Teen Skepchick Interviews: Catherine A. Fiorello
This post is part of the Teen Skepchick Interviews series, where TS writers talk with amazing women scientists and skeptics about life, the universe, and everything.
In this week’s interview, school psychologist Dr. Catherine Fiorello weighs in on what the research says about ADHD, cognitive assessments, full inclusion and treatment for students with disabilities, and more, as well as the civil rights issues involved in how our schools treat, label, and segregate students.
She talks about the background and the purpose of cognitive tests as well as how they are misused, common myths in psychology, and examples of some bogus treatments and techniques for people with disabilities, such as facilitated communication.
Do learning styles really exist? Are IQ tests still used in schools? Is ADHD overdiagnosed? Are you reading this with only 10% of your brain? Read on to find out . . .
If you have questions for Dr. Fiorello after reading this interview, add them to the comments here or on Facebook, or send a tweet to @teenskepchicks.
What does full inclusion for students with disabilities mean and why do you advocate it?
Full inclusion means that students with disabilities are included with their peers in their regular neighborhood schools, with appropriate supports and services, rather than segregated in separate classes and separate schools. I support it for two reasons: One is a civil rights issues—separate is not equal. The other reason is that the research literature says that outcomes are better, for both the student with disabilities and for the typical peers.
There is a lot of woo out there for treating illnesses and disabilities, and families and students can use critical thinking to avoid wasting time, money, and hope on useless treatments. Blue-green algae and cod liver oil are not going to cure your ADHD. Acupuncture and cranio-sacral adjustment are not going to cure your dyslexia. A gluten-free, casein-free diet and avoiding vaccination are not going to cure your autism. And so on. . . .
Is ADD/ADHD overdiagnosed or often misdiagnosed?
Some of both. The diagnosis of ADHD is based on a checklist of observed behaviors. Those behaviors are assumed to indicate a disorder of executive functions—that is, there is a weakness in the control mechanism of the brain. A person with ADHD may not be able to sustain attention, or shift attention, or inhibit their impulses. Making the diagnosis depends on the clinician understanding how those behaviors manifest over the developmental period and in different environments, and also on ruling out any of the many things that can mimic ADHD. In some populations, it is overidentified because the alternate explanations aren’t ruled out. In some populations, it is underidentified because of the lack of access to health care.
There are basically two kinds of disorders—one is an obvious difference from what is typical, and one is just an extreme place on a continuum. Using an example from medicine, a heart murmur is different from normal, while high blood pressure is just an extreme version of normal. ADHD is more like high blood pressure. Where you set the cut-off makes a big difference in who gets identified—it’s not a yes or no answer. Everyone has trouble focusing their attention, shifting their attention, or inhibiting their impulses at times.
Is there any evidence for non-drug treatments or coping techniques for people with ADD/ADHD?
Oh, absolutely. But no quick fixes, I’m afraid. First, the evidence is that medication, when carefully prescribed and titrated, is very effective. Getting a prescription for Ritalin or Adderall from your pediatrician without any formal evaluation or followup, not so much. Second, behavioral techniques are also very effective (though most effective in combination with medication). But implementing behavioral techniques requires training and ongoing assistance. You probably can’t just buy a book and implement it at home. Another complicating factor is that ADHD has a genetic root, and it is very common for one or both parents to also have ADHD. This makes implementing a structured behavioral plan at home quite challenging.
Does the level of care for kids with ADHD and similar conditions change when they get to high school? Do they get less attention paid to helping them?
In general, services at the high school level are more difficult and fragmentary, because kids have a lot of different subjects and teachers. It’s hard to coordinate services. There’s also the belief that by high school, kids should be coping on their own.
It’s true that kids learn more coping strategies as they mature, but ADHD is a life-long condition, and some accommodations will probably be required forever. Teachers (and professors and employers) have more difficulty accepting and accommodating an invisible disability. When you see someone in a wheelchair, it’s pretty clear that they are not going to just need the ramp for a few weeks or months. But sometimes people expect a person with ADHD (or a learning disability or a mental illness) to get some help and then get over it!
Do we really have different learning styles (such as visual, auditory, kinesthetic)?
Nope. Although the concept that people have different learning styles is very popular, there is a lot of evidence that tailoring teaching to these styles is useless. What matters is using a teaching style that is appropriate for the material being presented. Besides, there’s no way to completely separate out the different processing modes—we all learn in a multisensory way all the time. Now, that’s not to say that people don’t have strengths and weaknesses—they do. But asking about “style” or “preferences” doesn’t tell you anything about how to teach them.
What kinds of cognitive assessments are given in schools?
There are two basic categories—group tests and individual tests. The group tests are given to everyone, and may be used for placement or screening. The group tests are less accurate but cheaper to administer. Individual tests can only be given with parental permission. They are generally administered by a school psychologist or a licensed psychologist. Private schools may use them for entrance exams. Public schools may use them for gifted program eligibility or eligibility to start school early or skip a grade, but they are mostly used to identify if a student has a disability.
How has the IQ test changed since it was first used?
The test was originally designed to decide if a student could benefit from general education or if the student needed something different—what we might call differentiating a kid with a cognitive disability from a kid with a motivation or emotional problem. Binet’s original test gave a “mental age,” which was basically the average age of kids who performed like you did on the various tasks. When Terman brought the Binet over to the U.S. and adapted it, he invented the notion of IQ, the Intellectual Quotient. It was your mental age divided by your actual chronological age (multiplied by 100 to get rid of the decimal place). The focus back then was on the one overall score.
