Assessment models: behavioral, developmental, ecological and neuropsychological lenses

Transcript

SoheeDinner time, and a 6-year-old throws his food. Not once. Most nights. His parents bring him to an outpatient clinic, worn out.

RyanAnd the psychologist doesn't start with a personality test, or an IQ test. She hands them a notebook.

SoheeFor two weeks, the parents write down what happened right before each episode, and right after. And a pattern appears. The throwing usually follows a request to eat vegetables. And it usually ends with the plate being taken away.

RyanSo the behavior works. It gets him out of eating the vegetables.

SoheeWelcome to EPPP Prep, the podcast. I'm Sohee.

RyanI'm Ryan. Today's knowledge statement is about assessment theories and models, and it names four: developmental, behavioral, ecological and neuropsychological. Think of them as lenses. Each one asks a different question about the same person.

SoheeOur dinner table story is the behavioral lens, and the method is a functional behavioral assessment, often shortened to F B A. Iovannone and colleagues describe its goals: to identify the relation between a person's challenging behavior and the environmental events around it, and the function or outcome the behavior produces.

RyanFunction is the key word. Not what the behavior looks like, but what it gets the person. Two functions the article names are escape from something, and access to attention.

SoheeThe relationship gets summed up in a hypothesis statement. Something like: when asked to eat vegetables, he throws food, and the plate is removed, so the behavior lets him escape the demand. That hypothesis then drives the behavior intervention plan.

RyanAnd a good plan doesn't only try to stop the behavior. The article says hypothesis-linked interventions modify the antecedent events that predict the behavior, and teach appropriate replacement behaviors that let the person get the same outcome.

SoheeSo instead of throwing food to escape, the child might learn to ask for a small portion, or a break. Same function, acceptable behavior.

RyanThe article lists what a technically adequate assessment includes. The sources of the data. A clear, operational definition of the target behavior, meaning observable and measurable. Baseline data. Setting events. The antecedents that come before the behavior. The responses that follow it. And a hypothesis with a valid function.

SoheeAnd there's a legal piece worth knowing. The federal special education law, the Individuals with Disabilities Education Act, mandates these assessments and behavior plans for students with disabilities when their behavior results in a change of educational placement and is determined to be a manifestation of their disability.

RyanThe authors call the functional behavioral assessment process the gold standard for addressing challenging behavior, cemented by over 50 years of research.

SoheeLet's pause and think. In a group home, an adult with an intellectual disability hits his head several times a day. A psychologist interviews staff and collects data on the time, setting, and staff response connected with each episode, and concludes that head-hitting reliably brings staff attention. What kind of assessment is this?

RyanA functional behavioral assessment. Environmental events, a consequence, and a function: attention.

SoheeAnd the tempting wrong answers in that question each belong to a different lens. A projective personality test uses ambiguous stimuli to tap unconscious processes. A developmental screening checks whether a young child is meeting age-expected milestones. A norm-referenced intelligence test compares a person's score with a large reference group. None of them looks at what happens before and after a behavior.

RyanWhich brings us to the developmental lens, and three words the exam likes to blur: monitoring, screening and evaluation.

SoheeThe Centers for Disease Control and Prevention lays it out clearly. Developmental monitoring is observing how a child grows and changes over time, to see whether they're reaching milestones in how they play, learn, speak, act and move.

RyanAnd who does it? Parents, grandparents, early childhood providers, and other caregivers. Often with a brief, free checklist of milestones. It's ongoing and informal.

SoheeDevelopmental screening takes a closer look. It uses formal questionnaires or checklists based on research, and it's done by health care providers or other professionals who've been trained to use those tools. The agency calls it more formal than monitoring, and recommended for all children at specific ages.

RyanThose ages are worth knowing. The American Academy of Pediatrics recommends developmental screening at least at 9, 18 and 30 months, and autism screening at 18 and 24 months.

SoheeAnd the purpose of screening is to find out whether a child needs more support, and whether further evaluation is recommended. When a concern is identified, further evaluation through the state's early intervention system is often the next step.

RyanSo: monitoring is ongoing watching by anyone. Screening is a formal, validated tool used by trained staff at set ages, to decide on referral. Evaluation is the in-depth assessment after a concern turns up.

SoheeAnd the three often happen in sequence. The agency describes it from the parent's side: if a child is missing a milestone, or anyone has concerns, the doctor may do a developmental screening test as the next step.

RyanOne of our practice items captures that handoff perfectly. A mother has been using a free milestone checklist at home and notices her 2-year-old isn't yet combining words. At the next visit, the clinic's psychologist gives a formal, validated questionnaire to decide whether to refer the child to early intervention.

SoheeThe mother was monitoring. The psychologist is screening. And if the child is referred, the early intervention team's assessment is the evaluation.

SoheeYu and colleagues make the same distinction for autism. Developmental surveillance is continuous monitoring that may or may not involve standardized instruments, whereas autism screening uses specific standardized, evidence-based tools.

RyanAnd this matters, because developmental disabilities are common. The agency estimates that about 1 in 5 children aged 3 to 17 in the United States has one or more developmental disabilities.

SoheeSecond pause and think. A home-visiting nurse trained in a validated developmental questionnaire completes it with the parent of every 18-month-old on her caseload, as her program requires at that age. It doesn't yield a diagnosis. It shows whether the child should be referred. What is it?

RyanDevelopmental screening. Formal, validated, a specific age, and its purpose is the referral decision.

SoheeNow the ecological lens. OpenStax summarizes Bronfenbrenner's ecological systems theory this way: development occurs based on interactions among environments such as school, family and community.

RyanFor assessment, the ecological question is: what is happening in this person's settings, and between them? A child who struggles only at school, and not at home, is telling you something.

SoheeEven research frameworks built around brain and behavior make room for this. The National Institute of Mental Health's research framework calls the study of the environment equally important, including the physical environment, cultural components, and social determinants of health.

SoheeAnd you can see the ecological lens hiding inside good behavioral work, too. One of our practice items has the psychologist recording antecedents and consequences across settings, not only in one classroom.

RyanFinally, the neuropsychological lens. It looks at performance across cognitive domains and connects it to brain function. Gronchi and colleagues, writing about cognitive decline after radiation to the head, describe test batteries spanning domains like memory, executive functions, language and abstract reasoning.

SoheeAnd they tie a domain to a brain structure: memory is generally agreed to be the function most often affected by cranial irradiation, because of the involvement of the hippocampus.

RyanThey add a measurement caution that we'll come back to in our outcomes episode. Memory test performance is the most influenced by practice, so repeated testing has to account for practice effects.

SoheeLet's recap. The behavioral lens asks what a behavior does for the person. A functional behavioral assessment links antecedents and consequences to a function, writes a hypothesis, and guides a plan that teaches a replacement behavior.

RyanThe developmental lens asks whether a child is on track. Monitoring is ongoing and informal. Screening is formal and validated, recommended at least at 9, 18 and 30 months, plus autism screening at 18 and 24. Evaluation comes after a concern.

SoheeThe ecological lens looks at the person in their settings: family, school, community. And the neuropsychological lens maps performance across cognitive domains onto brain function.

RyanIf you've been memorizing these as separate lists, try thinking of them as four questions you could ask about the same child. That's how they'll stick.

SoheeYou're building a real clinician's toolkit here, one lens at a time. Take a short break, then try a few practice items on these models. We'll see you next time on EPPP Prep.

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