Assessment Flashcards
two key aspects of the adequacy of classification systems are…
validity and utility
Classification Validity
refers to the extent to which the principles used in classifying an entity are effective in capturing the nature of the entity
Classification Utility
refers to the usefulness of the resulting classification scheme
categorical approach to classification
an entity is determined to be either a member of a category or not.
The assumption underlying categorical classification is that there is an important qualitative difference between entities that are members of a category and those that are not
dimensional approach to classification
is based on the assumption that entities differ in the extent to which they possess certain characteristics or properties
This approach focuses on quantitative differences among entities and reflects the assumption that all entities can be arranged on a continuum to indicate the degree of membership in a category.
Within a dimensional classification system, the different dimensions may or may not be related, but it is essential that the dimensions reflect
significant higher-order constructs rather than simple descriptive features (e.g., a construct such as neuroticism, rather than specific psychological phenomena such as sadness, nervousness, loneliness, poor self-esteem, or poor self-confidence).
diagnostic system
a classification based on rules used to organize and understand diseases and disorders.
diagnosis
the result of applying the decision-making rules of a diagnostic system to the symptoms of a specific individual
prototype model
members of a diagnostic category may differ in the degree to which they represent the concepts underlying the category.
As an example, if you think of all the features pertinent to the category “mammals,” dogs are more prototypic of the category than are platypuses. Applying the prototype model to psychiatric diagnosis implies that not all people receiving the same diagnosis have exactly the same set of symptoms.
Accordingly, in contrast to strict neo-Kraepelinian assumptions, two people with the same diagnosis may not have exactly the same disorder (i.e., the same set of symptoms) and therefore may require somewhat different treatments
developmental psychopathology
a framework for understanding problem behaviour in relation to the milestones that are specific to each stage of a person’s development
underlines that biological and psychological systems are constantly changing
emphasizes the importance of major developmental transitions (such as starting daycare, learning to speak, going to high school, or moving into a long-term care facility) as well as disruptions to normal patterns of development (such as loss of a loved one, the effects of poverty, or exposure to trauma)
what is central to the developmental psychopatholpgy approach?
Central to this approach is a reliance on empirical knowledge of normal development. So, for example, in understanding problems in very young children, it is essential to be informed by research on a wide range of issues, including interpersonal attachment, cognitive development, and sleep patterns. Understanding difficulties that are evident in preschool-age children requires, in particular, knowledge of language development and of ways that adults promote children’s self-esteem and self-control. Problems in school-age children can be considered in the context of what we know about academic functioning, peer relationships, and harmonious families.
No diagnosis is based on a…
single symptom
-Diagnostic criteria always include a cluster of symptoms that co-occur
Unlike medical diagnostic systems, classification systems for mental disorders rely almost entirely on the…
observation of symptoms (mostly from self-report data).
the diagnosis of a disorder does not just require the co-occurrence of a set of statistically rare symptoms or behaviours; it also requires that…
what was the concept originally referred to
there is something wrong or dysfunctional and that this dysfunction causes harm to the individual or to those around him or her
the diagnosis of a disorder does not just require the co-occurrence of a set of statistically rare symptoms or behaviours; it also requires that…
what was the concept originally referred to?
there is something wrong or dysfunctional and that this dysfunction causes harm to the individual or to those around him or her
harmful dysfunction
Widiger has suggested that the concept of dyscontrol should be part of the definition of mental disorder - what is it?
what is the problem with this concept?
the resulting impairment must be involuntary or, at least, not readily controlled. This addition is important, especially in legal contexts, because it means that someone who intentionally and willfully engages in unacceptable behaviour such as sexually abusing a child or shooting participants at a summer camp would not be considered to have a mental disorder.
is difficult to operationalize. After all, how can you accurately determine whether another person is unable to control a behaviour or is simply choosing not to control the behaviour?
