lecture 3

Question 1

Why should we assess?

Answer 1

• classification
• facilitate decision making
• evaluation
• data collection

What about psychological assessment?
- a psychological assessment ( as described by the APA) is…
- the gathering and integration of data to evaluate a person’s behaviour, abilities, and other characteristics, particularly for the purpose of making a diagnosis or treatment recommendation.
- - Psychologists assess diverse psychiatric problems (e.g., anxiety, substance abuse) and nonpsychiatric concerns (e.g., intelligence, career interests) in a range of clinical, educational, organizational, forensic, and other settings.
- Assessment data may be gathered through interviews, observation, standardized tests, self-report measures, physiological or psychophysiological measurement devices, or other specialized procedures and apparatuses.

Question 2

How is psychological assessment different?

Answer 2

devices, or other specialized procedures and apparatuses.
How is Psychological Assessment Different?
- Systematic: not just doing one test: you need multiple need different ways to look at it.
- Driven by assessment questions/ goals.
- Develop and evaluate iterative hypotheses.
- Consider multiple sources of information.
* Integrate ↑ information in drawing conclusions.
o Typically consult clients regarding the accuracy of conclusions.

Question 3

what is the purpose of assessment?

Answer 3

• Assessment-focused services
  ▪ Stand-alone
  ▪ Answer basic questions and provide recommendations
  ▪ Opinion regarding changes in functioning
  ▪ Conclusions and recommendations may have ↑ consequences
  ▪ Need to consider the context of referral
• ▫ Intervention-focused assessment services
  ▪ First step in intervention
  ▪ Use to determine appropriate interventions, evaluate progress etc.

Screening
- Identify individuals with/ at risk of developing relevant problems.
Diagnosis
- Integrate data on current symptoms, and compare with diagnostic criteria
▫ Case Formulation
- Develop a comprehensive conceptualization of psychological functioning
▪ Put the client in the context
- Prognosis/prediction
- Predict the future course of psychological functioning
- Difficult – must weigh time/cost of prediction, cost/consequences of making the wrong call
- Influenced by base-rate

Question 4

What is sensitivity & specificity, and what are the differences?

Answer 4

Sensitivity
* ▪ True positives/(true positives + false negatives)
* ▪ How often can you accurately detect that _ is present?
* ▪ e.g., how well can you detect who has/will develop an eating disorder
Specificity
* ▪ True negatives/(true negatives + false positives)
* ▪ How often can you accurately detect that _ is not present?
* ▪ e.g., how well can you detect who does not/will not develop an eating disorder
Trade-off
- Consider relative costs

Question 5

what should you consider about treatment

Answer 5

• ▫ Treatment planning
  o ▪ Purpose of most assessment
  o ▪ Decide which treatment will likely be most effective given client characteristics/context
   ▫ Problem identification
   ▫ Set treatment goals (short-term and long-term)
   ▫ Identify treatment strategies/tactics with established effectiveness
• ▫ Develop a treatment plan in collaboration with the client
• Treatment monitoring
  o ▪ Crucial to effective treatment
  o ▪ Use formal assessment tools
  o ▪ Alter course as needed
• ▫ Treatment evaluation
  o ▪ Compare outcome data with intake data
  o ▪ Look at individual clients, clinician, clinics, therapy
  o ▪ Helps set expectations, build informal norms, alert to problems

Question 6

testing vs. assessment

Answer 6

• ▫ Psychological testing
  o ▪ A particular device is used to gather a sample of behavior in a specific domain
  o ▪ A score is assigned to the resulting sample
  o ▪ This score is compared with the scores of other people in order to interpret it
• ▫ Tests meet standards of standardization, reliability, validity, and norms
• ▫ Assessment is more complex, multifaceted
  o ▪ Integrate many sources of information
  o ▪ Develop a coherent, unified description of the client/client’s experience
  o ▪ Tests are just part of the assessment

Question 7

what is reliability

Answer 7

• ▪ Consistency of the test
• ▪ Internal consistency, test-retest, inter-rater
• ▪ Specific to purpose and population
• ▪ Requirements vary but expectations higher for clinical use

Question 8

what is validity

Answer 8

• ▪ Whether the test measures what it is supposed to
• ▪ Content, concurrent, predictive, discriminant, incremental
• ▪ Applies to whole tests and to subscales
• ▪ Specific to purpose and population
• ▪ Consider whether likely to be useful for particular client

Question 9

what are norms

Answer 9

• ▪ Compare scores to normative sample to interpret
• ▪ Consider how client’s score relates to cut-off, distribution
  Percentiles, standard scores, developmental norms
  ▪ Consider quality and appropriateness of normative sample

Question 10

what are important ethical principles?

