This week’s blog was contributed by Jeremy Sharp, PhD, licensed psychologist and clinical director at the Colorado Center for Assessment & Counseling and the host of the Testing Psychologist Podcast. Dr. Sharp earned his undergraduate degree in experimental psychology from the University of South Carolina and earned his master’s degree and doctorate in counseling psychology from Colorado State University. He specializes in psychological and neuropsychological evaluation of children and adolescents and provides private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. He lives in Fort Collins, Colorado with his wife (also a therapist) and two kids.
Have you seen that social media meme on “The last normal school year” that’s been going around? It has one column listing kindergarten through Grade 7 (students’ current year) and another column showing their last “normal” school year, which was, at this point, THREE GRADES AGO. Essentially, a kid who is now in seventh grade hasn’t had a typical school year since they were a fourth grader. The math makes sense, but it truly blew my mind. That means that current kindergarteners, first graders, and second graders have never experienced a typical school year. Eighth graders are just now getting a real sense of what middle school is like (for better or worse). Though the pandemic is far from over, psychologists and other mental health folks have several considerations to keep in mind as students encounter their third school year of the pandemic.
First, the impact of the pandemic cannot be underestimated. At baseline, children are generally more vulnerable to the stress of a pandemic because they have more difficulty understanding the scope and circumstances of a global event than adults. Studies around the world are consistently documenting the negative effects on kids. A variety of personal and environmental issues have been proposed as contributing factors. For example, authors cite increased parental stress, increased risk of abuse and domestic violence, and increased exposure to social media as potential reasons for elevated mental health symptoms. Physiologically, there is some evidence to suggest that kids and adolescents are experiencing higher levels of cortisol, eating poorer diets (or experiencing notable food insecurity), and missing out on the brain development that comes from participating in novel social and academic situations. And children have varying responses to the pandemic. Variables that contribute to a child’s response include prior exposure to traumatic events, socioeconomic status (SES), and disability status. Regarding specific mental health symptoms, research shows that anxiety, loneliness, and depression are the most common mental health concerns to arise from the last several months. Others have described increased clinginess, distraction, irritability, and fear for family members’ safety. I’ve experienced this firsthand, as my eight-year-old daughter developed significant and acute separation anxiety upon going back to school this fall.
What about the impact on academic skills during the last 18 months? Data is still emerging, but some have attempted to estimate the decline in achievement. Researchers suggest that kids, on average, may have acquired about 65% of the reading skills and 37–50% of the math skills they would have gained in a typical school year. Studies that look at the influence of missing instructional days have shown that crystallized intelligence decreases by 1% of a standard deviation for every 10 days of missed learning. These numbers are simply estimates, however, as many highlighted the fact that kids didn’t only miss out on instruction, they also missed out on timely assessment and the resulting feedback or adaptation to their learning that comes from knowing their level of achievement in real time. But again, individual and environmental characteristics matter. Learners with a growth mindset adapted more quickly to online learning compared to those with a fixed mindset approach. Motivated learners and those from higher socioeconomic backgrounds experienced less decline or even made gains in some cases (i.e., reading skills in higher-SES kids).
Given these concerns, how can we adjust our expectations for this school year? First, we must keep in mind that kids will be coming into this school year with widely varying degrees of achievement and learning from the past year. This exaggerated version of the typical “summer setback” will likely show wider gaps between the kids with access to food, internet, financial stability, and parental stability and those without. Kids with identified learning or mental health concerns are also likely to be further behind. Social–emotional needs may be higher across the board.
As mental health folks, we need to recognize that our assessments and interventions for the next 6–12 months have a huge asterisk beside them. We should be less confident identifying learning and behavior disorders, knowing that kids are in an ongoing period of adjustment (at best) or trauma (at worst). We can test academic and social–emotional functioning more frequently to keep a handle on kids’ evolving needs. Children will likely need more instruction and more review. Providing stability and predictability will be important. Giving kids the benefit of the doubt and being deliberate as we consider more externalizing disorders (i.e., oppositional defiant disorder) is also crucial. Our report recommendations may shift from providing numerous, long-term recommendations to making sure we are only recommending what kids and families need right now. Relatedly, we can assure families that our findings may not be permanent, and that we can help them navigate the next several months by providing updated, brief evaluations throughout the school year.
RELATED POST: Dr. Sharp discusses trauma-informed assessment
Finally, a brief word on assessment using personal protective equipment (PPE). We don’t know much about whether or how the use of PPE affects assessment results. Limited research with adults (using the Neuropsychological Assessment Battery [NAB]) showed lower scores on the Language Index but no other differences. If you’re still testing with PPE, like many of us are, try to choose the option(s) that provide the most protection for you and the client with the least amount of deviation from standardization.
