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Clinical assessment

CPSE Prep

QuestionAnswer
Clinical assessment: Definition a) Collecting and evaluating info for purpose of determining a Dx. b) Identifying Tx plan, evaluating progress and outcomes of Tx.
Clinical assessment: Sources of information a) Client, family members, physicians, ed or employment records. b) Collateral info from police reports, forensic evals, personnel files, insurance claims. c) Referral to specialist evals, such as med Dr.
Clinical assessment: biopsychosocial orientation to assessment 1) Biological factors include health history of client & family. 2) Psychological factors history of behavioral, emotional, cognitive functioning. 3) Social factors include social environment, social context info available from tests & interviews
Clinical assessment: Legal & ethical issues in assessment & role of informed consent Ethics Code requires assessments, evals, diagnostic services receive informed consent first, unless a) Mandated by law, gov't regs; b) it is routine ed, institutional, or organization activity; c) evaluation of decisional capacity.
Clinical assessment: Legal & ethical issues in assessment & release of test data a) Ethics Code provides guidelines for explaining assessment results to clients & others. b) Explaining assessment results is also addressed in Standards for Educational & Psychological Testing.
Clinical assessment: Legal & ethical issues in assessment & explaining assessment results Interpretations of test results should: a) describe in simple language what the test covers, b) what scores mean, c) precision of scores, d) common misinterpretations of test scores, & e) how scores will be used.
Clinical assessment: Legal & ethical issues in assessment & limiting disclosure of protected health info Ethics Code requires only that a) info germane to purpose of communication be included in written/oral reports & consults, b) The "minimum necessary" disclosure to accomplish the disclosure's purpose.
Clinical assessment: Legal & ethical issues in assessment & electronic storage or transmission of info HIPAA's Security Rule (SR) regulates: a) creation, b) storage, c) transmission of test data/other protected health info in any electronic form.
Clinical assessment: Legal & ethical issues in assessment & required implementation specifications A covered entity (CE) must assign a unique password to each employee used to access electronic PHI.
Clinical assessment: Legal & ethical issues in assessment & safeguard categories for electronic protected health information (ePHI) The two categories are: "required implementation specifications" and "addressable implementation specifications."
Clinical assessment: Legal & ethical issues in assessment & leeway allowed by addressable implementation specifications Covered entities (CE) get leeway when a) it is determined a specification is not reasonable or appropriate for a CE, or b) CE documents whey specification is not reasonable & implements an equivalent alternative measure.
Clinical assessment: Legal & ethical issues in assessment & CA's data breach notification law requirements State agencies & private businesses that own or license computerized data are to notify CA residents or unauthorized access to unencrypted personal information.
Clinical assessment: Legal & ethical issues in assessment & encrypted protected health information Electronic protected health information (ePHI) is regulated by CA state law, but encrypted ePHI avoids liability due to unauthorized access of such information.
Clinical assessment: Legal & ethical issues in assessment & use of assessments & results a) Psychologists are to ordinarily base conclusions about clients on in-person evaluations supporting such conclusions. b) Deviation from standard administration is generally avoided, but acceptable when supported by research/evidence.
Clinical assessment: Legal & ethical issues in assessment & use of translated test items Reliability & validity of a translated version should be established before that test is used.
Clinical assessment: Legal & ethical issues in assessment & interpretation of assessment results Psychologists must consider examinee's test-taking style, language, physical abilities, & cultural familiarity w/ content of test as well as situational factors affecting their responses to the test. This info must be included in the test report.
Clinical assessment: Legal & ethical issues in assessment & use of obsolete test results Avoid basing assessment & intervention decisions on old test versions or testing results from an outdated examination session.
Clinical assessment: Legal & ethical issues in assessment & use of scoring or interpretation services Select automated or other scoring services on the basis of the validity of the information they provide. (We are responsible for the appropriate application of such results, regardless of if we score them ourselves or use a computerized service to do so)
Clinical assessment: Legal & ethical issues in assessment & test integrity & security Permitting a client to view test items before taking the test would be a breach of test security that may also have a negative impact on the test's integrity.
Clinical assessment: Legal & ethical issues in assessment & definition of test integrity Also known as psychometric integrity, it refers to test's reliability & validity.
Clinical assessment: Legal & ethical issues in assessment & definition of test security This refers to limiting unauthorized access to test items and other test materials.
Clinical assessment: Legal & ethical issues in assessment & definition of test materials a) Manuals, instruments, protocols, and test questions or stimuli. b) Does not apply to test data.
Clinical assessment: Principle 1 of the guidelines for ethnic, linguistic, & culturally diverse populations Psychologists are aware of how their own cultural background, attitudes, & values impact their work w/ clients, & make efforts to correct prejudices & biases. They are cognizant of limits of their training & experience, seek consultation, make referrals.
Clinical assessment: Principle 2 of the guidelines for ethnic, linguistic, & culturally diverse populations Consider the impact of ethnicity &culture when working w/ members of ethnic & cultural groups.
Clinical assessment: Principle 3 of the guidelines for ethnic, linguistic, & culturally diverse populations Be aware of research & practice issues relevant to populations we serve.
Clinical assessment: Principle 4 of the guidelines for ethnic, linguistic, & culturally diverse populations Interact w/ clients in the language requested by the client or make an appropriate referral. If not possible, obtain services of a translator w/ cultural knowledge & professional background or trained paraprofessional.
Clinical assessment: Principle 5 of the guidelines for ethnic, linguistic, & culturally diverse populations We document relevant sociopolitical & cultural factors in the records of culturally diverse members of the population, such as # of years in country, fluency in English, stress level due to acculturation, & familiarity or comfort w/ majority culture.
Clinical assessment: self-assessment & client preference guidelines for improving cultural sensitivity of assessments when working with ethnic, linguistic, & culturally diverse populations 1) Conduct self-assessment of biases & prejudices, familiarity w/ client's culture. 2) Determine client's preferred language, refer them to clinician who is familiar, or obtain interpreter.
Clinical assessment: Relationship, multi-method assessment, and impact of culture guidelines for improving cultural sensitivity of assessments when working with ethnic, linguistic, & culturally diverse populations 1) Establish therapeutic relationship with client before assessment. 2) Use multi-method assessment approach including culturally sensitive instruments. 3) Consider impact of client's culture on results of testing
Clinical assessment: Ethnic assessment & client's stage of racial/ethnic identity/level of acculturation This refers to a person's sense of collective identity, based on perception of sharing common racial or ethnic heritage with a group. Sue's Model has 5 stages.
