What is a mental health evaluation?

Diagnosing mental health disorders in children can be difficult because many different factors can affect children’s moods and behaviors, including physical health problems, experiences in their environment, or mental health disorders. For this reason, a mental health evaluation is often essential to understanding a child’s difficulties and how best to help him or her.

 A mental health evaluation (or assessment) is a process by which a professional gains detailed information about a child’s difficulties in order to make an accurate diagnosis and provide recommendations for the most appropriate treatment. The type of problem a child is experiencing will determine the type of evaluation needed and where it will be completed. Some evaluations take place in a child’s school; others are completed at medical centers, community mental health centers, or private outpatient offices.

Overview of the evaluation process

Types of evaluations  

Tests and tools used during evaluations

How to prepare your child for an evaluation



An Overview of the Evaluation Process (Back to top)

Parent/Caregiver Interview

Evaluations often begin with a meeting between the child’s caregivers and the clinician. During this meeting, the clinician gathers comprehensive information about the child including:

  • Description of present problems and symptoms
  • Information about health, illness, and treatment (both physical and psychiatric), including current medications
  • Parent and family health and psychiatric histories
  • Information about the child’s development
  • Information about school and friends
  • Information about family relationships
  • Family and psychosocial history- medical history, developmental milestones, family mental health history, academic performance.
  • Information about the current problem - when symptoms began, where/when they occur, duration/intensity of symptoms, how caregivers handle the problematic behavior
  • Relationships: peer relationships, family relationships, relationships with other adults
  • Daily functioning: self-care, leisure activities/hobbies
  • Strengths

Interview and/or One-on-One Testing with the Child

Typically, a clinician will talk with the child in order to learn whether the child is aware of the problems noted by their caregivers and to see if the child is experiencing any other symptoms or problems. This interaction also gives the clinician a chance to observe a child’s social skills, thought processes, and the presence or absence of other behaviors. The child may also be asked to complete questionnaires or a range of tests assessing different areas of functioning.

Observation Inside and/or Outside the Office

 The clinician will observe the child’s behavior during the office visit, and may watch the child engage in ordinary activities, such as playing with toys. Sometimes, a clinician may want to observe the child at school in order to see his behavior(s) in a different environment and with peers.

Information from Other Significant People

Often, with parental permission, clinicians will seek out additional information about a child from other significant adults in the child’s life.  This may include the child’s pediatrician, therapist, teachers, daycare provider and other relatives.

Information gathered from a these people can be important in assessing the nature of a child’s problems, as it shows whether or not a child’s behavior is consistent across settings and situations. A clinician may speak with these adults directly or send them questionnaires to complete about the child.

Feedback

The final step in the evaluation process is a meeting in which the mental health professional shares the results of the evaluation with the family. This is done in a number of ways. Some professionals will meet with the parents and child together, others will meet with the parents and child separately, and some will do both depending on the child’s age. Generally, these meetings involve the following:

  • An explanation of the diagnosis or diagnoses, if any, that the clinician has made and why the clinician came to this conclusion
  • Information about the diagnosis, such as how the diagnosis typically progresses or changes over time and the outcomes that may be expected
  • Recommendations for how the child can best be helped, which often includes what type of therapy a child and his family might benefit from, ways the family can support the child at home, or changes to the child’s environment that would be helpful.


Types of Evaluations (Back to top)

Type of evaluation

When is this type of evaluation needed? 

Who conducts the evaluation?

What is unique about this type of evaluation? 

Psychiatric Evaluation

  • A child is showing serious emotional or behavioral problems
  • To determine if symptoms have a physiological cause
  • Medication is being considered as a treatment option
  • Child and Adolescent Psychiatrist

 

  • A psychiatrist has specialized knowledge of medications for mental health problems and can give prescriptions if necessary
  • If needed, laboratory studies such as blood tests, x-rays, or physical examination are ordered to rule out physical health problems as a cause of symptoms

Psychological Evaluation

  • A child is showing serious emotional or behavioral problems
  • A child’s diagnosis is unclear or needs clarification
  • Clinical Psychologist

 