Answer 10

• Protecting test security College Code of Conduct)
• ▫ Knowledge of test properties, proper use and interpretation, and limitations (College Code of Conduct)
• ▫ Acknowledge limitations of conclusions (III.8)
• ▫ Acknowledge the source of interpretive statements (College Code of Conduct)

Question 11

▫ Which of the following would be considered an open question (as opposed to a closed question)?

Answer 11

• Where did you grow up?
• b) Did you experience heart palpitations?
• c) When did these problems start?
• d) What was going on for you at the time? *
• e) Did your boss get angry at you?

Question 12

Which of the following is an element of effective active listening?

Answer 12

1. a) Paraphrasing
2. b) Summarizing
3. c) Asking questions
4. d) Using reflections
5. e) All of the above *

Question 13

What are the limits of confidentiality (and relevant laws) ?

Answer 13

• imminent risk of harm to self or others (college code of conduct)
• child abuse/ neglect (child, family, and community service act)
• unsafe to drive (motor vehicle act)
• court order (but not necessarily subpoena, college code of conduct)
• multidisciplinary/ hospital settings:
  o team
  o file audits.

Question 14

Interviews vs. conversations

Answer 14

• Different contexts and structure
• Different tone
• Interviews are confidential.
• Different purpose and focus
• Differ in the level of self-disclosure.
• Differ in how to approach painful topics.
• Differ in record keeping.

Question 15

What are the three types of interviews?

Answer 15

• unstructured
• semi-structured
• structured

Question 16

What are unstructured interviews?

Answer 16

• standard clinical interview
• Create a safe environment.
• Structure sessions to ensure that cover relevant topics.
  o Clinician decides what to cover.
   Presenting problem(s), past problems
   Treatment history (including current medications)
   Medical conditions
   Psychosocial history (e.g., childhood, school, work, relationships)
   Goals/ expectations for treatment
  o Ask about difficult topics (e.g., suicidality)
  o Very flexible

Question 17

what are semi-structured interviews?

Answer 17

• Specific format, a specific sequence
• Start with a fixed set of questions.
• There is some flexibility (can ask additional questions)
• Often include screening questions
  o Ask follow-up questions based on responses.
• Explicit decision rules
• Broad coverage
• Clearly follow diagnostic criteria
• Improves diagnostic reliability and inter-rater reliability.
• Can be long.

Examples
- Structured clinical interviews for Axis I Disorders (SCID), SCID-CV (common conditions only), SCID-II
o Parallels DSM Criteria
o Anxiety Disorders Interview Schedule (ADIS)
o Yale-Brown Obsessive-Compulsive Scale (YBOCS)
o Yale-Brown Obsessive Compulsive Scale_ Body Dysmorphic Disorder (YBOCS_BDD)

Question 18

What are structured interviews?

Answer 18

• Asked a fixed set of questions in a fixed sequence
• No deviating from standardized questions
• More common in research and hospital settings
• Efficient
  Example:
• M.I.N.I International Neuropsychiatric Interview (MINI: can also use as semi-structured)
• Trade-off = flexibility vs. control

Question 19

how would you ask about suicidality directly?

Answer 19

• ▪ Suicidal thoughts (frequency, intensity, duration)
• ▪ Nature of thoughts (general, concrete)
• ▪ Whether they have a plan (how concrete/specific)
• ▪ Access to means
• ▪ Intent to act on thoughts
• ▪ Do they think they could follow through
• ▪ Why they consider suicide to be an option
  - Hopelessness
• ▪ Past attempts
• ▪ Past self-harm
• ▪ What has stopped them
• ▪ Available supports

Question 20

How would you interview couples?

