Babies also learn through trial-and-error and cause-and-effect multiple times a day. It might be that he shakes a rattle to make noise or pulls a string to bring a toy closer to himself. Babies are little scientists and quickly learn to solve problems, and make predictions about how their behaviour has an effect on others. They way you respond has an impact on the conclusions infants will make.
 
Preoperational Stage

Have you noticed that your 2-year-old calls all ladies ‘mummy’? Or all men ‘daddy’?  Welcome to the preoperational stage of development! During this stage, children react to all similar things as if they are identical.  They also make inferences from one specific object to another.  Looking at an orange in the fruit bowl your child is likely to reason, “My ball is round, that thing is round, so that thing must be a ball”.

Children are yet to use logic to understand ideas. This is why you might be experiencing frustration trying to use logic to explain something to your preschooler.

Most preoperational thinking is self-centred. I bet you’ve noticed that your child has difficulty understanding life from any other perspective than his own, right? Your child at age 4-7 is very me, myself, and I oriented. At this stage your child assumes that other people see, hear, and feel exactly the same as he does.

Notice that when two children at this developmental stage are playing with one another, although they probably talk to each other in turn, they have their own agenda and may seem oblivious to the content of what the other child is saying! All normal!  

As children work through this stage they build on their experiences and adapt to the world around them. They become able to mentally represent events and objects, and engage in symbolic play.

The Concrete Operational Stage

Children in this stage are generally around 7-11 years. This is when we see children use logic to solve problems, but for the most part this logic is limited to physical objects. These children are not yet able to think abstractly or hypothetically. You will find your child has lost their “all about me” thinking as well.

One indication that a child has reached this stage is that they understand something stays the same quantity even though its appearance changes. This is called conservation. For example, if liquid is poured from a short wide container into a tall narrow container your 8-year-old will likely tell you it’s the same quantity of water. Your 5 year-old, on the other hand, is likely to insist that there is more water in the taller container because the appearance has changed.

The Formal Operational Stage

This final stage in Piaget’s theory begins at about 11 years of age and continues throughout adulthood. Piaget did indicate, and this is supported by subsequent research, that some people never reach this stage of cognitive development.

This stage sees adolescents gain the ability to think in an abstract manner. Ideas (such as maths problems) can be manipulated in your child’s head without having to rely on physical objects.

How a child solves the following problem gives an indication of whether or not they have reached the formal operation stage of development: If Sam swims faster than James and Declan swims faster than Sam, who is the fastest swimmer?

Children in the Concrete Operational stage might need to draw a picture to help them solve the problem, whereas children in the Formal Operational stage can reason the answer in their heads. 

In the early years of life, relationships with primary caregivers provide the experience that shapes how genes express themselves within the brain. Piaget’s take home message was that children need to be active in exploring the world around them and making discoveries.

​Opportunities are everywhere! So encourage your child to learn through experience and observe the beauty that is a child learning and developing. Caring, responsive adults play a vital role in providing stimulation and support for children’s cognitive development. 
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