Since then, there has been increasing differentiation of the cognitive abilities that we assess, starting with Wechsler’s division into Verbal and Performance IQs and currently including up to 9 or 10 different broad cognitive abilities. That’s one reason we now call them “cognitive assessments” rather than “IQ tests.”
The original tests were very loaded with the majority language and cultural knowledge. This led to some real inequities and evils—people being involuntarily sterilized for having low IQs, Jews fleeing the holocaust being turned away at immigration for not scoring well, minority students being shuffled off to dead-end classes. . . . Now we have a better understanding of the influence of language and culture on test performance, but we still have problems. The most widely used tests (the various Wechsler scales) still have a large language and cultural load, and minority kids are still placed in special education at a disproportionally higher rate.
Do cognitive assessments or their interpretation take into account disabilities, cultural background, or other differences?
(laughs) Oh, they certainly should! There are a wide variety of cognitive assessments available now, which makes it easier to choose a test that won’t discriminate against an individual because of language or cultural background or disability. And interpretation should always take individual background into account. A colleague of mine, Kevin McGrew, always says “we are the instrument!” If we just wanted to mechanically give the same test to everyone and get a total IQ score, we could turn the job over to a chimpanzee . . . or a computer.
What is their ideal purpose vs. how they are actually used?
A cognitive assessment should be used to figure out how a student learns and processes information, to describe strengths and weaknesses so that we can individualize instruction. The assessment should be done by a trained individual who will integrate contextual information with the actual test performance to draw conclusions and make recommendations.
Often, however, they are used as gatekeeping devices. If you get this score, you qualify for this; if you get that score, you’re not eligible for that. If that is done, especially if the test is one that is culturally or linguistically inappropriate, the test is being misused to deny people their rights.
When you were a teenager, did you know you wanted to get into psychology?
I always planned to be a scientist of some kind. I was the only girl in my elementary school classes who had a chemistry set and a microscope, and my mother really didn’t appreciate the preserved snake on my bureau! But then I took my first psychology class in high school and that was when I knew it was for me. Human behavior and problem solving are interesting and complex enough to keep a lot of scientists busy for a long time.
How and why did you get into the field of school psychology specifically?
I was a psychology major in college before I even heard of school psychology. I did my undergraduate work at Clark University, which has a renowned psychology department, and took classes with and worked with a wide variety of psychologists. Once I got into studying cognition, and saw how school psychologists used that information to improve education for students, I started looking for graduate programs in school psychology.
What is the most interesting research in your field right now?
In my area, the integration of neuropsychological research into cognitive assessment research is fascinating. Much neuropsychological research is based on people who have brain injuries, and much cognitive research is based on typical people, so figuring out how we can bridge these differences to develop a model of cognitive functioning is where the fun is!
What areas of your field require the most skepticism?
Treatments for kids with disabilities require a lot of critical thinking to sort through. Education and parenting are both susceptible to fads, and anecdotal information about things that appear to be effective spread like wildfire, especially since the Internet. The Internet has been great for people with disabilities, and parents of kids with disabilities, to find out information and seek out support groups. But there are also a lot of weird ideas out there, and when people are desperate for a cure, they can be vulnerable.
I’ll give you one example: Facilitated communication. This is the idea that people with autism or other serious developmental disabilities who are non-verbal can be helped to communicate on a keyboard by supporting their arms. It became very widespread, and you still see it recommended. It is very exciting for parents to think that they are communicating with the child that is “locked inside” their child’s body. Unfortunately, studies have shown that it is the helper who is typing, not the person with the disability. It’s unconscious, like using a Ouija board, not deliberate fraud. But it has led to things like kids being removed from homes and parents being jailed because of accusations of sexual abuse made through facilitated communication!
What are some common myths or areas of pseudoscience related to psychology?
“We only use 10% of our brains.” That’s probably my favorite. If you know anything about evolution, you have to figure that one is false. How could an organ evolve that uses so much oxygen and glucose if we weren’t using all of it?
“Sugar causes hyperactivity.” I even had to do a single-blind demonstration of this one to convince my husband it wasn’t true! Really, there’s no difference in kids’ behavior whether they have sugar or not—but if you tell the parents the kids had sugar, they think they are being more hyper.
“Little differences in parenting make a huge difference in a kid’s later life.” There really isn’t a huge difference in outcomes between cloth/disposable diapers, spanking/time out, pacifier/no pacifier, breastfeeding/formula feeding, male circumcision/no male circumcision. . . . If you are not abusive and you’re a reasonably responsive parent, your kid will probably be fine—you really can ignore the mommy wars!
Have you always been a skeptic? If not, how did you become one? Were there any particular turning points or influences?
It depends on what you mean by “skeptic.” I was always a scientist at heart, always questioning everything. But I was really fascinated by things like pyramid power and ancient astronauts and telepathy and the Loch Ness monster as a kid. Of course, I was also fascinated by black holes and relativity. It wasn’t clear to me then what was plausible and what wasn’t. James Randi and Martin Gardner helped me with that—as well as getting more science and research education.
Do you have any advice for young women interested in psychology but uncertain about what to specialize in?
All of psychology is based in science, but the first thing to think about is whether you would be more interested in the research end or the clinical end of psychology. As a primary researcher, you might be working with computer simulations, or research animals (yes, we still do study white rats), or people. As a primary clinician, would you like to work with individuals? Couples? Groups? Organizations? What age range? Would you rather focus on treatment or prevention? Do you want to work with people handling typical life problems, or serious mental illness or disabilities? Find a variety of psychologists to talk to about what they do, what they like about it, and what they don’t like. And make sure you know yourself and what you will be happy doing.
Catherine Fiorello is a licensed psychologist, board certified in school psychology, and an associate professor of school psychology at Temple University. She is married with a son just graduating from college.