Chapter 8: Assessment (Integration and Clinical Decision Making) Flashcards
Personality
the tendency to consistently behave in specific ways
Objective Personality Tests
tests that can be scored objectively, always using the same scoring system
Behavior Checklists
lists of behaviors that are rated for frequency, intensity, or duration
Projective Personality Tests
tests requiring drawings or a response to ambiguous stimuli, based on the assumption that responses reveal information about personality structure
Validity Scales
scales designed to detect whether a person is faking good, faking bad, or responding randomly
Malingering
emphasizing negative characteristics and deliberately presenting a more problematic picture
Clinical Utility
the extent to which a test and the resulting data improve upon typical clinical decision-making and treatment options
Empirical Criterion-Keying Approach
a method of test construction that involves the generation and analysis of a pool of items
those items that discriminate between two clearly defined groups are retained in the scale
Content Approach
a method of test construction that involves developing items specifically designed to tap the construct being assessed
Overpathologize
the tendency to exaggerate and overestimate the extent of pathology
Code Types
summary codes for the highest two clinical scale elevations on the MMPI scales
What are projective and self-report measures?
tools used to assess various aspects of personality or specific domains such as mood, distress, psychosocial functioning, etc.
How can the subjective perceptions of clinical psychologists be highly inaccurate?
not immune to bias
prejudicing influence of theoretical orientations
extraneous client characteristics
deliberate attempts at deception
tendency to self-confirm working hypotheses
What was Mischel’s idea of personality?
personality is like a person’s face: something consistent about face’s over course of time, personality is an enduring or persistent set of traits
but personality is not stable between different settings
huge overlap between personality and behavior
Why are personality measures utilized?
is past behavior combined with a description of a social situation a better determinant?
for example, little reference is made to the construct of personality in applied behavior analysis
discriminative stimuli in that situation; past behavior is only important in that it reveals much about one’s reinforcement history
How do we define psychopathology on the basis of unusual behavior across different situations?
by definition, if a patient’s maladaptive behavior exists only in a relatively narrow realm, it is unlikely that they are suffering from a major disorder such as depression, schizophrenia, phobia, etc.
important to understand the conditions that mediate the expression of those symptoms, and utilize that information to improve functioning
What are validity scales?
some self-report personality instruments incorporate validity scales specifically to provide information regarding response style
among the first of these were the LFK scales included in the MMPI; subsequent versions have expanded these
useful in detecting random responding, attempts at “faking good”, “faking bad”, inconsistency, answering all true
Why would someone participate in malingering during a test?
faking bad for financial gain or to get out of a crime
Why would someone participate in faking good during a test?
want to be cleared
Why would someone give random responses during a test?
maybe they are fed up with the task
What is a “fake good” profile in MMPI-II?
scales of psychopathology are lower than average
What is a “fake bad” profile in MMPI-II?
symptoms are exaggerated
What are the tests that are designed specifically to detect malingering?
Test of Memory Malingering (TOMM), Green’s World Memory Test (WMT), and Medical Symptom Validity Tests (MSVT)
both capitalize on the fact that individuals who deliberately feign symptoms will tend to do so in a highly exaggerated way, that does not yield scores characteristic of genuine pathology
the WMT, in particular, has extremely high validity and is especially useful in both civil and criminal forensic investigations
even highly sophisticated individuals who are coached on strategies for undermining the test results are unlikely to suceed
In what way are self-report measures are at least somewhat transparent?
i.e., a sophisticated test-taker with elementary knowledge of psychology may be able to detect the purpose of certain items, and attempt to distort their responses accordingly
projective measures are much less obvious, but may have markedly less test validity and hence add little to the assessment as a whole
How does cultural bias influence validity?
must maintain awareness that ethnic and cultural background influence our clinical opinions as well as interpretation of test results
particularly true where cutoff scores are used to demarcate normal from abnormal scores
estimate the anticipated bias: if the patient is very similar to members of the standardization group (e.g., Caucasian Canadian versus Caucasian northern USA) it may be feasible to use the test with suitable cautions
written report status that the results may be less accurate than they appear
What are the five steps necessary to develop a parallel test form?
translate test items into the language spoken by the target population; a seperate translator than reverses the process back into English (many phrases and concepts do not directly translate from one language to another, significant disparities between the two versions are a clear indication that language refinement is necessary)
an initial group of subjects take the translated test; look for difficulty with wording and complaints about the applicability of the items
reliability should be analyzed to see if the test has potential value
means and distribution of all test scales re recalculated so the values will be comparable between the original population and the new population
ongoing validation studies
Are self-report and projective measures of any value?
we can differentiate between “basic” research into the construct validity of any given instrument, and “applied” research the deal strictly with questions of clinical utility
basic questions aside, it becomes a simple question: does the use of this instrument make any difference in treatment outcome?
numerous studies tell us that many self-report and projective measures can have excellent psychometric properties: whether or not they contribute to improved clinical outcomes is a seperate question
How are psychological tests compared to medical tests?
psychological tests can have validity and reliability equal to or, in some cases, superior to those of traditional medical etsts
yet medical tests make a much greater contribution to clinical outcomes
this is not to say that psych tests have poor content validity, just that knowledge of those constructs may not influence treatment that much
challenges their continued use for planning interventions
we spend more time pursuing and refining the psychometric characteristics, and simply expect clinical utility to follow from that naturally
What is the Minnesota Multiphasic Personality Inventory?
