Psychological Assessment Flashcards
what does psychometrics measure?
difference in personality, intelligence, and psychological function
what are the seven assumptions of psychological assessments?
-psychological traits and states exist
-psychological traits can be quantified and measured
-test related behaviour predicts non test related behaviour
-tests have strengths and weaknesses
-various sources of error are part of the assessment process
-testing and assessment can be conducted in a fair, unbiased manner
-testing and assessment benefit society
what complex constructs do psychological assessments set out to measure?
mood, intellectual functioning, memory, attitudes
How does psychological compare to medical testing in reliability and validity? (Meyer et al., 2001)
-psychological tests are as, or more, reliable than many biological medical tests
-psychological tests are as, or more, valid than many medical tests
How would you describe an intelligent person in the categories of learning, vocabulary and problem solving?
learning: remembering lots of information and grasping things easily
vocabulary: can find the rights words quickly
problem solving: applying their knowledge to solve real world problems
what roots does psychological intelligence testing have in history?
19th century- pioneers (Galton, Wundt, and Cattell) objectively measured sensory abilities and reaction times
1905, Alfred Binet and Theodore Simon published first modern intelligence scale
WW2- screening intellectual ability of new recruits
David Wechsler (1958) definition of intelligence:
a global concept that involves an individual’s ability to act purposefully, think rationally, and deal effectively with the environment
What is one of the most widely used intelligence scales?
Wechsler Adult Intelligence Test (WAIS). reportedly used by 90% clinical psychologists
What is the most recent version of WAIS?
WAIS-IV (the fourth)
What was WAIS standardised according to ?
2200 people aged between 16 and 90 in the USA
What two things are extended every time the WAIS is re standardised, and what does this mean?
IQ range, and age range. reflects increased longevity but also a recognition that elderly are more commonly referred for testing than other age groups
Why must psychologists resist from deviating the standard instructions of the WAIS?
for the fairest test, because the test norms were obtained using the standard instructions
How is intelligence measured in children ages 6 to 16?
The Wechsler Intelligence Scale for Children (WISC-V)
In what ways are the WAIS and WISC similar?
in structure, subtests, and psychometric properties
How would an elderly raw score be different than young/middle aged individuals in the WAIS?
the scores are age corrected and so the elderly raw score will be lower than younger individuals but if someone is exactly average for their age their IQ would still be 100.
How is the WAIS arranged?
consists of 10 core subtests arranged to 4 higher level indexes with an overall IQ
Which age do subtests have a peak performance?
some subtests including psychomotor speed has a peak performance at 17/18 years whereas other subtests have a later peak performance such as vocabulary
What are the four indexes in the WAIS?
-Verbal comprehension
-Perceptual reasoning
-Working memory
-Processing speed
What skills does the Verbal Comprehension Index measure and how does it do this?
-measures well consolidated verbal material and verbal reasoning. Words are asked to be defined and similarities testing (asking how two words are alike) for abstract reasoning.
-information measures general knowledge and verbal comprehension
What does Perceptual Reasoning measure and how does it do this?
measures perceptual reasoning! using three subtests; matrix reasoning, block design and visual puzzles
What skills does Working Memory measure and how does it do this?
tests the ability to retain and manipulate information.
the digit span test is divided into three sections- digits forward, digits backward, and sequencing
there is also an arithmetic subtest
What skills does Processing Speed measure and how does it do this?
measures psychomotor speed using two subsets; coding and symbol search
What Processing Speed Function is sensitive to almost any form of Cognitive disfunction?
Coding
What indexes are typically impaired following a head injury?
working memory and processing speed indexes
true or false: reliability is a necessary condition for validity
True
What does a reliability coefficient tell us?
how much variability in scores on tests is true variability and how much of it is a measurement error. it also allows us to form confidence intervals on scores
if the reliability coefficient is 0.8, what percentage is measurement error?
20%
What does reliability allow us to do?
quantify the confidence we have in test results and to assess whether differences between an individuals scores are liable to reflect true differences in ability or may have arisen by chance
why are psychologists warned not to reify a test score?
it is only an estimate of an individuals true ability or mood level etc.
What is an example of a failure to consider reliability of measures?
Chapman and Chapman (1973): schizophrenic patients were compared to a healthy control sample on two tasks. the schizophrenic sample had severe deficit on one of the tasks. However, the tasks were the exact same tasks but one version rendered less reliable (via shortening the original test)
What did Nunnally and Bernstein (1994) generously propose as a reliability coefficient?
0.90
What did Sattler 2001 more recently suggest as a reliability coefficient?
0.70 and above
What are two methods to measure reliability?
Cronbach’s Alpha and Test-retest Reliability
What is Cronbach’s Alpha determined by?
the number of items in the test and the size of correlations between the items
What makes a test more reliable?
longer and with higher correlation
Explain why a vocab test with four words would be less reliable than one with many words?
there’s an enormous amount of words and a sample of four isn’t enough. some people may do better or worse with four particular words by chance than if all words were tested
Are longer tests unconditionally more reliable?
longer tests are only more reliable provided the items in the longer test are as good (highly correlated with other items) as shorter versions
What are short tests developed for and how do they stay reliable?
short tests are developed to save time. this can be done by only marginally lowering reliability because poor items (not high correlated with other items) are selectively dropped.