Clinical assessment: Ethnic assessment & Stage 1 of Racial/Cultural Identity Development Model Conformity: People in this stage have positive attitudes toward and a preference for dominant culture values & depreciating attitudes toward their own culture. They likely prefer a therapist from dominant culture.
Clinical assessment: Ethnic assessment & Stage 2 of Racial/Cultural Identity Development Model Dissonance & Appreciating: This stage is marked by confusion & conflict over contradictory attitudes toward self & others of the same & different groups. In this stage people likely prefer a therapist from a minority group.
Clinical assessment: Ethnic assessment & Stage 3 of Racial/Cultural Identity Development Model Resistance & Immersion: In this stage people actively reject dominant culture & have + attitudes toward themselves & members of their own group. They prefer a therapist from same racial/cultural group & likely perceive all problems as the result of opp.
Clinical assessment: Ethnic assessment & Stage 4 of Racial/Cultural Identity Development Model Introspection: In this stage people exhibit uncertainty about the rigidity of their Stage 3 beliefs. Conflicts between loyalty & responsibility toward own group & desire for autonomy. Continue to prefer therapists from own group, also more open to others
Clinical assessment: Ethnic assessment & Stage 5 of Racial/Cultural Identity Development Model Integrative awareness: Sense of self-fulfillment Re: cultural I.D. & strong desire to eliminate oppression. Adopt multicultural perspective, examine values, beliefs, etc. of own & other groups before deciding. Emphasize similarity of world views
Clinical assessment: Ethnic assessment & level of acculturation This influences psychological help-seeking, compliance, & outcomes, is important factor when working w/ Native Americans or immigrants.
Clinical assessment: Ethnic assessment & definition of acculturation The degree to which a member of a culturally diverse group accepts & adheres to values, behaviors, customs, etc. of own group & dominant group. Is described in terms of four categories.
Clinical assessment: Ethnic assessment & four categories of acculturation 1) Integration: maintains own culture & incorporates dominant culture; 2) Assimilation: relinquishes own culture, accepts dominant one; 3) Separation: accepts own, withdraws from majority; 4) Marginalization: doesn't I.D. with own or dominant culture.
Clinical assessment: Factors affecting accuracy of clinical judgment & decision making 1) Client responses, including malingering & defensiveness, & 2) Clinician biases, including preconceived notions & confirmation bias
Clinical assessment: Six strategies for improving clinical judgment & decision making 1) Establishing rapport & trust, 2) Consider all sources of data, 3) Supplement client data with info from other sources, 4) Familiarize self with theories & research relevant to client, 5) Use base rate info, & 6) Be aware of own expectations, biases
Clinical assessment: Client responses as a factor affecting accuracy of clinical judgment & decision making The reliability of a client's responses to questions & test items may be impacted by client's emotional state, reactions to clinician, & willingness to talk. Also, client may consciously deceive or mislead by "faking good" or "faking bad"
Clinical assessment: Clinician biases as a factor affecting accuracy of clinical judgment & decision making The accuracy of assessment results is affected by clinician's biases operating consciously or unconsciously.
Clinical assessment: Malingering or "faking bad" responses as a factor affecting accuracy of clinical judgment & decision making This is a conscious effort by client to present being worse than really is the case in order to get external rewards. This should be suspected when they seek med evals for legal reasons, or marked discrepancy between symptoms and objective findings.
Clinical assessment: Additional reasons to suspect malingering or "faking bad" Person does not cooperate with diagnostic evaluation or prescribed Tx, person has Antisocial Personality Disorder.
Clinical assessment: Defensiveness or "faking good" responses as a factor affecting accuracy of clinical judgment & decision making This is a conscious effort to present as better off than is the case. Motives for this include seeking release from hospital, obtaining custody, or just making a favorable impression.
Clinical assessment: Reasons to suspect defensiveness or "faking good" a) Individual provides minimally responsive answers to questions, guarded responses to test items inconsistent with history, b) Client seems overly interested in convincing about numerous strengths, capabilities, accomplishments exceeding likely truth
Clinical assessment: Preconceived notions as clinician bias affecting accuracy of clinical judgment & decision making Perceptions & judgments may be influenced by beliefs Re: people based on a) age, b) gender, c) race, d) ethnicity, e) sexual orientation, f) socioecon background, g) physical appearance, & h) context of assessment testing
Clinical assessment: Confirmation bias in clinician affecting accuracy of clinical judgment & decision making Opinions about a client form early, based on info from referral source, data gathered early in assessment, & preconceived notions. This affects what added info clinician collects & how this gets interpreted.
Clinical assessment: Strategy #1 for improving clinical judgment & decision making Establishing an optimal level of rapport & trust thru reflection, paraphrasing, other active listening techniques, knowing when & how to ask added questions probing for info, & paying attention to client's nonverbal behavior to get clues Re: emotions.
Clinical assessment: Strategy #2 for improving clinical judgment & decision making Consider sources of info, don't overlook inconsistent data. Attend closely to indications of client strengths & pathology in order to get balanced view of client. Consider client's circumstances & environment before drawing conclusions.
Clinical assessment: Strategy #3 for improving clinical judgment & decision making Supplement client self-report data with info from other sources including client's family & friends, other professionals, medical evals, life records, & behavioral observations.
Clinical assessment: Strategy #4 for improving clinical judgment & decision making Be familiar w/ theories & research relevant to client. This includes being familiar w/ empirically validated assessments & interventions as well as w/ info on impact of racial, ethnic, cultural factors on diagnosis & treatment.
Clinical assessment: Strategy #5 for improving clinical judgment & decision making Use base rate info to estimate utility of assessment procedures, especially for predicting rare phenomena. Base rate refers to expected frequency of a characteristic, behavior, or Dx in a particular population. A rare behavior may not be predictable
Clinical assessment: Strategy #6 for improving clinical judgment & decision making Be aware of own expectations & biases, take steps to reduce impact on clinical decisions. Avoid misdiagnosis caused by gender, ethnic, racial biases by making sure your diagnoses are based on careful attention to DSM-5 diagnostic criteria.
Clinical interview: definition Clinical interviews are the core of assessments, allow clinician to obtain info directly thru client's answers to questions & indirectly by observing client's verbal & nonverbal behaviors during interview.
