We are lucky. Because there is a very good chance we’ll be able to retrieve that piece of information. (Technique: do something else, and it will probably pop out.) But what about those that can’t remember, and are challenged by a bottle-neck in that very same channel?! We are able to ‘stay on top of’ things because we can remember. But what happens to those that face such a challenge? Should it be assumed that ‘they don’t know’? Or, that they are less intelligent?
I use this as a simple example to show how and why testing must be so much more that scoring ‘yay’ or ‘nay’ on a set of test items. For as can be seen in the above case, what is the meaning of such a score, if it reflects only that ‘the right answer’ came out? Is it an honest ‘assessment’ of the individual? If it is us, then we can show what we are able to retrieve, and how we are able to perform. But with those that face challenges, the same score may only indicate that that retrieval or performance is not forthcoming. But that score tells us nothing about why. And if an individual requires a customized educational program that focuses on their needs, then an answer to why is needed.
For starters, it is also important to note how many such challenges may exist. There are broad categories, of course: problem solving, memory, attention, perception, language. But within each of these there are a multitude of possibilities. Secondly, it is important to remember what those scores actually reflect (e.g., the scores on intelligence or educational tests): they primarily reflect the norms for individuals the same age. In other words, just as we can perform well in relation to our peers (and can score well on these tests), those with challenges don’t. But again, that is all that the scores are indicating – these individuals don’t perform well in comparison to others, in general.
Yet we may have the responsibility to design a program for these individuals, which must not only address their reality, but also help them to deal with it, i.e., a program that addresses their challenges and can help them to learn and develop, as well as compensate for their challenges and participate in the world as fully as possible. As such, it is the challenges themselves that must be assessed.
This is a tricky business, but also not beyond our purview, as it can be done with those very same tests. We can even use those very same scores in doing this! But those scores become part of an interpretive and exploratory process. They become means to map out a terrain, showing the client’s high and low spots, strengths and weakness. But that is just a first step, as one must then try to discern why the terrain is shaped like that. And the terrain of an individual’s mental, emotional and social makeup is a very subtle thing. Plus one must account for their experiences up to that time as well.
As such, the task is, at the very least, daunting. And it can be easily understood why educational systems fall back upon normed scores to place and position individuals. But thankfully we can examine our client’s performances on those tests, item by item. And in that we can start to see what may underlie their performance, test further, and then eventually find what underlies that terrain. And this is an ongoing process. For the individual’s subsequent program can be structured to test that terrain too. But the initial key is to first perform a decent assessment. With that, we can start to open the door for them.
Luckily, the modes for doing this have been explored, and have been shared for some time now, with those very same tests that standardized scores are reported from. One of the primary approaches to this mode of testing is called the Process Approach.Via the Process Approach, one examines how the individual arrived at their answers on a test. In fact, on some of those same tests, alternative means are provided. For example, if one cannot retrieve a name, one may be able to recognize it, thus testing for the very blockage I mentioned earlier. Regrettably though, an individual’s issues are often not that simple. In fact, the combination of two or three challenges can provide quite a knot to be untied.
But that is why testing across the whole terrain becomes so important. This is the cornerstone of Neuropsychological testing, of which the Process Approach is a part. Obviously, on one hand, schooling in terms of brain functions can play an important part in the interpretive process. With head injuries and conditions leading to insults of the brain, one can see specific impairments in function and in the performances that result from localized damage. However, the parts of the brain are not organized in isolation of each other. Instead, the brain normally performs its functions via connections made between multiple areas of the brain, so that multiple processes can occur simultaneously. As such, when you hear something, there is an order and partitioning to processing what you hear. Multiple systems (e.g., cognitive, mnemonic, linguistic and perceptual) may be brought to bear on the processing of a single piece of information, and an additional full set of processes may in turn be brought to bear on one’s reaction to it, which can include a response (e.g., motoric or linguistic) and/or seeking further information (thus involving perceptual, attentional or linguistic processes).
If a brain insult occurs to one of the areas responsible for a part of one of these processes, then an isolated impairment may be seen, which will be seen when testing these individuals. In fact, they can be very similar to our ‘tip of the tongue’ example, with all else functioning normally (e.g., the rest of their language and thinking being in place) but with their just not seeming to be able to perform that one piece. It’s like it just ‘dropped out’. Or, depending on the injury, there may be multiple such pieces. Or worse, qualitatively different complexes. But still, there can be an identifiable, ‘localized’ sense to these.