  • A psychologist has specialized knowledge of children’s mental health problems and treatment
  • One-on-one testing with the child (i.e., intellectual, personality, information processing, memory, and/or attention testing)
  • Possible observation of the child’s behavior at school

Psychoeducational Evaluation

  • A child is having difficulty learning
  • Eligibility for special education is being considered
  • School, Clinical, or Educational Psychologist

 

 

  • These professionals have specialized knowledge of how children learn and classroom interventions
  • One-on-one testing with the child (i.e., intellectual, achievement, speech and language, information processing, attention, and/or personality testing)
  • Observation of the child’s behavior in class

Developmental Evaluation

  • A young child (birth  to 7 years) is not showing age appropriate skills or is not meeting developmental milestones
  • Eligibility for special education is being considered
  • Usually by a team that could include a psychologist, physician, speech/language pathologist, physical therapist, occupational therapist, or nurse

 

 

  • These professionals have specialized knowledge of child development
  • One-on-one testing with the child (i.e., motor skills, communication, pre-academic skills, adaptive functioning)
  • Observation of the child’s behavior in the office and/or school

Neuropsychological Evaluation

  • Child is experiencing problems with memory, attention, problem-solving and/or visual-motor functioning
  • Child has a medical condition that may affect brain functioning (e.g., brain tumor, brain injury, cancer, epilepsy, etc.)
  • Neuropsychologist

 

 

  • A neuropsychologist has specialized knowledge of brain functioning
  • One-on-one testing with the child (e.g., intellectual, achievement, speech and language, information processing, attention, visual-motor, and/or personality testing)

Psychosexual Evaluation

  • Sexual abuse perpetration is alleged or suspected
  • Information is  needed regarding child’s risk of re-offending, need  for supervision, and/or treatment recommendations
  • Clinical Psychologist, usually with specialized training in sex offender management

 

  • This psychologist has specialized knowledge of sexual development and issues related to sexual abuse perpetration
  • Interviews with caregiver and child focus more on a child’s sexual development, sexual attitudes, sexual interests, and sexual behaviors
  • One-on-one testing with the child (i.e., personality testing)



Tests and tools used during evaluations (Back to top)

Type of Assessment Tool 

Why is it used and what does it measure? 

What is involved in completing the test? 

Intellectual or IQ tests

(ex: Wechsler Intelligence Scales, Stanford Binet Intelligence Scales, Woodcock Johnson Tests, etc)

  • Assesses a child’s cognitive abilities such as problem solving with words and images, memory, thinking speed, and verbal knowledge compared to others his age
  • Used by psychologists to understand a child’s general level of cognitive functioning
  • Often used by schools when considering children’s performance and placement in school
  • Test is administered by a psychologist one-on-one with the child
  • Child completes pencil and paper tasks, answers questions verbally (ex: gives definitions of words), and does hands-on activities (ex: using blocks to make designs)
  • Usually takes 1 to 2 hours to complete (time varies depending on the individual)

Achievement tests

(Ex: Wechsler Achievement Scale, Woodcock Johnson Test of Achievement, etc)

  • Assesses a child’s academic skills in areas such as reading, writing, math, and spelling
  • Often used by schools to assess whether a child is performing to their potential and to identify academic strengths and weaknesses
  • Test is administered by a psychologist one-on-one with the child
  • Child completes academic tasks using pencil and paper and by answering questions verbally
  • Usually takes 1 to 2 hours to complete (time varies depending on the individual)

Neuropsychological tests

(Ex: Beery Developmental Test of Visual-Motor Integration, NEPSY-II, California Verbal Learning Test, Finger Tapping Test, etc)

  • Measures functions that are controlled by brain systems such as attention, motor performance, visual and auditory processing, memory, problems solving, etc.
  • Used when a medical condition or injury may have impacted brain health
  • Used when sudden, unexpected, and unaccounted for changes appear in mental or cognitive functioning
  • Used following either gradual or sudden onset of unusual physical, sensory, or motor changes
  • Tests vary significantly and can include asking the child to remember words read aloud, copying shapes with paper and pencil, or having the child manipulate objects with his hands
  • Some tests a relatively short, taking only minutes to complete, while others require up to an hour to complete
  • Multiple tests are often given during one visit

