What is a clinicalpsychological assessment?

“He can't sit still for a minute in class, but he'll build Lego for two hours.” Sound familiar? Parents usually arrive at a clinical assessment after a long stretch of not quite knowing. Something about your child's day is harder than it should be (they cannot settle, they worry constantly, or the mornings have become a battle), and the explanations you have been offered so far contradict each other.

A clinical psychological assessment is, in practice, a careful answer to that uncertainty. It is a structured investigation, carried out by a licensed psychologist, of how a child is functioning in the areas that matter: thinking, learning, attention, emotion, behaviour and relationships.

Where does an assessment start?

Good assessment is not a fixed set of tests handed to every child. It begins with a referral question: the specific thing you, the school or your child's doctor want to understand. For example, “Why can he not sit still in lessons but concentrate for two hours on Lego?” is a referral question. So is “Is her low mood the cause of the slipping grades, or the result?”

Everything that follows is chosen to answer that question. This is why two children of the same age may be assessed with quite different instruments, and why the fee for an assessment cannot sensibly be quoted before the first conversation.

What is actually assessed?

A clinical assessment typically covers several areas, in whatever combination the question requires. Here are the main ones:

• —How your child reasons, understands language and thinks visually and spatially, how much they can hold in mind at once (working memory, a kind of RAM for the brain) and how quickly they process information. These cognitive abilities are usually measured with an instrument such as the WISC-V.
• —How well they sustain focus, hold instructions in mind, plan, start and finish tasks, and resist impulses (attention and executive functioning).
• —How new information is taken in, held and retrieved (learning and memory).
• —How they understand and express themselves (language), including the subtle comprehension difficulties that hide behind fluent-sounding speech.
• —How they manage anxiety, mood, irritability, friendships and self-esteem (emotional and behavioural functioning), using rating scales such as the BASC-3, completed by you and, with your consent, by teachers.

Alongside the tests sit three sources that are just as important. The first is a detailed developmental history, taken from you. The second is observation during the sessions: how a child handles a task that gets too hard is often more revealing than the score. The third is information from school.

How does it differ from a psychoeducational assessment?

The two overlap, and often one report covers both. Broadly, a psychoeducational assessment is oriented towards the classroom: why reading or maths is hard, and what teaching should change. A clinical assessment is oriented towards development and wellbeing: whether a neurodevelopmental or mental health condition is present, how significant it is, and what treatment is indicated. When a child has both academic difficulty and emotional distress (which is common), the sensible route is a combined assessment.

What do you get at the end?

A written report, in English, that sets out your child's profile in standard scores and percentile ranks, with plain-language descriptions. It includes a clinical formulation, meaning the explanation of how the pieces fit together; a diagnosis where the evidence supports one, and an explicit statement where it does not; and recommendations, split between what home can do, what school should do, and what may need onward referral to a paediatrician, psychiatrist, speech and language therapist or occupational therapist.

Before that report arrives, you should have a feedback meeting in which the findings are explained to you face to face, in ordinary words, with time for your questions. A report that lands in your inbox without that conversation has done half its job.

What if you are worried about the result?

Many parents delay an assessment because they fear what it might find. In practice the commonest outcome is relief. Uncertainty is heavier than information. Children very often already know that something is harder for them than for their classmates, and have quietly concluded that the reason is that they are not clever enough. Being told, accurately, that their difficulty has a name and a set of solutions is usually the kindest thing that has happened to them all year.