Methods of Assessment Flashcards
Reliability is the extent to which a given finding will be consistently reproduced on other occasions.
assessed in three ways…
Test re-test: Running the same test over time to the same person. Most psychological tests are based on the assumption that most traits and personal characteristics are relatively stable and can be reliably measured. if the test has high test-retest reliability, then when an individual is given the test two separate times, the two scores should be highly correlated.
Inter-rater Reliability: The same test conducted by different people (among two independent judges). most highly structured tests, such as personality inventories, will have high inter-rater reliability because the scoring system is clearly defined and there is little room for individual clinician judgements when interpreting the test. Projective tests are an example of low inter-rater reliability where scoring schemes are not rigidly defined.
Internal Consistency/Reliability: The individual items of a test (e.g. personality and trait inventories). consistency of different items intended to measure the same thing. Cronbach’s alpha is a statistical test used to assess the internal consistency of a questionnaire or inventory.
Validity is whether a test is measuring what we claim it is measuring. we collect evidence through a number of criteria to support the validity of our test as a measure of whatever the subject matter is.
assessed in 4 ways…
Concurrent Validity: assessed by the extent to which it shows high associations with other measures to which it should be related
Predictive Validity: assesses whether a measure can accurately predict future behaviour and symptoms, and so be valuable enough to help with the planning of care, support, and treatment.
Face Validity: measures what the questionnaire claims to measure
construct validity: hypothetical or inferred attribute that may not be directly observable or directly measurable. used to help understand some of the cognitive factors that may cause or maintain mental health problems, and so being able to measure them is a useful tool in diagnosis and treatment. the more independent evidence that can be gathered to show that a measure of a construct is related to other similar measures, the greater the construct validity of the measure.
Clinical Interviews
clinical psychologists try to gain a broad insight into the client and their problems. questions may relate to the nature of the symptoms the client’s experiences, their past history, and their current living and working circumstances.
the questions depend on the theoretical orientation of the clinician. Must be skilful in guiding the client towards revealing the kinds of info they are looking for.
Problems with Clinical Interviews:
- clients withholding info
- clients having poor self-knowledge
- unstructured interview
Structured Interviews
Clinicians use this method to acquire the kinds of standardised info they need to make a diagnosis or construct a case formulation, but this requires that they conduct the interview in a structured way.
meaning all questions, their sequence and detailed information to be gathered are all predetermined
one technique used in this interview is Structured Clinical Interview for DSM-IV-TR (SCID). a branching, structured interview in which the clients response to one question will determine the next question to be asked. establishes the main symptoms of the client, their severity and whether a combination of these symptoms and severity meet DSM criteria for a particular disorder
Also used to determine overall levels of psychological and intellectual functioning, especially in older people with degenerative disorders such as dementia. one structured interview is the Mini Mental State Examination (MMSE) which takes 10mins and provides info on clients overall cognitive and mental functioning.
Psychological Tests
one of the most common forms of assessment in clinical psychology
represents highly structured ways of gathering info about the individual. usually through the client answering questions in a written questionnaire.
most psychological tests are based on the psychometric approach. the idea that the test assumes there are stable underlying characteristics or traits that exist at different levels in everyone.
Advantages to this method:
- they usually assess the client on one or more specific characteristics or traits (e.g. anxiety, depression, IQ..)
- they will usually (but not always) have very rigid response requirements so that the questions can be scored according to be pre-concieved scoring system, (e.g. the State-Trait Anxiety Inventory)
- once data from these tests have been collected from large numbers of participants, statistical norms for the tests can be established (known as standardisation). this allows clinicians to see where an individuals score falls in relation to the normal distribution of scores for that test. can use this score to estimate whether the client meets the diagnostic criteria for a psychological disorder.