the WHO World Mental Health Survey collected data on the disability and treatment of mental and physical disorders Across countries, mental disorders were found to be…
more disabling than physical disorders such as chronic pain, heart disease, cancer, and diabetes. At the time of the interview, survey participants with mental disorders were much less likely to be receiving treatment for their disorders than were those with physical disorders, and this was especially true for lower-income countries
Modern theories of the etiology of mental disorders are all based on what type of model?
biopsychosocial model
in a longitudinal study of common fears, the impact of __________ factors that influenced fear intensity during childhood tended to diminish over time, whereas the impact of ___________ increased over time
genetic
life experiences
Which edition of the DSM was described as changing the entire focus of the field?
third
First, the manual was explicitly atheoretical, which allowed for the possibility of greater acceptance within the mental health field and for the introduction of concrete behavioural descriptions of most disorders. Second, the diagnostic criteria were much more explicit than they were previously, with lists of symptoms provided for each diagnosis. Third, as a significant part of the effort to improve upon the reliability of psychiatric diagnoses, thousands of patients and hundreds of clinicians were involved in field trials of the diagnostic system.
What approach does the DSM-5 use for classification?
largely based on a categorical approach to classification
However, because some disorders may be better represented by dimensional categorization, the classes of disorders were clustered with similar disorders
How are disorders clustered in the DSM-5?
Using the concepts of internalizing and externalizing disorders, disorders with anxiety, depressive, and somatic symptoms were grouped together (i.e., internalizing features), as were disorders with impulsive, disruptive conduct, and substance use symptoms (i.e., externalizing features)
What does it mean by a lifespan approach used in the DSM-5?
listing disorders more frequently diagnosed in childhood at the beginning of the manual, and disorders more frequently diagnosed among older adults at the end of the manual
The DSM-5 includes how many main diagnostic classes?
20
Evidence-based assessment (EBA)
an approach to psychological evaluation that uses research and theory to guide
(a) the variables assessed,
(b) the methods and measures used,
(c) the manner in which the assessment process unfolds.
It involves the recognition that the assessment process is a decision-making task in which the clinician must repeatedly formulate and test hypotheses by integrating data obtained throughout the assessment
assessment-focused services
services conducted primarily to provide information on a person’s psychosocial functioning to provide information that can be used to address a person’s current or anticipated psychosocial deficits
psychologists must use EBA tools and must follow all ethical standards in providing these services
Psychological assessments are most commonly conducted in the context of…
intervention services
intervention-focused assessment services
the psychological assessment is not a stand-alone service but is conducted as a first step in providing an effective intervention. All intervention should involve some assessment.
screening
The purpose of screening for a disorder, condition, or characteristic is to identify, as accurately as possible, individuals who may have problems of a clinical magnitude or who may be at risk for developing such problems.
Individuals who are screened may not have sought out assessment services; rather, they are receiving the assessment as part of the routine operations of a clinic, school, hospital, or employment setting.
People may also actively seek out a screening assessment. In the United States, there are national screening days for a number of psychological disorders, including the National Alcohol Screening Day and the National Depression Screening Day.
How are screening and diagnosis different?
Although screening is useful in identifying those at risk, it is important to remember that screening tools are not the same as tools used in diagnosis. So, for example, if you score high on a depression-screening instrument, it does not mean that you would necessarily meet diagnostic criteria for depression.
What is diagnosis currently called?
case formulation
is now more commonly used to describe the use of assessment data to develop a comprehensive and clinically relevant conceptualization of a patient’s psychological functioning. Typically, a case formulation provides information on the patient’s life situation, current problems, and a set of hypotheses linking psychosocial factors with the patient’s clinical condition.
Whether or not it is stated explicitly, psychological assessment always implies what?
some form of prediction about the patient’s future.