Answer 20

• Focus on one client, couple, or family member
• Must make space for both people to talk and engage with both partners
• Look for differences in perspective, interpretation
• Observe how they interact
• May need to structure the conversation for the,
• May also, indeed, individual

Question 21

How would you interview families?

Answer 21

Interviewing family
- Need to establish rapport with several people
o Attend to each person at some point
- Set expectations upfront
- May need to cut people off
- Normalize (and validate) differences in perspective

Question 22

how would you interview older adults?

Answer 22

• Be aware of problems in daily living
• Health problems may play a bigger role in the presentation
  
  • Also, medications
• Concerns may focus on the loss of autonomy, caregiver relationships, bereavement, mortality
• Make sure to be aware of the purpose of services, establish informed consent/assent
• ▫ Be sensitive to potential cognitive impairments, differences in style/experiences
• ▫ May need to involve caregivers
• ▫ Screen for maltreatment

Question 23

how would you interview children?

Answer 23

• Kids can provide useful information
• Observe how to interact with you
• Explain the purpose of the assessment
• Adapt approach
  o Make sure understandable
  o More flexible
  o Consider developmental appropriateness.
  o Consider awareness of time
  o Ask questions to clarify, build rapport
  o Alter style

Question 24

what are some key observations to make during interviews?

Answer 24

• Observe relevant behaviour during the interview (e.g., attention, impulsivity, activity level, interpersonal behaviour)
• Behaviour may be reactive.
• May supplement with naturalistic observations
  o Home
  o Schools
• Use to generate hypotheses and combine with other assessment data.
• Rarely use standardized observational coding systems.

Question 25

what is the Flynn Effect?

Answer 25

• IQ scores on the rise
• The greatest increase in visuospatial abilities in developing countries.
• Possible reasons:
  o Factors related to the tests (unlikely)
  o Genetic factors factor (40-80% genetic)
  o Educational improvements
  o Other environmental factors
  o Epigenetic effects

Question 26

How would we define intelligence?

Answer 26

• Definitions range from broad (e.g., ability to learn/adapt) to narrow (e.g., ability to engage in abstract thinking)
• Have moved from an interest in academic performance to the context of life more generally
• Wechsler:
  o Capacity to act purposefully, think rationally and deal effectively with his/her environment.
  o Involves a range of problem-solving skills acquired through education and life experience.
• Current theories:
  o Intelligence = combination of abilities in multiple areas of life ▫ Most tests are limited in scope

Question 27

what are some models of intelligence?

Answer 27

• Factor models
  o Multiple factors at the same level
• Hierarchical model
  o Lower-order and higher-order factors
• Information processing model
  o Focus on processes and operations that reflect how the brain handles information.
• Disconnect between theories of intelligence and how we assess intelligence

Question 28

what is Spearman’s “g”?

Answer 28

• Looked at intercorrelations among sensory tests
• Two-factor model
   All intellectual activities share a common core
   “G” OR “GENERAL FACTOR”
   More highly correlated = more g
  o Also, specific factors unique to task (i.e., “s”)
  o Performance on task = g +s
• Not hierarchical
• The idea of “g” is retained in most theories of intelligence.

Question 29

what are Thurstone’s Primary Mental Abilities

Answer 29

• Ealy alternative to Spearman’s model
• Many abilities measured is not highly correlated
  o Influenced by something other than “g”
• ▫ Primary mental abilities:
  o ▪ Spatial orientation, perceptual speed, numerical ability, associative memory, verbal comprehension, word fluency, reasoning, deduction, and induction
  o ▪ Relatively distinct
  o ▪ Overlap = “g”
• ▫ Developed a measure of intelligence based on model

Question 30

what is the Catell-Horn-Carroll Theory

Answer 30

• Existing tests too focused on verbal academic tasks
• Fluid vs. Crystallized intelligence
  o Fluid: the ability to solve novel problems; innate potential
  o Crystallized: what we have learned from education and life experiences
• ▫ 3 levels: “g”, broad, narrow
• ▫ Is reflected (to some extent) in Wechsler scales

Question 31

what is Sternberg’s Triarchic theory

Answer 31

• ▫ Rather than “g”, 3 interrelated elements:
  o ▪ Componential: executive functioning, problem-solving, knowledge acquisition
  o ▪ Experiential: problem-solving when faced with novelty/unfamiliarity
  o ▪ Context: ways of interacting with the environment (adaptation, alteration of the environment, selection of a different environment)
• ▫ Need to consider learning history and environment in understanding intelligent behaviour

Question 32

What is emotional intelligence?

