Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
(All cases are fictionalized)
1. A young man is referred for therapy because he is very unhappy at work. He is far away from is home and his family. Despite being very handsome, he does not have a girl friend. He thinks he is depressed. He is correct but depression is not his primary problem. He will need to be tested and the results will be quite interesting.
2. Parents of a young child, who is doing very poorly in school, have been referred for treatment. The parents insist that the child is bright and cannot understand why he is having any problems. Testing shows results that will upset the parents and change the class the child is in at school.
3. A man, an attorney, is extremely successful in life and earns a fortune of money. However, his wife and children complain bitterly that he is never home and when he is home, he just doesn’t seem to hear their complaints. He agrees to go for testing and the results are fascinating.
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4. A young adolescent girl is hyperactive and constantly in trouble in school. She cannot sit in her classes, cuts classes, and with stealth and sneakiness, pulls the fire alarms. She is always caught and always in trouble. Her family is at their wits end. No one seems to understand what is wrong. The results of a complete medical and psychological work up will provide answers different from what one might expect.
What do all of these cases have in common? All four cases called for testing, assessment, and medical examinations. All revealed results that might have taken years to figure out had medical and psychological attention not been focused on the patient.
In the first case, the young man comes from an upper middle class, successful family in which he is expected to succeed, but never seems to perform up to expectations. Why is he unhappy at work and unable to meet girls? When he is referred to a neuropsychologist, who specializes in testing and assessment, it is revealed that he suffers from Attention Deficit Disorder (ADD). In addition to this, he has a minor neurological impairment that reveals it is difficult for him to process a lot of auditory information. This results in his missing important social cues when he is dating women. Women misinterpret his behavior and miscues as arrogance, deliberate self centeredness, or narcissism. In other words, they start out liking him but get grow disillusioned because he seems to not care about them. He is mystified about why he does so poorly socially. The same hold true for his work. Until his ADD and his neurological impairment are dealt with using medication, as well as focused cognitive behavioral therapy, he will continue to do poorly.
In case number two, the therapist knows something is terribly wrong the moment he meets the child. Immediately, it appears to him that the child looks and sounds very odd and that he most probably is retarded. Yet, at school he is in classes for children of normal intelligence and the parents mention nothing about retardation. The therapist refers the parents to a specialist who will give their child a battery of tests to determine what is really happening with this youngster. In the meantime, he gets permission to request the full school records for the child. What is the result of the battery of tests and what do the school records reveal? They reveal that the child is quite retarded and neurologically impaired. In addition, the school system originally had placed the child in classes for the mentally retarded. However, the parents refused to admit that their son was severely impaired and insisted that he be placed in normal classes. The job of the therapist was to break through the denial on the part of the parents in order that the child could get the proper social services and appropriate placement in school. In the face of all this information, it would be difficult for the parents to maintain their denial.
In case number three, the man presents as extremely successful, well spoken, intelligent, and self confident. However, his answers to a few questions leave the therapist with the impression that, despite his success, the man could have ADD, which is why his family complains that he never listens to them. In turns out that they are correct. The patient does not listen because he has ADD. He is extremely brilliant and moves quickly from one task to the next, leaving details to subordinates, while he is on to the next idea and concept. He agrees to psychological testing because he has always suspected that has ADD. The test results are positive. However, he is fearful of going on medication because he knows he has an edge over competitors and fears losing it. Of course, his edge is his brilliance and not his ADD.
In case number four, everyone probably believes that the young woman suffers from Attention Deficit Hyperactivity Disorder (ADHD). However, when all the results are in, including a complete medical examination, it turns out that this young teenager suffers from a hyperactive thyroid gland which makes it impossible to sit still, concentrate, and be in self control. Medical treatment for her thyroid condition brought dramatic results that pleased her family, teachers, and herself.
Psychological testing is sometimes a controversial subject. People criticize it for being inaccurate, racist, and unfair. Of course, anything can be used for unsavory or prejudicial purposes. However, the purpose of psychological tests, whether they are to get an IQ score, diagnose a neurological problem, or even determine the likelihood of someone being successful in a particular field of work (personality assessment), is to provide appropriate treatment or placement for either children or adults.
In case number two, above, a severely retarded child was in a class for children of average intelligence. That inappropriate placement could only cause him to feel scared, confused, and threatened by normal children who constantly teased him. In a similar way, I have had the experience of gifted children failing at school because they were placed in classes that left them bored and unchallenged. Testing and the appropriate class placement often make a dramatic difference in the lives of many children. The same is true for adults as indicated in three of the above cases.
Your comments and questions are welcome.
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