Psychological principles can be used to guide interventions and treatments. But, to be able to do this, we need scientifically grounded and comprehensive assessment. However, relative to the literature on evidence-based treatment, there is not a lot of research on evidence-based assessment. This chapter discusses important issues in providing an evidence-based assessment of child and adolescent emotional, behavioral, and social functioning (which is called psychological assessment).

How does evidence-based assessment with children and adolescents take place?

An assessment is successful when it answers the referral question. This type of assessment often consists of a clear description of the types of problems that a child or adolescent is experiencing and the potential causes of these problems. This is called a ‘case conceptualization’. A correct assessment also leads to recommendations for interventions based on this conceptualization. To be an effective clinician, one should have knowledge about assessment techniques. To aid clinicians in this process, there have been models developed for evidence-based assessment. There is a call for evidence-based assessment because this can help professionals conduct psychological assessments, communicate their findings to others, and evaluate assessment results from other professionals.

In this chapter, the focus is on an evidence-based assessment of children and adolescents. The model that is described is guided by three principles:

1. Every decision made during an assessment with a child or adolescent should be guided by the most current and best available research.
2. Results from tests should be used only for making interpretations for which they have been validated.
3. The assessment process should be guided by a hypothesis-testing approach. That is, one should address the referral question (e.g., Why is this child doing poorly in school?) by developing possible hypotheses based on research (e.g., the child has a learning disability; the child has problems sustaining attention) and then collect data to determine which hypothesis is most consistent with the available data.

What is the difference between evidence-based and traditional approaches to psychological assessment?

In evidence-based assessment, it is important to include an assessment of the child or adolescent’s psychological context. This is because, to understand a child, it is important to take a ‘meta-systems’ approach. A meta-systems approach refers to the various systems involved with the child. The literature on this indicates that the ratings of a child’s personality and behavior in different contexts are only modestly correlated. These modest correlations suggest that different assessors provide different views of the child’s personality and adjustment. By understanding the characteristics of various contexts, the child’s behavior can be explained. In traditional approaches, the focus is not on the context and instead only on the child’s emotional and behavioral functioning.

Another characteristic of evidence-based assessment is that it should be ‘construct-centered’. For example, the literature on child or adolescent depression can inform the assessor about the important constructs to assess, which is not only ‘looking sad’, but also ‘loss of interest in activities’ and ‘thoughts of death’.

Another principle of evidence-based assessment is that the assessment process is like a scientific manuscript: the clinician engages in hypothesis testing and arrives at a conclusion that informs interventions based on the data collected during the evaluation.

How does the assessment of treatment outcome take place?

Assessing change during treatment leads to more treatment fidelity and improves treatment outcomes. Therefore, this should become routine in child mental health settings. Evidence-based assessment is possible for this type of assessment, too. First, the criteria by which treatment progress is evaluated should be measurable. Second, only measures that have proven to be sensitive to change should be used for the purpose of treatment monitoring. Third, the criteria for evaluating treatment outcomes should be meaningful. Fourth, the criteria for evaluating treatment outcomes must be feasible: this is client-specific.

What are ethical and professional issues in the assessment of children and adolescents?

When working with children and adolescents, it is important to determine who has the right to consent for the assessment to be conducted. Also, the clinician must be effective in communicating and maintaining rapport with parents, children, and teachers. Confidentiality should also be discussed with all the relevant parties.

Frick developed a self-examination for professionals, that can help to determine whether their assessments meet the ethical and competent criteria. So, professionals should:

• ensure that they have appropriate training for the assessment methods to be used,
• consider the client’s background in interpreting assessment results,
• receive informed consent before initiating the assessment,
• consider to whom assessment feedback should be provided,
• take appropriate steps to maintain the client’s confidentiality,
•  obtain releases to provide information from the assessment to outside parties

 What are general issues in selecting measures?

When selecting methods and measures, the clinicians should keep in mind the child’s developmental context. For example, hyperactivity takes on a different meaning when the child is 2, 10 or 16 years old. The clinician should also be able to compare the child to same-aged peers, with the use of norms. When selecting measures for evaluation, the clinician must look at whether the scores from the test are proven to be valid and reliable for the population that he or she wants to use it.

Another issue in selecting measures is evaluating the clinical utility of a particular tool. This is defined as ‘the extent to which a measure will make a meaningful difference in relation to diagnosis accuracy, case formulation considerations, and treatment outcomes’. Lastly, it is best to use an assessment battery (multiple tests) instead of just one test, because every test has strengths and weaknesses.

What are some of the most common assessment methods?

There are different assessment methods: interviews, behavioral observations, intelligence tests, behavior rating scales, and laboratory tasks.

Clinical Interviews

In an interview, a description of the problem and impairments are discussed. Interviews can be structured or unstructured. Unstructured interviews do provide information about the client, but are often unreliable and do not permit conclusions about the extent to which the child’s difficulties are significant relative to same-aged peers. Structured interviews provide the interviewer with a script to follow. They also include guidelines on how a child’s responses are to be scored. These interviews have shown to be more reliable and valid. Therefore, structured interviews can be helpful in determining whether the child meets the criteria for a particular diagnosis.

Behavioral Observations

Children and adolescents can be observed when they are tested, during interactions with their parents, in the classroom, when they are alone, or all of these.  These observations can take place informally or through structured observational systems, such as the Behavior Assessment System for Children and the Test Observation Form. When conducting observations, the clinician must be aware of ‘reactivity’: the person knows that he or she is being watched and changes his/her behavior accordingly.

Intelligence Tests and Academic Functioning

There are well-normed standardized intelligence tests, for example, the Wechsler Intelligence Scale for Children. These tests have clear procedures for administration and scoring, but they require specialized training to administer and score.

Behavior Rating Scales

Rating scales are scales for different domains relevant to a child’s psychological adjustment. They are often standardized and thus allow for age-based comparisons on constructs of interest. Broadband or omnibus scales are scales that have a lot of subscales that assess different domains of functioning. Examples are the Achenbach System of Empirically Based Assessment, the Behavior Assessment System for Children, and the Conners-3.

Laboratory Tasks

These tasks are designed to elicit performance that will help to confirm or disconfirm the presence of a specific problem or disorder. For example, one can use behavioral avoidance tasks for anxiety.

What are the benefits and challenges of an assessment battery?

There is not a single best method for assessing all important constructs. Therefore, an assessment battery should include procedures that provide data from multiple informants who interact with the child in different settings. It is also important that different methods are used so that the strengths of one method can compensate for limitations in another. Informants can be parents, teachers, children themselves or peers. A parent is thought to be the most useful and critical informant. For teachers, they are especially useful when the child is young and has only one teacher. Children themselves can provide information about internalizing symptoms, which are invisible to others.

How is information across different informants integrated?

To integrate information across informants, one can use the attributions bias context (ABC) model.

First, the clinician should document all significant findings across constructs and informants. Then, any areas in which convergence is evident are noted and likely point to an area of concern. Third, the clinician should try to determine the reasons behind any discrepancies. In this step, he should consider cultural or systemic influences on the information obtained as well as other potential influences on the responses. In the fourth step, the clinician should develop a hierarchy of problems from primary to secondary. Secondary problems are apart from the clinical issue or may be considered additional manifestations of the primary problem. In the fifth and last step, the clinician determines all the relevant information that should be in the assessment report.