Clinical interview: Types of clinical interviews 1) Intake interview, 2)Case (Psychosocial) history interview, 3) Diagnostic interview 4) Crisis interview
Clinical interview: The intake interview This is used to I.D. nature of client's problem, determine if resources or competencies are available to help client; provide client w/ info Re: nature of available services, Tx options, & office policies. It obtains client's informed consent.
Clinical interview: Working relationships as a result of the intake interview The intake interview provides an opportunity for the clinician to begin to establish a working relationship with the client.
Clinical interview: The Case (psychosocial) history interview A case history obtains added info Re: the client's background to help formulate Dx & determine how presenting problem fits into wider context of life. Info is obtained Re: client's developmental history, family-of-origin, education, employment, recreation
Clinical interview: The diagnostic interview The goal of diagnostic interview is to obtain info needed to classify client's symptoms according to DSM. Interview may be unstructured, structured, or semi-structured.
Clinical interview: The unstructured diagnostic interview Interviewer uses clinical judgment to decide what questions to ask client, what issues to further investigate, what areas to set aside. Interviewer forms hypotheses Re: the client & symptoms, then tests these hypotheses by looking comparatively at info
Clinical interview: The structured diagnostic interview This provides explicit direction, standard questions asked in a specific order, a rating system for client's responses. Have good psychometric properties, but limit type of info to be obtained.
Clinical interview: The semi-structured diagnostic interview Contains standardized questions designed to elicit specific info in a consistent way. In contrast to structured interviews, includes many open-ended questions allowing follow up on important issues raised by responses.
Clinical interview: The crisis interview The goal of a crisis interview is to identify the nature of the client's crisis, provide immediate support to the client, & identify methods for resolving crisis as quickly as possible.
Mental status examination (MSE) The MSE provides info on client's current level of mental functioning. The info collected is used to fom appropriate psych Dx & plans for further assessment & intervention such as referrals, admit to psych hospital, eval for med problems affecting psych
Mental status examination (MSE) and domains of functioning it evaluates for There are 9 domains of functioning the MSE evaluates: 1) Appearance, 2) Activity & behavior, 3) Attitude toward examiner, 4) Mood & affect, 5) Speech & language, 6) Thought content, 7) Thought process, 8) Insight & judgment, & 9) sensorium/cognition
Mental status examination (MSE) and examples of the appearance domain of functioning Examples include: Apparent age, dress & hygiene, abnormal physical traits, posture, facial expression, & eye contact
Mental status examination (MSE) and examples of the activity & behavior domain of functioning Examples include: purposfulness of movement, poverty of movement, agitation, tics, & compulsions
Mental status examination (MSE) and examples of the attitude toward examiner domain of functioning Includes: cooperativeness, sensitivity, resistance, defensiveness, suspiciousness, & hostility
Mental status examination (MSE) and examples of the mood & affect domain of functioning Includes: predominant mood (sustained emotional state) & type, intensity, range, & appropriateness of affect (outward expression of emotional state)
Mental status examination (MSE) and examples of the speech & language domain of functioning Examples include: rate, volume, fluency, prosody, vocabulary, & pronunciation
Mental status examination (MSE) and examples of the thought content domain of functioning Examples include: statements, themes, & beliefs (distortions, obsessions, compulsions, phobias, suicidal ideation, homicidal ideation, delusions, hallucinations)
Mental status examination (MSE) and examples of the thought process domain of functioning Examples include: flow & organization of thought (flight of ideas, loosening of associations, perseveration)
Mental status examination (MSE) and examples of the insight & judgment domain of functioning Examples include: awareness of internal & external realities (e.g. awareness of one's illness & its consequences), ability to assess social situations correctly & respond appropriately, & ability to make & carry out plans
Mental status examination (MSE) and examples of the sensorium/cognition domain of functioning Examples include: orientation, level of arousal, memory, attention, abstract thinking, and general knowledge
Mini mental state exam (MMSE) purpose and use a) Was developed as a shortened version of the MSE for assessing cognitive functioning. b) Useful as initial screening device for cognitive impairment, also used to follow course of illness, monitor response to Tx. Is not a substitute for Dx dementia
Mini mental state exam (MMSE) assesses 6 aspects of cognitive functioning 1) Orientation, 2) Registration of recall, 3) Attention & calculation, 4) Recall, 5) Language, 6) Visual construction
Mini mental state exam (MMSE) & the assessment of orientation Orientation to time & place is assessed by asking the person the date, season, name of the city or state, etc.
Mini mental state exam (MMSE) & the assessment of registration Registration is a measure of immediate verbal recall and is evaluated by determining how many trials it takes for the person to accurately repeat three words named by the examiner
Mini mental state exam (MMSE) & the assessment of attention & calculation Attention & calculation are assessed by asking the person to count backwards from 100 by a specific number of digits
Mini mental state exam (MMSE) & the assessment of recall Recall is a measure of delayed recall & involves asking the person to recall the three words that were previously named by the examiner
Mini mental state exam (MMSE) & the assessment of language Language is evaluated with several questions including asking the person to name familiar objects and to follow a simple three-stage command
Mini mental state exam (MMSE) & the assessment of visual construction Visual construction is assessed by asking the person to copy a simple geometric figure. The maximum score is 30, and a score of 23 or 24 is ordinarily used as a cutoff, with scores below indicating cognitive impairment.
Factors of the client affecting scores on the mini mental state exam (MMSE) Scores on the MMSE have been found to be affected by premorbid intelligence, educational experience, & race/ethnicity
Definition of behavioral assessment A scientific approach to psych assessment emphasizing use of minimally inferential measures, use of measures that have been validated in ways appropriate for context of assessment, & assessment of functional relations
Behavioral assessment's emphasis on multiple iterations as part of it's scientific approach The use of behavioral assessment uses derivation of judgments based on measurement in multiple situations, from multiple methods & sources, and across multiple times.
Purposes for behavioral assessment These are conducted to obtain data that assists in deriving diagnoses, determining appropriate interventions for problematic behaviors, & assessing progress & outcomes of interventions
Distinguishing behavioral assessments from other assessments 1) Behavioral assessments focus on directly measurable behaviors, view of behavior is situationally specific. 2) Targets of this assessment are individual's overt behaviors. 3) Also focuses on physiological phenomena such as muscle tension, heart rate, et
Behavioral assessment & environmental events Environmental events are events that elicit, maintain, or otherwise affect behavior, & are important in behavioral assessment. Antecedents, consequences, reprimands are all examples of environmental events.