However, with the neurological challenges that children face, the situation is different. The subtle contributions of development are so strong that isolatable functions and performances are less likely, especially in terms of how we know those functions in our fully-developed, ‘adult’ terms. Kids are still putting the pieces together. So even the role that a function may have (e.g., naming or remembering things) may be very different than it is for us. And that is so in their daily lives and the development which is the core focus of their lives. For example, it is not just that piece that is lost (e.g., when retrieving a piece of information), but the entire structure of their knowledge and ways of knowing, which they are actively building, that they need those ‘pieces of information’ for! By comparison, we have already ‘built’ our knowledge bases, so only need the information in the moment. And in the most general terms for the child, each of the sub-systems, (e.g., attentional, perceptual, linguistic, and motoric) play a part in development coordinated with the others. If one of them does not play its part, a broader set of issues may arise. These are like the complexes I mentioned for adults above, but their ramifications go even further. For they effect that ground that is being built for and by the child, through their development. As such, with kids, one is assessing a dynamic terrain, and having to judge occurrences yet to come.
But before we start feeling too phenomenally intimidated by all this, let’s drop back and look at a single test item, to see how we may tackle it. Part of what is so interesting about the standardized tests is how many systems may come into play within one test item. This is obviously the case, given the description I gave a few paragraphs back of how multiple systems must be coordinated for processing a single piece of information, much less our having to respond to it as well. As such, there is seldom an item that is a solely “verbal’ or solely “perceptual”. Like anything else, an item will be made of parts. A test with a set of such items may be similar. But caution must be taken here too, for new processes may be added on with later items, so that they are ‘harder’. For example, with an arithmetic problem, there’s a qualitative difference between addition of single digits versus addition of double digits, the addition of two numbers and the addition of 3 or more numbers, etc.. As such, our basic unit must be the single test item, with our noting exactly what the task demands are in each item.
But within a single such item one can see the whole of how an assessment can account for the above too. A single item, in this respect, is a microcosm of the larger whole, with the larger whole operating by the same principles. A single item is made of parts, so examine how those parts are dealt with, and you will be able to see how the whole operates.
Take a standard arithmetic word problem. If Mary has 6 tomatoes and sells 3 … . You’ve already solved it, without my even having completed the statement. Interesting, eh? You did it ‘in your head’, mentally. And you did it ‘automatically’ – I didn’t need to ‘tell you’ to do it. Six minus 3 equals … . And you used memorized ‘math facts’. Still a child counting on their fingers could solve it. But there is a strong linguistic component too. How did you (and the child) arrive at subtraction? A linguistic ‘convention’ indicated by ‘sells’ tells us this, plus the concepts behind ‘Mary has’, so that we’re looking for some alteration in that amount.
That is an example just a small piece of the mental terrain that is your life, that you don’t even think about. Yet the child must build a terrain like that which you now stand on. But our judgments of a child and their performance are not always so lenient. Even if transferred to paper, written down and solved, these are clearly mental manipulations. But what if a child can’t do it without writing it down? Are they unable to perform the ‘mental manipulation’? Hardly, especially if they did all the steps of translating and transferring the problem, performing the calculation, and arriving at the solution. No, rather, that child may be burdened by some other aspect of short term retention, of not being able to hold on to the information and perform the mental manipulation at the same time. Now we are starting to get at something.
However, whereas this ‘single item’ is probably not making you feel comfortable with this world of assessment yet, let me expand to show you where it fits. What if that single item, just the mental arithmetic problem alone, with its answer scored as ‘right’ or ‘wrong’, is all the information gotten from the testing?! Then all that underlies there is missed. For we that can ‘pop out’ with our answer, this is not a problem. But for a child that is struggling with some aspect of this, it is a problem. Luckily, in this case, it is likely that our child will be given a sheet of written problems to solve too. But if they do well with those, then it may be said “good with calculations, but not good with mental manipulations”. And even worse, that mental arithmetic score may be entered into an over all “verbal score” for the child (as they are ‘word’ problems), thus lowering that score too. Of course, any test worth its salt, and the testers who administer them, will note the significant difference of this test from others within that ‘verbal’ domain. But in the process of getting those scores reported, and meeting the demands for the classification and placement decisions for all students, are these differences really noted?
