Assessment Flashcards
DASS - anxiety cut off scores
Normal: 0-7
Mild: 8-9
Moderate: 10-14
Severe: 15-19
Extremely severe: 20+
8-10-15-20
DASS - depression cut off scores
Normal: 0-9
Mild: 10-13
Moderate: 14-20
Severe: 21-27
Extremely severe: 28+
10-14-21-28
DASS - stress cut off scores
Normal: 0-14
Mild: 15-18
Moderate: 19-25
Severe: 26-33
Extremely severe: 34+
15-19-26-34
K10 - cut off scores
10-19: likely to be well
20-24: likely to have MILD mental disorder
25-29: likely to have MODERATE mental disorder
30-50: likely to have SEVERE mental disorder
10-20-25-30
SDQ - Strengths and Difficulties Questionnaire
- Emotional symptoms
- Conduct problems
- Hyperactivity/ Inattention
- Peer relationships problems
- Prosocial behaviour
1+2+3+4 —> total difficulties
SDQ cut off score
Parents version:
- may be significant problems: 14-16
- substantial risk: 17-40
- emotional: 4 —— 5-10
- conduct: 3 —— 4-10
- hyperactivity: 6 ——7-10
- peer: 3 —— 4-10
- prosocial: 5 —— 0-4
Self completed
- 16-19 —— 20-40
- emotional: 6 —— 7-10
- conduct: 4 —— 5-10
- hyperactivity: 6 —— 7-10
- peer: 4-5 —— 6-10
- prosocial: 5 —— 0-4
WAIS WISC age
Wais - 16 to 90:11
Wisc - 6 to 16:11
Weschlers overview
Predictors of both academic and functioning in occupation
Best for making short term predictions
Assessing strengths and weaknesses
Mean score 100
Standard deviation 15
Bell curve
FSIQ and GAI
FSIQ: Less important when difference between index scores are 23 or higher
GAI:
- WAIS: verbal comprehension and perceptual reasoning
- WISC: verbal, visual and fluid reasoning
Eliminate working memory and processing speed as they are most sensitive
Calculating difference between FSIQ and GAI - determine brain, age, situation sensitive subtest could be lowering performance
Weschlers stages of analysis
Level 1: FSIQ, percentile rank, classification
Level 2: index scores, cluster groupings
Level 3: substest variability
Level 4: qualitative/ process analysis
Level 5: analyse intrasubtest variability
Weschlers level 2 interpetation
Indexes only be interpreted when there is less than 5 point subscale difference within the index.
If difference higher than this - DO NOT interpret, but investigate - look at other combinations of subtests
Strengths and weaknesses
Anything falling outside range - causing impairment
Significant difference between indexes
Weschlers clusters
Fluid reasoning: matrix reasoning + figure weights
Visual processing: blocks designs + visual puzzles
Verbal reasoning: similarities + comprehension
Lexical knowledge: vocab + similarities
General information: comprehension + information
Long term memory: vocabulary + information
Short term memory: letter number sequencing + digit span
Visual motor speed: block design, symbol search
Problem solving without visual motor speed: matrix reasoning, visual puzzle, picture completion, figure weights
Non verbal fluid reasoning: matrix reasoning, picture concepts
Quantitative reasoning: figure weights, arithmetic
General information: comprehension, information
Long term memory: information, vocab
Auditory working memory: digit span, number letter sequencing
Cognitive proficiency: digit span, picture span, symbol search, coding
Weschlers subtest variability
Clinical judgement guided by theory - specific for each case eg challenges with speed, motivation, short term memory?
Weschlers qualitative analysis
High/ low scores?
Unusual responses?
