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History clinical assessment[1]


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  • 2. 1890 James Cattell develops a "mental test" to assess college students . Test includes measures of strength, resistance to pain, and reaction time. 1905 Binet-Simon scale of mental development used to classify mentally retarded children in France. 1916 Terman develops Stanford - Binet test and develops the idea of Intelligence Quotient
  • 3. 1941-1960 vocational interest measures developed
  • 4. 1920 - 1940 factor analysis, projective tests, and personality inventories first appear.
  • 5. 1961-1980 item response theory and neuropsychological testing developed
  • 6. 1980 - present : Wide spread adaptation of computerized testing. "Smart" Tests which can give each individual different test items develop  
  • 7. The Projective Hypothesis • The projective hypothesis (Lawrence Frank, 1939): When people try to understand vague or ambiguous unstructured stimuli, the interpretation they produce reflects their needs, feelings, experience, prior conditioning, thought processes – Shakespeare, Hamlet, II.ii: "Nothing is either good or bad, but thinking makes it so."
  • 8. The Problem • The difficulty is answering: Which particular ' needs, feelings, experience, prior conditioning, thought processes' are reflected? – projective tests can (by their own claim) draw equally upon the imagined and real, the conscious and unconscious, the recent and old, the important and the trivial, the revealing and the obvious – Much room for interpretation is left given to the tester, making test validation almost impossible • These tests flourished more in the psychoanalytical era, 1940-1960
  • 9. History • The earliest use of inkblots as projective surfaces was J.Kerner's (1857) – He was the first to claim that some people make idiosyncratic or revealing interpretations • In 1896, Alfred Binet suggested that inkblots might be used to assess personality (not psychopathology) – Some work was done on this suggestion – the first response set was published by G. M. Whipple (1910)
  • 10. History • Herman Rorschach, a Swiss psychiatrist, was the first to suggest (1911) the use of inkblot responses as a diagnostic instrument – In 1921 he published his book on the test, Psychodiagnostik (and soon thereafter died, age 38)
  • 11.  
  • 12. History • Rorschach's test was not well-received, attracting little notice – David Levy brought it to the States – His student, Samuel Beck, popularized its use here, writing severalpapers and books on it starting with Configurational Tendencies in Rorschach Responses (1933) • Several other early users also published work on the Rorschach – several offered their own system of administration, scoring, and interpretation, leading to later problems in standardization
  • 13. The Rorschach Inkblot Test • The Rorschach Inkblot Test is the most commonly used projective test – In a 1971 survey of test usage, it was used in 91% of251 clinical settings survey – It is one of the most widely used tests that exists – It is widely cited in research
  • 14. Psychometric Properties of the Rorschach • Obviously, it is almost impossible to measure any of the usualproperties in the usual way – Validity and reliability are both rendered meaningless by the openendedmultiplicity of possibility that is allowed and by the lack of universally-accepted standardized instructions, administrationprotocol, and scoring procedure (but see Exner, 1974) • one approach: blind diagnosis made from a protocol alone – In one study, 85% of protocols were matched to case descriptions, in batches of 5 – reliability studies that have been done find r-values varying from 0.1 to 0.9 • One was done on cases after electroshock, because it "wipes out memory for the first test but does not change personality" – Protocols were reported to be very similar
  • 15. Other common projective tests • The Thematic Apperception Test (TAT): 30 grayscale pictures + one blank for elicitation of stories – Not all are (though all may be) seen by everyone: some are suggested for men, some for women, some for youth, some for elderly • Most subjects see 10-12 cards, over two sessions – Based on Murray's (1938) theory of needs (sex, affiliation, dominance, achievement etc.) • Thema = Interaction between needs and environmental determinants • Standardization of administration and scoring is minimal • Many variations on this 'story-telling' test exist
  • 16.  
  • 17. August 14, 1919 -December 15, 2005 National Scientist (1988)
  • 18. Other common projective tests • House-Tree-Person Test (Buck, 1948) & Draw-A-Person (Machover, 1949): Subject is asked to draw – Scoring is on absolute size, relative size of elements, omissions "If there is a tendency to over-interpret projective test data without sufficient empirical grounds, then projective drawing tests are among the worst offenders." Kaplan & Saccuzo, Psychological Testing 1993
  • 19. HAND TEST Identifies aggressive tendencies likely to be expressed in overt behavior
  • 20.  
