Fidgets/movement during psychoed testing?

[mypointlesspov]

---

Members don't see this ad.

Is there a consenus on the appropriateness of this? My inclination is to say no as they might impact a child's focus/invalidate the results since it's not administered in a standardized way, but I admittedly did let the child use some while doing certain subtests of the WJ Ach and WISC. . However, I just had a parent reach out to me concerned that I asked their child to put fidgets down during testing (particularly during timed writing based tasks). They also asked if they could bring a bungee chair or if I have a stability ball for them to sit on. The original reason for referral was for executive functioning concerns and we're also testing for autism (which the child's behaviors are consistent with).

I noticed that the child was struggling as we completed the cog portion today and offered to end the session 1 1/2 hours early. It was at this point that the parent disclosed to me that the child (who likely has autism) had an exceptionally long and taxing day yesterday full of doctors appointments and errands and was tired, but they insisted on finishing up the testing session which resulted in the nearly 12 y/o sliding onto the floor and refusing to continue until their parent threatened a loss of privilege related to their special interest. I also offered a snack, which the child accepted, and gave them some extra time during that break.

We continued and I administered some additional subtests that were somewhat "easier" until we ran out of time. I offered breaks for movement and encouraged the child to move around but they stayed in my office each time (which admittedly, did yield very helpful observational data). Any feedback on how I can improve/address this with the parent would be helpful. I'm okay with the child having fidgets if the data supports it, I just want to be sure I'm not impacting the scores in any way.

The parent also added that a large regional hospital makes evaluations "fun" for their students during six hour testing sessions. Any suggestions on how to do this would also be helpful. I'm thinking some brain break videos might be good.

Thanks!

 

[AcronymAllergy]

I don't work with children, but my inclination for a psychoed eval is to not offer any type of accommodation (parent-provided or otherwise) or departure from standardized procedures. After all, that's part of what we're trying to assess--how does the evaluee perform under standard conditions. If it's suspected that the absence of accommodations impacted performance, that can be addressed in the report.

As for the 12 y/o, in that situation, I might've discontinued testing, even if the parent didn't want to, since it seems likely you aren't getting adequate engagement. Unless you don't think completing testing on another day would make any difference. But if I'd continued testing that day (which doesn't seem altogether unreasonable), seems like you made the best of a bad situation. When I have adults with likely dementia who exhibit similarly variable engagement, I'll discuss it in the report.

 

[PsyDr]

“We both want an scientific evaluation. I administer tests in the standardized manner required. While I appreciate we both want the best for your child, I will not violate the standards of my profession for anyone. If this is unacceptable to you, I would be happy to provide you a list of alternative providers. In the mean time, please let me know the name of the psychologists at the hospital who are violating testing standards so I can report them to the board.”

 

[mypointlesspov]

I appreciate the responses here. I got very different replies when I asked a different group of testing psychs. I can see their perspective and also want to be mindful of doing things in a standardized way.

I responded to the parent last night and emphasized that we would be completing an ASD test today that includes potentially more "fun" activities so hopefully that helps. I also encouraged them to bring some special snacks to look forward to when we take a long break mid way through testing and at the end of the session.

The parent ended up apologizing for their tone saying they felt like they were at their wits end, their child has a tendency to overgeneralize when upset, and that they appreciated the snacks I had because their child ate all of the ones they packed on the way to the appointment lol.

Also, does an immediate board complaint not seem extreme? I don't feel comfortable reporting anyone based off of what one upset parent says, especially if it's something that can be remedied via conversation. I did my postdoc at this hospital, though in a different department, and I don't want to ruffle any feathers. I'm basing this off of 1.04 on the ethics code.

 

[PsyDr]

I appreciate the responses here. I got very different replies when I asked a different group of testing psychs. I can see their perspective and also want to be mindful of doing things in a standardized way.

I responded to the parent last night and emphasized that we would be completing an ASD test today that includes potentially more "fun" activities so hopefully that helps. I also encouraged them to bring some special snacks to look forward to when we take a long break mid way through testing and at the end of the session.

The parent ended up apologizing for their tone saying they felt like they were at their wits end, their child has a tendency to overgeneralize when upset, and that they appreciated the snacks I had because their child ate all of the ones they packed on the way to the appointment lol.