Weschlers intrasubtest variablity
Abnormal patterns
Eg person missed first item, pass other items - may suggest attentional deficit or memory loss related to retrieval difficulties
Crystallised vs fluid intelligence
Crystallised: acquired
Fluid: ability
Weschlers range
<70: extremely low
70-80: very low
80-90: low
90-110: average
110-120: high average
120-130: superior
130+: very superior
Verbal comprehension
WAIS: vocab, similarities, information
WISC: similarities, vocab
Low scores: difficulties with spoken language
Influenced by cultural factors
Professional occupation likely to have higher scores
Perceptual reasoning
WAIS: block design, matrix reasoning, visual puzzle
WISC (Visual spatial): block design, visual puzzles
Less affected by educational background
Low scores: challenges with following spatial directions, finding objects in house
Picture completion WAIS supplementary - identify missing part in the picture
Fluid reasoning
WISC only: Matrix reasoning, figure weight, picture concepts (supplemental), arithmetic (supplemental)
Less affected by cultural background
Working memory
WAIS: digit span, arithmetic
WISC: digit span, picture span
Low score: poor concentration, may also be difficulties w executive functioning
Not a diagnostic predictor for ADHD
Processing speed
WAIS: coding, symbol search
WISC: coding, symbol search
Planing and organising
Sensitive to dementia, traumatic brain injuries, adhd, learning disabilities
Those w high iq tend to have this as lowest, and verbal reasoning as highest
Cancellation- supplemental
FSIQ include
WAIS (10): Block Design, Similarities, Digit Span, Matrix Reasoning, Vocab, Arithmetic, Symbol Search, Visual Puzzle, Information, Coding
WISC (7): Block Design, Similarities, Digit Span, Matrix Reasoning, Vocab, Coding, Figure Weights
PAI general
Self report
344 items
How true a statement is - 4 point scale
18-89
PAI-A for adolescents 12-18
4 validity scales
11 clinical scales
5 treatment scales
2 interpersonal scales
Low reading level (grade 4)
Less than an hour
PAI interpretation steps
4
- profile distortion (test validity)
- determine appropriate reference comparision
- interpret individual scales
- interpret profile configurations
5
- Test validity
- Analysis if Critical Items - potential of crisis situation
- Full Scale - general population vs clinical sample - T > 2SD
- Subscale - more meaning eg ANX-T
- Configural - combining to make a meaningful clinical results (only experienced does this)
PAI Validity
INCONSISTENCY (ICN)
10 pairs of items with similar content
63 < T < 73: proceed with caution
T > 72: Invalid - STOP interpreting
INFREQUENCY (INF)
8 items (to be similarly rated)
59 < T < 76: interpretation w caution
T > 75: problematic, interpret with caution
NEGATIVE IMPRESSION (NIM)
83 < T < 92: negative distortion
T > 91: malingering (pretend), careless - clinical judgement whether to continue
— MAL index - 2-5 potential
> 4 strong likelihood of malingering
— RDF - similar to MAL, T > 59 purposeful malingering
POSITIVE IMPRESSIONS (PIM)
56 < T < 68: denying problems, defensive
T > 67: proceed with caution, under responding problems
— DEF 69 - purposefully defensive
— CDF 69 - reflect how they want to be portrayed rather than how they truly function
PAI clinical - SOMATIC COMPLAINTS SOM
Concern of physical health
- presence of real medical problems
- individual’s experience with their medical problems
T 69: poor health
T 86: preoccupied w health concerns
T 94: delusion
SOM-S: general complaints
SOM-C: headache, fatigue, gastro - T 69
SOM-H: health concerns - T 69 believe health concerns are complex and difficult to treat
PAI Clinical - Anxiety ANX
Worry, tension
Anxiety disorder, depression w anxiety
T 69: impact daily functioning
T 89: impairment
Cognitive anxiety ANX-C: T 69 overly concerns
Affective anxiety ANX-A: T 69 stress, worry, hard to calm down - most related to GAD
Physiological anxiety ANX-P: T 69 physical symptoms and somatic (SOM should be elevated w this)
PAI Clinical Anxiety related ARD
Examine 3 scales separately rather than together
OCD - ARD-O: T 65: impair functioning, T 74: disruptive behaviour
Phobias ARD-P: T 69: fear and avoidance
Traumatic stress ARD-T: T 64: trauma in the past - T 75: trauma is primary focus of concern
ARD commonly elevated along with DEP and BOR
Overall scale - motivation for treatment
The higher the more likely to refuse treatment
PAI Clinical Depression DEP
T 69: significant
T 79+: likelihood of MDD
Cognitive DEP-C: thinking of worthless, helpless T 69 unable to meet demands of life, self esteem, self efficacy
Affective DEP-A: T 69 distressed, gloomy, losing interest
Physiological DEP-P: appetite, sleep, motivation, energy level T 69
PAI Clinical Mania MAN
