FAQ – Child testing

This is a complex question to answer, but the simplest answer is that if a child is not functioning at their ‘potential’ (due to cognitive problems in a particular domain) then it is often possible to address this: but they still may not reach the level of a child with a higher degree of natural ability. There are training programs that target ‘Working Memory’ and boost a child’s ability to hold information in mind and mentally manipulate it: and there is also evidence of improvements in a child’s ‘Working Memory’ if children with ADHD take stimulant medications.

If there are problems with language skills, these can often be improved with increased exposure to the English language, correcting any hearing problems, and addressing speech problems. There are some studies that have shown the benefit of training children in problem-solving methods, and other studies that have shown the benefits of certain types of video games in terms of visual-spatial skills, but these findings are not always consistent.

IQ is different to a child’s academic achievement. If a child is performing academically below what is predicted from their IQ, then there are interventions that addresses literacy, numeracy, emotional coping, social skills, and self-esteem, which  will in many cases have a benefit in terms of boosting the child’s academic performance.

The first thing we will do is discuss in detail the results of testing with you as parents, and with an adolescent if you feel it is going to be helpful for them to hear. We will then write a report that highlights the areas of strength and areas of concern, including any literacy and/or numeracy problems.

As a first step, we would recommend a discussion between parents and the Special Education Coordinator of the school: often this discussion is sufficient to put into place a program of support that appropriately addresses your child’s needs. If you want to know about evidence-based educational interventions other than the ones that your school offers, we can discuss what your options are.

Also, if there are any problems with the school obtaining funding, or if you feel that the school would benefit from a discussion with the clinician that carried out your assessment, we can arrange a phone discussion or a school visit. Following a period of intervention designed to improve your child’s literacy and/or numeracy skills you may also wish to obtain a repeat assessment here at the clinic (usually at least a year after the initial assessment) to measure progress.

This question has some overlap with the questions on attention, executive function, and ADHD: but essentially our opinion at the clinic is that a child will almost never be ‘lazy’ as a conscious choice that they feel is beneficial to them. Usually, nobody is more aware than the child (or more upset) when it comes to a failure to complete tasks, a tendency to make mistakes, difficulty getting started with things, and problems carrying out instructions.

Rather than ‘labelling’ the child as lazy (which implies a choice or negative personality characteristic), it is often more helpful to consider whether there is an issue with attention or Executive Function. Similarly, a child will rarely choose to be poorly behaved when they have the emotional and social skills required to behave otherwise: again they will usually be just as aware as others of the negative effects that this brings but they may need psychological intervention to learn the skills they need to respond differently.

Lastly, a child may be viewed as ‘unmotivated’ because they do not know how to get started with activities, they suffer from low energy, they have problems with their mood, or they worry that they will under-perform in things so they choose not to engage in order to avoid failure. Again, understanding the underlying reasons can help us move forward in a way that may not have been considered yet.

ADHD stands for ‘Attention Deficit Hyperactivity Disorder’. As with many psychiatric diagnoses, the symptoms exist on a continuum with normal functioning: for example most people feel anxious sometimes but this is not always indicative of an anxiety disorder. Similarly, most people will report attention problems or feeling fidgety from time to time: but children with ADHD have these problems more often than others, to a more severe extent, and with a greater level of disruption to their home and school functioning.

There are actually three types of ADHD: some children mainly have problems with attention and distractibility, others mainly have problems with impulse control and overactivity, and a third group have problems with all aspects. ADHD often co-occurs with executive function difficulties: in fact some researchers feel this is almost always the case. There can also be other conditions that go along with ADHD such as behavioural or emotion regulation difficulties, but not always.

Executive function is often referred to by itself, but it is actually a group of skills performed mainly by the pre-frontal cortex of the brain that are responsible for behaviour that has a purpose or is directed towards a particular goal.

A child with Executive Function difficulties may have problems with inhibition (avoiding impulsive responding, waiting their turn, and holding back from risky or inappropriate behaviour), getting started with tasks, organising a large task into smaller parts, organising their belongings, planning their approach to a complex task, maintaining emotional control under upsetting circumstances, showing flexibility when there are multiple ways of responding, solving complex problems, making decisions by weighing up options, monitoring how well a task is going, and transitioning between activities.

These skills are often impaired in ADHD, but difficulties with Executive Functioning are not exclusive to ADHD and a child may struggle with some but not all components of Executive Functioning.

Attention problems can take a number of different forms. One common difficulty children have is with their ‘sustained attention’: this means that the child finds it hard to maintain attention over a long period of time. This might be seen as ‘flitting’ from one activity to another, becoming bored quickly, making ‘careless’ mistakes during long tasks due to ‘switching off’, problems listening for a long time, and having problems finishing a whole activity (such as a long game or homework session). This can look like ‘laziness’, not caring, or poor motivation, and it can reach a point where the child starts to avoid activities that require concentrating for a long time because they know how difficult it is for them.

Another sign of attention problems is distractibility, which is a difficulty with ‘filtering out’ or resisting things that compete for attention: examples are when a child cannot concentrate in a noisy or visually stimulating environment, they get ‘side-tracked’ by other fun things in the room when asked to do something, and they find it hard to focus on just one thing. There are also frequently problems with ‘holding in mind’ the information needed, particularly large volumes of information: this can seem like forgetfulness, losing the ‘train of thought’, or a difficulty with long or multiple instructions.

Children’s attention problems often go unrecognised, especially if the child is quietly daydreaming and not causing trouble in class: or conversely they may be seen mainly in terms of their behavioural problems rather than their attention issues. Lastly, there can also be problems with ‘executive function’ in children with attention issues, and this area is dealt with in another question below.

Yes you can, and the Wechsler Intelligence Scales for Children (also known as the WISC) are widely considered to be the ‘gold standard’ in measuring a child’s intellectual abilities. On the other hand, in most cases, somebody’s intellectual ability cannot be fully summarised by just quoting a single ‘number’.

The Full Scale IQ score (FSIQ) is calculated based on scores from several different subtests, and quoting the FSIQ alone would ignore the fact that the individual child may have particular strengths and weaknesses in different abilities such as their verbal skills, visual-spatial skills, conceptual reasoning, mental manipulation of information, and mental processing speed.

For some children their scores on the various subscales might be quite similar, whereas other children might have strengths and weaknesses that are so dramatically different that the FSIQ by itself is almost meaningless. Understanding this full picture usually helps provide a more in-depth picture and set of recommendations for your child. And of course, looking at the wider factors such as behaviour, self-esteem, and emotional coping will enrich our understanding even further: and addressing these factors may boost academic function as well as overall quality of life.

Cognitive assessment with children is about finding out what the child struggles with so that the school and family can help maximise their learning outcomes. A child who struggles with reading or maths may have a ‘pure’ deficit in one of those areas, but very often there will be other areas of difficulty (such as language skills or conceptual reasoning skills) that will need consideration also.

Another issue is that if two children both have reading skills at the 10th percentile (i.e., performing better than 10% of children their age), one of them might have average intellectual abilities (i.e., the 50th percentile) whereas the other may have intellectual ability at the 10th percentile: these two profiles would lead to very different recommendations for the family and school.

So we would always assess a child’s ability level so that we have something to compare their academic skills to, and so that we can identify underlying issues that may help us better understand their academic profile.