Also, does an immediate board complaint not seem extreme? I don't feel comfortable reporting anyone based off of what one upset parent says, especially if it's something that can be remedied via conversation. I did my postdoc at this hospital, though in a different department, and I don't want to ruffle any feathers. I'm basing this off of 1.04 on the ethics code.

a. I wouldn't actually report someone to the board for that. But there is a reason I suggested that.

b. People get nervous, and that's when they start demanding things. Most CBT literature will tell you that you cannot soothe their anxiety by complying with those demands. It was likely a long process to get to see you. It is probably expensive, and the imagined results are probably scary. It would be reasonable to be concerned that a hard to manage kid would do something, and then the assessment would have to be rescheduled 800 days in the future. They were telling you about someone else's practice because they were anxious about their kid complying with testing, or doing poorly on testing leading to 1MM imagined horrible outcomes, or or or.

c. If someone does not value or trust your professional opinion, they should not see you. The same applies for anyone consulting an attorney, an accountant, a physician, plumber, roofer, etc. In our attempts to create a therapeutic relationship, I think our profession does a pretty bad job with setting the tone with patients. Patients and their psychologists share the same goal. But you are the professional, and you know what you are doing. I think reminding patients, "what this other person is doing is NOT okay", and to let them know that they can choose other providers if they want. This is the same process for most professions.

d. Something something boundary testing.

 

[ClinicalABA]

Oh no! I let the 18 month I assessed today hold on to his taggie blankie during cognitive testing! Call the board!!

Testing manuals will almost always include a section related to accommodations, with suggestions as to how to account for and report these, as well as- such as with the WPPSI-IV manual that is right now on my desk- reference articles to check out. It is not a simple black-and-white "if the child is not seated at the table, butt in chair, feet on the floor, .8475 meters away from the examiner, the norms are invalid." There is going to be some variations in administrations between individual clients, and thus between your clinical population and the normative sample. The test manuals seem to account for this. For example, the aforementioned WPPSI-IV as well as the Bayley-4 manual report range-bands in overall testing times in the normative sample that vary substantially within the sample and across subgroups (e.g., different dx categories), implying some variance not only in testee response times, but also in the time some of the extra "rapport building" activities might take. As to the OP and the fidget spinner, I'd try to do the test without it. If there was a lot of protests from the client or warnings for others (e.g., "don't try to take that from him") I'd probably allow it, report normative scores, and be sure to indicate that the test was conducted while the child was holding the fidget spinner. Maybe not such a big deal for subtest (talking WPPSI-IV here) like Information or Similarities, but potentially much more negatively impactful for something requiring fine motor skills, such as Block Design or Bug Search. In the latter cases I would still report normative scores, but caution that they were potentially influenced by the fidget spinner, should be interpreted cautiously, and seen as a measure of what the child DID today under the current testing circumstances rather than a prediction of how they might do under different circumstances.

TLDR- Normative testing- at least with younger children- per the administration manuals- assumes a certain degree of reasonable accommodations, with the expectation that the evaluator acknowledges significant changes to standard administration and accounts for these when reporting/interpreting results. Remember, even under perfect replication of the normative standards, confidence intervals are thing.

 

[R. Matey]

In all applied testing, there's an acceptable level of measurement error. It's why you should reports CIs.

 

[cara susanna]

Based on this thread, I think the answer is probably somewhere in the middle (as it usually is)

 

[oliversacks4thewin]

I always come back to the purpose of the evaluation for informing these types of decisions. If the design of the evaluation is to demonstrate impairments, absent any additional interventions, as some schools may not be able to provide these types of accommodations, then I most certainly want to measure how the child performs in the absence of these. If the purpose of the evaluation is to evaluate the function of the person with these accommodations, then I will definitely put in my observation section the impact they had on performance, in the sense that this appeared to be a factor in their ability to engage across evaluations (and note where lack of these accommodations caused different outcomes). Additionally, I always ask myself, "what is the purpose of this measure and what is it clinically assessing," and make adjustments based on this. For example, a Stroop test is not, in itself a design of deuteranomaly, so I may not use this tool with a color-blind individual, because then I am testing the wrong domains and functions. Conversely, if I want to assess someone's skill in expressive language skills, what does it matter if they are playing with a poppit under the table?

 

[borne_before]

LOL like 20% of my evaluations involve chasing patients around and shoving testing books in their face.

Just document (1) the modification, (2) consult another testing psych to see if it impacted the validity of results, (3) discuss results using tempered language.