T 64: irritability, grandiosity, restless, acting rashly
T 74: likelihood of manic or hypomanic episode
Acitvity level MAN-A: increase speed T 64: disorganised, T 74: confusing others
Grandiosity MAN-G: T 70: grandiose, narcissistic
Irritability MAN-I: T 70: disagreement, non-cooperative
NOT often elevated with others
Can be elevated w BOR
Elevated - not hopeful for psych treatment
PAI Clinical - PAR paranoia
T 69: suspicious, hostility, monitoring threats around
T 83: paranoid delusions
Hypervigilance PAR-H: guardness T 70 preoccupied w potential threat - likelihood of paranoid personality
Persecution PAR-P: being treated unfairly T 69: believe others making efforts to get in the way
Resentment PAR-R: bitterness T 70 hold grudges, distribute personal failure on others
Exam DOM and AGG for how the person would respond, aggressive or passive aggressive
Elevated mean hard to form and maintain therapeutic alliance
PAI Clinical Schizophrenia SCZ
Subscale rather than overall
T 69: blizzard/ odd thinking, impair attention and concentration
Psychotic Experience SCZ-P: positive symptoms of scz, T 70: perception and beliefs that may be delusional - actively experiencing psychotic episode
Social Detachment SCZ-S: T 69 tend to isolate themselves, lack of interests in relationships
Thought disorder SCZ-T: T 69: confusion, loose association
SCZ elevated w Paranoid, BOR, Alcohol and Drug problems
PAI Clinical Borderline features BOR
T 69: rapid swings of mood, easily feel hurt or betrayed
T 90: likely to meet criteria for borderline personality disorder
Affective Instability BOR-A: T 69: sudden, uncomfortable shifts of emotions, rapid changes to anger or negative feelings
Identity Problems BOR-I: T 69: uncertain about who they are, rely on help for making decisions
Negative Relationships BOR-N: T 69: stormy relationships, problem attachment, disappointed due to high expectations
T 80: easily offended, extremely sensitive
Self harm BOR-S: NOT suicidal tendency - T 69: act impulsively - T 85: reckless and dangerous behaviours
PAI Clinical Antisocial features ANT
T 69: impulsive and dangerous to themselves and others
T 82: likely to meet criteria for antisocial personality disorder
ANT-A: personal traits, history behaviours - T 69: rules breaking behaviour in the past, difficulties w authorities
Egocentricity ANT-E: T 69: little regards for those around, exploit others, rarely feel remorseful
Stimulus seeking ANT-S: T 69: potential threat to themselves and others, craving, risky,
Most commonly elevated w alcohol and drug
Little motivation to change, hard for therapy
PAI Clinical ALCOHOL ACL
T 69: struggle w alcohol abuse , likely to have problems w personal relationships and health
PAI Clinical Drug DRG
T 69: qualify for drug abuse, likely to have problems w interpersonal, job performance and health concerns
PAI Treatment Aggression AGG
T 70: angry, hostile, fully prepared to exhibit anger
T 82: anger management problem impacting relationships and job
Attitudes AGG-A: traits and beliefs and ability to control anger T 70: losing temper easily - if behaviour is not elevated, likely to be suppressing or passive aggressive
Physical aggression AGG-P: T 70: destroying property and violence towards others
High AGG: resistant, explosive in therapy
Low AGG: passive, submissive, assertiveness training required
PAI Treatment Suicidal Ideation SUI
Warning signs only
Even when Low, but DEP, STR, NON are high, still potential of suicidal ideation
T 69: active ideation, MUST be followed up
Potential relationships w DEP-C, BOR-S, DRG
PAI Treatment Stress STR
T 69: too much to handle
T 84: more probe to psychopharmacology
The higher and more likely to get help
High score = likely to respond well with problem solving strategies, and learning coping skills
PAI Treatment Nonsupport NON
T 69: limited support offered
T 87: no support
More likely to seek help and treatment
Therapy to be caring and supportive
PAI Treatment rejection RXR
T 59: not easy to admit problems, no need for change
Difficult to engage in therapy
PAI Interpersonal Dominance DOM
T < 35: lack self confidence
T < 45: passive, assert, uncomfortable being the centre of attention
T > 59: confident
T > 69: overbearing, dominating, intolerant to disagreement
Can predict potential power struggle w therapist
PAI Interpersonal WARTH WRM
T < 35: uninterested in forming deep connections
T < 45: distant in relationships
T < 60: flexible in relationships
T < 70: warm, empathetic, value deep relationships
T > 69: overly concerned being liked and accepted, too caring, too giving, avoiding conflicts
PAI ADDITIONAL CLUSTER
Self-concept: MAN-G, DEP-C, BOR-I: individuals thinking and feeling about themselves and how stable this is
Interpersonal style: DOM, WARM: 4 different styles