Ultimately, kids going back to school is a positive step for the vast majority of us. As assessment clinicians, this is just another time for us to practice flexibility and think outside the box with our jobs. It won’t do for us to administer tests and interventions robotically—we need to be cognizant of kids’ individual needs as we do our best to support them.
RELATED POST: Assess trauma symptoms exhibited at school
Catch up with the Testing Psychologist podcast on their website, via Apple Podcasts, Google Podcasts, or on Spotify.
Trauma is the leading cause of mortality in children. Adverse childhood experiences are occurring at a staggering frequency, and they have significant downstream effects on behavior and learning potential. But kids can’t thrive at school unless they feel safe, supported, and ready to learn.
As they return to school this year, it’s imperative to quickly assess how severely your students have been affected by trauma—including pandemic-related trauma—and how it’s impacting their behavior and performance at school.
Developed by noted school psychologist and educational neuropsychologist Steven G. Feifer, DEd, the FACT Teacher Form can help. It’s the first comprehensive instrument measuring the impact of stress and trauma on children’s (ages 4–18 years) behavior and performance in school from the teacher’s perspective. It’s being made available for immediate use now while the full FACT—which will include parent and self-reports—is being developed.
Armed with the information provided by the FACT Teacher Form, you can formulate targeted interventions that better meet your students’ needs. Learn more at parinc.com/FACT_Teacher
The past 18 months have been a rollercoaster for all of us. It seems like a lifetime ago when we got the news that my then-seven and eight-year-old children would NOT be going back to school after spring break in March 2020. I remember thinking, “Okay, we can get through this for a couple of months...things will be back to normal in the fall.” But no! Things were definitely NOT back to normal in the fall for us or for most families in the U.S.
There are many implications for kids being out of school or partially attending school for the better part of a year. I’d like to focus on the implications for practitioners who may be seeing increased referrals for issues like ADHD and learning issues.
Although some data suggest that mental health utilization (both psychotherapy and assessment) went down during the pandemic, this frankly does not match the anecdotal evidence from around the country. It seems like every practitioner I talk to is completely full—with longer waitlists than ever. Our practice has seen a huge increase in referrals for assessment of ADHD and learning disorders, and I think there is a direct link to the pandemic. Here are a few reasons why:
Instability in the environment. Kids do well with stable, consistent environments. Speaking for myself, other parents, and practitioners around the country, there was very little stability or consistency over the past year. Here are just a few examples of environmental changes: kids transitioning from in-school to in-home learning, parents transitioning to working from home, parents transitioning to being an in-home teacher, and cancellation of after-school programs and activities. Many families experienced variation or reduction in income. Marginalized groups and lower-income families may have experienced food insecurity. The list goes on and on. Increased instability = increased anxiety, acting out, distraction, or withdrawal.
Parents getting a firsthand look at kids’ behavior and academic skills. During the pandemic, many parents transitioned into the role of in-home teacher or a facilitator of education. For those parents who previously relied primarily on teacher comments or conferences to gauge their kid’s academic performance, this was an eye-opening experience. Parents suddenly got to see just how distractible, unfocused, fidgety, and (sometimes) disruptive our kids could be throughout the school day. If any parents of kids with ADHD were in denial about their children’s symptoms, those symptoms quickly became clear. Were they likely worsened by the instability mentioned above? Definitely. But many parents acknowledged and sought support once their kids were home all day trying to learn.
Parents being more burned out than usual. Not only were kids under more stress, but parents were also struggling during the pandemic. As mentioned previously, the world was turned upside down for us, too! It was challenging to juggle work (if you were still employed), finances, kids being home, spouses suddenly being home together more than usual, and any number of other things. When parents get stressed, it’s easy to focus on the negative or undesirable aspects of your child’s behavior. These might include not sitting still, interrupting the teacher, not doing their work, blurting things out, and so forth. Even if these behaviors are occurring with typical frequency, a stressed-out parent may notice them more often and perceive them to be more severe.
Increased variability in learning. Again, structure is important. In addition to the big-picture environmental instability discussed earlier, the academic realm itself was quite variable for many kids. Teachers absolutely did their best to develop and implement remote learning options. And yet, many children ended up with multiple platforms or websites to navigate. Many did not have stable internet access, which disrupted video and audio delivery. The remote school day typically looked different than the in-person school day, with many kids completing their work more independently than before. For kids with attention concerns, this was a recipe for disaster.
Related post: Jeremy Sharp on Trauma-Informed Assessment
All of these factors created quite a dilemma. Yes, many clinicians have seen increased referrals for ADHD evaluations, but how does one evaluate ADHD with so many environmental influences? These are just a few strategies that we’ve employed:
Conduct a more thorough intake. Our intakes now include explicit questions to gauge the impact of the pandemic. We ask about changes to the family routine, including parent work schedules, parent involvement in learning, kids’ reactions to the pandemic in general, loss of sports or after-school activities, and the timeline of in-person vs. remote learning.