Behavioral assessment & antecedent environmental events Environmental events that precede a target behavior are antecedents, & include verbal instructions, the presence of a specific person, & participation in a particular activity.
Behavioral assessment & consequences Events that follow a behavior are referred to as consequences, & include desirable events that increase the behavior (praise, tokens) & undesirable events such as reprimands, loss of privilege)
Behavioral assessment as functional behavioral assessment a) When identifying antecedents and consequences, this assessment is referred to as a functional behavioral assessment. b) The antecedents and consequences explain the function (purpose or cause) of the behavior.
Behavioral assessment & results of a functional behavioral assessment a) The results provide info needed to develop a functional behavior plan that I.D.s alternative behaviors b) This assessment is often used in schools to I.D. appropriate interventions for students, & in mental health settings to I.D. autism interventions
Behavioral assessment & use in mental health settings I.D.s appropriate interventions for behavioral problems of those with Autistic Disorder, Schizophrenia, acquired brain injury, and other disorders.
Behavioral assessment & use in schools I.D.s interventions for underachieving students and students who engage in disruptive, challenging behaviors.
Behavioral assessment methods This incorporates a variety of methods including interviews, behavioral observations, behavior rating scales, self-report inventories, & measures of physiological events.
Behavioral assessment interview protocol/procedure This begins with: a) interviews w/ individual & family, b) teachers, c) other people familiar w/ individual's behaviors.
Behavioral assessment purpose of interviews The purpose is to obtain preliminary info Re: the behavior & its antecedents & consequences (e.g. what the problematic behavior looks like, when it's most & least likely to occur, & what happens after behavior occurs.
Behavioral assessment behavioral observations a) observations take place in natural settings. b) They use several methods to record data from observations
Behavioral assessment methods of data collection a) narrative recording, b) event recording, c) interval recording, d) self-monitoring, involving individual recording info Re: his/her own behavior or cognitions
Behavioral assessment & the narrative recording method This involves verbal descriptions of the behavior.
Behavioral assessment & the event recording method This involves recording the frequency, duration, or intensity of the behavior.
Behavioral assessment & the interval recording method This involves recording whether or not the behavior occurred during predefined time intervals.
Psychological testing: purpose and use a) Test scores alone are not sufficient for making diagnostic and Tx decisions. b) They must be integrated w/ data from other sources, such as clinical interview, clinical impressions, observations, & information from collateral sources.
Psychological testing: Choosing a psychological test This depends on a) the purpose of testing, b) characteristics of the client, c) examiner's training & experience, & d) psychometric properties of the test with appropriate norms & adequate reliability & validity
Psychological testing & norms a) Norm-referenced tests compare examinee's performance to the performance of a norm group. b) The extent to which an examinee's characteristics match those of people from the norm sample determines the ability of the test to provide meaningful info
Psychological testing & questions to ask when evaluating test norms a) Is the norm sample representative of the population it's intended to represent? b) Do the characeristics of the norm group match the characteristics of the examinee? c) How recent are the test norms? They should be periodically updated.
Psychological testing & reliability a) This is consistency, the ability of a test to provide dependable, consistent scores. b) Affected by the degree to which scores are susceptible to measurement error. c) Reliability reported in terms of a correlation coefficient ranging from 0 to 1.0.
Psychological testing & preferred reliability coefficient score For most tests a reliability of .90 or higher is preferred when test results will be used to make important decisions about an examinee.
Psychological testing & methods to evaluate test reliability a) Test-retest reliability, b) Alternate forms reliability, c) Internal consistency reliability, d) Inter-rater (interscorer) reliability
Psychological testing & Test-retest reliability methods to evaluate test reliability This is used to determine the reliability of tests designed to measure attributes relatively stable over time, not affected by repeated measurement (practice effects). It is appropriate for aptitude tests, but not mood tests.
Psychological testing & alternate forms reliability methods to evaluate test reliability This reliability indicates consistency of responding to different item samples (different forms of a test). Also, consistency when forms are administered at different times, and consistency of responding over time.
Psychological testing & internal consistency reliability methods to evaluate test reliability This is used to evaluate reliability when a test is designed to measure a single characteristic, when the characteristic measured by the test fluctuates over time, or when scores are affected by repeated exposure to the test.
Psychological testing & two methods of evaluating internal consistency reliability Split-half reliability & coefficient alpha are two methods for evaluating internal consistency reliability.
Psychological testing & inter-rater (inter-scorer) reliability Interscorer reliability is of interest whenever scores depend on a rater's judgment. Behavioral observation scales and projective personality tests should have evidence of adequate inter-rater reliability
Psychological tests & interpretation of scores Use caution when interpreting scores; a confidence interval constructed around a score helps to describe a range within which a true score is likely to fall.
Psychological tests & Methods for evaluating the validity of tests a) Content validity, b) Construct validity, c) Criterion-related validity
Psychological tests & definition of validity Validity refers to accuracy; a test is valid when it accurately measures what it is intended to measure.
Psychological tests & content validity method of evaluating the validity of tests Content validity is established through judgment of subject matter experts who determine if test items are adequate and representative of the domain assessed by the test.
Psychological tests & construct validity method of evaluating the validity of tests Construct validity is established thru systematic accumulation of evidence that the test is actually measuring the construct the test was designed to measure
Psychological tests & criterion-related method of evaluating the validity of tests Two types of criterion-related validity: a) Concurrent validity which is used to estimate current status on the criterion; b) Predictive validity predicts future performance on the criterion.
Psychological tests & assessment through correlation of criterion-related validity Concurrent and predictive validity are assessed by correlating scores on the test (predictor) with scores on the criterion obtained by a sample of examinees.
Psychological tests & objective personality tests These are highly structured tests that present examinees with multiple-choice questions or other unambiguous stimuli.
