A psychological assessment is a:
procedure in which a clinician provides a formal evaluation of an individual's cognitive, personality, and psychosocial functioning.
Clinicians conduct assessments for a variety of reasons and under a variety of conditions. A common use of the assessment process is to provide a:
diagnosis, or at least a tentative diagnosis, of an individual's psychological disorder.
However, clinicians may also use assessments for other purposes. For example, in forensic assessments, clinicians may seek to determine whether their clients can:
participate in their own defense or were capable of judging that their actions were criminal.
Clinicians might also provide information that employers can use to evaluate:
an individual's appropriateness for a particular job.
Assessments are also useful when clinicians need to evaluate an individual's what?
level of functioning in a specific area.
-For example, an older woman experiencing memory problems may seek a neuropsychological assessment to determine whether she has a cognitive impairment that will require further intervention.
For Ben, the assessment process is critical to understanding the nature of his current symptoms. The clinician must evaluate what?
the potential roles of both brain injury and what may have been the appearance of symptoms unrelated to the train incident.
-His immediate treatment plan and his long-term psychological development will depend on the outcome of the evaluation. Dr. Tobin p
To be useful, clinicians must hold assessments to standards that ensure:
they provide the most reproducible and accurate results.
A test may be evaluated for its:
reliability to determine the consistency of the scores it produces.
To be reliable, the test should produce the:
same results regardless of when it is given, and the individual should answer items within the same subscale of a test in reasonably similar fashion.
The validity of a test reflects:
the extent to which a test measures what it is designed to measure.
-An intelligence test should measure intelligence, not personality.
-Before using a given test, clinicians should be aware of its reliability and validity, information that is readily ava
A test will be reliable and valid only to the extent that it is administered and scored similarly from person to person. In other words, it should meet the criterion of:
standardization, which clearly specifies a test's instructions for administration and scoring.
-Each individual receiving the test should have the same amount of time, and each person scoring the test should do so in the same manner according to the same
In addition to determining a test's reliability and validity, it is important to take into account its applicability to test-takers from:
a diversity of backgrounds.
-Increasingly, test publishers are designing their measures for use with individuals from a range of ability levels, first languages, cultural backgrounds, and age.
-For example, clinicians may need to adapt assessment instrume
When interpreting test results, there is a common trap that clinicians can fall into known as the:
Barnum effect. Named after legendary circus owner P. T. Barnum (who supposedly said, "There's a sucker born every minute"), this is the tendency for clinicians unintentionally to make generic and vague statements about their clients that do not specifical
Here's an example of a Barnum effect statement:
Julia is often shy around other people, but at times she can be very outgoing. When presented with a challenge, she can often perform very well, but she occasionally becomes nervous and intimidated." These two sentences could apply to Julia, but they cou
You are most likely to encounter the Barnum effect in situations such as:
reading your horoscope or a fortune cookie, which is written so generally that the message could apply to anyone.
-Such situations are relatively harmless, unless you decide to invest a great deal of money on the basis of an unreliable prognosticator.
In a clinical situation, the problem is such statements are not particularly insightful or revealing and do not help inform the assessment process. Clients who receive this type of feedback may be:
misled, and even clinicians may have a tendency to believe a statement that "can" apply to their clients.
To ensure that they are using the best assessment methods possible, clinicians should keep up with the literature. In other words, they should adhere to the principles of evidence-based assessment, which include:
(1) relying on research findings and scientifically viable theories
(2) using psychometrically strong measures, and
(3) empirically evaluating the assessment process (Hunsley & Mash, 2007).
By following these guidelines, clinicians ensure that they will evaluate their clients using?
the most current and appropriate materials available.
-For example, a seasoned clinician may have a preference for using the assessment methods she learned about in graduate school 20 or 30 years ago, and those might still be fine, but she should be on th
Consider the case of an assessment suggesting that a client is experiencing significant depressive symptoms even though she seeks help for what she describes as anxiety attacks. Following the criteria for evidence-based assessment, the clinician would nee
tools that will allow her to distinguish between depression and anxiety disorders, particularly as the woman's symptoms evolve over the course of treatment.