So we stop for a moment, and start with our single item again. If we at least have it as a snap shot of the student, that may give us an honest starting point, before all else is swept under the rug. While our single item is still no less intimidating, it at least gives us something – something real.
The trick for using it though, is in using it in combination with other test items – across tests – but doing so in terms of those ‘parts’ I illustrated. If two test items on different tests, share two parts, but differ on a third part, and the child’s performance is different on these two items, then … .This is why so many tests are administered during neuropsychological testing. Only in this way can you get a true picture of this child’s terrain, for their particular strengths and weaknesses. For example, that very subtle difficulty in ‘retaining and comparing information when problem solving mentally’ may show up elsewhere. Of course, with experience, you know what tests those may be, so you use them! As now you are looking at the terrain itself, testing it. The scores are secondary. Though you calculate them too, so that when writing about your findings, you can say, “the child fell below the norms on … “, but then with your comparison of items you can say, “… but here appears to be the reason why”. It is the combination of elements within particular tasks that you are now looking at … or more precisely, that you are looking at to see how the child responds. A similar task with just perceptual combinations may not give the child a problem. But that may be because the perceptual problem is ‘seen’, and can be solved by using mental manipulations of visually-present materials (such as puzzles). Or, because they got to perform the task motorically. So you look at tests that require the manipulation (juxtaposition and selection) of visually-presented materials without motor manipulation – quite a mouthful, but you know the tests, and what is done with them. Or maybe it’s the retention of linguistic information, which must then be manipulated, that is giving the child a hard time. So you look to see if they can handle other types of verbal materials that require inferences and prediction. Or is there something in the word/arithmetic problems themselves? Or is the problem in the character of number, and how the child relates to that?
In this way, all the single items are like atoms, bouncing off of each other. And the sets they come from, that may have similarities and differences within them as well, are like molecules. So you can see whether the atoms do or don’t bond. One watches their behaviors, and performs tests to see how they behave. And in this way one can come to know a child’s terrain – by closely examining it with these special tools, tools that one becomes familiar with, and with which one is able to see the nuances of an individual.
But finally, with a view of the child, one must then approach the dynamic of their development. As noted, a child’s purpose and place with all of this is very different from ours. They are testing and trying things. They are learning and coming to be. But as it is ‘us’ that is viewing ‘them’, so there is another point we should remember – we have values that we are bringing to this picture, much like the judgments I mentioned above. But is it the child we see, or our judgments? For we see a low score in mental arithmetic, or his need to use paper to solve the problem, but is that the end of the world? Our view says, ‘something is wrong’. But have we looked at its meaning for the child … and most importantly, for their development? For, what is the effect the pronouncement of ‘wrong’ itself? With that (and our normative scoring systems), we become as much of an ‘effect’ upon development as anything else!
I put this like this to suggest what our role is at this point, as we head toward setting out a program for the child – one that hopefully relates to their educational needs! So let’s say we find that there’s a mix, right there at the point where the linguistic aspect of the problems meets the arithmetic itself. And, that to overcome this impasse, the child has to write down the problem. We find that this enables them to make the transition. But (hypothetically), what if the other children aren’t allowed to do that, and there is a very stringent rule at the child’s school about this? Should our child be allowed to? Will he/she be given an unfair advantage thereby? Or do we look at our child as a developmental whole, who could well use that aid, to open and ease their way in the world.
Now obviously, I’m being a bit simplistic with this example. But it’s to make a point. To bring that point home, we are only talking about a single, easily imagined aid and solution, for a problem that does not appear that severe. And a solution that few would object to. But what if the linguistic gap is much larger? For example, our child has been found to have a real difficulty dealing with ‘abstractions’, exactly of the type found in word problems. I.e., our testing led us down a path that showed those aspects to be malfunctioning. Now what are our responsibilities, and how can they be met? What ‘compensations’ will be ‘allowed’? Will the child be allowed to use a calculator, even though he/she can perform the operations sufficiently without one. But what if this aids their linguistic challenge in this case, which can be tested and shown? Here we are starting to cross over a line, out of the land of our familiar, conventional knowledge and judgments. Here we are moving into that land above, the terrain of the brain systems themselves. And this is the child’s brain, the one they need to build their mental world with!