What’s the reliability of WAIS-IV subtest in UK and US?
they are all of or above 0.9
What subtests tend to be lower, how are these assessed, and why is it lower ?
processing speed subtests which use the test-retest method. Partially this is because it is made up of only two components (coding and symbol search)
What is the reliability of composites (e.g. IQ) related to?
a function of reliability of components (subtests) and correlation between the components
Under what circumstances do composites have superior reliability to components?
always: when the components are correlated
What is the nature of reliability of WAIS-IQ and FSIQ?
the reliability is among the highest of any psychological instrument
FSIQ has true variance of 0.98. what is the measurement error?
2% measurement error
What does temporal stability refer to?
the extent which a measure yields consistent scores over time
How is temporal stability tested?
using the test-retest method
What is the test-retest method?
correlation between scores at test and retest
What was the mean test re-test interval used in stability of WAIS-IV?
22 days
What did Deary et al 2000 find in a study that took place over 66 years?
found a correlation of 0.73 between an IQ administered age 11 and again at 77
why is there normally an interval between administrations?
to avoid inflating estimate of stability due to testee’s memory of previous items
What is the stability coefficient for WAIS-IV FSIQ?
0.96
true or false: temporal stability of components will be higher than temporal stability of composite?
false. temporal stability of composite will be higher than for its components
what is a complication when psychologists test if individuals cognitive abilities have genuinely improved or deteriorated?
practise effects
Why are practise effects problematic?
they may exaggerate false impressions of recovery or improvement, and mask a deterioration in functioning
Why is the WAIS bad for practise effects?
there are no alternative forms of WAIS and so the same test has to be administered in retesting an individual
True or false: high test reliability indicates absence of practise effects
False
Which subtests are particularly susceptible to practise effects?
psychomotor and subperceptual subtests
Is an identical score at retest a positive sign?
no, this is a cause for concern
How can psychologists deal with practise effects?
they can keep in mind to factor the effects of practise effects when interpreting a person’s score
What does HADS (Zigmond and Snaith 1983) stand for?
The Hospital Anxiety and Depression Scale
How is the HADS scored?
Likert Scale- rank between 0 and 4
List as many Anxiety items in the HADS as you can recall: (there’s 7)
-I feel tense or wound up
-I get a sort of frightening feeling as if something awful is about to happen
-worrying thoughts go through my mind
-I can sit at ease and feel relaxed
-I get a sort of frightening feeling like butterflies in the stomach
-I feel restless as if I have to be on the move
-I get sudden feelings of panic
List as many Depression items in the HADS as you can recall: (there’s 7)
-I still enjoy the things I used to enjoy
-I can laugh and see the funny side of things
-I feel cheerful
-I feels as if I am slowed down
-I have lost interest in my appearance
-I look forward with enjoyment to things
-I can enjoy a good book or radio or TV programme
What are the pro’s of using self report mood scales?
-they are quick to administer
-they are cheap to administer
-they are generally reliable
-the client/patient directly reports their feelings rather than them being filtered through ‘lens’ of a clinician’s
What agreement do psychologist’s have regarding testing?
we should use multiple indicators when possible such as self report and clinician’s interview. A patient’s self report scale responses can be raised in the clinician interview
Why are some items in HADS reverse scored?
to counter effects of acquiescence bias and as an attempt to have respondents pay attention to items. this is also a check on inattention or lack of motivation
How is the reliability of self report mood scales assessed?
Cronbach’s Alpha
Describe the reliability of HADS:
fairly high reliability but not as high as for some other self report scales. Cronbach’s alpha 0.84 for anxiety scale, and 0.78 for depression scale in general population sample. overall reliability 0.87 (Crawford et al., 2009)
Why does HADS not contain items that measure somatic or vegetative symptoms?
it was developed for use in general medical settings so items were chosen so that effects of a medical condition did not masquerade as depression or anxiety
In what way was the solution to not involve medical condition in the HADS flawed?
any major medical problem could lead people to endorse ‘I feel as if I’m slowed down’
Can HADS measure independent dimensions of anxiety and depression?
contrary to Zigmond and Snaith 1983, it cannot
What are Zigmond and Snaith’s original cut of scores for HADS (Normal, Mild, Moderate, Severe)?
Normal: 0-7
Mild: 8-10
Moderate: 11-15
Severe: >16
What did clinician’s decide about Zigmond and Snaith’s cut off for ‘mild’ and what is evidence for this?
the cut off for mild is very inclusive and should not be used to establish caseness.
Crawford et al 2001: reported 33% of general population sample scored 8 or above on anxiety scale
What is validity?
Does a test measure what is claims to measure. A valid test shown to be valid for a particular use, population, and time
What is validation?
The process of acquiring evidence and evaluation
What are three types of validity that add to pool of evidence?
content validity, criterion-related validity, construct validity
Define Face Validity:
does a test appear to measure what it claims to measure?