-Similarly, in Ben's case, the clinician must validate the findings from neuropsychological assess
Clinicians typically begin their assessment with the clinical interview:
a series of questions that they administer in face-to-face interaction with the client. The answers the client gives to these questions provide important background information, allow them to describe their symptoms in their own words, and enable clinicia
The least formal version of the clinical interview is the unstructured interview:
which consists of a series of open-ended questions regarding the client's symptoms, health status, family background, life history, and reasons for seeking help.
-In addition to noting the answers to these questions, the clinician also observes the client
The typical clinical interview covers the areas outlined in Table 2. Because the clinical interview allows for more freedom of administration than a test with preset questions and response categories, the clinician can vary the what?
order of questions and the exact wording he or she uses to obtain this information. The main point is the clinician must obtain the information, even if the methods used to gather it differ slightly from client to client.
AREAS COVERED IN A CLINICAL INTERVIEW
...
Age and sex:
Obtain basic demographic information.
Reason for referral:
Hear client's reason for seeking treatment, in his or her own words.
Education and work history:
Obtain socioeconomic status and determine whether client is still working.
Current social situation:
Find out whether client is currently in a relationship and how much social support is potentially available.
Physical and mental health history:
-Determine whether client has any medical illnesses and whether there has been a recent change in health.
-Find out about history of present problem including past diagnoses and treatments and whether treatment was helpful or not.
Drug/alcohol use and current medication:
Ascertain whether client is using psychoactive drugs (including alcohol and caffeine). Obtain list of medications to avoid potential interactions with any psychopharmacological interventions.
Family history:
Find out whether client's family has medical and psychological disorders, particularly any relevant to client's current symptoms.
Behavioral observations:
Note behaviors, including nonverbal behaviors, which indicate whether client is experiencing anxiety or altered mood. Also note whether client seems to be experiencing difficulties in attention or compliance. Attempt to determine client's mental status. C
Over the course of a 30- to 45-minute interview, to get the best information, the clinician should help the client feel:
as relaxed as possible.
-Because the client is providing highly personal information, the clinician attempts to draw the client out with questioning that is respectful, but also matter of fact. The clinical interview is not like an ordinary conversation i
In Ben's case, the clinical interview provided Dr. Tobin with key information about his history including his education, vocational background, and relationship history. She determined that, prior to the incident, he enjoyed engaging with others, so his c
change from his previous pattern of social functioning.
-However, his general appearance was slightly disheveled (i.e., his clothes were wrinkled and he was unshaven).
Dr. Washington in turn obtained more detailed information from his clinical interview with Ben. Upon further questioning about his symptoms, Ben stated that:
he has difficulty concentrating, and that his main symptom is the occurrence of "very strange thoughts" that have been quite troubling to him.
-Specifically, he stated that he feels too afraid to leave his apartment because he believes that the police wil
Unlike the clinical interview, the structured interview provides standardized questions that are:
worded the same way for all clients.
-A structured interview can either provide a diagnosis on which to further base treatment or classify the client's symptoms into a DSM disorder.
One of the most widely used clinical interviews is the :
Structured Clinical Interview for DSM-5 Disorders (SCID-5), presented in Table 3. Though the title uses the word "Structured," clinicians who administer the SCID-5 modify the wording and order of questions to accommodate the particular individual whom the
EXAMPLE OF SCID QUESTIONS FOR CURRENT MAJOR DEPRESSIVE EPISODE:
...
Now I am going to ask you some more questions about your mood
In the last month . . .
. . . has there been a period of time when you were feeling depressed or down most of the day nearly every day? (What was that like?)
If yes: How long did it last? (As l
A. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure.
(1) depressed m
An advantage of a structured interview is this type of interview is a?
systematic approach that is less subject to variations among clinicians than an unstructured interview.
Furthermore, anyone with the proper training in the instrument can administer the SCID, not necessarily only licensed mental health professionals as is
A clinician uses a mental status examination to assess?
a client's current state of mind.
In conducting a mental status examination, the clinician assesses a number of features of the client including:
appearance, attitudes, behavior, mood and affect, speech, thought processes, content of thought, perception, cognition, insight, and judgment.
