Psychological testing is an empirically-based and objective approach to diagnostic assessment and treatment planning.

Testing involves administering standardized and scientifically validated instruments that measure different psychological characteristics. This makes it possible to objectively compare an individual’s performance to the “norm” or what is expected for a given age. It also allows one to contrast different characteristics of the same person to identify strengths and weaknesses.

The types of tests that are used, and the amount of time involved, depend upon the specific nature of the questions. Typically, a group of tests are selected and administered to provide answers to questions. Data are then combined with interviews, observations and the like to arrive at a diagnostic formulation and recommendations.

There are many different types of tests and they range from “simple” measures of perceptual and motor skills to “complex” and multi-faceted measures of cognition, problem-solving and personality. Tests can be broadly divided into four groups:

1. Intellectual/Cognitive: Involves traditional “IQ” testing to examine cognitive strengths and weaknesses. Useful for assessing developmental delays, intellectual disability, giftedness, readiness for kindergarten and school placement.

2. Neuropsychological: Involves testing of attention, executive skills, learning and memory and other specific cognitive functions. Useful for assessing ADHD, deficits in planning and organizational skills, concussion and post-concussion syndrome and memory decline or changes in functioning associated with advancing age.

3. Academic Achievement: Involves profiling a student’s strengths and weaknesses across tests of reading, writing and math. Useful for identifying specific learning disabilities such as dyslexia, dyscalculia (math learning disability) and the like. This information can be used to develop 504 plans, IEPs or plans for tutoring and remediation.

4. Personality and Social-Emotional: Involves the assessment of temperament, emotional regulation, defenses, self-esteem, reality testing and specific psychiatric symptoms through questionnaires and projective techniques. Most useful for differentiating between psychiatric diagnoses that overlap or share common outward signs and symptoms (e.g., bipolar disorder vs. substance dependence).

Psychological testing complements traditional interviewing and observational methods and is particularly useful when other approaches have not provided a clear diagnosis or treatment response. 

For example, it can help establish and clarify diagnoses, assist with educational planning and school placement, in developing tutoring and remediation plans, in assessing intellectual ability, with identifying neuropsychological difficulties, in understanding social-emotional functioning and with guiding treatment decisions.

Thus, just as lab values, x-rays, and medical tests complement history-taking and physical examinations in the medical realm, psychological tests are "tools" that enhance interviewing and observational methods in the realms of psychiatry and psychology.

A psychological evaluation involves a combination of interviews and testing. In addition, old records are reviewed when available and ratings and input are sought from collateral informants to provide additional perspectives.

Evaluations are typically scheduled in 2 – 3 hour blocks depending on the age of the person being tested and the range of questions. Usually the face-to-face portion of testing can be completed in 1 – 3 meetings.

Interviews are conducted to help clarify questions and review the relevant history and presenting concerns. In addition, this provides an opportunity to answer questions about testing and the testing process itself.

Different tests assess different areas of functioning. Most tests involve a question-and-answer format or working with materials on a table. Computers are used to administer some tests and, in general, testing is an active and interactive process making the time pass relatively quickly.

After the face-to-face meeting(s), tests are scored, interpreted and synthesized with the other sources of information. Typically a written report is provided which includes a summary of the history and test findings and recommendations related to academic needs, clinical treatment and other specific target questions.

Impressions and recommendations are verbally discussed during a “feedback” meeting. The purpose of this meeting is to discuss the formulation and questions about the findings and to make sure recommendations are clear, understandable and actionable.

Additional meetings can be scheduled for ongoing discussion or to assist with the implementation of the recommendations. Lastly, consultation with other individuals (e.g., therapists, psychiatrists, schools, etc.) may also occur with appropriate consent.

Referrals come primarily from individual patients, family and friends, schools/educational consultants and “medical” (e.g., physicians, psychiatrists, neurologists, etc.) and mental health practitioners (e.g., psychologists, social workers, professional counselors).

While the reasons for a referral are quite varied, they usually center on issues of differential diagnosis and treatment planning. Common reasons for referral include:

1. Establishing and clarifying diagnoses such as learning disabilities (e.g., dyslexia), ADHD, anxiety, depression, autistic spectrum disorders, bipolar disorder, personality disorders, etc.
2. Assisting with educational planning, school placement and school readiness.
3. Helping to develop nuanced plans for tutoring and remediation and documenting the need for testing accommodations in older students.
4. Assessing intellectual ability and IQ (e.g., giftedness and intellectual disability) and establishing a baseline in order to gauge what is reasonable to expect of a given student.
5. Identifying neuropsychological difficulties (e.g., slow processing speed, limitations in working memory, attentional deficits, executive problems and weaknesses with learning and memory) related to illnesses such as dementia or injuries such as concussion and post-concussion syndrome.
6. To understand social-emotional functioning, personality organization and the underlying causes that can lead to substance abuse, behavioral problems and misconduct.
7. To guide treatment decisions (e.g., medication vs. therapy), to document changes in functioning over time and to gauge treatment response (e.g., testing pre-post design to evaluate the efficacy of a stimulant medication for ADHD).