Why is face validity a potential problem for some neuropsychological tests?
Tests can appear like a child’s game, losing cooperation with adults when there is no clear focus
When is face validity undesirable?
detection of deception
Define Content Validity:
does the measure adequately sample that domain of interest
Describe content validity in context of education and depression:
education- does a test sample everything that was taught
depression- do items cover all core symptoms
How can content validity be evaluated?
experts writing or reviewing items, comparing against a formal established criteria for example does depression scale cover list of symptoms for a diagnosis of depression in DSM?
What are the top three depression scales when evaluated against the DSM criteria for depression?
1- Hamilton Rating Scale- 7 criteria addressed completely, 2 addressed partially
2-Beck Depression Inventory- 6 criteria addressed completely, 2 partially
3-Zung Self-Rating Depression Scale- 5 criteria addressed completely, 4 partially
What is the DSM-IV criteria for a Major Depressive Episode?
five or more criteria must be present during the same two week period, criteria one and two must be present.
There are 9 Criteria:
-depressed mood most of the day nearly everyday
-diminished interest or pleasure in all or almost all activities
-significant weight loss or gain and significant change in appetite
-insomnia or hypersomnia nearly everyday
-psychomotor agitation or retardation nearly every day
-fatigue or loss of energy nearly every day
-feelings of worthlessness or excessive guilt nearly every day
-diminished ability to think or concentrate or indecisiveness
-recurrent thoughts of death or suicidal ideation or a suicide attempt
At what points are individual symptoms of depression discredited towards diagnosis?
when symptoms are clearly due to a medical condition or when symptoms arise from effects of a substance
How many symptoms in the DSM-IV Depression Criteria are concerned with vegetative or psychomotor aspects?
4 out of 9. traditionally more emphasis has been placed on these in the UK
Do you have to report being depressed for a diagnosis of depression?
No, you can meet criteria without reporting being depressed e.g. in instances when patient might not know they are experiencing depression
In what 3 symptoms of depression in DSM-IV would a deviation from norm in either direction count towards a diagnosis?
Weight, Psychomotor, Sleep
Which depression scales do well in terms of content validity when evaluated against DSM criteria?
Hamilton Rating Scale, and Beck Depression Inventory
How is Hamilton Rating Scale commonly used?
widely used as a clinician’s rating scale, not a self report scale
What issue does PHQ-9 depression scale manage to tackle?
tackles the issue of content validity directly and explicitly. items are designed to index each of the nine DSM symptoms for depression
List as many items from PHQ-9 depression scale (Kroenke et al., 2001) as you can recall:
-little interest or pleasure in doing things
-feeling down, depressed, or hopeless
-trouble falling or staying asleep, or sleeping too much
-feeling tired or having little energy
-poor appetite or overeating
-feeling bad about self or that you are a failure, or that you have let your family down
-trouble concentrating on things such as reading newspaper or watching TV
-moving or speaking so slowly that others have noticed or the opposite being so fidgety or restless that you have been moving around a lot more than usual
-thoughts that you would be better off dead or hurting yourself in some way
Define ecological validity:
refers to the degree which test performance corresponds to real world performance
How can ecological validity be assessed?
test scores can be compared with rating of every day behaviour for the domain of interest using self and informant questionnaires, clinical rating scales, and observation of stimulates tasks
What is executive function?
executive function refers to skills in problem solving, decision making, planning and completion of tasks, and reflecting on activity
What are examples of dysexecutive problems?
starting or finishing tasks, planning ahead, making decisions, thinking through problems and forming solutions, behaving appropriately and controlling emotion such as anger
Describe the Dysexecutive Questionnaire (DEX, Burgess et al., 1998):
20 items measuring behavioural, cognitive, motivational, and emotional changes from pre morbid functioning generating
What can neuropsychological tests of executive functioning be compared to?
Dysexecutive Questionnaire (DEX) scores
What are four putative executive tests (Burgess et al., 1998) that correlate with DEX ratings, and are these significant?
-Phonemic Fluency
-Modified Card Sorting Test
-Six elements
-Cognitive estimates
all the correlations are significant with exception of Cognitive Estimate Task (CET)
Asides from DEX, what is another test that measures dysexecutive problems?
behavioural assessment of the dysexecutive syndrome (BADS) Wilson et al., 1996
Aside from Burgess reports, what information provides better correlations with ecological validity?
informant, clinical, parent or carer ratings
What factors can effect ecological validity test results?
environment, limited behaviour observed, compensatory strategies
Why are carer ratings of everyday functioning unreliable?
relatives may be protective or overly negative
Describe construct validity:
the broadest form of validity, does a test measure what it’s meant to test
How can construct validity be assessed?
constructs are unobservable but tests such as the WAIS can measure them. researchers can assess this by making predictions on how scores may change in various ways: test homogeneity, evidence from changes with age, evidence from pre test and post test changes, evidence from distinct groups, convergent and divergent evidence, and factor analysis
What are convergent, and Divergent evience?
Convergent=Demonstrates that two different measurement methods produce similar results for the same construct
Divergent= Demonstrates that a measurement of one construct is distinct from measurements of other constructs
What is factor analysis?
