1. Psychological testing can reveal underlying mental health or learning problems that are either not observed or are underreported. Testing can often put these pieces together with those that are observed and diagnosed to complete the puzzle of why an individual chooses to turn to substances as a way to cope with problems, or why an individual keeps using or abusing even after dire consequences or curtailing interventions have taken place. Psychological testing often gets to the root of a mental health or learning problem sooner than psychotherapy or can confirm a suspected problem seen in psychotherapy sooner rather than later.
2. The intent of the Muir Wood program is to provide neuropsychological testing to all of the residents who are admitted, but that is not always possible. Sometimes parents do not want the testing. Sometimes the resident has been recently tested in school or another venue. In some cases, the testing here at Muir Wood can be helpful to assess the course of treatment and remediation already in place, for example in a situation where a resident has a previous IEP for learning disabilities.
3. 1. It is not necessary to be free of medications. In most cases, individuals who are taking their prescribed medications as directed are functioning as well as or better than their normal un-medicated state, so their test performance is a more accurate assessment of their current functioning. It is strongly advisable for the resident to be free of illicit substances and not in a state of withdrawal when the tests are administered. The testing is likely to be invalid if the individual being tested is under the influence of any illicit substances, because the substances will have a negative effect on mental acuity, attention, concentration, and memory. This will invalidate the intelligence and achievement tests. The Personality and projective tests will also reflect differences in the resident’s approach to coping and problem solving, and in their ability to use their imagination while under the influence. The results may show such symptoms as withdrawal from social interactions, depression, or increased anxiety and paranoia that is not evident when they are free of substances.
4. At Muir Wood, the testing psychologists administer a full battery of tests, including an intelligence test which is seen as the foundation of psychological functioning, as well as an academic achievement test. We also administer neuropsychological screening tests that measure hand-eye coordination, processing speed, working memory, planning ability, and executive functioning skills. In addition, we give several tests of personality, emotional and social functioning, and coping abilities in order to provide a well-rounded picture of each individual’s current functioning at the time of testing. Some of the personality and emotional functioning tests are projective tests, meaning that the person is shown a picture or image of something and asked to either say what the picture is or tell a story about the picture. We also review the Muir Wood records and progress notes, obtaining information and observations from the Treatment Team, Clinical Team, and floor staff, and interview the parents. When the referral question involves possible diagnoses of ADHD or ASD, we administer appropriate questionnaires to the parents as well.
5. It takes 4-6 hours to administer the tests, which can take place on one or two days. Scoring, interpreting and report writing take two weeks; however, a preliminary report is sent to the Treatment, Clinical and Medical Teams within 48 hours after administration once most of the tests have been scored.
6. The tests are a screening tool for most kinds of learning disabilities that affect verbal and non-verbal functioning, sensory and reasoning processing problems, and executive functioning impairments. Specific types of dyslexia and specific visual or auditory processing problems are outside the scope of the tests administered to Muir Wood residents. If the screening reveals one of these more complex learning or processing disabilities a referral is made to a learning specialist or educational psychologist specializing in learning disabilities.
7. The testing is an assessment of the individual’s current functioning, so it can often provide information about how the individual is managing strong emotions, like anger and fear, and it can often shed light on the individual’s difficulties with emotional management. Interpersonal skills are assessed by the projective tests and by observation and interaction with the resident. It is important to note that psychological testing is not treatment, but it can provide information that is helpful to the treatment team, helpful in obtaining re-authorization for treatment by insurance, and to inform and support discharge planning for residents.
9. The testing report is given to the Clinical Director, Carolyn Younger, LMFT, and to the Medical Team, psychiatrists Michael Genovese, MD and Marina Post, MD, and is available to the Muir Wood Treatment and Clinical Teams. Again using the puzzle analogy, the testing results offer pieces of the puzzle, particularly about the resident’s internal world, and help to confirm or augment diagnosis, treatment and discharge planning.
10. The final testing report is given to parents. While it is not always possible to meet with parents in person, we regularly provide feedback about the final report to parents, as well as to the resident, after the parents have been given the final report. We strongly recommend that the resident not see the final report. It is for parents and professional clinicians only. We also welcome and provide meetings and phone consultations with parents about the report when requested (in addition to the feedback session).
11. Evidence of depression and/or anxiety tend to show up in many of the tests administered and the testing results are integrated to provide the most complete picture of the resident’s functioning. Specific tests are given that provide measures of depression and anxiety, and the Rorschach Ink Blot test is administered which has indices of depression and anxiety.
12. Psychological testing is one of the tools used to diagnose ADD/ADHD, impulse control difficulties and oppositional defiant behavior. No one test is used to give a specific diagnosis. Information from other tests and other sources – intake assessment, history, Treatment and Clinical team reports and impressions – to inform diagnosis. Information from the testing can be used for treatment planning.
13. If a resident has specific learning disabilities or seems to show signs of a specific mental disorder, the testing can elicit information that would help to inform the Treatment Team.
14. At Muir Wood, our overarching philosophy is to provide the best and most effective assessment and treatment possible for our residents. Psychological and Neuropsychological testing is one part of that assessment, and can add significant value to the treatment process.