Psychological tests & MMPI-2 objective personality test a) A self-report measure assessing social and personal maladjustment, b) Use to assist in diagnosis of mental disorders and Tx planning. c) Consists of 567 t/f items & gives scores on 10 clinical & 8 validity scales, numerous sub- & supplementary scales
Psychological tests & MMPI-2 clinical scales & their interpretations: Hs/Hypochondriasis Measures preoccupation with physical symptoms
Psychological tests & MMPI-2 clinical scales & their interpretations: D/Depression Measures depression, hopelessness, dissatisfaction w/ self
Psychological tests & MMPI-2 clinical scales & their interpretations: Hy/Hysteria Measures repression, denial, immaturity, somatic complaints
Psychological tests & MMPI-2 clinical scales & their interpretations: Pd/Psychopathic Deviate Measures antisocial behaviors, rebelliousness, social alienation
Psychological tests & MMPI-2 clinical scales & their interpretations: Mf/Masculinity-Femininity Measures stereotypic masculine or feminine interests
Psychological tests & MMPI-2 clinical scales & their interpretations: Pa/Paranoia Measures paranoia, cynicism, interpersonal sensitivity
Psychological tests & MMPI-2 clinical scales & their interpretations: Pt/Psychasthenia Measures anxiety, obsessions, compulsions
Psychological tests & MMPI-2 clinical scales & their interpretations: Sc/Schizophrenia Measures psychosis, unusual thought processes, social alienation
Psychological tests & MMPI-2 clinical scales & their interpretations: Ma/Hypomania Measures unstable mood, impulsivity, grandiosity, flight of ideas
Psychological tests & MMPI-2 clinical scales & their interpretations: Si/Social Introversion Measures shyness, social withdrawal/avoidance
Psychological tests & MMPI-2 validity scales & their interpretations: ? (Cannot say/omitted items) High score measures defensiveness, indecisiveness, reading difficulties
Psychological tests & MMPI-2 validity scales & their interpretations: L (lie) a) High score measures attempt to fake good, defensiveness, denial; b) Low score measures frankness, exaggeration of negative characteristics
Psychological tests & MMPI-2 validity scales & their interpretations: F (infrequency) a) High score measures exaggeration of problems, deliberate malingering; b) Low score measures absence of unusual behavior, social conformity
Psychological tests & MMPI-2 validity scales & their interpretations: K (correction) a) High score measures attempt to face good, defensiveness, lack of insight; b) Low score measures attempt to fake bad, excessive self-criticism
Psychological tests & MMPI-2 validity scales & their interpretations: Fb (Back-F) High score measures deviant responding to items at the end of test
Psychological tests & MMPI-2 validity scales & their interpretations: Fp (Psychopathology infrequency) High score measures endorsement of extremely bizarre content
Psychological tests & MMPI-2 validity scales & their interpretations: VRIN (Variable response) High score measures inconsistent responding to similar items
Psychological tests & MMPI-2 validity scales & their interpretations: TRIN (True response inconsistency) High score measures if test-taker gives true or false responses indiscriminantly
Psychological tests & MMPI-2 age range This test is appropriate for 18 years or older with at least 5th grade or 4.6th grade reading level, although some sources claim a 6th or 8th grade reading level. MMPI-A is for adolescents 14-18 years.
Psychological tests & MMPI-2 scoring & interpretation Raw scores on each scale are converted to T-scores that have a mean of 50 and SD of 10. A T-score of 65 or more is considered clinically significant.
Psychological tests & MMPI-2 interpretation a) Begins by determining validity of a profile by considering scores on validity scales. b) When L, F, & K assume "V"-shape, clinical scales must be interpreted with caution.
Psychological tests & MMPI-2 interpretation: Elevated "F" scale score Extremely elevated F scale score and a high value on the F minus K index (> 9) suggest symptoms exaggeration or attempt to fake bad, linked to malingering.
Psychological tests & MMPI-2 and clinical scale scores Only if profile is valid, then interpret clinical scores looking for two or three most elevated scores.
Psychological tests & MMPI-2 interpretation: 2-7/7-2 code Significant depression and anxiety with agitation, perfectionism, somatic symptoms
Psychological tests & MMPI-2 interpretation: 4-9/9-4 code Acting out behaviors, characteristic of people with history of marital problems, A & D abuse, delinquency, sex offenses.
Psychological tests & MMPI-2 interpretation: 1-2-3 code (with scales 1 and 3 substantially higher than 2) "Neurotic triad" or "conversion valley", associated w/ somatization of psych problems
Psychological tests & MMPI-2 interpretation: 6-7-8 code (w/ Scales 6 & 8 substantially higher than 7) "Psychotic valley" and is associated with delusions, hallucinations, disordered thought, Dx of schizophrenia (especially paranoid type)
Psychological tests & MMPI-2-Restructured Form (RF) a) Published in 2008, an alternative, not replacement for MMPI-2, b) Has 338 items, c) This version clarifies clinical scale scores, can tell if elevations are due to psychotic symptoms or due to demoralization/general distress
Psychological tests & Millon Clinical Multiaxial Inventory-III (MCMI-III) a) A 175-item true/false self-report test, b) Assists in diagnosing DSM Axis I & Axis II disorders, c) Provides scores on 14 personality disorder scales, d) 10 clinical syndrome scales, e) Four correction scales detect distortions in responses
Psychological tests & Millon Clinical Multiaxial Inventory-III (MCMI-III): Age & reading ability a) Considered appropriate for ages 18 and older, b) At least 8th grade reading level, c) Millon Adolescent Clinical Inventory is for ages 13 to 19 years w/ reading ability at/above 6th grade level
Psychological tests and projective personality tests a) These tests differ in terms of content, format, and interpretation, b) Based on assumption that examinee's responses to ambiguous stimuli can elicit meaningful info Re: personality, underlying motivation & conflicts
Psychological tests and Rorschach Inkblot Test projective personality test a) Consists of 10 cards each contain symmetrical inkblot. b) Primary use to obtain information assisting in Dx & Tx plan. c) Admin in 2 phases: Free association and subsequent inquiry phase
Psychological tests and Rorschach Inkblot Test age range May be administered to ages 2 and older.
Psychological tests and Rorschach Inkblot Test scoring & interpretation Scoring & interpretation systems include the following dimensions: a) location, b) determinants, c) form quality, d) content, & e) frequency of occurrence. Interpretation involves considering the number and type of responses in each category.