Factor analysis determines the underlying relationships between sets of variables such as test scores
What are factors in factor analysis?
relationships are called factors i.e. the construct such as intelligence or personality test
How is Factor Analysis used in psychometrics?
FA is used as a data reduction technique. It takes individual tests and the correlations between them. Patterns of scores clustering together suggest they are measuring the same thing
‘do you like going to parties/socialising/are you the life and soul of a party’ may all be constructs measuring what?
Extraversion
How may researchers use Factor Analysis data?
they can collect data and make specific predictions on how scores should correlate based on their theories
What has factor analysis traditionally been used to study?
Construct Validity
What is Confirmatory Factor Analysis used for?
a relatively recent technique for evaluating the construct validity of psychological tests. it is now widely used.
Define Latent Variable:
an underlying factor that is not directly observable
What does a single headed arrow indicate in CFA?
causality
How are latent variables represented in CFA?
as ovals or circles
what does error represent in Confirmatory Factor Analysis?
it is treated as a latent variable that represents that variance in observed variables that is not explained by the factor
explain first order and second order factors in CFA:
two factors are first order factors. a further higher factor accounts for the relationship between the two factors
What are fit statistics?
a number of statistics that tell us which model the data best fits
What does a large chi square value tell us in factor analysis?
that a model has poor fit
Describe cumulative fit indices in factor analysis:
Cumulative fit indices values indicate the model’s fit. There are a variety of CIF which have characteristics ranging from 0 to 1. High values, which is usually above 0.9, suggest the model has good fit
What is indicated by a null model?
there are no relationships between variables
What is the status of construct validity of WAIS-IV?
findings support construct validity for WAIS-IV. results replicate the results found in a USA standardisation sample. this shows the WAIS-IV is measuring the same broad dimensions of ability in UK and USA
How is the model with best fit identified?
subtests are combined into four indexes plus overall. Confirmatory Factor Analysis tells us the model structure that has best fit
What increases a psychologists confidence in a measure?
if the initial findings have been replicated
Explain convergent validity:
if a measure has convergent validity it correlates with other measures of the same construct.
it is preferable for the test to correlate with ratings obtained by multiple methods
How can construct variance be interfered with?
some construct variance can be swamped by method variance (the way we have measured it)
In the Ratings of Child Depression from children and their Mothers there was good agreement across different scales when children rated their own level of depression, and good agreement across the same scales when mother’s rated their child’s level of depression. Explain why there is still a low correlation
There is very poor agreement between the two different methods of assessment
What does it mean if a measure has good discriminant validity?
it does not correlate with measures it should be unrelated to or weakly related to
If a test on geographical knowledge correlates highly with writing speed, what is this an example of?
poor discriminant validity
why is there a problem with the discriminant validity of depression scales and social desirability scales?
depression scales correlate highly with measures of social desirability. social desirability scales are meant to measure the extent to which people attempt to present themselves in an overly positive light. this is why there is an issue in validity when it correlates with self rated depression scales.
Why do social desirability scales have poor discriminant validity?
non depressed people protect their self esteem by seeing themselves in overly positive light, depressed people do not, and actually devalue themselves. therefore the social desirability scales correlating with depression scales means they have poor discriminant validity
True or False: Anxiety and depression scales have generally good convergent validity
True
What is the nature of discriminant validity between anxiety and depression scales?
they have poor discriminant validity. the correlation is not significantly different from 0.1
How do anxiety scales commonly correlate with other anxiety scales?
anxiety scales correlate more highly with depression scales than other anxiety scales
What is the Tripartite Theory? (Clark and Watson)
proposes that anxiety and depression share a common feature: negative affectivity
What is negative affectivity?
refers to unpleasant engagement including feeling distressed, scared, upset, irritable.
What is it proposed that anxiety and depression scales may measure instead of anything specific to each one?
they predominantly measure negative affectivity
What component is specific to depression according to Tripartite Theory?
low positive affect, the absence of feelings like enthusiasm and interest. this is similar to anhedonia
What component is specific to anxiety according to Tripartite Theory?
physiological hyperarousal
How can the discriminant problem be solved between anxiety and depression?
if self report depression scale targets low positive effect, and anxiety scales target anxious arousal
what are two scales part of the Mood and Anxiety Symptom Questionnaire (MASQ, Clark and Watson)?