For example, recommendations that the person seek psychotherapy to address bulimic symptoms or that special academic tutoring is needed to compensate for a learning disability imply that, without some form of intervention, the present problems will either continue or worsen
Prognosis
predictions made about the future course of a patient’s psychological functioning, based on the use of assessment data in combination with relevant empirical literature.
base rate
the frequency with which a problem or diagnosis occurs in the population
the less frequently a problem occurs (the lower the base rate is), the more likely…
a prediction error will occur
sensitivity
proportion of true positives identified by the assessment
true positive = the situation in which the prediction is accurate and the event predicted (diagnosis) did, in fact, occur (was accurate)
Let’s assume that a psychologist conducted assessments on hospital inpatients in a patient care unit in order to predict who was at risk for future suicide attempts. In our example, sensitivity provides information on how well the assessment procedures were able to detect future suicide attempts
specificity
proportion of true negatives identified by the assessment.
true negative =occurs when the psychologist predicts that an event will occur, but in fact, it does not occur (e.g., the psychologist diagnoses ADHD in a child who does not have the disorder)
Let’s assume that a psychologist conducted assessments on hospital inpatients in a patient care unit in order to predict who was at risk for future suicide attempts. In our example,specificity provides information on how well the assessment procedures were able to identify individuals who would not attempt suicide
a decision about which assessment procedures to select should be informed by what two things?
a thorough consideration of the procedure’s sensitivity and specificity
the psychological and financial costs stemming from inaccurate clinical predictions
A useful treatment plan must cover three general areas:
problem identification, treatment goals, and treatment strategies and tactics
what is the difference between treatment strategies and treatment tactics?
a description of treatment strategies provides information on the general approach to addressing the clinical problems, whereas a description of treatment tactics provides details of specific tasks, procedures, or techniques that will be used in treatment.
To address Justin’s symptoms of depression and relationship conflict, for example, the treatment strategy may be to use individual interpersonal therapy or to use emotionally focused couples therapy (EFT) with both Justin and his partner Pat. The treatment tactics, however, would deal with the specific elements of treatment, such as, within EFT, having the couple work on emotionally reconnecting with each other and developing renewed trust in each other’s emotional availability
All clinicians have an implicit sense of how the patient is progressing, but treatment monitoring refers to…
explicitly tracking progress through the use of specific questions or psychological measures
Data gathered for treatment monitoring can affect treatment services provided to an individual client, but data gathered for treatment outcome purposes…
can yield information relevant to an entire psychological practice or service
although you may be able to quickly develop a questionnaire designed to measure some aspect of human functioning, it is not a psychological test until it has been demonstrated to have met the standards of what three things?
reliability, validity, and norms
difference between testing and assessment
testing can be part of an assessment but it must be considered part of the information gathered in the process of psychological assessment - No score should ever be interpreted in isolation
testing occurs when a particular device is used to gather a sample of behaviour from a client, a score is assigned to the resulting sample, and comparisons with the scores of other people are made in order to interpret the client’s score.
Assessment is more complex and multifaceted than testing and may or may not involve the use of psychological tests
The result from a test is a score that can be interpreted based on comparisons with the scores of others; the result from an assessment is a coherent, unified description of the client or selected aspects of the client’s experience
All mental health professionals conduct assessments, but compared with other mental health professionals, psychologists…
receive far more training in issues related to testing and are far more likely to use tests
assessment of children requires what different measures from the assessment of adults? why?
a much larger number and variety of tests and measures be used than is typically the case for adults
children are in a process of rapid cognitive, physical, and emotional development
The lives of children are best understood with reference to the contexts in which they are embedded—in families, schools, and peer groups
child assessment, by its very nature, involves the integration of information obtained from multiple methods (e.g., interviews, ratings, direct observations), informants (e.g., child, parent, teacher), and settings (e.g., home, classroom).
what are psychometric considerations?
standardization (of stimuli, administration, and scoring), reliability, validity, and norms
Standardization
consistency across clinicians and testing occasions in the procedure used to administer and score a test
Without standardization, it is virtually impossible for the psychologist to replicate the information gathered in an assessment or for any other psychologist to do so. Furthermore, without standardization, test results are likely to be highly specific to the unique aspects of the testing situation and are unlikely to provide data that can be generalized to testing by another psychologist, let alone to other situations in the person’s life.