MMPI and its descendants are amongst the most commonly used
original version was created in 1943 and standardized on hospital inpatients, as well as their visitors
MMPI-2, contains 567 items which are all endorsed as true or false: scoring generally occurs by computer software, or acetate overlays
covers a broad range of clinical conditions and results in “code types” based on the two highest scale evaluations
descriptions of individuals who score high or low on individual scales is also common
contain an assortment of validity scales useful in assessing the interpretability of the profile
What are the criticisms of MMPI?
excessive overlap among some of the scales, and poor specificity, i.e., other-pathologizes
What is the reliability of the MMPI?
median reliability of the MMPI-2 scales is 0.62 (clinical) and 0.64 (validity)
a number of MMPI scales have poor internal consistency although the test-retest reliability statistics are all in 0.80
keep in mind, that categorical diagnosis is an inherently unreliable task in some diagnostic categories
the MMPI has been exhaustively researched since its original inception
What is the administration of the MMPI?
computer, Scrantron-like sheet fastened to a booklet comprised of pages with various widths
there are audiotaped question sets available for individuals unable to read the items
What is computer interpretation?
interpretive summaries generated by computers are available
must be used with great caution, and the psychologist maintains responsibility
conversely, picking and choosing passages only because they correspond to the clinicians subjective impressions of the client may be a significant source of bias
as with all psychological test results, any tests given must be interpreted and inconsistencies among the data, or between the data and the clinician’s impressions must be addressed in the report
What is the MCMI-III and MACI?
heavily steeped in Theodore Millon’s theories of personality
175 items in length; take less time to complete than MMPI-2
designed to assay disorders, personality style, clinical syndromes
like the MMPI-2, not appropriate for use with general population
standardization sample contained both US and Canadian adults with psychiatric diagnoses: ethnic groups are arguably underrepresented; however, norms have been developed for use with correctional populations
internal consistency values range from the 0.7 to 0.9 levels and test-retest values tend to exceed 0.80
objections have been raised concerning item overlap, and also the tendency for the instrument to be inadequately specific
What is the personality assessment inventory (PAI)?
344 item self-report for adults, about 1 hour to complete
parallel form for adolescents (PAI-A)
reading level is grade 4 which provides an advantage over the MMPI for less literate individuals
contains validity scales as well as clinical scales and has about the best psychometric characteristics of any of the inventories commonly used
code types can be derived, and scoring can be conveniently completed on the computer
What is the California Psychological Inventory (CPI)?
“sane man’s MMPI”: only one (discussed here) appropriate for general population
tends to describe personality well but is less useful for detecting frank psychopathology
What are self-report checklists?
much more symptom/sign oriented than personality inventories
more narrow in focus, but have good psychometric properties
not helpful in detecting unexpected psychopathology: doesn’t necessarily imply better treatment outcomes
What is the child behavior checklist (CBCL)?
separates problems/items into either externalizing or internalizing categories
externalizing: acting-out behaviors such as aggression, stubbornness, refusal, fighting, and being argumentative
internalizing: subjective distress, preoccupation, and low mood
excellent reliability and validity
both caregivers and children can complete seperate versions of the scale, and the correspondence between them can be subsequently compared
What are the criticisms of CBCL?
version completed by the subject and a caregiver often result in scores that correlate poorly
even scales intended for use by adults, in describing adults tend not to produce highly consistent results
What is symptom checklist-90-revised (SCL-90-R)?
amongst the most used self-report measures
contains nine scales that cover a broad range of symptoms applicable to many seperate diagnostic categories
internal consistency and test-retest reliability are fairly good
shows some sensitivity to treatment changes although the construct validity of the measure itself has been called into question
again, insufficient specificity and high inter-correlations amongst the subscales
What is the beck depression inventory-II (BDI-II)?
useful in quantifying subjective feelings of sadness and anxiety
not sufficient (by itself) for the diagnosis of depressive disorder given that is considers a timeframe of only two weeks due to the wording of its questions
there is also a children’s version, the Children’s Depression inventory (written by a different author), but alike in layout
What is the outcome questionnaire 45 (OC-45)?
designed specifically for detecting changes in symptom distress, interpersonal relations, and social role functioning, not a diagnostic tool per se
although the skills correlate highly, it yields a total score which provides a decent reflection of overall client distress
good psychometric characteristics across a number of populations and pathologies, and there is mounting evidence that it is useful in gauging clinical process
meta-analytic research suggests that it can lead to marked improvements in treatment success rates as well as maintenance rates
What is the central approach of projective measures?
provide some incomplete, or ambiguous stimuli to which a patient responds following some instructions from the examiner
may be less transparent in that it is often less obvious what constructs they are intended to assess
What is the heritage of projective measures?
the term “projective” reveals both a psychoanalytic heritage as well as the assumption that responses to these instruments depend on clients projecting something of themselves into the stimulus situation
secondary to assessing the validity of these instruments as diagnostic tools
for example, cognitive researchers often use task ambiguity to make inferences about mental events
What is the Rorschach inkblot test?
full Rorschach set contains 10 cards
originally they were all black and white, were subsequently modified to include some color cards
administration occurs by presenting the cards in a fixed order and asking the client to report what they see in each image
no standard means of interpreting or scoring patient responses until the mid-1990s
utilizes the same cards, but standardizes the instructions, circumstances under which clarification can be requested from the patient, and the scoring
attempts to develop norms in 2007 but suffered form high levels of variability in the data gathered different countries
should not be used exclusively for diagnosis
What is the thematic apperception test (TAT)?
31 cards depicting ambiguous social situations
examinees are asked to tell a story about each card; each story must contain a beginning, middle, and end
the entire set of cards is not always utilize, neither is there a fixed order in which they should be presented
no norms or standardized method of scoring
no evidence concerning the validity of the instrument