Anhedonic Depression Scale; measures specific components of depression
Anxious Arousal Scale; measures specific components of anxiety
What is the reliability and Validity of the MASQ?
it is at least as reliable as existing scales and they have decent convergent validity. MASQ scales have good discriminant validity, and have better psychometric properties which appear to target specific components of anxiety and depression
What are legal requirements that must be considered in the employment process?
there is a legal requirement to try and avoid subjective influences and unconscious biases
what are six job analysis methods?
observations, records, questionnaires, interviews, diaries
what is the purpose of job analysis?
to understand the nature of job task requirements, job descriptions and person specification
Describe the Position analysis Questionnaire (Sanchez and Levine, 2013):
consist of self report and employer/management report. covers areas like knowledge, skills, organisational relationships, responsibilities, decision making, working environment, qualifications, primary purpose of job
What is the reliability and validity of the Position Analysis Questionnaire?
acceptable reliability: inter-rater reliability 0.79
reasonable validity: relatively few studies with small sample sizes, potential source for subjective bias
What are four steps in recruitment process:
1) job analysis
2) job and person description
3) advertise
4) select best candidate
Name five selection techniques:
autobiographical data
interviews
cognitive ability tests
personality and integrity tests
assessment centres
is autobiographical data reliable?
tends to be reliable, low faking levels
good predictor of job performance, useful for screening candidates
for psychology students what autobiographical data is a predictor (Sulastra et al., 2015)?
-work experience is a predictor of getting a job after graduation
-GPA is a predictor of getting a psychology based job
What is the purpose of job interviews?
interviews are a form of assessment that are frequently used as an initial method of data collection for job selection. interviews gather data about people and make predictions about their behaviours
What is the reliability and validity of employment interviews?
poor inter-rater reliability and predictive validity (Wagner, 1949). however, panel interviews are better than single interviews and structured interviews have better reliability and predictive validity compare to unstructured interviews (Wiesner and Cronshaw 1988)
what are disadvantages of unstructured job interviews?
free ranging and unplanned, potential for halo effects, influenced by social situation and biases
define halo effects:
the tendency for an impression created in one area to influence opinion in another area
what are advantages of structured job interviews?
standardised questions thar focus on job, relate to job analysis and person specification, consistent panel with transparent scoring, reduces biases
What type of job interview is typically a better assessment? (Levashina et al., 2014)
structured interviews have considerably higher predictive validity and reliability.
they reduce bias against women and ethnic minority groups
what are some domains of cognitive ability tests?
intelligence, verbal skills, numerical ability, spatial perception, problem solving, speed of processing
Describe the Wonderlic Personnel Test:
multiple aptitude with job relevant abilities; mechanical, motor, perceptual, clerical. often use group multiple choice tests
what is the reliability and validity of group cognitive ability tests for job assessment?
excellent reliability and generally good predictive validity. cognitive ability is well established predictor of job performance
What are the five factors in the Five Factor Model of Personality (Costa and Macrae)?
OCEAN; openness, conscientiousness, extraversion, agreeableness, neuroticism
what is the Five Factor Model of Personality measure by and is it reliable/valid for job assessment?
measured by Neo-PI questionnaire. Good reliability but low predictive validity
Describe Personality X Job Situation interactions for conscientiousness, neuroticism, and extraversion (Judge and Zapata 2015):
Conscientiousness= predicts job performance where job requires independence
Neuroticism= negatively related to job performance when dealing with difficult customers
Extraversion= positively related to job performance where social skills are required, but not when job requires attention to detail
True or False: predictive validity of personality traits for appropriate jobs is less than that of predictive validity for jobs as a whole
False: predictive validity of personality traits for appropriate jobs double that of predictive validity for jobs as a whole
What are integrity tests?
detect undesirable behaviours and attitudes e.g. attitudes to theft, disregard for fellow employees
what is a criticism for the predictive validity of integrity tests?
it is dependent on the test publisher information
what is the most co effective procedure for identifying integrity attitudes in job assessment?
The Counterproductive Behaviour Index
what are some key elements of assessments centres?
leaderless group discussion, role play, presentation skills, interview, work sample or situational judgement test, case analysis
what assessments were used in the assessment centre for anaesthetists(Gale et al 2010)?
structured interviews, portfolio review, previews, medical simulation
what does emotional intelligence overlap with in job assessment?
cognitive ability and personality traits
what are the best combinations to predict job success (Schmidt and Hunter 1998)?
ability tests + work sample
According to UK data, what jobs is assessment a stronger predictor for?
complex/managerial jobs
what was the underlying cause of was Mrs Y being referred to social services for not being able to look after/control her kids?
she’d had a serious head injury 25 years previous
What was Mrs Y estimated premorbid IQ and WAIS FSIQ?
premorbid IQ= 115
WAIS FSIQ= 98
List five uses of Clinical Neuropsychological Assessment for Patients with Suspected Brain illness:
-case formulation
-patient care
-prognosis
-planning interventions
-legal assessment
What is the main aim of Clinical Neuropsychological Assessments?
understand nature of problems and how best to support functioning in everyday life
what do structured clinical interviews assess for patients with brain injury/illness?
symptoms and awareness, mental state
what are six procedures for assessing brain damage?
-personal and family history
-demographics
-neuroimaging
-observations
-tests
-questionnaires/informant ratings
Define a percentile:
percentage of the population who achieve less than a given score
what percentile is an IQ of 70?