Environmental perception: NON STR: how individual perceive their environment, 4 different styles
Potential for dangerousness: SUI, AGG
PAI cutscore
Validity:
- INC: 64 — 73
- INF: 60
- NIM: 73 - MAL 3+, RDF 60
- PIM: 57 - DEF 6+, DCF 66
Clinical
- MAN, MAN-A 55
- BOR-A, BOR-I, BOR-N 70
- AGG, AGG-A/E/S: all 70
- The rest 60T
70T is 96th percentile
DASS general
21 or 42
NOT diagnostic tool
Rating period: last week
Progress in therapy
Gaps for Aboriginal
NOT recommended for below 14 years
Anxiety scale - others anxiety (trembling, panicky, loss of control, worries about performance, breathing difficulties)
Stress scale - GAD ( touchy, easy to upset, nerve, fidgety, unable to relax, irritable)
Depression - Mood disorders (pessimistic, gloomy, unable to feel satisfied, slow, lack of initiative)
K10 General
Distress
Score 10-50
NOT diagnostic tool - just screener
Non specific psych distress eg nervousness, agitation, fatigue, depression
1-5 scale none to all the time
Rating period: last 4 weeks
SDQ General
4-17 years
Further assessment or treatment, evaluating treatment outcome
25 questions
5 scales
Only one w supplement
Also have follow-up questions
Version for preschool teachers and parents 2-4
Self report for 4-17
Acceptable use with Aboriginal - peer problem need caution
WPPSI
2 - 6:7
15 subtests - Five primary index (like WISC)
24-62 mins
Stanford-Binet SB5
2 - 85+
Fluid reasoning
Knowledge
Quantitative reasoning
Visual spatial processing
Working memory
10 subtests make FSIQ
Verbal (5) and nonverbal (5)
Abbreviated Battery IQ - when time limited - estimate overall function level and can be used as screening tool - 15-20 mins
Full scale: 45-60 mins
Wechsler Abbreviated Scale of Intelligent WASI-II
Brief measure
6 - 90:11
Clinical and educational and research setting for estimate IQ when comprehensive test is not necessary, to determine if full test is warranted, or as re-test measure.
Vocab and Similarities = Verbal Comprehension
Block design and Matrix Reasoning = perceptual reasoning
30 mins for 4
15 mins for 2
NOT designed for diagnosis or education support decisions
WJ-III cog
Cattell-Horn-Carroll therory
GIA score
2 - 90
40 mins - 2 hours
Raven’s progressive matrice RSPM
Nonverbal estimation of fluid reasoning
Can be used for culturally diverse populations or nonverabal children
4 - 90
WIAT - individual achievement test
9 subtests - 4 composites:
- Reading
- Maths
- Written language
- Oral language
Specific learning disorder, strengths and weaknesses for intervention and education services
4-85 years
4-11 years: 45-90 mins
12+: 90-120 mins
ABAS-3 adaptive behaviour assessment system
Adaptive behaviour for daily functioning
Strengths and weaknesses and measure effectiveness of treatment
Any age
15-20 mins each form
Parents: 0-5
Teacher: 2-5
Parent: 5-21
Teacher: 5-21
Adult: 16-89
General adaptive composite GAC
- conceptual (communication, functional academics, self direction)
- social (leisure and social skills)
- practical (community, home living skills, health and safety, selfcare)
- motor (only for 0-5)
- work (optional)
Wechsler Memory Scale WMS-III
16 - 90
Logical memory
Verbal Paired associcated
Visual reproduction
4 new tests
- Brief cognitive status exam
- Designs
- Spatial addition
- Symbol span
5 norm-reference index scores:
- auditory
- visual
- visual working (only for 16-69)
- immediate
- delayed memory
Brief cognitive status exam BCSE (cognitive screen)
60 mins
WRAML - wide range of memory and learning
Memory deficits eg dementia, developmental disabilities
5-90
3 core indexes:
- verbal
- visual
- attention concentration
—> general memory index
Optional:
- working memory
- delayed
- recognition
Screening memory for in-depth assessment
Used in school, rehabilitation, vocational training, hospitals, private practice, in research
1 hour
Self directed search SDS
Career - identify career interest and match w suitable occupations
15+
6 categories:
- realistic R
- investigative I
- artistic A
- social S
- enterprising E
- conventional C
5 sections:
- occupation daydreams - list up to 5 occupation
- activities (66 items like dislike)
- competencies (66 items yes no)
- occupations (84 items yes no)
- self estimates of abilities and skills (12 items 1-7 low to high)
3 most rated letter for result eg SEC
30-40 mins
Strong interest inventory SII
Aid career decision making - career development, exploration and employee engagement, leadership, executive coaching, employment reintegration
260 occupational scales OSS based on the US
Personal style scales PSS
- work style
- learning environment
- leadership style
- risk taking
- team orientation
5 scales:
- General Occupation themes (GOTs) - Hollands 6 personality Realistic, Investigative, Artistic, Social, Enterprising, Conventional.