  • 21. The problem with drawing tests - Among the plausible but empirically untrue relations that have been claimed: - Large size = Emotional expansiveness or acting out - Small size = emotional constriction; withdrawal, or timidity - Erasures around male buttocks; long eyelashes on males = homoeroticism - Overworked lines = tension, aggression - Distorted or omitted features = Conflicts related to that feature - Large or elaborate eyes = Paranoia
  • 22. Chapman & Chapman- Test Results Are What You Think They Are • People tend to over-estimate the frequency of correlations they believe in (i.e. of associations) -or, equivalently, people tend to confuse correlation with semantic association – This confusion is very resistant to change – It remains even when the actual correlation is negative, or when there are cash rewards for accurate estimations of correlation "senses are fallible…clinical judgments
  • 23. The two-way projection problem "Objectivity in human relationships is impossible. Therapists affect thebehaviour and feelings of patients, and patients affect therapists. When achart notes that a patient is 'hostile', it should also note, in the interests ofbalance, that the therapist is 'paranoid'. If a therapist calls a patient'defensive', chances are that the patient would call the therapist 'aggressive'.Both should be noted in a chart, if either is, since both are equallyprobable. “ Shelagh Lynne Supeene As For The Sky, Falling
  • 25. The primary activity of neuropsychologists is assessment of brain functioning through structured and systematic behavioral observation. Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, language, and executive functions, which are necessary for goal-directed behavior
  • 26. By testing a range of cognitive abilities and examining patterns of performance in different cognitive areas, neuropsychologists can make inferences about underlying brain function. Neuropsychological testing is an important component of the assessment and treatment of traumatic brain injury, dementia , neurological conditions, and psychiatric disorders. Neuropsychological testing is also an important tool for examining the effects of toxic substances and medical conditions on brain functioning.
  • 27. As early as the seventeenth century, scientists theorized about associations between regions of the brain and specific functions. The French philosopher, Descartes, believed the human soul could be localized to a specific brain structure, the pineal gland. In the eighteenth century, Franz Gall advocated the theory that specific mental qualities such as spirituality or aggression were governed by discrete parts of the brain. n contrast, Pierre Flourens contended that the brain was an integrated system that governed cognitive functioning in a holistic manner. Later discoveries indicated that brain function is both localized and integrated. Paul Broca and Karl Wernicke furthered understanding of localization and integration of function when they reported the loss of language abilities in patients with lesions to two regions in the left hemisphere of the brain
  • 28. The modern field of neuropsychology emerged in the twentieth century, combining theories based on anatomical observations of neurology with the techniques of psychology, including objective observation of behavior and the use of statistical analysis to differentiate functional abilities and define impairment.
  • 29. The famous Soviet neuropsychologist Alexander Luria played a major role in defining neuropsychology as it is practiced today. Luria formulated two principle goals of neuropsychology: to localize brain lesions and analyze psychological activities arising from brain function through behavioral observation.
  • 30. American neuropsychologist Ralph Reitan emphasized the importance of using standardized psychometric tests to guide systematic observations of brain-behavior relationships.
  • 31. Muriel Deutsch Lezak is an American neuropsychologist best known for her book Neuropsychological Assessment , widely accepted as the standard in the field. Her work has centred on research into, assessment and rehabilitation of brain injury Dr. Lezak is Emeritus Professor of Neurology at the Oregon Health and Science University School of Medicine. In 1996 she received the Distinguished Neuropsychologist Award from the US-based National Academy of Neuropsychology
  • 32. Luria-Nebraska Battery The Luria-Nebraska Neuropsychological Battery, also known as LNNB or Luria-Nebraska Battery, is a standardized test battery used in the screening and evaluation of neuropsychologically impaired individuals.
  • 33. The LNNB is based on the work of A. R. Luria, a Russian neuropsychologist who performed pioneering theoretical and clinical work with regard to brain function. Luria believed in a primarily qualitative approach to assessment and was opposed to standardization. He did not believe that neuropsychological functioning could be measured quantitatively. Thus, although his name is part of the test itself, his contribution to the LNNB is entirely theoretical. Also, the LNNB is based, in part, on Luria's Neuropsychological Investigation, a measure developed by Christensen in 1975. This test included items asked by Luria in his clinical interviews, some of which are used in the LNNB.
  • 34. The battery, written in 1981 by Charles Golden , is appropriate for people aged 13 and older and takes between 90 and 150 minutes to complete. It consists of 269 items in the following 11 clinical scales: reading writing arithmetic visual memory expressive language receptive language motor function Rhythm
  • 35. The Halstead-Reitan Neuropsychological Test Battery is a fixed set of eight tests used to evaluate brain and nervous system functioning in individuals aged 15 years and older. Children's versions are the Halstead Neuropsychological Test Battery for Older Children (ages nine to 14) and the Reitan Indiana Neuropsychological Test Battery (ages five to eight).
  • 36. The purpose of this battery is to provide the clinician with a database for inferring the nature, location, and extent of the structural changes in the brain that may underlie and explain the pattern of intact and impaired functions derived from the measures and qualitative information yielded by the battery. The present battery consists of 10 tests which have been shown empirically to best discriminate between normals and patients with documented cortical damage. The authors offer convincing data favoring clearer brain damage localization with the HRNB for acute lesions rather than more chronic neuropathology.
  • 37. The CANTAB tests are simple: computerised, non-linguistic, and culturally blind. They can be administered by a trained assistant. Importantly, interpretation of a patient’s condition can be easily understood by a clinician.
  • 38.