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Psychodiagnostic Assessment

Beach Fench

Psychodiagnostic assessment, sometimes referred to as psychodiagnostic testing, psychological testing, or psychological assessment, is intended to assist with better understanding the rationale for a client's presenting strengths and challenges. Common referral questions may include inquiries such as, “Why can I hyperfocus on some tasks but despite all effort, cannot seem to concentrate or complete other tasks?,” “Why do I feel so overwhelmed in response to certain sensory stimuli?," "Why do I have such a hard time reading or completing math computations?," "Why does my child continue to regress in school?," "Why isn't my child reaching developmental milestones at the same rate as other children?," "How can my child be so intelligent but struggle to complete activities of daily living like tying his/her shoes?," etc.

 

The first step of a psychodiagnostic assessment is to conduct a clinical interview in order to gather information regarding a client's past and present functioning as holistically contextualized by his/her developmental, cultural, familial, social, educational, mental health, and medical histories. With children, this initial phase of assessment may also involve consulting with teachers or academic staff as well as a classroom observation in order to collect data pertaining to functioning within the school setting. 

 

Evidence-based objective (skill/activity-based) and subjective (survey-based) measures are then administered so as to assess functional domains pertinent to the referral question. These domains may include intellectual, neuropsychological, socioemotional, communicational, sensory, personality, or behavioral strengths and vulnerabilities. Results are then scored per instrument relative to empirically-validated standards, and interpreted within the context of the information gathered during the clinical interviewing phase of testing. The purpose of this interpretation is to ideally, answer the referral question as outlined in a written report which is later provided to the client or legal guardian during the feedback session. This report similarly includes client-specific recommendations intended to aid with bolstering a client's strengths in order to manage or treat presenting challenges. For instance, should results reveal that a client qualifies for a specific learning disorder, a primary recommendation would be coordination with his/her school in the provision of appropriate academic supports and accommodations. 

 

Over the course of my clinical experience, I have recognized some of significant shortcomings of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) (the latest edition being the DSM, Fifth Edition, Text Revision: DSM-5-TR) particularly in the realm of identifying and supporting neurodivergent individuals. "Neurodivergence" (a term originally coined by Judy Singer, an Australian sociologist, in 1998) refers to the broad degree of biodiversity in the human race, resulting in a variety of different neurotypes or brain styles. For instance, one neurostyle is autistic, referencing a brain style with specific neurobiological strengths and challenges relative to allistic (non-autistic) brain styles. What may sometimes appear confusing is that each neurotype can manifest with a great deal of heterogeneity; for example, how autism presents can drastically vary per individual. The construct of neurodivergence is multidimensional and contextualized by an individual's lived experience; it therefore, frequently conflicts with the binary, often pathologizing, and sometimes ecologically invalid/impractical criterion outlined by the DSM when formally diagnosing a neurodevelopmental or other mental health condition. When neurodivergence overlaps with other compounding experiences, such as developmental trauma (a frequent cooccurrence), reliance on the DSM as a clinical guide becomes even less helpful.

 

Specific to psychodiagnostic testing, I have similarly recognized limitations to what have been historically known as “gold standard" assessment approaches such as deferring to the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) as a primary defining/qualifying instrument when assessing for autism; thereby, possibly neglecting the recognition of masking and reinforcing an oversimplified, deficit-focused, ableist conceptualization of this diagnosis. It is worth noting that most standardized, psychodiagnostic testing instruments are not actually constructed or designed by the populations which they aim to assess.   

 

Due to these limitations, it is my clinical responsibility to continuously learn and expand my understanding of neurodivergence beyond the extent of the DSM and some of the more typical differential diagnostic testing approaches. Of note, how neurodivergence is societally understood and supported worldwide varies; for instance, diagnostic gaps exist between the United States and the United Kingdom as well as Australia in recognizing masking as well as neuroprofiles such as pathological demand avoidance (PDA) (sometimes preferentially referred to as pervasive drive for autonomy). I mention these considerations with the aim of communicating a value I uphold in my practice: the provision of client-centered, sensitive, empowering, ethically-sound, neurodiversity affirming testing services. That being said, my assessment approach is perpetually evolving and maturing with the hope of effectively supporting the unique strengths and struggles of the neurodivergent community. 

At this time, I provide (solely in-person) psychodiagnostic assessment services to child and adult clients to assist with the rule-out of the following diagnoses listed below. I also offer personality testing.

  • Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Autism 

  • Specific Learning Disabilities (Dyslexia, Dyscalculia, and Dysgraphia) 

  • Intellectual Disability

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