The outcome of the mental status examination is a comprehensive description of how the client :
looks, thinks, feels, and behaves.
The Mini-Mental State Examination (MMSE) is a :
structured tool that clinicians use as a brief screening device to assess neurocognitive disorders.
The clinician administers a set of short memory tasks and compares the client's scores to established norms.
If the client scores below a certain cutoff, t
In Ben's case, Dr. Washington noted that Ben was not:
experiencing an altered mental state at the time of the interview. He arrived on time and was alert and fully oriented. His conversational speech was normal in tone, rhythm, volume, rate, and prosody.
The clinician noted that his receptive language appear
We tend to think of intelligence testing as specific to the schools, but intelligence tests can serve a variety of functions, including:
overall cognitive evaluation, diagnosis of learning disabilities, determination of giftedness or intellectual disability, and prediction of future academic achievement.
Clinicians may use intelligence tests in the diagnosis of neurological and psychiatric
For clinicians, intelligence testing makes it possible to obtain standardized scores that permit them to evaluate what?
the cognitive strengths and weaknesses of their clients rather than simply to assign a score.
The most commonly used intelligence tests in clinical settings are administered on a one-to-one basis, providing a comprehensive view of the client's abilities t
Stanford-Binet Intelligence Test:
First developed in the early 1900s by Alfred Binet, the Stanford-Binet is now in its fifth edition, known as the Stanford-Binet 5 (SB5).
Children taking this test receive a deviation intelligence (IQ) score, calculated by converting their raw scores to st
Fluid Reasoning:
Ability to solve novel problems
ex: Sort picture chips into groups of three
Knowledge:
Accumulated fund of general information
ex: Show how to perform a given action
Quantitative Reasoning:
Ability to solve problems with numbers or numerical concepts
ex: Count a set of items
Visual-Spatial Reasoning:
Ability to analyze spatial relationships and geometric concepts
ex: Assemble puzzle-like forms
Working Memory:
Ability to store, transform, and retrieve information in short-term memory
ex: Recall a sequence of taps
Wechsler Intelligence Scales:
The first comprehensive individual test that researchers specifically designed to measure adult intelligence was the Wechsler Adult Intelligence Scale (WAIS). Originally developed in 1939 by David Wechsler as the Wechsler-Bellevue test, the WAIS, first pu
Verbal Comprehension:
Vocabulary
Information
Comprehension
Similarities
Define the word "barrel"
How many minutes are there in an hour?
Why do plants need water?
How are an elephant and a cat alike?
Perceptual Reasoning:
Matrix reasoning
Visual puzzles
Block design
Picture completion
Choose which pattern logically follows after a set of patterns
Indicate which pictures of shapes go together in a drawing of a puzzle
Arrange a set of blocks so that they reproduce a design
S
Working Memory:
Digit span forward
Digit span backward
Letter-number sequencing
Recall a series of digits in forward order
Recall a series of digits in backward order
Recall a set of digits from smallest to largest
Recall a set of mixed letters and numbers from largest t
Processing Speed:
Symbol search
Coding
Copy numbers that match symbols into appropriate boxes
Clinicians use tests of personality to understand a person's:
thoughts, behaviors, and emotions.
There are a variety of personality tests that clinicians adapt for their purposes, including whether the goal is diagnosis or clinical formulation. Personality tests also vary in their theoretical orientation, another fa
Self-Report Tests:
A self-report clinical inventory contains standardized questions with fixed response categories that the test-taker completes independently either on paper or via tablet, laptop, or desktop computer. In a self-report inventory, test-takers rate the approp
The most widely used self-report inventory is the:
Minnesota Multiphasic Personality Inventory (MMPI), originally published in 1943. The current version of the test is the 1989 revision known as the MMPI-2 (Table 7). There are 567 true-false items on the MMPI-2, all in the form of statements that describe
CLINICAL AND VALIDITY SCALES OF THE MMPI-2, WITH ADAPTED ITEMS:
...
Hypochondriasis:
Bodily preoccupations and concerns, fear of illness and disease.