How do test developers reduce variability in the testing situation?
provide detailed instructions regarding the nature of the stimuli, administrative procedures, time limits, and the types of verbal probes and permissible responses to the client’s questions. Instructions are provided for scoring the test.
what are the aspects of reliability of a test?
whether all aspects of the test contribute in a meaningful way to the data obtained (internal consistency)
whether similar results would be obtained if the person was retested at some point after the initial test (test-retest reliability)
whether similar results would be obtained if the test was conducted and/or scored by another evaluator (inter-rater or inter-scorer reliability)
test itself does not have reliability—reliability must be considered in a broader context that takes into account what two things?
the purpose for which the test is being used (there are numerous psychological tests for which one would not expect internal consistency or test-retest reliability to be very high - Take the example of a measure of stressful life events - if such a test was taken at the age of 18 and then again at the age of 25, one would not necessarily expect high test-retest reliability—such a test is not intended to measure a characteristic that is stable over time.)
the population it is being used with (So, simply because high levels of reliability have been found for an instrument when used with young adults, it should not be assumed that comparable levels of reliability will be found when used with older adults. )
How much reliability is necessary for a test?
this is a similar question to how high a ladder should be—the answer in both cases is that it depends on the purpose you have in mind. Nevertheless, there is a clear consensus that the level of acceptable reliability for tests used for clinical purposes must be greater than it is for tests used for research purposes
In considering internal consistency reliability, a number of authors have suggested that a value of .90 is the minimum required for a clinical test - For research purposes, values greater than .70 are typically seen as sufficient, with lower values being unacceptable
reliability influences how much error there is in a test score. This can be extremely important in clinical work where precise test cut-off scores are used
what does validity of a test tell us?
we are evaluating both the degree to which there is evidence that the test truly measures what it purports to measure and the manner in which the test results are interpreted - A standardized test that produces reliable data does not necessarily yield valid data, because a test purporting to measure one construct may in fact be measuring a different construct or may be misinterpreted
what are the aspects of validity?
ensuring that the test includes items that are representative of all aspects of the underlying psychological construct the test is designed to measure (evidence of content validity)
that it provides data consistent with theoretical postulates associated with the phenomenon being assessed (evidence of concurrent validity and evidence of predictive validity)
that it provides a relatively pure measure of the construct that is minimally contaminated by other psychological constructs (evidence of discriminant validity)
evidence of incremental validity
the extent to which a measure adds to the prediction of a criterion above what can be predicted by other sources of data (Hunsley & Meyer, 2003; Sechrest, 1963). It is not necessarily a case of “the more data the better” in clinical assessment. As described previously, there are costs associated with the collection of assessment data. The collection of excessive amounts of data can lead to both unnecessary costs and the introduction of unnecessary error creeping into the assessment. Despite the clear importance of incremental validity in conducting clinical assessments, there is currently very little research available to guide clinical psychologists in their selection and use of tests.
Fernandez, Boccaccini, and Noland (2007) outlined a four-step process psychologists can use in identifying and selecting translated tests for Spanish-speaking clients (and which is applicable to translated tests in other languages). what are the steps?
First, the range of translated tests should be identified by reviewing the catalogues and websites of test publishing companies. Next, research evidence for each relevant translated test, not just the original English-language versions, must be examined. Third, the nature of the Spanish-speaking samples used in the studies should be examined to determine if the results are likely to be relevant to the client (e.g., research conducted in Spain may not be generalizable to a client who recently emigrated from Ecuador). Finally, the strength of the validity evidence must be weighed in determining whether the test is likely to be appropriate and useful in assessing the client.
what are norms?
To meaningfully interpret the results obtained from a client, it is essential to use either norms or specific criterion-related cut-off scores
Without such reference information, it is impossible to determine the precise meaning of any test results. So, if you were told you had a score of 44 on a test of emotional maturity, it would provide no meaningful information unless you knew the range of possible scores and how most other people score. In psychological assessment, comparisons must be made either to criteria that have been set for the test (e.g., a certain degree of accuracy, as demonstrated in the test, is necessary for the satisfactory performance of a job) or to some form of norms.