- tests are both reliable and valid
Psychological Tests: Personality Inventories
Minnesota Multiphasic Personality Inventory (MMPI):
Used by clinical psychologists and psychiatrists which consists of 567 self-statements to which the client would respond to on a three point scale (true, false, or cannot say). Assesses the characteristics of the client across a range of different traits and domains.
has good inter-rater reliability and excellent validity
limitation: time, needing to answer 567 questions.
Psychological Tests: Specific Inventories
measures one specific area or psychopathology,
example of inventory;
Obsessive Belief Questionnaire (OBQ) is designed to assess beliefs and appraisals considered critical to the acquisition and maintenance of obsessions.
these kind of tests can be used to measure variables that are directly observable and measurable, such as characteristics found in observable behaviour.
Increasingly being used to measure hypothetical constructs; constructs that are not necessarily directly observable but have to be inferred from other data.
some tests are valuable and has good face validity,
however majority of trait inventories fail to include questions to indicate whether the clients are faking responses or careless with their answers
Psychological Tests: Projective Tests
a group of tests usually consisting of a standard fixed set of stimuli that are presented to clients, but which are ambiguous enough for clients to put their own interpretation on what the stimuli represent. because they are open-ended tests, they are less reliable and valid than structured tests.
most widely used is the Rorschach Inkblot Test, the Thematic Apperception Test (TAT), and the Sentence Completion Test.
Rorschach Inkblot Test:
a projective personality test using inkblots created by dropping ink onto paper and then folding the paper in half to create a symmetrical image. certain themes in the clients responses can provide evidence of underlying conflicts.
The Thematic Apperception Test (TAT):
a projective personality test consisting of 30 black and white pictures of people in vague or ambiguous situations. the picture serves as a vehicle for the clients to describe their own feelings as if they were involved in the ambiguous scene.
the Sentence Completion Test:
an open-ended projective personality test that provides clients with the first part of an uncompleted sentence which they complete with words of their own. can identify topics to further explore, ways the individual might bias their thinking, and the way they process info.
Psychological Tests: Intelligence tests
IQ Tests have high internal consistency, test-retest reliability, and good validity.
WAIS (Weschler Adult Intelligence Scale)
intelligence tests can be used:
- with other measures of ability to diagnose intellectual and learning disabilities
- IQ tests can also assess the needs of individuals with ASN so support can be provided
- as part of a battery of assessments used in neurological evaluations and can help to detect when a client has brain damage caused by traumatic injury or cerebral infections, or has a degenerative brain disorder such as Alzheimer’s disease.
limitations:
- intelligence is an inferred construct (no clear definition)
- many IQ tests are culturally biased
- tests are static - only provide a snapshot of ability
do not measure the individuals capacity to learn or their potential to acquire new cognitive abilities
- conception of intelligence as measured by IQ tests are too narrow (does not include music ability e.g.)
Psychological Tests: Neurological Impairment Tests
identifying any damage to the structure or functioning of the brain and the central nervous system.
caused by traumatic injury, cardiovascular problems, cerebral infection, a brain tumour, or a degenerative brain disorder.
this can result in personality changes and deficits in cognitive functioning depending on the areas of the brain that are affected.
tests used:
Adult Memory and Information Processing Battery (AMIPB) - compromising two tests of speed of information processing, verbal memory test (list learning and story recall) and visual memory tests (design learning and figure recall)
Halstead-Reitan Neuropsychological Test Battery - used in USA, compiled to evaluate brain and nervous system functioning across a fixed set of eight tests. the tests evaluate function across visual, auditory and tactile input, verbal communication, spatial and sequential perception, the ability to form mental concepts, make judgements, control motor output and to attend to and memorise stimuli
Biologically Based Assessments:
psychophysiological tests
psychophysiological tests:
electrodermal responding - uses electrodes attached to the fingers of participants to test emotional responses such as anxiety, fear or anger by measuring changes in sweat-gland activity. (not always foolproof)
electromyogram (EMG) - measurement technique that measures the electrical activity of muscles. 4 ways skin conductance measures have been used in a variety of contexts. PG55
electrocardiogram (ECG) - measurement technique used for measuring heart rate
lie detectors - the measurement of changes in autonomic responding used to identify whether an individual is lying in response to specific preset questions. this is a controversial technique used in criminal prosecutions and employment screening.
electroencephalogram (EEG) - assessment measure which involves electrodes being attached to the scalp that record underlying electrical activity and can help to localise unusual brain patterns in different areas of the brain.
