During our recent PARtalks webinar series on assessing individuals with disabilities, PAR received some questions about adapting, modifying, and accommodating assessments. It is important to be mindful of a range of psychometric, social, clinical, and disability-related issues. We hope the following will provide helpful guidance when determining if modifications or accommodations are necessary.
There are many issues to consider that may complicate the psychological testing of people with disabilities. It is important to attend to issues of bias, reliability, and validity.
Language, motor, sensory, medical, and cognitive disabilities can impact aspects of an assessment. Additionally, comorbid conditions or secondary disabilities can be a complicating factor.
It is crucial for examiners to consider each individual's disability and how it relates to other functions to develop a strategy that ensures the appropriate construct is being measured. For example, disability-related symptoms such as fatigue and pain can confound psychometric tests and artificially inflate measures of depression. Or a motor-functioning disability that affects fine motor control may create results that mistakenly imply cognitive impairment. Examiners who do not take these issues into consideration risk drawing misleading inferences, making inaccurate conclusions, and offering unsuitable treatment recommendations.
To determine if an instrument is suitable for use with a client with a disability, clinicians must evaluate if the measure(s) being considered are appropriate for use without introducing accessibility challenges. If the construct to be measured will be measured in a way that requires a specific functional ability that is related to the client’s disability, or if the measure’s administration instructions and response options are related to the client’s impairment, for example, another measure may be considered.
The clinician should consider validity information regarding a measure’s use with people with specific disabilities, just as they would for any other population. Quantitative measures should be supplemented by qualitative and functional assessments. Before testing, it is important to meet with the client to understand disability-specific characteristics related to the constructs of interest. It is the clinician's responsibility to describe the assessment and subsequent results in terms that the client can easily understand.
Any decisions to modify protocols requires thoughtful consideration and justification but may be useful ways to support individuals with disabilities. There are two types of alterations to testing, accommodations and modifications. Accommodations improve access to the test without affecting the construct being measured. Modifications may affect the construct and may influence validity.
Accommodations: A testing accommodation is a change in test format, presentation, administration, or response procedures. Accommodations do not alter the construct being measured and scores are comparable with the original test.
Modifications: Modifications are testing changes that may alter the intended construct. The purpose of a modification is to improve accessibility while retaining as much of the original construct as possible.
Accessibility means the ability to access, interact with, and respond appropriately to test content. It involves designing a measure in a way that reduces barriers to a valid assessment of a given construct. Accommodations and modifications are often made to increase accessibility, but if accessibility is designed into the structure of an instrument, they may not be required.
Determining the necessity of an accommodation depends on how the disability presents as well as the construct or constructs being assessed. Accommodations help clients with varying levels of ability by removing access barriers that might influence the individual’s results. However, accommodations do not alter the construct being measured.
Accommodations may be made to the environment or to the way a task is presented without changing the content of the task. An accommodation for a student with a visual impairment might be enlarging print materials; an accommodation for a student who is deaf might be providing an ASL interpreter.
Modifications, however, can be changes that are made to the content or expectations of an assignment, task, or assessment. A student with a learning disability might receive a modification that reduces the number of questions on a test or provides untimed access to the materials. Modifications change what the individual is expected to learn or do in order to make it more accessible.
In general, modifications are more significant changes. Modifications alter what is expected of the individual; accommodations are less significant changes that provide support for the individual to access the same content and activities as their peers.
Learn more about modifying psychological assessments for individuals with disabilities:
American Psychological Association (APA) Guidelines for Assessment and Intervention with Persons with Disabilities: APA has developed these guidelines to help psychologists develop and implement effective, fair, and ethical psychological assessments and interventions.
National Joint Committee on Learning Disabilities (NJCLD): The NJCLD has developed guidelines for the assessment of individuals with learning disabilities. The NJCLD offers recommendations for modifying psychological assessments.
National Association of School Psychologists (NASP): NASP offers advice and guidance on modifying assessments as well as evaluating the effectiveness of those interventions.
The PAR Training Portal. Catch up on the PARtalks disability series on the PAR Training Portal. Recorded webinars are available on demand to help you learn more about working with individuals with a variety of disabilities.
This week’s blog was contributed by Nikel Rogers-Wood, PhD, LP, HSP. Dr. Rogers-Wood is a licensed psychologist and a project director at PAR. She has a PhD in counseling psychology.
“I’ve been feeling really anxious, my heart races, and I can’t concentrate. I already know I have generalized anxiety disorder because I watched a bunch of TikToks and took a quiz online that came back with a diagnosis.”
Sound familiar? Social media, particularly TikTok, is a place where clients and potential clients sometimes go to find answers to their mental health questions. Though it's encouraging to see more social acceptance and support for mental health challenges, there are so many influencers out there that it can be difficult to know who has professional expertise and what information is accurate.
Further complicating the situation are online quizzes. Type “Do I have depression?” into Google and get pages of results. Many of these quizzes also show up as ads and links embedded in social media feeds. What differentiates these free social media quizzes from well-researched and empirically validated tests? A great deal. Can the general public tell the difference? Not yet. That’s where PAR can help.
As one of our assessment customers, you already know the value of an accurate evaluation. After all, quality assessment results in accurate diagnosis, which drives effective treatment and positive client outcomes. That’s why it’s so important for clients to seek testing and support from qualified professionals. So how do you help someone who has self-diagnosed find their way to more accurate and helpful information?
