Assessments and Classification Flashcards
reliability
- test = instrument = tool
- consistency of measurement
- degree to which test/procedure yields the same results repeatedly under the same circumstances
types of reliability
- test-retest
- interrater
- internal consistency
test-retest
test produces similar results when given at 2 different points in time
inter-rater
2+ raters administer a test to an individual and come to similar conclusions
internal consistency
various parts of measure yield similar/consistent results
validity
- extent to which a tool measures what it is supposed to measure
- accuracy, match with the “truth”
types of validity
- predictive
- construct
- content
predictive validity
how well a test anticipates person’s B/response
construct validity
how well a test relates to the characteristics or disorder in question
content validity
- how well a test measures what it is intended to measure
- test assesses all important aspects of phenomenon
standardization
administering tests/conducting interviews in the same way for everyone
ways of standardizing
- procedures
- scoring
- interpretation
standardization sample
- used as reference
- group of people who initially took the measure
- performance used as norm for comparison
- test takers should be similar to the standardization sample for tests to be valid
psychological assessment
- gathering/integrating info about person in order to form a judgment/impression
- helps predict course of disorder/future functioning
- helps plan for treatment
- helps monitor treatment progress
gathering/integrating info about person in order to form a judgment/impression includes ______
- abilities
- emotional function
- psychological problems
- traits
- skills
- can result in diagnosis
evidence-based assessment
- selects assessment measures based on criteria of the measures and reading level required
- use of multiple methods of assessment
- assessment that is developmentally/culturally sensitive
- assess strengths and weakness of individual/context
- monitoring symptom change over time
main assessment methods
- biological tests
- interviews
- mental status exam
- observations
- psychological tests and inventories
main assessments methods: biological tests
- brain imaging
- neuropsychological measures
- psychophysiological measures
interviews
- from trained clinicians
- observe client and collect data about the person’s life history, current situation and personality
types of interviews
- structured
- semi-structured
- unstructured
clinician autonomy will vary with the style
interviews: domains of interest
- current and historical symptoms
- developmental and family history
- medical history
- occupational history
- recent events or major life changes
- socio-cultural factors
- strengths
- treatment history
- treatment goals
structured approaches
- clinicians often resist use of structured approaches
causes of avoiding structured approaches
- clinical intuition is better (37%)
- take too long (34%)
- disturb relationship with patient (32%)
observations
- naturalistic or coontrolled
- highly structured/specific or less formal
- functional analysis (ABC)
- self-monitoring
refer to notes on antecedents, behaviours and consequences
self-monitoring
individual assesses themselves with possible guide of clinician
mental status exam
- objective:
evaluate client’s cognitive, psychological, behavioural functioning - use structured questions, open-ended questions, observations, tasks
- subjective
mental status exam: general description
- appearance
- mood and affect
- speech
- thought process, content
- memory
- judgment and insight
cultural and mental status exams
- client’s eye contact and posture may reflect cultural factors
- cultural background can influence assessment
psychological tests/inventories
- standardized tools
- projective tests
- self-reports inventories
- intelligence tests
scores compared with norms
psychological tests/inventories measure ___
characteristics
- personality
- social skills
- intellectual abilities
- vocational interests
projective tests
- present standard, ambiguous stimuli
- assumes that people faced with stimuli will project their own needs/personality/conflicts
- reliability and validity = mixed
types of projective tests
- Rorschach inkblot test
- thematic apperception test (TAT)
- sentence completion test
- draw a person test
issues with projective tests
analysis and interpretation are subject to wide variation
thematic apperception test
- what is happening now?
- what lead up to the event?
- what will the outcome be?
- what are they thinking and feeling?