Biologically Based Assessments:
Neuroimaging Techniques
computerised axial tomography (CAT) - uses sophisticated versions of X-ray machines and can be used to form a three-dimensional picture of the brain. patients lie down on a doughnut-like ring. can help to detect abnormal growths in the brain such as tumours or enlargement of the ventricles in the brain that can indicate tissue degeneration typical of dementia or schizophrenia.
Positron Emission Tomography (PET) - allows measurement of both brain structure and function by utilising radiation emitted from the participant to develop images. useful tool for assessing cognitive functioning and provides info about brain functioning in degenerative diseases such as Alzheimers disease and brain functioning in intellectual disabilities such as Down Syndrome.
Magnetic Resonance Imaging (MRI) - involves the participant being placed inside a large circular magnet that causes the hydrogen atoms in the body to move. this produces an electromagnetic signal that is converted by the scanner’s computer into visual pictures of the brain.
Functional Magnetic Resonance Imaging (fMRI) - allows the clinician to take brain images so quickly that tiny changes in brain metabolism can be detected and can provide minute-by-minute info about actual brain activity.
Clinical Observations
pg59 advantages to using observational techniques
involves directly observing the clients behaviour in it’s natural context such as home, or school.
this provides info on the frequency of the behaviour, what precedes the behaviour and events that immediately follow the behaviour
observation techniques can identify the factors that might be triggering and maintaining challenging behaviour:
- ABC Chart requires the observer to note what happens before the target behaviour occurs, what the individual did, and what the consequences of the behaviour were.
- ecological validity is the extent to which conditions simulated in the laboratory reflect real-life conditions.
- analogue observations are carried out in a controlled environment that allows surreptitious observation of the client
- self observation involves asking clients to observe and record their own behaviour, perhaps by using a diary to note when certain behaviours or thoughts occur and in what contexts they occur.
- self monitoring involves asking clients to observe and record their own behaviour, to note when certain behaviours or thoughts occur and in what contexts they occur.
- ecological momentary assessment (EMA) the use of diaries for self-observation or self-monitoring, perhaps by using an electronic diary or a smartphone.
Cultural Bias in Assessment
examples of cultural anomalies in assessment and diagnosis:
- some ethnic groups score differently on assessment tests than others
- black Americans have a higher rate of diagnosis of disorders such as alcoholism or schizophrenia whereas white Americans are more likely to be given the less stigmatising diagnosis of major depression.
- the apparent bias in assessment and diagnosis in ethnic minorities, individuals from low socioeconomic backgrounds as more disturbed than those from higher socioeconomic groups, and this may result from clinicians stereotypes of different socioeconomic groups.
causes of cultural anomalies in assessment and diagnosis:
- stress and health problems can manifest differently in different cultures, this can complicate the process of diagnosis when assessing clients from different cultural backgrounds
- language differences and difficulties
- different spiritual or religious beliefs
- client from the ethnic minority may feel more apprehensive and intimidated with a clinician from the ethnic majority which will affect the way they converse at the interview
- a discussion between client and clinician can be influenced by racial and ethnic stereotypes
Addressing cultural anomalies in assessment and diagnosis:
- DSM has attempted to identify potential cultural anomalies in diagnosis by including a specific section on ‘culture, age and gender’ factors within most diagnostic categories
- clinicians needs proper education and training when required to assess and diagnose minority persons.
- aspire to create culture-free assessment methods by making tests and assessments more valid and reliable.