Objective personality tests

(Ex: Minnesota Multiphasic Personality Inventory for Adolescents, Millon Adolescent Clinical Inventory, Personality Inventory for Children, etc)

  • Used to clarify the type and severity of a child’s behavioral or emotional problems
  • Measures the presence or absence of a wide range of behaviors, beliefs/attitudes, and emotional experiences of a child
  • Adolescent completes multiple choice questions either with paper and pencil or on a computer under the supervision of a psychologist
  • For young children, parent completes multiple choice questions about their child’s behavior and tendencies
  • Usually takes 30 minutes to 1 ½ hours to complete

Projective personality tests

(Ex: Rorschach Inkblot Test, Roberts Apperception Test, House-Tree-Person Test, etc)

  • Used to understand a child’s clarity of thought and emotional state
  • Testing procedures vary but may include having the child draw pictures, report what they see in inkblots, or make up stories about a picture shown to them
  • Completion time depends on the specific test, but may take between 15 to 45 minutes to complete

Checklists and questionnaires

(Ex: Child Behavior Checklist, Behavior Assessment System for Children, Children’s Depression Inventory, etc)

  • Used to gain additional information about a child’s behavior and emotional state
  • Measures the presence and severity of symptoms
  • Some questionnaires are completed by parents or other adults in the child’s life, while others are completed by the child
  • Questionnaires generally involve multiple choice or true and false questions
  • Completion time varies, with some short questionnaires taking as little as 10 minutes and longer questionnaires taking 30 minutes or more.



Preparing your child for an evaluation (Back to top)

For most children, participating in a mental health evaluation will be a new experience and they may feel nervous or confused about why they need to go. Preparing your child ahead of time by telling him or her what will happen and why the testing is important can alleviate some anxiety. Below are five suggestions that can help to make the experience of a mental health evaluation a positive experience for your child.

1. Talk to your child about testing

Some children may worry about what is “wrong” with them when they learn that they need to go for testing. It’s important to let your child know that many children and teens go for evaluations at some point to understand how they think, learn, or experience and deal with their emotions. With older children, it may be helpful to encourage them to think about whether they have any questions of their own that they would like to talk with the professional about.

2. Avoid telling your child that they will be playing “games”

Children often find some of the tasks involved in evaluations fun, but some tasks may be challenging or boring to your child. A child may be disappointed or upset to find that the tasks are not what they would consider to be “games.” Instead, you can tell your child that they will likely be asked to answer questions and complete tasks, some of which will be easy and some that might be more difficult.

3. When possible, carefully schedule testing dates

Check your child’s schedule to make sure that they will not be missing a field trip, sports game, or other special activity when testing; their disappointment or upset could affect their attitude towards testing. Also be aware of changes in family routine that might affect your child, such as a move or a caregiver being out of town.

4. Make sure your child gets a good night sleep before testing

A good night sleep is important to ensure that a child is able to perform their best at testing. A child’s ability to pay attention and their level of effort can all be affected by a poor night's sleep.

5. Make sure your child has eaten well before testing

Food is also essential to a child’s ability to think and pay attention. If testing is taking place in the morning, make sure your child eats a good breakfast. If your child is testing in the afternoon, consider giving them a snack on the way. Also, you can ask the professional doing the testing if it is okay to bring a drink or snack for your child if testing will last a few hours.



Sources

Information provided on this website about child mental health evaluations is drawn from sources including:

American Academy of Child and Adolescent Psychiatry. (2008). Facts for Families: Comprehensive Psychiatric evaluation. No. 52 [Brochure]. Washington, D.C.: Author.

Division 40 (Child Neuropsychology), American Psychological Association. (2001). Pediatric Neuropsychology: A guide for parents. [Brochure]. Washington, D.C.: Author.

Sattler, J. M. & Hoge, R. D. (2006). Assessment of Children: Behavioral, Social and Clinical Foundation (5th ed.). La Mesa: Jerome M. Sattler, Publisher, Inc.

 

Date Reviewed: May 31, 2011