I have a hard time with nausea and vomiting.
Depression:
Unhappiness and feelings of low personal worth.
I wish I were as happy as others appear to be.
Hysteria:
Denial of psychological problems and over-reactions to stressful situations, various bodily complaints.
Frequently my head seems to hurt everywhere.
Psychopathic deviate:
Antisocial tendencies and delinquency.
I was occasionally sent to the principal's office for bad behavior.
Masculinity-femininity:
Adoption of stereotypic sex-role behaviors and attitudes.
I like reading romantic tales (female item).
Paranoia:
Feelings of persecution and suspiciousness of others.
I would have been a lot more successful had others not been vindictive toward me.
Psych asthenia:
Uncontrollable urges to think and act; unreasonable fears.
Sometimes I think thoughts too awful to discuss.
Schizophrenia:
Disturbances of thinking, mood, and behavior.
I have had some rather bizarre experiences.
Hypomania:
Elevated mood, accelerated speech and motor activity.
I become excited at least once a week.
Social introversion:
Tendency to withdraw from social situations.
I usually do not speak first. I wait for others to speak to me.
Validity scales (composed of items from clinical scales):
...
Lie scale:
Unrealistically positive self-representation
Correction:
Similar to L scale�more sophisticated indication of tendency toward positive self-presentation
Infrequency:
Presenting oneself in an unrealistically negative light
In the decades after its publication, researchers and clinicians became aware of limitations in MMPI-2 clinical scale scores. These scores did not correspond to the original clinical categories, meaning that the test's administrators could not interpret t
specific diagnoses (i.e., a high "Schizophrenia" scale score did not imply that the individual had a diagnosis of schizophrenia).
Consequently, MMPI-2 users are incorporating the MMPI's newer, restructured clinical scales (or RCs). In fact, the newest ver
CLINICAL SCALES OF THE MMPI-2-RF:
...
RCd:
Demoralization
General unhappiness and dissatisfaction
RC1:
Somatic complaints
Diffuse physical health complaints
RC2:
Low positive emotions
Lack of positive emotional responsiveness
RC3:
Cynicism
Non self-referential beliefs expressing
RC4:
Antisocial behavior
Rule breaking and irresponsible behavior
RC6:
Ideas of persecution
Belief that others pose a threat to the self
RC7:
Dysfunctional negative emotions
Maladaptive anxiety, anger, and irritability
RC8:
Aberrant experiences
Unusual thoughts or perceptions
RC9:
Hypomanic activation
Over-activation, aggression, impulsivity, and grandiosity
Another self-report measure, the Personality Assessment Inventory (PAI) (Morey, 1992), offers?
an alternative to the MMPI.
The PAI consists of 344 items organized into 11 clinical scales, 5 treatment scales, 2 interpersonal scales, and 4 validity scales.
One advantage of the PAI is that clinicians can use it with clients who may not have the langua
The SCL-90-R (Derogatis, 1994) measures the test-taker's current experiencing of ?
90 physical and psychological symptoms.
One advantage of the SCL-90-R is that it focuses on the client's current status rather than asking about symptoms over a previous period of time.
Consequently, clinicians can track the progress of their clients over
Less oriented toward clinical use is the NEO Personality Inventory (Revised) (NEO-PI-R)(Costa & McCrae, 1992), a?
240-item questionnaire that measures five personality dimensions, or sets of traits. The scales are designed so the test-taker can complete them as well as individuals who know the test-taker, such as spouses, partners, or relatives (Form R). People use t
Clinicians and researchers may also use specific self-report inventories designed to investigate a ?
given disorder for which a general test may not be as relevant.
There are literally hundreds of these developed for such purposes, including measures of individual diagnoses as well as measures that tap qualities related to such clinical traits as narciss
A projective test is a technique in which:
the examiner asks the test-taker questions about an ambiguous item.
The underlying idea behind projective tests is that people cannot or perhaps will not provide accurate statements on self-report inventories.
For example, clients may not wish to say that
Projective tests are most useful when combined with?
self-report inventories rather than used as the sole basis for diagnosing or evaluating a client.