- Basic Interest scales (BIS): specific area such as art, science, athletics, social science, sales, office management
Administrative indices for test error and unusual profiles
16PF
Self report
Vocational and occupation preferences
Warmth
Reasoning
Emotional stability
Dominance
Liveliness
Rule consciousness
Social boldness
Sensitivity
Vigliance
Abstractedness
Privateness
Apprehension
Openness to change
Self-reliance
Perfectionism
Tension
5 global factors
- extraversion
- anxiety
- tough-mindedness
- independence
- self-control
16+
25-50 mins
NEO-PI-R
5 factor model:
- neuroticism
- extraversion
- openness to experience
- agreeableness
- conscienciousness
5 domain scores
6 facet scores for each domain
17+
Version for 12+
30-40 mins
Beck depression inventory BDI
Severity of depression
21 items represent symptoms of depression
13+
5-10 mins
4 point rating 0-3
Total: 0-63
American adult:
0-13: minimal
14-19: mild
20-28: moderate
29-63: severe
0-14-20-29
Global assessment of functioning GAF
Axis V of DSM-IV-TR
Psychological symptoms severity
Social functioning
Occupational impairment
No longer include in DSM-5
WHODAS 2.0 is used instead
Score 1-100 - the higher the healthier
State trait anxiety inventory STAI
Most commonly used for anxiety
Trait A - tendency to respond
State A - immediate threat, stimuli, temporary conditions
10 mins - sixth grade reading level
2 20 items self report
State: right now, at this moment
4 point scale - 1 not at all to 4 very much so
Trait: generally feel
4 point scale - frequency of feelings 1 almost never ti 4 almost always
WHODAS 2.0 - disability assessment
Generic assessment for health and disability used across multiple diseases
2 versions - short and long
Both clinical and general population
Applicable across culture for adults
Direct link to ICF (international classification of functioning disability and health)
6 domain:
- cognition
- mobility
- self care
- getting along
- life activities: leisure, work, domestic relationships
- participation
WHO-QOL (quality of life)
Perception of position in life
For adults
6 domains
- physical
- psych
- level of independence
- social relationships
- environment
- spiritual
Self report - 30 mins
Outcome rating scale ORS
Client functioning, therapy outcomes, progress
Used in clinical, counselling, community settings.