Psychological tests and Rorschach Inkblot Test scoring & interpretation using location This dimension of scoring and interpretation looks at where in the inkblot the client's perception is located
Psychological tests and Rorschach Inkblot Test scoring & interpretation using determinants This dimension of scoring and interpretation looks at what in the inkblot determined the client's response
Psychological tests and Rorschach Inkblot Test scoring & interpretation using form quality This dimension of scoring and interpretation looks at how similar the client's perception is to the actual shape of the inkblot
Psychological tests and Rorschach Inkblot Test scoring & interpretation using content This dimension of scoring and interpretation looks at the category the perception falls into -human, animal, or nature
Psychological tests and Rorschach Inkblot Test scoring & interpretation using frequency of occurrence This dimension of scoring and interpretation looks at the extent to which the perception is original or popular
Psychological tests and Thematic Apperception Test (TAT) a) Based on Murray's 1943 theory of needs. b) Consists of 19 cards w/ vague pictures of human figures, plus 1 blank card. c) Asked to make up a story about each picture. d) Includes request to include info on a number of dimensions about each story card.
Psychological tests and Thematic Apperception Test (TAT) requested information provided by examinee a) What happened in each picture, b) What led to that situation, c) How do the people in the picture feel, d) How the story ends.
Psychological tests and Thematic Apperception Test (TAT) scoring and interpretation (Murray's) a) Identify the story's hero, b) Evaluate intensity, frequency, duration of: c) needs, d) environmental press, e) thema, & f) outcomes expressed. Not useful for fine diagnosis, gross Dx only (neurosis vs. schizophrenia)
Psychological tests and projective drawing tests Include a) House-Tree-Person (H-T-P) test, b) Draw a Person (DAP), c) Kinetic Family Drawings (KFD). These are based on assumption that examinee projects an inner view of self, environment, important things onto drawings. Questionable validity for Dx.
Psychological tests and measures of intelligence IQ tests are used to a) assess scholastic aptitude, b) educational & occupational counseling, & c) diagnosing MR, LD, & other disorders. Yield 1 or more IQ scores, indicating performance in relation to a norm (standardization) sample.
Psychological tests and WAIS-IV a) Published in 2008, b) based on I.Q. as global ability w/ interrelated functions, c) WAIS-IV does not report VIQ & PIQ, now just Full-Scale IQ, plus 4 Index Scores, 10 core & 5 supplemental subtests.
Psychological tests and WAIS-IV Indexes: Working Memory Index (WMI) a) The WMI involves measures of simultaneous & sequential processing, attention, concentration, & learning ability. b) It's core subtests are digit span & arithmetic, it's supplemental subtest is letter-number sequencing
Psychological tests and WAIS-IV Indexes: Processing Speed Index (PSI) a) The PSI measures speed of processing, cognitive flexibility, learning ability, short-term visual memory. b) It's core subtests are symbol search & coding, it's supplemental subtest is cancellation
Psychological tests and WAIS-IV Indexes: Perceptual Reasoning Index (PRI) a) The PRI involves nonverbal reasoning, visual problem-solving. b) It's core subtests are block design, matrix reasoning, & visual puzzles, it's supplemental subtests are figure weights & picture completion
Psychological tests and WAIS-IV Indexes: Verbal Comprehension Index (VCI) a) The VCI involves meaures of verbal reasoning, learning ability, practical and social judgment, & general knowledge. b) It's core subtests are vocabulary, similarities, information, it's supplemental subtest is comprehension
Psychological tests and WAIS-IV age range This test is for individuals 16 years thru 90 years, 11 months. There is also the WISC-IV, ages 6 years to 16 years, 11 months, & WPPSI-IV, ages 2 years, 6 months through 7 years, 7 months.
Psychological tests and WAIS-IV: Scoring & Interpretation a) Raw scores convert to standard scores, b) FSIQ & index scores have mean of 100, SD of 15, while subtest scores have mean of 10 and SD of 3. c) Multi-level approach to interpretation considering FSIQ first, followed by index scores & subtest scores.
WAIS-IV Scoring & Interpretation: Standard deviation between index scores and subtest scores a) If there is a 1.5 SD or more discrepancy between any two index or subtest scores, the FSIQ and/or the index score must be interpreted w/ caution. b) Subtest scores are used to identify relative strengths & weaknesses.
WAIS-IV Scoring & Interpretation: General Ability Index (GAI) a) A GAI is derived from the VCI & PRI scores. b) Is useful when a summary score is wanted that minimizes impact of working memory & processing speed on general intelligence.
WAIS-IV Scoring & Interpretation: Increasing clinical utility The WAIS-IV Technical Manual provides score patterns characteristic of clinical groups, such as Borderline Intellectual Functioning, Mild Cognitive Impairment, Alzheimer's Dementia, depression, & ADHD.
Psychological tests and the Stanford-Binet Intelligence Scale, Fifth Ed. (SB5) The SB5 was designed as a measure of general cognitive ability, to assist in psychoeducational evaluation, the Dx of developmental disabilities & exceptionalities, and forensic, career, neuropsychological, & early childhood assessment.
Psychological tests and the Stanford-Binet 5 (SB5) development process (hierarchical general mental ability) The SB5 model of g incorporates five cognitive factors that are each measured by subtests and activities that represent verbal and nonverbal domains.
Psychological tests and SB5 cognitive factors Includes 5 cognitive factors: Fluid reasoning (FR); Knowledge (KN); Quantitative Reasoning (QR); Visual-Spatial Processing (VS); & Working Memory (WM).
Psychological tests and SB5 nonverbal domain subtests/activities SB5 includes these nonverbal domain subtests/activities: Object series-matrices; procedural knowledge, picture absurdities, quantitative reasoning, form board, form patterns, & delayed response, block span.
Psychological tests and SB5 verbal domain subtests/activities SB5 includes these verbal domain subtests/activities: early reasoning, verbal absurdities, verbal analogies; vocabulary; quantitative reasoning; position & direction; memory for sentences, last word.
Stanford-Binet 5 and Fluid Reasoning (FR) cognitive factor associated with its nonverbal and verbal domain subtests/activities FR is associated with object series-matrices nonverbal domain subtests/activities and is associated with early reasoning, verbal absurdities, & verbal analogies verbal domain subtests/ activities.
Stanford-Binet 5 and Knowledge (KN) cognitive factor associated with its nonverbal and verbal domain subtests/activities KN is associated with procedural knowledge & picture absurdities nonverbal domain subtests/ activities and is associated with vocabulary verbal domain subtests/ activities.
