Psychological Testing

I love psychological testing. It’s the majority of my professional job and it’s what hooked me in graduate school. I spend 7 hours a day, five to six days a week doing psychological evaluations.   I evaluate people who are applying for a variety of programs for people who report disabilities.  They are applying for assistance.

Lots of people dislike the process of being evaluated. I can sympathize with that. I’ve been evaluated. In order to perform the tests I have to take them. I like some of the tests better than others. I think some of them have clearer items. I think some of the items are more challenging. I think some of the items are too simple or not engaging enough. I think some are too hard to see. What people dislike about the process of being tested is the lack of feedback. I can’t tell someone if they got an answer right or wrong. I can’t tell them if they are doing as well as most people. So there is a lot of ambiguity in the process. Ambiguity makes people feel anxious.  My reports go to people who will be able to provide the people I evaluate with some feedback.  But I'm not in a position to do that.

Psychological testing gives me lots of data. I start collecting data from the moment I see the person. I might see the person in the parking lot or elevator or in the waiting room. I might not see them until I get their initial paperwork and call them in to be evaluated. I have a four page intake form. It is mainly check off boxes with brief answers for some history. I review the form with the person. An average person with a high school education can complete the form in 15 minutes.

Most people don’t realize that from that limited interaction of seeing someone walk down a hallway and having them complete a form made up of check off boxes I already have an approximate IQ score. I have an idea about what is wrong with them and what they are applying for. I have some idea about their ability to remember basic information.

After that I get to talk with them. My questions are to confirm or reject the hypotheses I am attempting to develop. Psychological testing has gradiations on how I can score responses. Some responses can get a score of 0. The response isn’t close enough to the answer to merit a number. Some responses get a 1. It’s closer, but it isn’t quite it. The person knows what I’m talking about but hasn’t articulated it or put it together enough. Some responses get a 2. The person knows what it is and can articulate it. There isn’t a test I know of that asks someone to describe a banana. So I can use it freely to describe it as an item. A zero would be a yellow thing. You keep asking the person to go further and tell you more but they can’t go beyond yellow. As far as you can tell it’s a yellow beach ball. A 1 point answer is something you eat or it has a peel or you cut it up for corn flakes. They clearly know what it is. A two point answer goes beyond that to a classification to a fruit. They may go further to a tropical fruit. Tropical fruit tells me they are smarter than the person who just says fruit. Now there are debates about people who use common use versus abstraction. You have to get the person to abstract before you score the response and you get around the debate. The tropical fruit person is going to keep me longer on the test and we are going to go through more items.

There is also speed. People who work quickly get more points than people who work slowly. Speed on tasks stays fairly constant. If it declines over time then the decline is steady. So if someone finishes the forms in 15 minutes then I expect an average perfomance on all the timed tasks. If they suddenly slow down when the timing starts it gets kind of obvious. It’s like they say to themselves “Oh, she brought out her stopwatch, let me slow down by 80% now.”

Then there is memory. People have lots of misinformation about memory functioning. Memory involves lots of parts to it. It involves paying attention long enough to put information into memory storage. Concentration to hold information in memory. Storage in memory in the immediate memory range. Transfer from immediate memory to intermediate memory. Then eventual transfer into long term memory and ultimately retrieval of information from memory. People will tell me they have “no memory.” That almost never happens. In addition they tell me that after completing 4 pages of historical information. Concentration problems are what people usually mean when they report memory problems. Occasionally there are some people who can’t remember. Vascular problems are the most common causes of memory difficulties. Depression is the next cause and is reversible. Finally there are actual problems with the brain. Accidents and diseases impacting the cortex can cause memory problems. People try to fake memory problems about 2-10% of the time. There are tests to evaluate faking. It’s sad that people think they have to exaggerate their real problems or fabricate problems to try to get a check for benefits. It complicates the lives of the people who have problems. It makes a lot of work for all of us in the field.

When everything lines up correctly, psychological testing makes the evaluation process easy. The person comes in with complaints. The complaints match everything the peron says. The complaints match all the data. The complaints match all the history. The complaints match all the statements from all the treating providers. The complaints match the objective psychological test data. There is a report to that effect. The analyst for the person makes a decision which is then comparatively easy. The person either gets benefits or they don’t.

The worst thing someone can do is to try to fake data or exaggerate their illness or problems. When they do that then they are considered suspect. Then everything has to be looked at with suspicion. So the person comes in and says “I don’t know what a banana is I’ve never eaten one. I don’t eat fruit.” That’s not a 0. That’s a 2. But the person is being a jerk. They clearly know the thing is a fruit. If they do that throughout the testing the test will not be able to be scored. They can be classified as above average but problematic. Lot’s of people are problematic. They don’t like testing and are resistant. I end up describing the resistance. I classify them. Resistance doesn’t help them. It hurts their case.
I ask lots of questions.

I also evaluate neuropsychological functioning.  The formal test materials are interesting.  Many of the items were last updated by the test creators in the 1950's.   The materials show things that were common then.  Old dial up telephones, pictures that reflect the 1950's version of modern.  The test still measures all aspects of cortical functioning and is up to date.  The pictures are just old.  They are better than the pictures from the 1940's.  But way out of date for 2010.  So the materials throw people.

Head injury is one reason for people to have neuropsychological evaluations.  The evaluations are a lengthy process, but the information can help dictate treatment plans and rehabilitation efforts.  It can also help to inform family members about what is going on.