Answer 32

• Ability to perceive, understand, and regulate emotions
• Many different definitions, many measures
• Ability-based measures similar to intelligence tests
  o e.g., Mayer-Salovey-Caruso Emotional Intelligence Test
  o Perception of emotion, use of emotional information in thinking, understanding emotions, managing emotions
• Does relate to better social outcomes, achievement, well-being, and adjustment.
• Not assessed in standard intelligence tests

Question 33

what afre the Weschler scales?

Answer 33

• Motivation = clinical utility
• Introduced scaled scores (previously compared chronological and mental age)
• MEAN = 100, SD = 15)
• ▫ Widely used
• ▫ Several tests:
  o ▪ Wechsler Adult Intelligence Scale (WAIS-IV)
  o ▪ Wechsler Intelligence Scale for Children
  (WISC-V)
  o ▪ Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV)
  o ▪ Wechsler Abbreviated Scale of Intelligence (WASI-II)
• ▫ Canadian adaptations available

Question 34

What is the structure like in the Weschler scales?

Answer 34

• Full Scale IQ (FSIQ; “g”)
  o Verbal Comprehension Index
   Perceptual Reasoning Index
   Working Memory Index
   Processing Speed Index
• ▫ Formerly VIQ and PIQ
• ▫ Good norms (in the USA)
  o Large, representative samples
• ▫ Some questions culture bound
• ▫ Use Canadian adaptation!

Question 35

What is The WAIS-IV (Weschler adult Intelligence Scale) ?

Answer 35

• ▫ Ages 16-90
• ▫ See the textbook for a description of subscales
• ▫ High reliability (internal consistency
• ▫ Good validity data
  o ▪ Correlates highly with the WAIS-II, so much of the older validity data is still relevant
  o ▪ Validity is specific to a purpose, population
• ▫ Canadian normative sample
  o ▪ > 1000 adults
  o ▪ Representative sample

Question 36

What is the WISC-V?

Answer 36

▫Ages 6-16 (16 years, 11 months)
* ▫ Slightly different subscales (see textbook)
* ▫ Very good reliability (internal consistency), especially for FSIQ
* ▫ Good validity data
o ▪ Correlates with other measures of intelligence
o ▪ Low correlations with EI
* ▫ Canadian normative sample
▪ 1100 children

Question 37

What is the WPPSI-IV?

Answer 37

Ages 2 years 6 months - 7 years 7 months
* ▫ Separate subtests and index scores for different age groups
o ▪ 2y 6m to 3y 11m = verbal comprehension, visual-spatial, and working memory
o ▪ 4y to 7y 7m = verbal comprehension, visual-spatial, fluid reasoning, working memory, processing speed
* ▫ Less emphasis on timed performance, verbal responses
* ▫ Good reliability and validity data, Canadian version available

Question 38

What is the WASI-II?

Answer 38

▫ Ages 6-89
* ▫ Much shorter
* ▫ Provides a good estimate of FSIQ
o ▪ Verbal Comprehension Index (vocabulary, similarities)
o ▪ Perceptual Reasoning Index (block design, matrix reasoning)
* ▫ Use when full WAIS is not possible/necessary

Question 39

How do we measure intelligence in babies?

Answer 39

▫ Difficult to estimate
* ▫ Some tests rely heavily on parent/caregiver reports
* ▫ Traditional tests consist largely of perceptual and motor responses
o ▪ , e.g., Bayley Scales of Infant Development
o ▪ Poor predictors of intelligence during childhood
 ▫ More relevant for low-scoring infants
 ▫ Largely used for screening
* ▫ Some focus on habituation-dishabituation
o ▪ e.g., Fagan Test of infant Intelligence
o ▪ Better predictor of childhood IQ

Question 40

What is the Standford-Binet test?