The initial intent in developing these tests is that they would provide a diagnosis, but clinicians who use them typically look for verification of major the
The most famous projective technique is the :
Rorschach Inkblot Test, named after Swiss psychiatrist Hermann Rorschach, who developed the method in 1911.
To administer the test, the examiner shows the test-taker a set of 10 cards (5 black and white, 5 with color), one by one.
The test-taker's job is
The Thematic Apperception Test (TAT) presents test-takers with a:
very different task than the Rorschach.
Test-takers look at black-and-white drawings that portray people in a variety of ambiguous situations such as standing in a dark hallway or sitting in a bedroom. Their task is to tell a story about what is happening
Unlike psychological tests, behavioral assessments record :
actions rather than responses to rating scales or questions.
The target behavior is what?
what the client and clinician wish to change.
Behavioral assessments include:
descriptions of the antecedents (i.e., events that precede the behaviors) and consequences (i.e., the outcomes of those behaviors).
For example, a child in a classroom may be unusually disruptive immediately following recess, but not immediately following
When clinicians record behavior in its natural context, such as the classroom or the home, this is called?
in vivo observation.
However, it's not always possible or practical to conduct an in vivo observation.
The teacher or a teacher's aide may be too busy to record the behavior of one child, and having a clinician in the room would create a distraction or in
Analog observations allow for?
such simulation to occur, taking place in a setting or context such as a clinician's office or a laboratory specifically designed for observing the target behavior.
A clinician assessing the disruptive child would need to arrange a situation as comparable
Clients may also report on their?
own behavior rather than having someone observe them.
In a behavioral self-report the client records the?
target behavior, including the antecedents and consequences of the behavior.
Self-monitoring is a form of behavioral self-report in which the client keeps a record of?
the frequency of specified behaviors, such as the number of cigarettes smoked or calories consumed, or the number of times in a day that a particular unwanted thought comes to the client's mind.
Clinicians may also obtain information from their clients using behavioral interviewing in which they ask ?
questions about the target behavior's frequency, antecedents, and consequences.
When psychologists conduct an assessment, they must take into account the person's:
cultural, ethnic, and racial background, by performing a multicultural assessment.
To do so, clinicians evaluating clients who speak English as a second language, or do not speak English at all, must ask a number of questions:
Does the client understand the assessment process sufficiently to provide informed consent? Does the client understand the instructions for the instrument? Are there normative data for the client's ethnic group? Even if clients appear as fairly fluent, th
Publishers of psychological tests are continually reevaluating their instruments to ensure that:
clients from a range of diverse backgrounds can understand the items.
At the same time, graduate trainees in clinical programs are trained to understand the cultural backgrounds of clients they assess, to evaluate assessment instruments from a critical pe
Neuropsychological assessment:
is the process of gathering inferences about the functioning of a client's brain from performance on psychological tests.
The way that clinicians use neuropsychological assessment measures is to compare a client's responses on a particular test with norma
In a neuropsychological assessment, the clinician can choose from tests that measure:
attention and working (short-term) memory, processing speed, verbal reasoning and comprehension, visual reasoning, verbal memory, and visual memory.
A number of tests evaluate what clinicians call:
executive functioning, the ability to formulate goals, make plans, carry out those plans, and then complete the plans in an effective way.
There are a variety of available tests within each category. If a clinician wishes to investigate one area in depth
There is no one set procedure for conducting a:
neuropsychological assessment.
Particular clinicians may have preferences for certain tests, but these preferences are not set in stone.
Moreover, neuropsychologists typically adapt their choice of tests based on the client's presenting symptoms and possi
Certain neuropsychological tests are derived from or the same as tests on the:
WAIS-IV, such as Digit Span (used to assess verbal recall and auditory attention) and Similarities (used to assess verbal abstraction abilities).
These tests have the advantage of being widely used and comparison data from them are readily available.
The Trail Making Test, also called "Trails," is a simple test of:
executive functioning. Figure 3 shows a sample item from Trail Making Test Part A.
In this example, the test-taker is asked to draw a line connecting the numbers in order.
