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  • Clinicians engage in a thorough assessment process in order to arrive at a psychodiagnosis. Psychodiagnosis helps create a picture of the client, helps the clinician develop treatment, helps facilitate communicate about the client and his or her disorder(s), and encourages the therapist to use assessment techniques that facilitate gathering of information necessary for classification.
  • Predictive validity : ex: SAT to predict performance in college courses. Criterion validity : ex: ability of a math test to measure mathematical knowledge Construct validity : the test results should be correlated with other measures of the construct, should be unrelated to measures that do not measure the same construct. For example, a test of mathematical aptitude should be related to other tests of mathematical aptitude, unrelated to measures of ability to speak Japanese (for ex., except for Japanese speaking people) and should be related to other measures of mathematical aptitude, such as grades in math. If a standardization sample is used (a group of people who have been given the test to establish norms), the sample must be appropriate.
  • The interviewer’s frame of reference, including perspective of psychology, therapeutic orientation and training, may affect interpretation of interview data. Composite International Diagnostic Interview : allows a trained clinician to arrive at a diagnosis Mental Status Exam : less structured than the CIDI; used to determine cognitive, psychological and behavioral functioning. Structured Clinical Interview for DSM IV TR: intended to render a diagnosis. Includes precise procedures for asking questions and rating clients.
  • Analysis and interpretation of projective tests may have poor reliability and validity, and interpretation may be highly structured and standardized, or unstructured, leading to more general data. These tests should be used in combination with others.
  • Less subjective and more easily scored than projective tests, interviews, or observations. Widely used. Less costly than projective tests.
  • Wechsler Intelligence Scale for Children (6 to 16) and Wechsler Preschool and Primary Scale of Intelligence (4 to 6) It does appear that brain wave patterns are strongly correlated with IQ scores on the WAIS, (Matarazzo, 1992) and with metabolic activity patterns (Matarazzo, 1992) – but these results are difficult to interpret. The K-ABC is less culturally dependent because the focus is on the process used to solve problems rather than the content.
  • Ex., high IQ might predict successful performance in school, but are grades a good indicator of success in other areas?
  • Several of the Halstead Reitan’s 11 tests are often omitted. Takes more than 6 hours to administer. There are versions for children 5+.
  • Early versions of the DSM were less reliable than the current version. DSM IV TR emphasizes cross-cultural assessment issues more than previous versions and includes description of cultural, age, and gender features for each disorder, as well as a listing of culturally bound syndromes. (see page 96).
  • Note the observation of Sarbin, 1997 in Sue, Sue and Sue, 2003, pg. 94) that 16 th century witch hunters developed reliable criteria for determining whether or not a person was a witch. Some argue that political and practical factors affect the DSM (ex., Pre-menstrual dysphoric disorder – which is not a diagnosis but a proposal for further study in the DSM - seen as sexist)
  • Note study by D. L. Rosenhan (1973) who sent 8 experimenters to different psychiatric hospitals where they first simulated psychotic symptoms to gain admission, but then behaved normally. No one ever detected they were normal, and their stays ranged from 7 to 52 days. All were initially diagnosed as schizophrenic and many of their behaviors were interpreted as manifestations of schizophrenia. They felt the hospital environment was harsh and served to maintain maladaptive behaviors. Some suggest that diagnoses should imply a difference of degree rather than type of behavior. Labels can be particularly damaging for children.
  • Click Here for a PowerPoint Presentation of Chapter Three

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