Answer 40

• ▫ Ages 2-85
• ▫ Standardized to mean of 100, SD of 15
• FSIQ and composite factor scores
  o Verbal and nonverbal IQ
  o Fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, working memory
• Good reliability and validity
• ▫ Good normative data (for the USA only)
• ▫ No Canadian adaptation/norms
  Scaled scores go higher and lower than Wechsler scores
• Can be useful for assessing giftedness, intellectual disability

Question 41

What are the Kaufman Scales?

Answer 41

• ▫ Kaufman Assessment Battery for Children
• ▫ Kaufman Adolescent and Adult Intelligence Test
• Process-based, focus on how people learn
• ▫ Subscales quite different from Wechsler
  o e.g., sequential processing, simultaneous processing, mental processing composite, achievement
   Looks at the gap between achievement and potential
• ▫ Designed to be culturally fair, relevant to educational contexts
• ▫ Not widely use

Question 42

What are Raven’s Progressive Matrices?

Answer 42

• ▫ Ages 5.5 up
• ▫ Assesses visual inductive reasoning
• ▫ Standard, color, and advanced versions
• ▫ Good measure of “g”, fluid intelligence
• ▫ Non-verbal, doesn’t require manipulation of objects, minimal verbal instruction
  o ▪ Good for people with language, hearing, or motor impairments
  o ▪ More culturally fair than Wechsler scales
• ▫ Good reliability, decent validity data, international and local norms available (representativeness unclear)
• ▫ Provides limited information about strengths/weaknesses

Question 43

What is cognitive assessment and why should we do it?

Answer 43

• Assess functioning in specific domains.
  o Identify strengths and weaknesses
• Helpful in differential diagnosis, diagnosing neurocognitive disorders
• Helpful in treatment and discharge planning
• Primarily conducted by neuropsychologists
• Helpful to know about tests
• May be more relevant if working with certain populations or in certain settings
  o Children
  o Older adults
  o Health psychology

Question 44

What are neuropsychological assessments?

Answer 44

• Evaluate cognitive and behavioural functioning
• ▫ Integrate with intellectual, diagnostic, and personality assessments, medical findings (including imaging)
  ▫ Examine the brain by studying its behavioural products
  o Specific cognitive deficits may indicate underlying pathology
• May reassess to examine change in functioning over time
• Use specialized tests
  o Customize the battery based on the referral question

Question 45

Which domains are assessed during an assessment?

Answer 45

• Orientation (Arousal) ▫ Sensation/Perception
  o Attention/Concentration
  o Motor Skills
  o Verbal Functions/Language
  o Visuospatial Organization
  o Memory
  o Judgment/Problem-Solving
  o Symptom Validity Testing

Question 46

Orientation (arousal)

Answer 46

• Assess overall level of consciousness/alertness
  o Awareness of self and the world around them
  o Relevant to performance
  o Can be a symptom of a neurological or psychological problem
• If low, may have difficulty participating in evaluation, intervention, rehabilitation
• Examples:
  o Galveston Orientation and Amnesia Test
   Assesses confusion and amnesia
   Simple questions (e.g., “ what is your name?”, “where are you now?”)

Question 47

how would you assess sensation/ perception?

Answer 47

• Assess sensation (i.e., reception of stimuli) and perception (i.e., understanding what that stimuli is) to rule out problems
  o May affect performance on other tests
  o May indicate specific neurological problems
  o Visual, auditory, and tactile
• Examples:
  o Visual field exam
  o Distinguish between similar words (e.g., first – thirst)

Question 48

How would you assess attention/ concentration?

