Assessment & Diagnosis


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Assessment & Diagnosis

  1. 1. PSYC 3553 – Psychopathology Week 4: Assessment and Diagnosis • September 29, 2009
  2. 2. What is assessment? <ul><li>Goals of clinical assessment: </li></ul><ul><ul><li>How and why a person is behaving abnormally </li></ul></ul><ul><ul><li>How that person may be helped </li></ul></ul><ul><ul><li>Also may be used to evaluate treatment progress </li></ul></ul><ul><li>Focus is idiographic – on an individual person </li></ul>
  3. 3. Characteristics of Assessment Tools <ul><li>Standardization </li></ul><ul><ul><li>A test is administered to a large group, and their performance serves as a common standard (norm) against which individual scores are judged </li></ul></ul><ul><ul><li>The “ standardization sample ” must be representative </li></ul></ul><ul><ul><li>One must standardize administration, scoring, and interpretation </li></ul></ul>
  4. 4. <ul><li>Reliability : The consistency of a test </li></ul><ul><ul><li>Test – retest reliability </li></ul></ul><ul><ul><li>Interrater reliability </li></ul></ul><ul><li>Validity : the accuracy of the test results </li></ul><ul><ul><li>Face validity </li></ul></ul><ul><ul><li>Predictive validity </li></ul></ul><ul><ul><li>Concurrent validity </li></ul></ul>Characteristics of Assessment Tools
  5. 5. Are Classifications Reliable and Valid? <ul><li>Reliability : different diagnosticians agreeing on diagnosis using same classification system </li></ul><ul><ul><li>DSM-IV : greater reliability than previous editions </li></ul></ul><ul><ul><li>Used field trials to increase reliability </li></ul></ul><ul><li>Validity : accuracy of information diagnostic categories provide </li></ul><ul><ul><li>DSM-IV has greater validity than any previous edition </li></ul></ul><ul><ul><li>Conducted extensive lit reviews and field studies </li></ul></ul>
  6. 6. I. Clinical Interviews <ul><li>Face-to-face encounters </li></ul><ul><ul><li>Often the first contact between a client and a therapist/assessor </li></ul></ul><ul><li>Used to collect detailed information, especially personal history, about a client </li></ul><ul><li>Allow the interviewer to focus on whatever topics they consider most important </li></ul>
  7. 7. II. Psychological Tests <ul><li>Six categories of psychological tests </li></ul><ul><ul><li>Projective tests </li></ul></ul><ul><ul><li>Personality Inventories </li></ul></ul><ul><ul><li>Response Inventories </li></ul></ul><ul><ul><li>Psychophysiological Tests </li></ul></ul><ul><ul><li>Neurological/neuropsychological Tests </li></ul></ul><ul><ul><li>Intelligence Tests </li></ul></ul>
  8. 8. <ul><li>Projective tests : Interpret characteristics onto vague & ambiguous stimuli or follow open-ended instruction </li></ul><ul><li>Strengths and weaknesses : </li></ul><ul><ul><li>Helpful for providing “supplementary” information </li></ul></ul><ul><ul><li>Rarely demonstrated much reliability or validity </li></ul></ul><ul><ul><li>May be biased against minority ethnic groups </li></ul></ul>II. Psychological Tests
  9. 9. Example: The Rorschach Inkblot
  10. 10. Example: Thematic Apperception Test
  11. 11. Example: Sentence-Completion Test <ul><li>“ I wish ___________________________” </li></ul><ul><li>“ My father ________________________” </li></ul>
  12. 12. Example: Draw-a-Person Test <ul><li>“ Draw a person” </li></ul><ul><li>“ Draw another person of the opposite sex” </li></ul>
  13. 14. II. Psychological Tests <ul><li>Personality inventories - self-report questionnaires </li></ul><ul><ul><li>Focus is on behaviors, beliefs, and feelings </li></ul></ul><ul><ul><li>Ask how similar/dissimilar a person is to a set of statements </li></ul></ul><ul><li>Strengths and weaknesses : </li></ul><ul><ul><li>Objectively scored and standardized </li></ul></ul><ul><ul><li>Although more valid than projective tests, often we cannot directly examine trait </li></ul></ul>
  14. 15. Example – The MMPI