Pay more attention to history. With a neurodevelopmental disorder like ADHD, history is always important. It should not just emerge out of nowhere. But with many parents now seeing longstanding or acute symptoms of ADHD firsthand, this factor is more important. In the past, we may have gotten by with documenting symptoms within the last year and going on our way with a diagnosis. Now, we must look further back. Were these symptoms present prior to the pandemic? Are they only happening during academic times? Do they vary based on in-person vs. remote learning?
Be less confident. Principle 5 of the American Psychological Association’s guidance on psychological teleassessment during the COVID-19 crisis explicitly states that we should widen our confidence intervals when making conclusions and clinical decisions. This is incredibly important. Most evaluations over the past 18 months have a big, metaphorical asterisk beside the results that says, “We are not as confident in these results as we typically are. Here’s our best guess.” We’ve gotten over the fear of saying, “This is unclear right now,” and have no shame about asking families to come back in 6–12 months for a brief, updated assessment.
In summary, there are many things for us to consider as we see increased referrals for ADHD testing. We must take environmental factors into account, acknowledge that parents and kids are more stressed out than usual, know that certain groups have less access to resources than others, and generally be more diligent and less confident in diagnostic results. It’s a thrilling time, as my colleague Dr. A. Jordan Wright says, to “be brave” with our work as we navigate challenging circumstances to do our best in helping these families.
Catch up with the Testing Psychologist podcast online, via Apple Podcasts, Google Podcasts, or on Spotify.
As children return to school, many may exhibit signs of anxiety and stress. Your job is to find out whether these are existing issues or whether they are related to the pandemic and quarantine.
Help is here.
The Pandemic Anxiety Screener for Students–12 (PASS-12) is a 12-item checklist developed by FAR, FAM, and FAW author Steven G. Feifer, DEd, designed specifically to evaluate the impact of a pandemic on a child’s school-based functioning.
Related article: OUR STORIES: STARTING THE NEW SCHOOL YEAR
A parent rating form, it allows you to rate the severity of anxiety symptoms specific to the pandemic and quarantine and provides information to help school professionals make important decisions.
To learn more or order, visit parinc.com/PASS-12.
School psychologists are facing a school year full of unknowns. PAR reached out to three different professionals to find out how they are adapting and what advice they have for others as they embark on a very different kind of school year.
Tamara Engle-Weaver, MS
Certified school psychologist, Lancaster-Lebanon IU 13 Sensory Impaired Program, Pennsylvania
I have classrooms located in more than one school district. Our districts are creating their own plans for the school year. Some are doing hybrid; some are face-to-face. Given that our classrooms are intermediate unit special education classrooms, they will most likely be operating 5 days per week with face-to-face instruction.
I plan to use a lot of technology this year. I will be trying to utilize virtual methodology as much as I can to reduce the amount of time I am in the classroom. I don’t feel the schools will be encouraging additional bodies to be in the classrooms. I will try to create social skill videos for my students that teachers can present at their leisure.
When you are on an airplane, they tell you to take care of yourself before you help the person you are with. I think that will be critical this year because there will be many students and staff who will be struggling with all aspects of coping with this virus. If we are not in a healthy mental state, we will not be able to help others achieve one either. We all need to do our best to care for ourselves and be compassionate and patient with others.
Maria Isabel Soriano-Lemen, PhD, RPsy
Director, Center of Psychological Extension and Research Services, Philippines
We are doing 100% online classes this year here in the Philippines. I usually ask students to work with a partner to come up with a psychological report that includes these areas of functioning: cognitive, psychological, emotional, behavioral, interpersonal, and interpersonal. So that requires them to work with different tests. I am at a loss at how to teach students to score their test results. I’m also concerned with access to testing materials and how students will be supervised. At this time, I really don’t know what to do. Classes will start in November.
Heather Bravener, DEd
School psychologist, Duncannon, Pennsylvania
At this time, parents have been given the choice to enroll in either the district’s cyber program or attend school for face-to-face instruction 5 days a week. We are a small district with three buildings on the same campus with graduating class sizes of approximately 140. The area’s COVID numbers are currently in the low range, which allows for the reopening of school with face-to-face instruction while implementing recommendations to prevent the spread of the virus.
My colleague and I are determining how to best complete assessments with students for the upcoming year in light of the pandemic. Considerations include wearing a mask, use of a plexiglass divider, a pencil for each student to use and then take with them, using a plastic screen to cover the manual, and use of disinfectant wipes. We are also considering the use of digital assessments.
Once schools closed in March, I had to balance completing my job at home while supporting my daughter during remote learning. It was quite a challenge and I can empathize with parents out there who are struggling to assist their child in learning.
As school psychologists, we are in a unique position where our roles may change significantly this fall. Flexibility will be key!
Related: Find out how the Pandemic Anxiety Screener for Students–12 (PASS-12) can help!