Answer 48

• Attention is critical to learning/memory
• Look at sustained attention (paying attention over a prolonged period) and selective attention (paying attention to more than one thing at a time)
• Examples:
  o Mental control tasks – involve simple, overlearned information but require an adequate level of attention (e.g., serial sevens)
  o Attention span – attend to verbal stimuli and repeat (e.g., digit span)
  o Sustained attention (e.g., tap when hearing the number 4)
  o Symbol Digit Modalities Test (scanning, visual tracking, sustained attention)
  o d2 Test of Attention

Question 49

how would you assess motor skills?

Answer 49

• Assess simple or complex motor skills/motor control
  o Gradually more complex, require more integration of cognitive skills
• Examples:
  o Gross motor – raise right hand
  o Motor speed – touch thumb to forefinger as quickly as you can
  o Fine motor – touch your thumb to each finger, one after the other
  o Ability to perform and inhibit motor behavior – I clap once, you clap twice, now I clap twice, you clap once
  o Graphomotor skills – copy shapes
  o Test for motor apraxia by getting them to demonstrate simple skills
  o Grip Strength
  o Finger Oscillation/Finger Tapping Test

Question 50

How would you assess verbal function/ language?

Answer 50

• Screen for intactness of language
  o Ability to understand, expressive language
• Examples:
  o Ability to comprehend simple and more complex commands (e.g., turn over the paper, hand me the pen, point to your mouth)
  o Ask to define words
  o Word and phrase repetition/sentence generation
  o Verbal fluency (e.g., name all the animals you can think of)
  o Visual naming
  o Writing, reading, and spelling
  o Token Test (follow commands that relate to tokens)
  o Controlled Oral Word Association Test (verbal fluency via naming words that begin within a single letter; C, F, and L)

Question 51

How would you asses visuospatial organization?

Answer 51

• Assess map skills, route finding, spatial integration and decoding, facial recognition
• Examples:
  o Directional skills and mazes
  o Clock drawing
  o Motor-free constructional tasks
  o Identify and compare faces, identify emotions
  o Visual sequencing (more integration, higher-order processing)
  o Bender Gestalt Test
  o Rey-Osterrieth Complex Figure Test

Question 52

How would you assess memory?

Answer 52

• Assess encoding (ability to put information into storage), retrieval
  o Look for memory defects, memory disorders
• Immediate and delayed, verbal and visual, recall and recognition
• Often multiple trials
• Examples:
  o Word lists
  o Story recall
  o Picture recall

Question 53

what is the Weschler memory scale?

Answer 53

• Assesses episodic declarative memory
• Start with brief cognitive status test, flexible administration of subtests
• Immediate, delayed, visual, and auditory memory index scores
  o Subtests described in textbook.
• Standardized to have a mean of 100, SD = 15
• Good reliability, good validity
  o Can detect impairment, differentiate between groups
• Normed with the WAIS-IV
  o American norms valid for Canadians

Question 54

How would you assess judgement/ problem-solving skills?

Answer 54

• Ability to use abstract reasoning, generalize learning from one situation to another, and insight
• Examples:
  o Proverb interpretation (e.g., you can’t judge a book by its cover)
  o Similarities/differences or analogies (e.g., how are an eagle and a robin alike)
  o Problem-solving tasks (e.g., what should you do if you can’t keep an appointment)
  o Detecting absurdities
  o Trail Making Test
  o Wisconsin Card Sorting Test
  o Tower of London

Question 55

what do achievement tests measure?

Answer 55

• Assess academic and problem-solving skills, how much a person has profited from learning and experience compared with others (not potential)
  o Most influenced by past educational achievement
• Useful in diagnosing learning differences
  o Watch for notable discrepancies between IQ and achievement
• Can use to plan remediation
• Examples:
  o Woodcock-Johnson Tests of Achievement
  o Wide Range Achievement Test
  o Wechsler Individual Achievement Test (WIAT)

Question 56

what is The Wechsler Individual Achievement Test (WIAT) ?

Answer 56

• Canadian version available
• Can be used with Wechsler intelligence scales
  o Easy identification of discrepancies
• Four composite scores (map onto main LDs):
  o Reading, mathematics, written expression, oral language
  o Subtests described in a textbook
  o First, see if the individual has had an intervention and if with help it helps the LD or if they are still performing badly with intervention.
• Good reliability and validity
• Definitely use Canadian norms.