  15. 16. II. Psychological Tests <ul><li>Response inventories </li></ul><ul><ul><li>Usually based on self-reported responses </li></ul></ul><ul><ul><li>Focus on one specific area of functioning </li></ul></ul><ul><ul><ul><li>E.G., emotion, social skills, cognition </li></ul></ul></ul><ul><ul><li>Strengths and weaknesses : </li></ul></ul><ul><ul><ul><li>Have strong face validity </li></ul></ul></ul><ul><ul><ul><li>Rarely careless/inaccurate questions </li></ul></ul></ul><ul><ul><ul><li>Few subjected to careful procedures </li></ul></ul></ul>
  16. 17. II. Psychological Tests <ul><li>Psychophysiological tests </li></ul><ul><ul><li>Measure physiological response as an indication of psychological problems </li></ul></ul><ul><ul><li>Most popular is the polygraph (lie detector) </li></ul></ul><ul><li>Strengths and weaknesses : </li></ul><ul><ul><li>Require expensive equipment that must be tuned and maintained </li></ul></ul><ul><ul><li>Physical evidence for psychological symptoms </li></ul></ul>
  17. 18. II. Psychological Tests <ul><li>Neurological tests: direct assessment brain function </li></ul><ul><li>Neuropsychological tests: indirect assessment via cognitive, perceptual & motor function </li></ul>
  18. 19. Example: Bender Visual-Motor Gestalt
  19. 20. II. Psychological Tests <ul><li>Intelligence tests </li></ul><ul><ul><li>Designed to measure intellectual ability </li></ul></ul><ul><ul><li>Assess both verbal and non-verbal skills </li></ul></ul><ul><ul><li>Generate an intelligence quotient (IQ) </li></ul></ul><ul><li>Strengths and weaknesses : </li></ul><ul><ul><li>Highly standardized, reliable and valid </li></ul></ul><ul><ul><li>Influences on performance…cultural factors </li></ul></ul>
  20. 21. Clinical Observations <ul><li>Naturalistic observations </li></ul><ul><ul><li>Occur in everyday environments : homes, schools… </li></ul></ul><ul><li>Analog observations </li></ul><ul><ul><li>If impractical, conduct observations in artificial settings </li></ul></ul><ul><li>Self-monitoring </li></ul><ul><ul><li>People observe themselves and carefully record the frequency of certain behaviors, feelings... </li></ul></ul>
  21. 22. Clinical Observations <ul><li>Strengths and weaknesses : </li></ul><ul><ul><li>Different observers focus on different aspects? </li></ul></ul><ul><ul><ul><li>Careful training and use of observer checklists </li></ul></ul></ul><ul><ul><li>“ Overload,” “observer drift,” and observer bias </li></ul></ul><ul><ul><li>Client reactivity may also limit validity </li></ul></ul><ul><ul><li>Observations may lack cross-situational validity </li></ul></ul>
  22. 23. Treatment: How Might Clients Be Helped? <ul><li>Treatment decisions : begin with assessment info & diagnosis to determine treatment plan </li></ul><ul><li>Other factors : therapist’s orientation, current research, empirical support, evidence-based treatment </li></ul><ul><li>Difficult question to answer: </li></ul><ul><ul><li>How do you define success ? </li></ul></ul><ul><ul><li>How do you measure improvement ? </li></ul></ul><ul><ul><li>How do you compare treatments – differing in range, complexity, skill, knowledge </li></ul></ul>
  23. 24. The Effectiveness of Treatment <ul><li>Is therapy generally effective ? </li></ul><ul><ul><li>… more effective than no treatment or placebo </li></ul></ul><ul><ul><li>In one study, average person in treatment was better off than 75% of untreated </li></ul></ul><ul><ul><li>Consumer Reports found that “consumers” of therapy found it to be helpful or at least satisfying </li></ul></ul><ul><ul><li>Can therapy can be harmful? Has potential… </li></ul></ul><ul><ul><ul><li>Studies report ~5% get worse with treatment </li></ul></ul></ul>
  24. 25. The Effectiveness of Treatment <ul><li>Are particular therapies effective for particular problems ? </li></ul><ul><ul><li>Studies now conducted to examine efficacy of specific treatments for specific disorders: </li></ul></ul><ul><ul><li>Recent studies focus on the effectiveness of combined approaches </li></ul></ul><ul><ul><ul><li>Drug therapy combined with certain forms of psychotherapy – to treat certain disorders </li></ul></ul></ul>