Although it may seem to be a simple task, individuals with frontal lobe damage may
There are a large number of tests that measure :
visuospatial ability.
Many neuropsychologists rely on the Clock Drawing Test (Sunderland et al., 1989), a simple procedure that involves giving the client a sheet of paper with a large predrawn circle on it.
Then the examiner asks the client to draw the n
The Wisconsin Card Sorting Test (WCST) (Figure 4) requires that the client do what?
match a card to one of a set of cards that share various features.
The test was originally developed using physical cards, but now clinicians typically administer the test in its computerized format.
The test requires that the client shift mental set, bec
Neuropsychologists use the Boston Naming Test (BNT) to assess:
language capacity.
Containing 60 line drawings of objects ranging in familiarity, clinicians can use the test to examine children with learning disabilities and adults who suffer from brain injury or dementia.
Simple items are those that have high frequen
The Paced Auditory Serial Addition Test (PASAT) assesses a client's:
auditory information processing speed, flexibility, and calculation ability.
The client hears a recording of numbers between 1 and 9 every 3 or fewer seconds.
The task is to add the number just heard with the number that preceded it.
If the recording was
Other neuropsychological tests investigate a variety of memory functions. The Wechsler Memory Scale, now in its fourth edition (WMS-IV) includes tests of:
working (short-term) and long-term memory for visual and verbal stimuli.
Examiners can choose from among the WMS-IV subscales according to which areas they believe are most critical to evaluate in particular clients.
For example, when testing an older adu
Computerized test batteries, which contain?
a range of tests adaptable to the possible brain damage in the client, provide the opportunity for adaptive testing, in which the client's responses to earlier questions determine the subsequent questions presented to them.
For example, the Cambridge Neur
Before deciding whether to move to a computerized test, the clinician must do what?
weigh the advantages of ease of administration and scoring against the potential disadvantages that may exist for clients who are disadvantaged in their ability to use computers, such as young children (Luciana, 2003).
However, given the relatively rapid
One useful instrument is the Glasgow Coma Scale (GCS):
, a common test that clinicians use to assess brain trauma during the period after an accident, or while the client is in critical care.
Included in the GCS are ratings, for example, of the individual's ability to hear and obey commands, open the eyes, an
Neuroimaging:
provides a picture of the brain's structures or level of activity and therefore is a useful tool for "looking" at the brain. There are several types of neuroimaging methods that vary in the types of results they provide.
The electroencephalogram (EEG) :
measures electrical activity in the brain. EEG activity reflects the extent to which an individual is alert, resting, sleeping, or dreaming. The EEG pattern also shows particular patterns of brain waves when an individual engages in particular mental task
computed axial tomography (CAT or CT) scan:
A series of X-rays taken from various angles around the body that are integrated by a computer to produce a composite picture.
is an imaging method that clinicians and researchers use to provide an image of a cross-sectional slice of the brain from any an
Magnetic resonance imaging (MRI):
uses radiowaves rather than X-rays to construct a picture of the living brain based on the water content of various tissues. The person is placed inside a device that contains a powerful electromagnet. This causes the nuclei in hydrogen atoms to transmit
positron emission tomography (PET) scan:
A measure of brain activity in which a small amount of radioactive sugar is injected into an individual's bloodstream, following which a computer measures the varying levels of radiation in different parts of the brain and yields a multicolored image.
, o
Functional magnetic resonance imaging (fMRI) :
provides a picture of how people react to stimuli virtually in real time, making it possible to present stimuli to an individual while the examiner monitors the individual's response. Researchers are increasingly using fMRIs to understand the brain areas
Researchers also use diffusion tensor imaging (DTI):
a method to investigate abnormalities in the white matter of the brain. DTI scans show the activity of water molecules as they diffuse along the length of axons, making it possible to investigate abnormalities in neural pathways.
It's important to keep in mind that brain scans can produce evidence of specific areas of ?
damage, but they do not necessarily correspond to a specific loss of behavioral functioning (Meyers & Rohling, 2009). At present, then, they can be suggestive of brain damage or lowered neural activity, but their links to how people think, remember, plan,