2nd percentile
what does sensitivity in a sample indicate?
percentage of diseased patients a test can capture
what does specificity in a sample indicate?
percentage of healthy patients a test can exclude
what factors should be considered when interpreting test scores in patients with brain damage?
malingering and litigation- can be improve by multiple testing sessions over time looking for inconsistencies and trajectory
concentration, motivation, and emotions i.e. distractibility, fatigue, flat affect, frustration
what is the long term prevalence of anxiety and depression following brain injury?
anxiety= 36%
depression=43%
what are risk factors for developinganxiety and depression following brain injury/illness?
gender (women), unemployment/employment status, psychiatric history
what are psychiatric risk factors for developing anxiety and depression following brain injury/illness?
apathy, psychosis, functional neurological disorder
name three structured interviews used to assess mood in clinical psychology:
-SCID (structured clinical interview for DSM)
-DSM
-Brief Psychiatric Rating Scale
what are three self report assessments used to assess mood in clinical neuropsychology?
-Beck Depression Inventory
-Hospital Anxiety and Depression Scales (HADS)
- importance of insight
How did performance in SCID compare to HADS following a study involving 100 participants with traumatic brain injuries? (Whelan-Goodinson et al., 2009)
31% of participants scored in the clinical range for anxiety in HADS but did not meet the criteria for clinical anxiety in SCID
what factors can be used in estimating premorbid ability ?
age, sex, gender, ethnic and cultural background, education and occupation
how much variance of FSIQ is predicted by demographic variables?
about 50%
what is the best predictor for estimating premorbid ability?
Occupation
what are ‘Hold tests’ and how accurate are they?
Vocabulary tests which are often multiple choice.These are insensitive to brain injury
what are word reading tests and how useful are these in assessing brain illness/injury?
e.g. National Adult Reading test (NART), Weschler Test of Adult Reading (WTAR). fairly insensitive to illness/injury, highly correlated to IQ in healthy sample
True or False: demographic variables are poorer at predicting IQ
True
How effectively did NART predict WAIS-IQ in healthy sample?
strongly predicted (r=.69)
what can be used to add validity to NART prediction of IQ?
demographics
reading tests are sensitive to which brain disorders?
moderate dementia and aphasia
in what circumstance might reading tests be invalid in predicting premorbid ability?
-in patients with dyslexia or pre existing language problems
-when English is not their first language
-when their access to education has been poor
how was the cognitive functioning of Camelford sample (poisoned by water) different to the control sample of relatives?
the poisoning impaired cognition. they had poorer memory and attention than relatives
What happened to Carole Cross after being poisoned by water with aluminium?
she died in hospital aged 59. she was found to have a severe form of a brain disease (cerebral amyloid angiopathy) associated with Alzheimer’s disease. there was an elevated level of aluminium in her brain
After JD was in a car crash he had problems with attention and executive function, what did this entail?
mild speech and motor issues, inability to return to work, difficulty multitasking, time management, memory, and social interactions
Did JD’s condition ever improve?
intensive rehabilitation resulted in improvements in executive function, time management, and function ability
sensory reception and perception, memory, thinking and decision making, motor functions, language, numerical processing, executive functions: are all examples of what?
classes of cognitive functions
What three aspects does cognitive function cover?
intelligence, memory, language
describe the structure of the WAIS:
ten core subsets
subsets arranged into four indexes
full scale IQ obtained by summing scores on all subtests
what can intelligence screening be useful for in clinical assessment?
-initial screening assessment; help decide areas to explore in more detail
How reliable and valid is WAIS?
excellent norms, good reliability and construct validity but poor predictive validity and treatment validity
what is procedural/implicit memory?
type of long-term memory that allows people to perform skills and actions without conscious thought.
what is prospective memory?
the ability to remember to perform a planned action in the future
What does the Wechsler Memory Scale assess?
auditory-verbal immediate and delayed memory, visual-spatial immediate and delayed memory, working memory
What aspects do WMS and WAIS-IV not measure?
WMS: does not assess procedural or prospective memory
WAIS: no assessment of verbal working memory
What is more sensitive to head injury; WMS or WAIS-IV?
WMS
what diagnostic scale can diagnose aphasia?
Boston Diagnostic Aphasia Exam (BDAE III)
What are the 8 subscales of BDAE (Boston Diagnostic Aphasia Examination)?
fluency, auditory, comprehension, naming, oral reading repetition, automatic speech, reading comprehension, writing
What does the Cookie Theft Task entail?
patient must describe the scene in a picture spontaneously
Evaluate Boston Diagnostic Aphasia exam:
time consuming, requires specialist training. small normal sample. acceptable reliability. good construct validity, diagnostic validity and treatment validity. only valid for those with relevant education and language exposure
How well do executive functions predict functional outcomes?
predict functional outcomes better than other cognitive variables
Struchen et al 2008 study with 121 people with brain injuries, what did executive functions predict?
return to work, social integration, marital success, caregiver burden
what was a more powerful predictor of occupational status than IQ, demographics, and clinical factors, including illness severity in bipolar ?
Executive Functioning
What are three types of executive functions?
-Planning: decide goals, execute and adapt plans
-initiation, monitoring and control: inhibition and switching, apathy
-socioemotional control: regulating mood and social behaviour
How can you measure executive function?
-Neuropsychological test: fluency, Wisconsin Card Sort Test, Tower of London, Stroop
-Structured interviews: dysexecutive questionnaire (DEX)
-Rating Scales
-Behavioural Assessments: multiple errands test
What are some issues in assessing EF?