As with validity considerations, it may be necessary to develop multiple norms for a test based on the group being assessed and the testing purpose (i.e., norms relevant for different ages and ethnic groups).
what is a common issue with norms?
It is very common to find tests that have norms based on samples of convenience—in other words, data were obtained from a group of research participants in a specific location and may not be representative of scores that would be obtained by others. Common convenience samples include undergraduate students, hospital inpatients, or patients in a single psychology clinic. Such norms should be treated very skeptically
People considering a psychological assessment should ensure that they receive sufficient details about the assessment to be able to make an informed decision about participation. They require information about…
the nature and purpose of the assessment, the fees, the involvement of other parties in the assessment, and any limits to confidentiality.
whatever is in a client file, with very few exceptions, can be seen by the client, and clients can authorize the release of file information to others such as teachers, lawyers, or other health care providers. This poses a potential challenge for psychologists, as they are also required to protect the security and copyright of test materials. As a result, it is becoming standard practice among psychologists to distinguish between…
test data and test material per se. Test data, like other parts of a client file, may be released to others upon the request of the client (or the client’s guardian or legal representative). Test material, including actual test questions and manuals, are not part of the file and must not be released.
in addition to stand-alone assessment services, psychological assessment can be used in…
screening, diagnosis and case formulation, prediction, treatment planning, and monitoring the effectiveness of interventions
What are the most commonly used strategies in clinical assessments?
interviews and observations
Interviews are the most common strategy to gather information necessary to make a diagnosis and serve many additional purposes. They are also used to obtain information for case formulation, problem definition, and goal-setting. Interview data include material that cannot be easily assessed in psychometric tests and that is important in generating hypotheses and elaborating on themes that have been identified in other assessment strategies
Structured interviews are typically used in what circumstances?
population surveys or other situations where the interviewer is not expected to have clinical training
Differences between social conversations and clinical interviews
Can take place anywhere / Usually in an office
May be overheard by others / Private
Variable duration / Usually 50 minutes to an hour
Details may be repeated in other conversations / Confidential, except to protect safety or with client’s written permission
Purpose is relationship maintenance /Purpose is to both gather information and establish a collaborative relationship
Free-flowing according to each person’s interest / Goal-directed, keeps to an agenda, clear sequence, keeps to relevant themes
Reciprocal: Something similar happened to me…That reminds me of the time when I …/ Focused on the client
Each person waits for an opening to make a comment: Now that you mention worries …/ Clinician interrupts and redirects conversation: Do you ever worry …
Maintenance of relationship usually takes precedence / May require persistent questioning over gathering information
Commonly avoids painful topics / Clinician raises painful topics such as abuse, violence, suicide
Participants rarely take notes / Psychologist may take notes
Not documented / Notes of session are kept by the psychologist
Not recorded / With client’s permission, may be audio or video recorded
advantages/disadvantages of open vs. closed questions
Open questions allow the client to give a more complex answer and do not suggest a particular response is required. However, open questions may invite the client to begin a long, tangential story that may be of limited relevance, in which case the psychologist must direct the client back to the topic at hand. Closed questions, on the other hand, yield brief, less ambiguous answers, allowing the rapid coverage of many topics. Many psychologists find it useful to begin discussion of a topic with an open-ended question and to follow up with closed questions that clarify details of the response.
a number of semi-structured interviews were developed to address what issue?
Researchers noted that although most mental health professionals agreed on the general features of a disorder, there was poor inter-rater reliability in assigning diagnoses; that is, there was low agreement between two interviewers about the precise diagnostic category.
They have a specific format for asking questions and a specific sequence in which questions are asked. Based on initial client responses, the interviewer is then directed to use follow-up questions that help confirm or rule out possible diagnoses.
