Social-emotional assessments: Clinical considerations of informants and techniques
By Dr. Scott Merydith
Perhaps with regards to no other suspected disability do members of a multidisciplinary team rely on the school psychologist for expertise and guidance than that of emotional disturbance. Is the child emotionally disturbed? Often this is the question that the school psychologist must provide an opinion based on his or her sharpest assessment skills, especially when attempting to integrate complex, and at times conflicting, data from various sources and assessment methods.
The Individuals With Disability Act (IDEA) federally mandates special education services for children identified as emotionally disturbed-- meaning a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance: (a) an inability to learn which cannot be explained by intellectual, sensory, or health factors; (b) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers; (c) inappropriate types of behavior or feelings under normal circumstances; (d) a general, pervasive mood of unhappiness or depression; or, (e) a tendency to develop physical symptoms or fears associated with personal or school problems. The term includes children who are schizophrenic, but does not include children who are socially maladjusted, unless it is determined that they are also emotionally disturbed.
Although the school may have referred a child for an evaluation because of concerns of persistent, overt, acting out behaviors, the school psychologist must determine whether the child is socially maladjusted or emotionally disturbed. A child can be, of course, socially maladjusted and emotionally disturbed and receive special education services, but he or she cannot be only socially maladjusted and be eligible for such services. Unfortunately, there is no psychometrically sound personality test, clinical interview, or observational procedure that can assuredly answer this question. The school psychologist must address this issue through the use of a variety of assessment procedures that principally try to establish the presence or absence of an internalizing disorder-- such as depression, social isolation, phobias, anxiety, and immaturity, even when externalizing disorders seem obvious-- such as acting out, aggression, conduct disordered. There have been efforts, however, by mental health organization and special education advocacy groups to eliminate the terms social maladjustment and emotionally disturb in favor of the term Emotional or Behavioral Disorder. This conceptual change nullifies the need to discover the presence of internalizing disorders in order to qualify for special education services. Congress, as of late, has rejected this proposed change of terms.
The use of informants
A truism that applies to the assessment practice of children's social-emotional functioning is that accurate assessment relies on data from multiple sources, that is, from the child, parents, teachers, and perhaps even peers. In fact, Achenbach's system of empirically based assessment, perhaps the most widely used approach among school psychologists, has incorporated cross-informant syndromes-- similar classification of internalizing and externalizing disorders from the viewpoints of the child, parent, and teacher. The clinician attempts to determine whether there is consistency or unanimity from the various data sources. A major limitation to this approach, however, is the improbability of cross-informant agreement. In an important meta-analytic study by Achenbach, McConaughy, and Howell (1987) that reviewed over 119 studies, it was determined that the mean correlations between different types of informants were exceedingly poor. Correlation coefficients ranged from r = .20 (child and teacher) to r = .27 (parent and teacher). This finding signifies that, at best, a child and teacher will agree about the child's social emotional symptoms four percent of the time and that parents and teachers' observations concur less than nine percent of the time.
Current thinking on the use of informants in social-emotional assessments is that the most useful informant varies with the specific type of problem, the age of the child, and the pool of available informants. Empirical evidence supports the accepted best practice approach that parents or caretakers can give reliable information on the history of a child's emotional and behavioral problems. Further, with elementary aged children, parents are a valuable source of information on internalizing problems, family functioning, and health attitudes. Teachers are the best informant for externalizing behaviors, peer relations, and school functioning. The child, on the other hand, is the best, or at least useful, source of information on his or her internalizing problems, family functioning, experienced distress, peer relations, and self-concept. As children develop into older adolescents and adults, they become the best reporters of their emotional well-being.
The various assessment procedures used in the appraisal of children's social-emotional functioning are typically categorized as objective or projective. Despite school psychologists' desire for more objective measures to assess children for emotional-behavioral disorders, oddly enough, test usage surveys consistently have shown that projective techniques remain among the most popular methods used by school psychologists. It may be the case that an objective vs. projective taxonomy for labeling social-emotional methods misses the mark. Rather, such instruments rely on either a highly verbal or nonverbal format, or even a combination of the two. School Psychologists use of both objective and projective methods, therefore, may be driven more by their attempt to tap both verbal and nonverbal mediums for a comprehensive social-emotional assessment of children then the desire for objective or projective methods.
Typical verbal instruments include interviews, behavior checklists, and self-reports. The most commonly used technique for learning about emotional functioning has been that of structured or semi-structured interviews. This is the predominant way to assess adult personality. What occurs is a verbal exchange between the practitioner and the client regarding the client's experiences and perceptions. The interview method has been extended downward for use with children. However, a major challenge of this method is that children have a limited vocabulary and a high use of personal references for feeling words; that is, there is less agreement among children by what they mean by "sad" than there is among adults. Edelbrock, Costello, Dulcan, Kalas, and Conover (1985) were able to show that parent psychiatric interviews are most reliable for young children and least reliable for adolescents. Just the opposite was found for children being interviewed-- young children give highly unreliable interviews.
Self-report measures are another highly favored verbal method to assess adult personality. An obvious restriction to the use of self-report social-emotional measures with children, however, is the limitation of children's reading abilities. It is not too surprising, therefore, that the vast majority of multidimensional self-report measures of psychopathology have been developed for adults and adolescents and not children. Perhaps the most significant limitation to the use of self-report verbal personality tests is that the items that can best discriminate among various emotional-behavioral disorders, are the ones that are most transparent. Individuals who are motivated to distort their responses are able to present themselves as overly virtuous and emotionally composed, or else feign symptoms of psychopathology. Research has shown that children have the cognitive capability to fake-good or fake-bad on self-report personality tests.
Nonverbal personality techniques encompass human figure drawings, family drawings, inkblots, and thematic apperceptions. These methods skirt the issue of children's reading abilities, are more difficult to fake, and tend to describe emotional functioning rather than identify a specific emotional-behavioral disorder. What is particularly troublesome about these nonverbal formats, however, is that many lack the standards of reliability and validity that accompany verbal personality tests.
In summary, the use of social-emotional assessments to determine whether a child has an emotional disturbance requires school psychologists to be familiar with a variety of instruments and recognize the strengths and limitations of the various approaches. It is crucial that school psychology training programs continue to provide this test knowledge in their curriculum. But perhaps just as important, all assessment procedures rely on the school psychologist's ability to establish rapport and a trusting relationship with the child who is about to be assessed. The relationship between the practitioner and the test-taker, therefore, is what sets the upper bound limits for valid test results, irrespective of the assessment tool used.