And this is still only scratching the surface. We may be helping to get the child by, but greater educational questions may need to be addressed as well. I.e., what ‘compensations’ may be needed if a part is not fully functioning, or potentially even “missing”. And, in terms of the IEP process, can the child receive an appropriate education if these challenges are not adequately identified and the necessary compensatory strategies not provided? Again, with the brain injured adult, that piece might be taken out, and a function lost. It is noted, and it is seen. Of course, such an occurrence, in and of itself, may be seemingly devastating, and means for compensating for the loss may be sought. But with the child, a distinct ‘piece’ is not as visible, because it has not as yet contributed its part to the child’s whole. And the child may present as being ‘of this character or that’, and may even seem fine. And, for example, in our world where ‘I’m not good at math’ is heard all the time, it may be easy to pass the problem by.
But we have identified a problem. We have looked further than the initial ‘word problem’ and the situation with arithmetic. And we are not satisfied with the global test score that may simply suggests that the child is a bit ‘slow’, if that is where this is leading. There is a reason why they are not performing well, and on a SET of very specific types of problems! So before the labels can be made to stick, what can be done?! If they have talents and strengths, those should be accentuated. How can they be given a better balance? As that is what we would feel, and hopefully seek for the brain injured above. So why not for our child too? Even if those stronger parts are not of an accelerated type, they must be supported and enabled to flourish, rather than the ‘whole’ simply receiving a label. This is where the ‘parts’ that have been identified by our initial test items can come into play. And work with those ‘parts’ should always continue. Even if it is never ‘complete’, ways may be found for the child to compensate, just as we would think about our brain-injured person who as ‘lost’ something. Yes, in the case of our child, it requires looking into the future, which is harder than noting something that was there and is suddenly gone. But we are looking at how they may grow, not weighed down by that part that they didn’t have, and by finding a way to live and work with it! And again, it is those ‘parts’ that we can ‘see’ in our tests!
In this way, an IEP should be sculpted to meet a child’s needs. And that should be an ongoing process over the years, tracking progress in the identified areas, and noting changes as they are needed. Of course, the challenges that may need to be faced, for and by any specific child, may be far more than portrayed above as well. The above picture was drawn to show a single thread. In actuality, a combination of linguistic, attentional, perceptual and motoric problems, can result in a rather complex terrain. But the challenge for us, as well as the child, is the same. Identify the problem, and deal with it. Scores and classifications mean nothing if they simply ‘place’ a child. That placement must be for the child’s identified needs. And their educational program, including placement and support services, must be for the same purpose. So the proper use of an assessment will be to tell us what those needs are. And it is only from that point that the work then begins. I.e., that which needs to be done to best facilitate and assure appropriate, measurable educational growth, leading to the achievement of the student’s independent functioning.
 Kaplan, Edith. A process approach to neuropsychological assessment. In Boll, Thomas (Ed); Bryant, Brenda K. (Ed), (1988). Clinical neuropsychology and brain function: Research, measurement, and practice, The Master lecture series, Vol. 7 (pp. 127-167). Washington, DC, US: American Psychological Association, 202 pp.
 Blau, A.F. Advocating for “Appropriate” Special Education Services: Focusing on the IEP. NYSBA Elder and Special Needs Law Journal Vol 21, No. 3, 20-24, 2011.
Anthony Rifkin is a neuropsychologist and clinical consultant working with Dr. Blau & Associates, PLLC, with offices based in New York City. Dr. Blau & Associates focus on communication, education, and vocational program customization for individuals with complex physical and neurological challenges. The people served range from infants to the elderly, based on a philosophy that supports customized intervention for functional self sufficiency throughout the life span. Anthony earned his Ph.D. in Developmental Psychology at CUNY in 1986 and completed a Re-specialization in Neuropsychology at Teachers College, Columbia University in 1990.
Reprinted with permission. All rights reserved.
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