self-report inventories
- questionnaires meant to assess people’s typical ways of thinking, feeling and behaving
- self-report or observe-report
- group norms
self-report inventories: tests
- Minnesota Multiphasc Personality Inventory - 3
(MMPI-3) - Behavioural Assessment System for Children (BASC)
self-report limitations
- fixed number of answer choices
- response bias or response style
- interpretations of the responses of people from different cultural groups may be inaccurate
- cultural factors may shape the way a trait is viewed
intelligence tests
- used to assess general intellectual functioning
- obtain IQ, or estimate of current level of cognitive functioning
- highly reliable
intelligence tests: used in assessments for ___
- learning disorders
- intellectual disability
- intellectual giftedness
- ADHD
common intelligence tests
- Wechsler Adult Intelligence Scale (WAIS-IV)
- Wechsler Intelligence Scale for Children (WISC-IV)
- Stanford-Binet Intelligence Test (SB5)
intelligence test limitations
- cultural bias
- does not capture all intelligence
- fail to consider effects of:
1. language proficiency
2. culture
3. poverty
4. discrimination
5. oppression
neuropsychological assessment
- indirect measures of brain and physical function
- test developed to assess behavioural disturbances caused by brain dysfunction
neuropsychological assessment: examples of tests
- Bender-gestalt Visual Motor Test
- Halstead-Reitan Neuropsychological Test Battery
Bender-gestalt Visual Motor Test
- copying geometric designs
- certain errors = characteristics of neurological impairment
- refer to slide 5, class 6
Halstead-Reitan Neuropsychological Test Battery
- differentiates patients with brain damage
- slide 6, class 6
brain imaging and neurological tests
- directly measuring brain structure or physical process in the brain
- includes structural imaging and functional imaging
structural imaging
- computerized axial tomography (CT)
- magnetic resonance imaging (MRI)
CT function
- cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside body
- provide more detailed information than plain X-rays
- radiation exposure remains
MRI function
- clearer image than CT scan
functional imaging
- diffusion tensor imaging (DTI)
- electroencephalograph (EEG)
- functional MRI (fMRI)
- magnetoencephalography (MEG)
- positron emission tomography (PET)
- single photon emission computed tomography (SPECT)
DTI function
- detects the white matter fibers that connect different parts of the brain
- show microstructural changes in brain by measuring the motility of water molecules in tissue
EEG function
- main goal is to detect epilepsy
fMRI function
- shows brain activity
- measures the small changes in blood flow that occur with brain activity
- to examine which parts of the brain are handling critical functions
- can guide brain treatment
MEG function
- measures the magnetic fields generated by electric currents in the brain
- provides a very accurate resolution of the timing of neuronal activity
PET function
SPECT function
psychophysiological assessment
- measure autonomic nervous system activity
- assessments not sensitive enough for diagnosis
- electrocardiogram
- electrodermal responding
electrocardiogram
measures:
- heart rate
- muscle tension
- blood flow
- etc.
electrodermal responding
skin conductance
purpose of assessment
- diagnose
- recommend placement or treatment
- provide baseline data at the beginning of intervention
recall of assessments
- evidence-based assessment incorporate multiple methods of assessment
- hoose tools that are reliable and valid
- likely use a combination of assessment tools, but not all
- use a hypothesis testing approach, you may collect more data to clarify
conflicting information
purposes of diagnoses
- communication – providers understand what the label means
- prognosis – label communicates information about future progression
- treatment planning – labels may help guide treatment choices
- practical reasons
- relief + help provide recognition and
understanding of symptoms - facilitate research – defines participant group
harms of diagnoses?
refer to Rosenhan’s 1978 study on mental hospitals
approaches to classification
- categorical
- dimensional
categorical approach to classification
- category based on theory of etiology or identified disease processes
- each disorder fundamentally different, non-overlapping
- have it or don’t have it
dimensional approach to classification
- cognitions, moods, behaviours represented by dimensions
- disorders reside on continuum (normal to severe)
DSM classification system
Diagnostic and Statistical Manual – 5th edition
- categorical approach
- diagnostic criteria include the physical,
behavioral, and emotional characteristics
associated with each disorder
evolution of DSM
- early editions strong psychodynamic orientations
- current edition more behaviorally based
additions since the DSM-4
- Added dimensional ratings within some disorders
- Added subtypes, specifiers, cross-cutting measures
- New conceptualization of some disorders
- New disorders (e.g., binge eating disorders)
Controversies and limitations of DSM: ASD
eliminates previous Asperger’s syndrome
Controversies and limitations of DSM: disruptive mood dysregulation disorder
criticized as temper tantrum disorder
Controversies and limitations of DSM: additions of gambling disorder
opens possibility of other behaviour additions
Controversies and limitations of DSM: bereavement
- can no longer exclude depression
- maybe over-diagnosing normal grieving
Controversies and limitations of DSM: premenstrual dysphoric disorder
has been subject of heated discussion
Controversies and limitations of DSM: general
- gives less attention to disorders of infancy and childhood
- fails to capture interrelationships and overlap known to exist among many disorders
- high rates of comorbidity
- culturally sensitive or applicable?
- disorders have variable reliability and validity
comorbidity
PTSD and substance use disorder (SUD)
- is it both PTSD and substance abuse?
- is it a new/different identity, not currently represented in the classification system?
- if our current diagnostic system is valid, then why is comorbidity the norm?
DSM vs ICD
- ICD covers all health conditions
- current editions are well aligned
- which classification you use depend on your profession, employment, setting, country of practice, etc.
misdiagnoses/missed diagnoses
- vary based on setting, who is completing assessment, diagnosis
- dependent on information you are receiving
- symptoms may change over time
- comorbidities