Stanford-Binet 5 and Quantitative Reasoning (QR) cognitive factor associated with its nonverbal and verbal domain subtests/activities QR is associated with quantitative reasoning nonverbal domain subtests/activities and is associated with quantitative reasoning verbal domain subtests/ activities.
Stanford-Binet 5 and Visual-Spatial Processing (VS) cognitive factor associated with its nonverbal and verbal domain subtests/activities VS is associated with form board & form patterns nonverbal domain subtests/ activities and is associated with position and direction verbal domain subtests/ activities.
Stanford-Binet 5 and Working Memory (WM) cognitive factor associated with its nonverbal and verbal domain subtests/activities WM is associated with delayed response, block span nonverbal domain subtests/ activities and is associated with memory for sentences & last word verbal domain subtests/ activities.
Psychological tests and SB5 age range The SB5 is appropriate for ages 2 to 85+ years.
Psychological tests and SB5 scoring and interpretation a) Subtest scores on the SB5 (M = 10, SD = 3) are combined to obtain composite scores with M = 100, SD = 15. b) The composite scores are five factor index scores, 2 domain scores (verbal, non-verbal), abbreviated battery IQ, & Full Scale IQ.
Psychological tests and Stanford-Binet 5 scoring and interpretation: Composite scores Composite scores allow criterion-referenced interpretation of an examinee's performance in terms of developmental level (age) & complexity of tasks; useful for evaluating extreme levels of ability, & tracking changes over time.
Psychological tests and Culture-fair tests Culturally sensitive tests have reduced cultural content & make use of a nonverbal format to overcome the cultural loading associated w/ language. These tests must be used w/ caution, because there is evidence that they may be culturally loaded as well
Psychological tests and Culture-fair tests: The Leiter International Performance Scale -Third Ed. (Leiter-3) The Leiter-3 was designed as a culture-fair measure of cognitive abilities for individuals aged 3 to 75+ years. It can be administered w/o verbal instructions & is useful for those with language problems or hearing impairment.
Culture-fair tests: The Leiter International Performance Scale -Third Ed. (Leiter-3) requirements for completion The Leiter-3 requires matching a set of response cards to corresponding illustrations on an easel. Test items emphasize fluid intelligence, evaluate four domains of cognitive functioning -visualization, reasoning, memory, & attention.
Psychological tests and Culture-fair tests: Raven's Progressive Matrices a) The Matrices is a nonverbal measure of (g) & considered culture-fair because it is relatively independent of the effects of specific education & cultural learning. b) Requires solving problems involving abstract figures & designs
Culture-fair tests: Raven's Progressive Matrices, the Standard Progressive Matrices (SPM), Colored Progressive Matrices (CPM), & Advanced Progressive Matrices (APM) a) The SPM are appropriate for individuals aged 6 years and older. b) The CPM is easier & shorter for ages 5 to 11 & older adults. c) APM is for those 12 years and older of above ave. intelligence.
Culture-fair tests: Raven's Progressive Matrices, ease of use and use by the disabled/ culturally disadvantaged Instructions for these tests are simple, can be pantomimed. They can also be used with hearing-impaired, non-English speaking individuals, & individuals with aphasia or physical disability.
Culture-fair tests: Columbia Mental Maturity Scale (CMMS) a) This is a test of general reasoning ability for children aged 3 to 10. b) It is 92 cards w/ 3, 4, or 5 drawings, c) It is required you indicate the drawing that does not belong w/ the others. d) It does not require verbal responses or fine motor skills
Culture-fair tests: Columbia Mental Maturity Scale (CMMS) & target population CMMS was developed for kids w/ cerebral palsy, & is useful for kids w/ brain damage, MR, speech impairments, hearing loss, limited English
Neuropsychological tests: Uses a) For screening brain dysfunction & diagnosis of neurological disorders. b) Evaluates mental processes ranging from simple motor performance to reasoning, problem-solving, other complex cognitive abilities
Neuropsychological tests: Halstead-Reitan Neuropsychological Battery (HRNB) a) Tests of the HRNB accurately differentiate between normals and brain damaged ones. b) We choose the type & # of tests to use, but also use a standard set of subtests to assess sensorimotor, perceptual, & language functions.
Neuropsychological tests: Halstead-Reitan Neuropsychological Battery (HRNB): The Impairment Index a) HRNB yields an average Impairment Index ranging from 0 to 1 b) Higher scores = more severe impairment, c) Intended for adults, but has a downward extension for kids ages 5 to 14 years.
Neuropsychological tests: Luria-Nebraska Neuropsychological Battery a) Consists of 11 subtests assessing different skills likely to be affected by brain damage. b) Scoring is: 0 = normal; 1 = borderline; 2 = abnormal. c) Provides scores on 14 scales (motor, tactile, visual, reading, arithmetic, memory, etc.)
Neuropsychological tests: Scoring the Luria-Nebraska Neuropsychological Battery a) A high score on three or more scales suggests neuropsychological impairment. b) Two forms of the Battery are available, 1 for adults & adolescents, and another for children.
Neuropsychological tests: Bender Visual-Motor Gestalt Test- 2nd Ed (Bender-Gestalt-II) a) Brief measure of visual-motor integration b) for ages 3+ years, c) Sixteen stimulus cards of geometric figures d) Requires copying the figures, then drawing from memory. e) Valid screen for neuropsych impairment & tracks developmental changes
Neuropsychological tests: Wechsler Memory Scale-Fourth Ed (WMS-IV) a) Comprehensive measure of memory, b) Provides scores on 5 Primary Indexes including: auditory, visual, immediate, delayed, & visual working memory. c) Co-normed to WAIS-IV, so permits comparison of an examinee's intellect & memory
Measures of specific symptoms, behavior, & abilities a) These include inventories/checklists that assist in detection & Dx, b) For fears, anxiety, depression, eating disorder, AD/HD, A & D abuse, MR, social skills, & Marital relatoinships. c) Used for Tx planning, monitoring, & outcome assessment.
Measures of specific symptoms, behavior, & abilities: Beck Depression Inventory-II (BDI-II) a) 21-item self-report measure for ages 13+, b) At least 8th grade reading level required, c) Assess severity of complaints, Sx, & concerns related to depression, d) Target specific Sx, those reflecting severe or hospitalizable Sx.
