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Chapter Three Assessment and Classification of Abnormal Behavior
The degree to which a test yields the same results repeatedly under the same circumstances.
Test-Retest reliability : whether a test yields the same results for the same person at different points in time.
Internal consistency : whether different parts of the same time yield similar results.
Interrater reliability : whether different raters or judges of a test yield the same results
Extent to which a test measures what it is intended to measure.
Predictive validity : The ability of a test to predict a person’s behavior, responses or performance.
Criterion validity : The ability of a test to measure and/or predict behavior, response or performance on a particularly criterion .
Construct validity : Extent to which a test is related to the construct it is intended to measure, compared to other established measures of that construct.
Content validity : Extent to which a test includes items that measure the content the test is intended to measure.
Standard administration : following common rules and procedures when administering a test; improves reliability and validity.
Assessment of Abnormal Behavior
Assessment: Process of gathering information and drawing conclusions about the traits, skills, abilities, emotional functioning, and psychological problems of the individual, generally for use in developing a diagnosis Four primary means of assessment:
Psychological Tests and Inventories
Observation of Abnormal Behavior
Conducted in a natural setting
Vary in degree of structure
Less structured observations require more interpretation on the part of the observer
Laboratory (Controlled, Analogue):
Researchers may give directions or tasks to participants
Vary in degree of structure
Two areas of caution when conducting observations:
Check the validity of observation against other measures
Try to minimize impact of observer on participant’s behaviors
Involve assessment of verbal and nonverbal behavior, as well as process (how the client communicates) and content (what the client talks about).
Standardization: common procedures are followed
Formal standardized interview : a checklist of questions, with scales for rating answers, is given to each client. Examples:
Composite International Diagnostic Interview
Mental Status Exam
Structured Clinical Interview for DSM IV TR
Errors: The structure and process of the interview, the ability of the client to accurately and subjectively provide information about himself, and the interviewer’s ability to accurately and subjectively record information may introduce errors.
Psychological Tests & Inventories
Standardized instruments used to assess:
Development of social skills
Personality dynamics & conflicts
Projective Personality Tests
Test taker is presented with ambiguous stimuli and is asked to respond to them in some way
Thematic Apperception Test (TAT)
Psychological Tests and Inventories
Psychological Tests and Inventories :
Provide a standard situation to elicit certain types of responses
Allow comparison of individual responses with standardized norms
Projective Personality Tests : Present the test-taker with ambiguous stimuli and assume her will project his attitudes, motives and personality in his description.
Rorschach Inkblot Test : developed by Hermann Rorschach, 1921; most used scoring system developed by Exner, 1983)
Thematic Apperception Test : set of ambiguous pictures
Sentence Completion Test: ex: “My ambition….”
Draw a Person Test: and make up a story
Test taker answers specific written questions or selects specific responses from a list of alternatives
Yields ratings on ten clinical scales (used for diagnosis) and ten validity scales (to measure the client’s honesty, confusion, etc.)
Best interpreted as a unit, rather than as single scales
Assesses both clinical disorders and personality
Limitations of personality inventories include:
Forces individuals to choose between answers that may not accurately describe them
Respondents may adopt response “strategies,” such as responding to similar items in similar ways
May be inaccurate across cultural groups
Figure 3.1: The Ten MMPI-2 Clinical Scales & Sample MMPI-2 Test Items Adapted from Dahlstrom & Welsh (1965)
Obtain Intelligence quotient (IQ), or estimate of current level of cognitive functioning
Assess intellectual deterioration in psychotic disorders
Provide clinical data
Wechsler Scales & Stanford-Binet Scales
Criticisms of Intelligence Tests
Popularized as measuring innate intelligence, actually reflect cultural & social factors
Disagreement over criterion variables
Miss multidimensional attributes of intelligence
Functions: to obtain an estimate of the person’s current level of cognitive functioning, to assess intellectual deterioration present in psychotic disorders, and to examine the person’s behavior during the testing event.
