Psychodiagnostic Assessment

Question 1

Psychodiagnostic assessment

Answer 1

Process of gathering/interpreting data to better understand a client’s psychological functioning.

Question 2

Assessment steps

Answer 2

1. Referral
2. Assessment
3. Diagnose
4. Feedback

Question 3

Referral

Answer 3

Receive and clarify referral question.
Source: Person/agency requesting assessment. For child clients, the source can be teachers, pediatricians, parents/caregivers, coaches. For adult clients, the source can be themselves, doctors, family/spouse.
Referral question gives you a starting point. You typically give clients broad screeners to catch what is going on. You want to have an answer for the client at the end of the process. Helps you properly direct them to the right resources.

Question 4

Assessment

Answer 4

Statistical judgment: Relies on research (more reliable source!)
Clinical judgment: Relies on clinical experience and expertise. Biases are problematic here, big issue in clinical psych. By not using statistical research, you are only using your experience and not drawing upon research conducted on samples larger than your exp.
Issue of bias: over-diagnosis of schizophrenia in black clients by white physicians, under-diagnosis of ADHD in children and girls. Need to have some level of clinical judgment to work with patients. Use steps that rely on statistical judgment prior to bringing in clinical judgment. Doing assessment gives you important data!

Question 5

Assessment process

Answer 5

Length: Can range from minutes to days, weeks, months. A long assessment prolongs obtaining proper treatment, may be a barrier (discouraging). A day to a few weeks is an ideal length of time. Presentation of symptoms may differ over time. Patients may have financial concerns. Assessment can be conducted through multiple methods and multiple reporters.

Question 6

Multiple methods

Answer 6

1. Structured interview
2. Semi-structured interview
3. Unstructured interview
4. Questionnaires
5. Observational assessment
6. Performance-based measures
7. Historical records

Question 7

Multiple reporters

Answer 7

1. Client
2. Close friends
3. Doctors
4. Teachers
   Having multiple reporters helps you see across context, helps you get any info that the client isn’t sharing. Harder to get multiple reporters for adults vs kids. Parent reports can also help with adult patient diagnosis (particularly for conditions such as Autism and ADHD)

Question 8

Types of judgment

Answer 8

Statistical and clinical judgment

Question 9

Clinical interview formats

Answer 9

1. Unstructured: Clinician decides what to ask and follow up on. There are no structured questions or phrasings used
2. Semi-structured: Identified ?’s, but some flexibility is permitted. MINI, more commonly used in clinical practice
3. Structured: Exact phrasing of ?’s and follow-ups (most statistically based format). SCID: most commonly used structured interview, gold standard for research.

Question 10

Pros and cons of interview styles

Answer 10

Unstructured interviews don’t provide helpful boundaries for guiding the assessment, can turn into more of a therapy session.
Semi-structured provides a balanced format for both the clinician and the client.
Structured interviews provide good statistical guidelines but may create a less personal/relatable feeling for the client, may feel too clinical/robotic.

Question 11

Projective tests

Answer 11

Invalid assessment tools. Example: Rorschach inkblots, thematic apperception (“tell me a story about what’s going on in this picture”), House-Kid-Tree
We do not want to be using projective tests to make assessments/diagnoses! Their reliability and validity is nowhere near the level of standardized assessments.

Question 12

Diagnosis

Answer 12

Use Diagnostic and Statistical Manual V (DSM) published by the American Psychiatric Association (APA). Official diagnostic system in USA, changes over time (fairly slowly) to incorporate newer research. DSM V changes: Asperger’s disorder dropped, incorporated into Autism Spectrum Disorder (ASD). ADD dropped, changed to ADHD.
Diagnoses are required for insurance reimbursement!!
Assessment can be very costly, which can create hesitancy about getting tested at all. This might motivate the clinician to change/skew their diagnostic decision since they know about how insurance works.
You have an ethical responsibility to provide accurate diagnostic/assessment info. “Unspecified” DSM disorders can help with this issue.

Question 13

Diagnosis steps

Answer 13

1. Integrate: Integrate assessment data using clinical judgment
2. Diagnose: Assign diagnosis (or diagnoses) as appropriate
3. Answer: answer referral question

Question 14

Feedback

Answer 14

Answer referral question and make treatment recommendations. Can include follow-up testing if necessary. Answer ?’s, address concerns - it can be overwhelming for clients so it’s important to provide the space for them to process the info). Can include sharing scores, including formal assessment report.