The first step is to validate what they’re seeking—answers. Something is happening in their lives that has driven them to find the answer on the internet. However, much like it's hard to find the right street when your GPS is programmed to another part of the country, it’s hard to find answers when you take a quiz that isn’t reliable or valid.
It’s important to educate our communities so they realize that building a good assessment measure goes beyond choosing questions to ask. They need to know that researchers and test publishers devote time and energy into determining whether individual items (and the test as a whole) measure what they are supposed to measure; if there are differences in outcomes based on demographic factors like age, sex, and race/ethnicity; if the results can be trusted to be reliable; and how the results fit in with diagnoses. Although it may be tempting to take a free quiz that pops up on our social media feed, when it comes to our mental health, wouldn’t it be better to find a resource that will give us accurate results?
PAR provides a wide variety of high-quality assessments that have been well built, validated, and thoroughly researched. We also offer our products in performance-based and self-report formats. For individuals who prefer a self-serve style of assessment, the Self-Directed Search asks questions about career interests and preferences and produces a thorough, client-friendly report with results and guidance on next steps. When a deeper dive is necessary, individuals can collaborate with a licensed professional and use an instrument like the PAI for answers.
The difference between unvalidated quizzes and validated assessment measures is the difference between cookies and a real meal. Can you eat either one when you’re hungry? Sure. However, the cookies only take the edge off hunger and your nourishment can’t be based on cookies alone. At PAR, we offer the five food groups. Snacks aren’t going anywhere, but when you want to get what you really need, come to us.
This week’s blog was contributed by Maegan Sady, PhD, ABPP-CN. Maegan is a project director in PAR’s research and development department in addition to being a licensed psychologist and board-certified neuropsychologist. She worked as a pediatric neuropsychologist for nearly a decade before joining PAR.
Add trauma screening to your evaluation checklist
Assessment clinicians are trained to look for hidden problems, and we all know the common ones. If a child comes in with a referral for an ADHD evaluation, we screen for anxiety and sleep problems. When an older adult complains of memory problems, we inquire about symptoms of depression. There’s a new kid on the block, though—trauma. Trauma isn’t new, of course, but more clients may be experiencing its effects along with whatever brought them to you for assessment.
Expanding the definition of trauma
Trauma is a broad term for experiences that are dangerous or threatening. Although abuse or violence quickly come to mind, experiences of losing a loved one, food insecurity, or chronic social isolation can just as readily result in symptoms. The COVID-19 pandemic has increased these experiences, and some argue the pandemic itself may be a form of trauma. The impact of multiple stressful events—say, experiencing displacement due to a wildfire during the pandemic—can be multiplicative. Similarly, existing health and economic disparities have been exacerbated by pandemic-related stressors.
Screening for trauma
Because traumatic experiences have increased, it makes sense that more clients are experiencing trauma effects. Trauma symptoms can mimic other disorders, including anxiety, depression, and even psychosis or personality disorder. Untreated, trauma effects can negatively impact physical health and lead to higher rates of suicide and substance abuse.
To decrease the chance that you miss trauma as a comorbid cause of your client’s problems, make it routine to ask about trauma history. A written checklist (e.g., the Adverse Childhood Experiences Questionnaire) can help clients feel more comfortable disclosing their history. Unless you are specifically trained in trauma-related care, do not ask your client for details, but assure them you will provide resources.
If there is a positive history of trauma, assess for associated symptoms to guide recommendations; structured checklists can identify the severity and breadth. No matter the age of the client, PAR has you covered with the TSCYC, TSCC, TSI-2, FACT, and the DAPS. When time is short, screening versions are also available for most of these measures. And because many digital options are available on PARiConnect, it's easy to add a variety of administrations to your inventory when you need them.
Referring for additional assessment or treatment
When trauma is a contributing factor for your patient, you can provide a referral for evidence-based treatment and/or educational resources. For children, the American Academy of Child and Adolescent Psychiatry and The National Child Traumatic Stress Network have handouts and book recommendations. For adults, visit the National Center for PTSD. For individuals of all ages, see the website for the International Society for Traumatic Stress Studies.
Making trauma screening a routine part of your clinical assessment may uncover important treatment targets, helping your client deal more effectively with their original presenting concerns.
Each year, International Women’s Day is celebrated on March 8, recognizing the social, economic, cultural, and political achievements of women around the world. The day is also an opportunity to raise awareness of the challenges and inequalities that women face and to advocate for gender equality.
It is no secret that women have historically faced greater barriers than men when it comes to fully participating in the economy. Disparities between men and women persist in the form of pay gaps, uneven opportunities for advancement, and unbalanced representation in important decision-making. Although women represent 58.4% of the U.S. workforce as of September 2022, women only represent 35% of senior leadership positions. And while 82% of Americans say it’s important that men and women have the same career opportunities, only about a third of Americans say their place of business prioritizes putting women in leadership positions.
Here at PAR, we are proud to have a staff that is 60% women. When we polled our staff to ask about women coworkers whose work deserved to be acknowledged publicly, the response was overwhelming—citing women who inspired them in their day-to-day life, those who were contributing their time and energy to charities and causes, those who had faced personal struggles, and many who had celebrated incredible achievements. We are so proud to work among such women today and every day.