13+
- Individual
- Interpersonal
- Social
- Overall wellbeing
Over previous week
1 min to complete
High scores = high level of functioning
Cut off for adolescent 28
MMPI personality
Psychopathology, commonly used in psychiatric setting
9 validity
10 clinical
15 content
9 restructured clinical
20 supplementary
567 items total true false
Clinical scale includes: content subscales, content scales, component scales, combination of all 3
18+
MMPI-A for 14+
60-90 mins
PHQ9 patient health
Screening for mental health disorders: depression, anxiety, alcohol, somatoform, eating disorders
Self admis - severity of depression
Inform and monitor treatment
Over the last 2 weeks, how often…
4 point 0-3 not at all, nearly everyday
2-3 mins
Can be used to DIAGNOSE depression
5-9 mild
10-14 moderate
15-19 moderately severe
29-27 severe
5-10-15-29
CBCL - child behaviour checklist
Adaptive behaviour and functioning
6-18
Parent - teacher - youth (11+) forms
Internalising: anxious, depressed, withdrawal, somatic complaints
Externalising: rule breaking, aggressive
Social, thought, attention
Competency and adaptive functioning
15 mins
SCID - structured clinical interview for DSM
Close to DSM decision trees
Open-ended questions
Skip structure
Clinical judgement needed, only for trained clinician
Most comprehensive structured interview
Assessment of clinical disorders
Assessment of personality disorders
Focused structured interviews
High risk
Follow up within 24 hours
Close monitoring
Medium risk
Re-assessment within 1 week
Contingency plan should be made
Low risk
Review at least monthly
After discharge from in-patient unit - re-assess within 1 week
Low assessment confidence
Re-assess in 24 hours
Impulsivity
Drug and alcohol
Impending court cases, child custody battles
Inability to complete assessment or collateral information
Risk assessment considerations
Engagement in support network
Be mindful of countertransference
Discuss consent - breaching consent
Getting emergency contact details
First 28 days after discharge is critical - remain high risk for 3-6 months
If someone is intoxicated - invalid risk assessment - cannot be assessed until sober
Brief psychiatric assessment
Psych symptoms eg depression
Psych history
Coping skills, capacity, supports
Risk assessment include comprehensive mental health assessment eg depression, schiz, bipolar, anxiety, personality, drug use
Note details risk assessment, management plans and observation on medical records
Increased risk factors
Aboriginal 2.8 times as many deaths
Demographic:
- male
- 25-44
- older people
- living in rural area
- minority group
- sexual identity conflicts
- immigrants, refugees
- homelessness
Higher risk:
- history if suicide
- mental illness
- abuse
- domestic violence
- alcohol
- victims of trauma
- serious physical illness
- prison, police
Current
- at risk mental state
- interpersonal crisis
- major loss or trauma
- alcohol intoxication
- drug withdrawal
- chronic pain illness
- financial difficulties, unemployment
- family breakdown
- lack support
- cultural conflicts
- difficulties accessing help eg language barrier
Element of suicide risk assessment
Distress, psychic pain
Meaning, motivation
At risk mental states eg body language
History of suicide
Current suicide thoughts
Intent, lethality
Presence of suicide plan
Access to means and knowledge
Safety of others
Coping potential or capacity
Self harm behaviour
Assessing degree of intervention
Diagnosis
Severity of illness
Impulsivity
Insight
Safety of current situation
Willingness to engage in treatment
Protective factors
Safety plan
Warning signs
Coping strategies
Contacting people
Contacting health care professional (business hours)
Following agencies or services 24/7
History taking approach
- Explain the purpose and rationale for assessment, getting consent
- Identify the range if concerns
- Prioritise and select issues
- Understand the present behaviour
- Identifying antecedents
- Identifying consequences
- Identifying secondary gains - what is reinforcing the behaviours
- Exploring previous solutions
- Identify coping skills, individual and environmental strengths and resources
- Explore perception of concern
- Ascertaining the intensity of concern
MSE general
Observation
General appearance
Feeling
Perception
Thinking
Orientation
Insight
Speech
Observe:
- Mood
- Physical appearance
- Facial expression
- Body posture
- Language
Ask:
- Inner thoughts
- Feelings
- Suicidal risk and delusions
MMSE - structure 11 items assessing:
- orientation
- registration
- attention
- calculation
- language
Score above 25 is normal
Under is potential cognitive impairment
MSE cognitive functioning
Consciousness and attentiveness
Orientation to person, place and time
Attention, need for redirection, distractibility
Concentration
Memory
Knowledge
Intelligence
Capacity for abstract thinking
MSE perception
Hallucination
Depersonalisation
Derealisation
MSE Thinking
Speech
Thought content (what is said)
Though form (how is it said)
Suicidal and homicidal ideation
Insight
Judgement - problem solving
MSE feeling
Affect (visible emotional state)
Mood (subjective emotional state)
MSE Behaviour
Appearance
Psychomotor agitation or retardation
Degree of cooperation
ABC STAMP LICKER
A appearence
B behaviour
C cooperation
S speech
T thought
A affect
M mood
P perception
L level of consciousness
I insight and judgement
C cognitive functioning
K knowledge
E ending (suicidal)
R reliability of information