-traditional psychometrics might not apply (can’t test-retest, must be unstructured)
-ecological validity is important
-poor convergent delivery
Describe the Tower Task:
mentally plan sequence of moves to solve puzzle in fewest moves possible, then execute the plan
What are strengths of the Tower Task?
sensitive to brain damage, correlates with measures of functioning and real world planning. suitable for use in children and adults, participants find tasks enjoyable
what is the Dysexecutive Questionnaire (DEX)?
20 item questionnaire. control emotion, behaviour cognition
What is the Multiple Errands Test?
shopping/work errands tasks; requires planning, self initiation, monitoring
Evaluate the Multiple Errands Test?
-observe behaviours and social interactions, assess behaviour in naturalistic setting, help design rehabilitation. evidence of adequate inter-rater reliability, predicts functional outcome
-observe behaviours and social interactions, assess behaviour in naturalistic setting, help design rehabilitation. evidence of adequate inter-rater reliability, predicts functional outcome
Why did General Pinochet fake dementia for tests?
he was being accused of war crimes and wanted to be deemed ‘unfit’ to stand trial
what are six key domains in assessment of older adults?
-medical history and medications
-informant reports
-clinical interview: mood and mental status test
-cognitive assessment
-activities of daily living/functional capacity
-legal decision making capacity
what activities are included in the basic activities of daily living? (ADL)
feeding, continence, bathing, personal grooming, movement
what activities are included in the instrumental activities of daily living (IADLs)?
shopping, cooking, managing finances, reading, news awareness, transport, medication, telephone
what do activities of daily living measure and how is this assessed?
assessed using self report or performance based tasks
what assessment of daily living is typically used for elderly people?
Lawton’s IADL assessment
describe the reliability and validity of IADL:
good reliability, good construct validity, convergent validity with other measures of functional status but there’s few studies
According to the DSM V what criteria must be met for a dementia diagnosis?
- Evidence of significant cognitive decline
- Cognitive deficits interfere with everyday activities
- Cognitive deficits not attributable to delirium or other mental disorder/other aetiology (e.g. stroke)
- Insidious onset and gradual progression of impairment
what is considered as evidence of significant cognitive decline for dementia diagnosis (DSM)?
concern from the individual informant or clinician, and substantial impairment in standardized neuropsychological testing in memory plus at least one other cognitive domain
what six neuropsychological assessments are procedure for suspected dementia?
-medical background and personal history
-mental state assessment
-current cognitive functioning
-premorbid ability
-mood
-ADLs
what is assessed towards mental state?
quick assessment of orientation, memory, thought, feeling, judgement
Which tasks are involved in Mini Mental State Exam (MMSE)?
orientation: what is the year/season/date/day/month
registration and recall: repeat three words, later given surprise recall test
attention: serial 7’s
language: name objects and repeat sentence
motor abilities: copy drawing
Evaluate MMSE:
good reliability, good predictive validity (sensitive to dementia), poor specificity (numerous reasons for low scores), does not assess executive function or problem solving
What is the MMSE not very sensitive to?
-early/mild dementia
-dementia in highly educated people
How would someone with Alzheimer’s Disease perform in Rey Auditory Verbal Learning Test?
impaired verbal learning (flat learning curve across repeated trials), recall impaired, recognition deteriorates, greater recency and less primacy (more reliance on short term memory)
What is Rey Auditory Verbal Learning Test able to predict (for two years later)?
dementia diagnosis
How did iris Murdoch’s final novel indicate she might be in early stages of Alzheimer’s?
the novel showed reduced vocabulary and simpler sentences
What happens to language in people with mild Alzheimer’s?
word finding difficulties, naming problems, circumlocution
what happens to language in people with moderate Alzheimer’s?
content of language more vague, verbal perseveration, syntax simplified
what is a key screening test of language in Alzheimer’s disorder?
semantic fluency (e.g. name as many animals as you can in one minute)
why should word reading tasks be insensitive to dementia?
If word reading tasks like NART are a valid measure of premorbid ability they should be insensitive to dementia
What raises uncertainties of word reading tests being a good measure of premorbid ability?
the ability to read irregularly spelt words is adversely affected in Alzheimer’s disorder
how was dementia/AD detected in a chess player (73) with high IQ but declining memory and chess skills?
through assessment of change collecting evidence of deterioration over time
name three types of dementias:
Alzheimer’s disease, frontotemporal dementia, vascular dementia
What can be difficult to differentiate dementia from?
different types of dementia, illness like delirium and stroke, cognitive decline in normal aging, mild cognitive impairment (MCI), mood disorders
what two disorders have an overlap of prominent features with dementia?
delirium and depression
On what grounds was the murderer Atkins trying to appeal his death sentence?
His IQ was 59 which is technically in the range of ‘mild mental retardation’
Name four key issues in legal/forensic assessment:
-assessment tools assist judgements about guilt, competence, sentencing
-importance of reliability and validity
-difficulty of researching this topic
-pressure on expert witness in adversarial system
What are three components of competency to stand trial?
