Evaluation of the Child or Adolescent

Evaluation of the Child or Adolescent

Difficulties in academic performance of children or adolescents can be related to a range of psychiatric, medical, or cognitive factors. To determine best the primary source of academic dif-ficulties, the evaluation should involve a comprehensive exami-nation of these areas. The psychiatric evaluation should clarify whether there is a psychopathological process. If one is present, it is useful first to determine whether the problems relate to a disruptive behavior disorder or to another psychiatric disorder. In particular, the disruptive behavior disorders have high co-morbidity with academic difficulties. A full assessment should clarify whether a disruptive behavior disorder is causing the difficulty with academic performance or is secondary to this difficulty. Disruptive behavior disorders can result in the stu-dent being unavailable for learning or being so disruptive as to require his/her removal from traditional learning environments. The frustration and failures caused by a learning disorder can be manifested by a disruptive behavior disorder. In some cases, the disruptive behavior disorder coexists with the learning disorder and the relation is less clear. Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have particular difficulty maintaining attention, and possibly with processing information. As a result, the same variables that have an impact on their attention also have an impact on their ability to learn. In such instances, they may have a learning disorder and ADHD.

Internalizing disorders such as depression or anxiety may result in an uncharacteristic disinterest in or avoidance of school expectations. If one of the internalizing disorders is present, it is important to clarify whether it is secondary or primary to the academic difficulty. Cognitive and language deficits as well as social skills deficits are often associated with learning disorders and can contribute to a dysphoric or anxious presentation.

The medical evaluation is necessary to explore the influ-ence of health factors on the individual’s availability and ability to learn. Problems in acquiring academic content can be signifi-cantly affected by most visual or hearing deficits. Generally poor health can influence the stamina, motivation and concentration needed to focus adequately on academic demands. Medications used for any purpose might cause sedation or other side effects that may affect the child’s ability to learn. Early developmental insults can result in global or focal deficits in neurological devel-opment. Undiagnosed seizures, especially petit mal and partial complex seizures, can result in difficulties in general cognitive functioning, specific deficits in memory and problems with attention.

The evaluation of cognitive, academic and neuropsy-chological functioning is critical to any assessment of learn-ing problems. Results of this psychoeducational assessment will indicate the parameters of the individual’s academic and cognitive liabilities while identifying her or his assets. In some instances, borderline cognitive development or mental retarda-tion may be the primary explanation for learning difficulties. Developmental delays are particularly evident with a preschool child; rapid and uneven developmental changes can lead to considerable variability in findings derived by measures of in-tellectual functioning. If any of the clinical evaluations yield results suggestive of a learning disorder, a more involved psy-choeducational assessment is needed. An appropriate psych-oeducational evaluation will reveal the magnitude of the child’s learning difficulties as well as the nature of the child’s cogni-tive assets and deficits. From this understanding, appropriate interventions can be designed and special accommodations can be initiated.

A family evaluation is an integral part of evaluation and must include an assessment of the parents and of the entire fam-ily. The first clinical question is whether the family is functional or dysfunctional. If the family is largely functional, there may be “normal” parenting issues that may be contributing to the child’s difficulty.

A normal parenting issue may be their lack of time or en-ergy to address the child’s academic difficulties.