The Wechsler Adult Intelligence Scale (also available in forms appropriate for children 6 to 16 (WISC) and 4 to 6 (WPPSI)) and the Standford Binet Scales are the most commonly used today.
The Kaufman Assessment Battery for Children (K-ABC) used to evaluate the intelligence and achievement of children 2.5 to 12.5
Used with both general and special populations, as well as with exceptional children
Less culturally dependent than other intelligence tests
Criticisms of IQ tests
IQ tests measure cultural and social factors rather than intelligence.
The Bell Curve (Hernstein & Murray, 1994) argued that IQ scores are determined by heredity, and that “social and status differences between intellectually different classes are therefore difficult to overcome,” (in Sue, Sue & Sue 2003, 83).
The ability of IQ tests to predict future achievement or behaviors has been questioned.
Researchers disagree about what future achievements or behaviors IQ scores predict.
Intelligence may be too multifaceted to be measured thoroughly and accurately by intelligence tests.
Tests for Cognitive Impairment
Unusual results on intelligence tests may reveal impairments
The Bender-Gestalt Visual Motor Test involves copying 9 figures (see pg. 85)
The Halstead-Reitan Neuropsychological Test is used to identify the type and location of brain damage and involves 11 tests of sensorimotor, cognitive, perceptual and attention abilities.
Luria-Nebraska Neuropsychological Battery : takes less time and is more standardized than the Halstead-Reitan; tests similar abilities to identify the type and location of brain damage.
Figure 3.2: The Nine Bender Designs Bender (1938)
CAT scan: Computerized Axial Tomography
Sophisticated X-Ray producing a 3-D picture of the brain
PET scan: Positron Emission Tomography
Shows which areas of the brain are most actively metabolizing a radioactive substance
Enables study of the biochemical and physiological functioning of the brain
MRI: Magnetic Resonance Imaging
Creates a magnetic field around the brain to produce a clear picture of brain tissues, including blood flow
The Ethics of Assessment
Confidentiality of records
Invasion of clients’ privacy
Unethical testing practices
Accuracy of tests
Whether computer testing is accurate or ethical
The DSM IV TR
Consists of 5 Axes (areas a clinician can consider in making a diagnosis)
Axis I – Clinical disorders an other conditions that may be a focus of clinical attention. Does the client have a clinical disorder? If so, which one(s)?
Axis II – Personality disorders and mental retardation. Does the client have a personality disorder or some form of mental retardation? If so, which one?
Axis III – General medical conditions. Does the client have a medical condition that could be relevant to treatment?
Axis IV - Psychosocial and environmental problems. Are there (or have there been) any psychosocial or environmental conditions that could be a focus of treatment?
Axis V - Global Assessment of Functioning. What is the client’s current level of functioning? Based on severity and degree of impairment; scale of 0-100.
Figure 3.3: Lifetime & One-Year Prevalence Rates for Mental Disorders Data from Robins, Locke & Regier (1991)
Evaluation of DSM Classification System
DSM-IV-TR has stronger reliability & validity than previous editions
Strong medical orientation rather than social & interpersonal
Distinctions in some disorders overlook difference in degree of severity
Question usefulness for research
Objections to classification & labeling
How are mental health problems categorized or classified?
What are some criticisms of the classification system?
Evaluation of the DSM Classification System
Some question its reliability and validity
Some feel the DSM is too biologically and medically oriented, considered more than half the included disorders have no known or presumed organic cause.
Some argue that political and practical factors affect the DSM
Some argue that diagnostic categories are less useful than study of symptoms or dimensions of symptoms.
However, although there are alternatives to the DSM, the widespread use of the DSM makes it convenient and useful.
Potential Dangers of Labeling
Diagnostic labels place people in a category of abnormal, which implies they are qualitatively different than “normal” individuals.
A label can encourage others to interpret the person as pathological
A label can cause others to treat the person differently
A label can become a self-fulfilling prophecy
A label may prevent the client and clinician from finding more helpful, comprehensive information about the client