-understanding of criminal process
-ability to consult with defence lawyer
-capacity to understand court proceedings
Most common reasons assessed to have lack of competence in court:
-low IQ
-very poor memory
-major mental illness
Why was Ramzi bin al-Shibh (one of five charged over 9/11 attacks) deemed unfit to stand trial?
he had been diagnosed with post traumatic stress disorder and associated psychotic features including a delusional disorder. his condition left him ‘unable to understand the nature of the proceedings against him or cooperate intelligently’
what was the strongest predictor of lack of competence to stand trial (Pirelli et al. 2011)?
psychotic disorder
which specific competency assessment was a strong tool to asses competency to stand trial? (Pirelli et al., 2011)
competency screening test stronger predictor of final competency judgement than WAIS
what was a concern about reliability of job competency assessments? (Guarenera and Murrie 2017)
concerns about inter-rater reliability
How can a person be found not guilt due to control of behaviour at time of crime?
-not guilty by reason of insanity (severe mental illness, drug induced psychosis)
-not guilty due to failure to understand consequences of actions (due to cognitive impairment, low IQ)
Describe the case where Oscar Pistorius trial was found to be ‘not mentally ill’:
An athlete who killed his girlfriend. Defence team argues he had a generalised anxiety disorder and his actions would be different under stress than an ‘able-bodied’ person under stress. He had also suffered a double leg amputation with difficulties standing which left him vulnerable and more able to fight than flight. He was ordered to undergo a 30 day mental health evaluation at a psychiatric hospital. It was ruled he does not suffer from a mental illness and was capable of appreciating the wrongfulness of his act
What factor is important to consider when determining a sentence and parole?
the likelihood of reoffending
What can be used to help determine the likelihood of reoffending?
Psychological Bulletin (Yang et al., 2010)- risk assessment tools for violence. 8 widely used measures with moderate predictive validity
Name one assessment tool for violence:
Violence Risk Appraisal Guide
How useful is used data from police databases in UK to evaluate validity of OxRec in predicting reoffending ?
good prediction of who re offended, but there was a systematic underestimation of probability of reoffending
What are some risk factors of reoffending according to Oxford risk of recidivism?
-sociodemographics: age, sex, education, employment, deprivation
-criminal history like violence and previous sentences
-clinical history like substance abuse and mental disorders
What is a personal injury claim?
compensation for an injury, commonly head injury, that has psychological evidence of consequences in executive function and is attributable to the accident/injury.
Why was a man awarded $9 million following a car accident?
there was evidence that a he suffered serious brain injuries from the car accident and this left him with permanent cognitive impairment. He was no longer employable and can never return to any from of employment, requiring 24 hour nursing care for the rest of his life. A majority of the reward is focused on anticipated cost of future care.
What is the role of neuropsychologists in court?
-assessment of premorbid ability
-assess IQ, attention, memory, executive function and if needed language, spatial, motor and sensory skills.
-provide evidence on reliability, validity, standardisation, theoretical models for all tests
-plausibility of pattern of deficits given injury
Why was Atkins IQ ‘defence’ for the death sentence not effective?
the intellectual stimulation the killer got by constant contact with lawyers in the case i thought to have raised his IQ above the threshold of 70
Describe the case of dozens of former Ney York police and firemen in 9/11 disability fraud:
72 police officers, 8 firefighters and 5 correction officers are among those charged. some reportedly falsely claimed disabling conditions arising from the attacks. some stand accused of coaching the former emergency workers on how to feign mental health problems and fail memory tests to draw disability benefits, collecting tens of thousands of dollars in kickbacks
What is the criteria for suspecting malingering?
- presence of external incentive
- clinical judgement (attitude of patient and inconsistencies)
- patterns of performance (below chance scores)
- Specific test sensitive to faking e.g. tests designed to be easier than they look
Describe test of memory malingering (ToMM), Tombaugh, 1996):
see 50 lines of drawings of common objects (twice), followed by recognition test with feedback. scores less than 45 out of 50 possibly indicate malingering
Evaluate Test of memory malingering according to Tracy (2014):
-most people with neurological disability score highly.
-good validity as memory test
-good sensitivity to malingering, admissible in court
-problems of awareness and coaching
According to the adults with incapacity (Scotland) Act 2000, what makes an adult lack capacity to make decisions for themselves?
if they are unable to make decision for themselves because of disturbance in mind or brain. 4 components: understanding, retaining, weighing up, communicating
Describe the structured interview for Capacity Assessment: (Herbert et al. 2019)
-detailed questions to evaluate person’s understanding, retention, weighing up, and communication of relevant information
-structured but tailored to specific case
-consider client characteristics and equality issues
Name some neuropsychological tests associated with capacity assessment:
language comprehension, memory tests, executive function tests, language production tests
Why was ‘Jack’ legally not allowed to manage his own finances?
he was deemed to not have the mental capacity, his management of finances passed to legal guardian
what is the key difference between doctor and psychologist assessments that made psychologists assessments take longer? (NHS Grampian, 2003)
executive function and interview differences