Beck Depression Inventory-II (BDI-II) cut-off scores & complimentary tests a) Cut-off scores: 1-13 = minimal depression; 14-19 = mild; 20-28 = moderate; 29-63 = severe. b) Complimentary tests: Beck Hopelessness Scale, Beck Scale for Suicidal Ideation can both be used to assess suicide risk.
Measures of specific symptoms, behavior, & abilities: Symptom Checklist-90-Revised (SCL-90-R) a) This is useful for evaluating type/severity, & Tx outcomes for individuals ages 13 and up. b) 90 items provide scores on nine Sx dimensions, and on 3 global indices. c) Brief Symptoms Inventory (BSI) is short version of SCL-90-R & has 53 items.
Symptom Checklist-90-Revised (SCL-90-R): Nine symptom dimensions Sx dimensions are: somaticization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, & psychoticism
Symptom Checklist-90-Revised (SCL-90-R): The three global indices Global indices: Global Severity Index, Positive Symptoms Distress Index, & Positive Symptoms Total.
Measures of specific symptoms, behavior, & abilities: Child Behavior Checklist for Ages 6-18 (CBCL/6-18) a) Obtains info Re: behavioral & emotional problems & competencies of a child/adolescent from the parents/guardian. b) 118 items describing areas of behavioral or emotional functioning + two open-ended items describing other concerns.
Child Behavior Checklist for Ages 6-18 (CBCL/6-18): Areas addressed by the CBCL/6-18 a) Child's activities, chores, friends, & grades. b) Separate scores are provided for externalizing Sx & internalizing Sx.
Child Behavior Checklist for Ages 6-18 (CBCL/6-18): Externalizing & internalizing symptoms measured a) Externalizing Sx: delinquent behavior and aggressive behavior. b) Internalizing Sx: anxious/depressed, social problems, attention problems.
Child Behavior Checklist for Ages 6-18 (CBCL/6-18): Other versions of the Achenbach System of Empirically Based Assessment (ASEBA) a) Younger children & adults; b) Teacher's Report Form for Ages 6-18, c) Youth Self-Report for Ages 11-18, d) Adult Self-Report, e) Semistructured Clinical Interview for Children & Adolescents.
Measures of specific symptoms, behavior, & abilities: Behavior Assessment System for Children, Second Edition (BASC-2) a) Multidimensional approach assessing emotions and behaviors of ages 2 to 21 years, 11 months. b) Includes Teacher Rating Scales, Parent Rating Scales, Self-Report of Personality, Student Observation System, Parenting Relationship Questionnaire.
Behavior Assessment System for Children, Second Edition (BASC-2): Purpose a) The BASC-2 is useful for identifying behavior problems under the Individuals w/ Disabilities & Education Act; b) Assists in determination of DSM diagnoses. c) The BASC-2 includes the Structured Developmental History as one of its diagnostic scales.
Measures of specific symptoms, behavior, & abilities: Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) a) This consists of a Survey Interview Form & Parent/Caregiver & Teacher Rating Forms, b) Evaluates personal & social skills from birth to age 90 years. c) Assists Dx of disorders (MR, Autism Spectrum, ADHD, Dementia, brain injury)
Vineland Adaptive Behavior Scales, Second Edition (Vineland-II): Uses & structure of the test a) The Vineland-II is useful for developing educational & treatment plans. b) Structured via Adaptive Behavior Composite score, 4 domain scores (Communication, Daily Living Skills, Socialization, & Motor Skills), and Maladaptive Behavior Index Score.
Measures of specific symptoms, behavior, & abilities: Activities of daily living a) ADLs are routine activities, tasks of everyday life for independent living. b) Distinction between Basic (BADLs) and instrumental (IADLs), c) Essential to evaluating legal competence, identifying interventions for Dementia, monitoring & evaluating
Measures of specific symptoms, behavior, & abilities: Basic activities of daily living & instrumental ADLs a) BADLs are tasks related to personal care & mobility, such as eating, dressing, toileting, & ambulation. b) IADLs are shopping, meal prep, financial management, & Tx compliance
Measures of specific symptoms, behavior, & abilities: Measures (tests) of activities of daily living a) Nottingham Extended Activities of Daily Living Scale, b) Laughton Instrumental Activities of Daily Living Scale, c) Functional Independence Measure
Measures of specific symptoms, behavior, & abilities: DSM-5 Cross-Cutting Symptom Measures a) These are designed for use in initial patient interview and during Tx to monitor progress, b) Consist of rating scales completed by client or parent/guardian. c) Provide info on important mental health domains that cross over psychiatric diagnoses
DSM-5 Cross-Cutting Symptom Measures: Level 1 cross-cutting Sx measures a) Level 1 assesses 13 domains for adults and 12 domains for children & adolescents b) Are useful for identifying areas that require added evaluation
DSM-5 Cross-Cutting Symptom Measures: Level 2 cross-cutting Sx measures b) Level 2 provides in-depth info on specific domains (e.g. anxiety, depression, substance use) that help guide diagnosis, Tx planning, & follow-up.
Measures of specific symptoms, behavior, & abilities: DSM-5 Disorder-Specific Severity Measures a) Are used to rate severity of symptoms corresponding to DSM-5 criteria for several Dx. b) Self-report instruments completed by the individual, c) Clinician-completed instruments
DSM-5 Disorder-Specific Severity Measures: Uses in clinical setting a) Like cross-cutting measures, designed for administration during initial interview, b) Administration thereafter at regular intervals during Tx to monitor progress, c) uses Clinician-Rated Dimensions of Psychosis Symptom Severity
DSM-5 Disorder-Specific Severity Measures: Self-report & clinician-completed instruments a) Self-reports: Severity Measure for Depression, Severity Measure for Generalized Anxiety Disorder, b) Clinician-completed: Clinician-Rated Dimensions of Psychosis Symptom Severity
Clinical assessment: Ethnic assessment & Gonsalves' Resettlement Stage #1 1) Early arrival 2) 1 week to 6 months 3) Sadness & guilt 3)
Clinical assessment: Ethnic assessment & Gonsalves' Resettlement Stage #2 1) Destabilization 2) 6 months to 3 years 3) Hostility & resistance
Clinical assessment: Ethnic assessment & Gonsalves' Resettlement Stage #3 1) Exploration and restabilization 2) 3 years to 5 years 3) Isolation & fear
Clinical assessment: Ethnic assessment & Gonsalves' Resettlement Stage #4 1) Return to normal life 2) 5 to 7 years
Created by: lyzimmerman