1. IzBen C. Williams, MD, MPH Lecturer

2. Clinical Assessment INTRODUCTION -1 There are two systematic methods for evaluating behavioral, emotional, and cognitive processes 1. The Mental Status Examination (MSE) 2. Psychometric evaluation (psychological testing) Both are important in understanding a patient’s current mental status

3. Clinical Assessment INTRODUCTION -2 The MSE and Psychometric evaluation are always used in conjunction with: A complete medical history A complete physical examination A neurologic examination Various laboratory and radiologic studies

4. Clinical Assessment INTRODUCTION -3 In this context…… The MSE is part of a broader psychiatric examination, The psychometric evaluation part of the broader perspective of psychological assessment There is overlap in item content and complex interpretation may be necessary to arrive at a conclusion

5. The Psychometric Evaluation Clinical Assessment of Intelligence, Personality and Achievement

6. The Psychometric Evaluation Definition: Definition: Psychometric evaluation is a set of test techniques by which a sample of behavior is elicited, observed, recorded, analyzed, and interpreted.

7. The Psychometric Evaluation Purposes of Psychometric Evaluation: Purposes of Psychometric Evaluation: 1. To provide descriptive information about an individual 2. To enhance understanding of psychological dynamics 3. To assist in establishing a diagnosis 4. To assist in making decisions (eg competency, placement) 5. To assist in treatment and discharge planning 6. For prognostic and predictive purposes 7. To establish baseline performance levels in monitoring change 8. To evaluate changes in brain-behavior relationship

8. The Psychometric Evaluation Principles of Psychometric Evaluation: Principles of Psychometric Evaluation: Three very important principles of psychometric measurement in general, are…… a. Standardization Collecting normative data from a representative population group, under controlled conditions b. Reliability Consistency and accuracy of the test c. Validity Whether the test measures what it is intended to

9. The Psychometric Evaluation Types of Psychological Tests: Psychological tests differ in 1. The nature of the information obtained and focus of the test, 2. The processes of the assessment procedure

10. The Psychometric Evaluation 1. The nature of the information obtained: 1. The nature of the information obtained: a. Cognitive ability tests (the most common are tests for intellectual functioning and academic achievement) b. Personality assessment tests (reveal information that may be descriptive of the individual or his ongoing personality dynamics)

11. The Psychometric Evaluation 1. …..nature of the information obtained: 1. …..nature of the information obtained: c. Vocational tests assess interests attitudes and aptitude in the context of a more general understanding of the individual, to assist in making vocational choices d. Neuropsychological tests assess brain-behavior relationship e. Behavioral assessment refers to assessment techniques that minimize inference and have particular emphasis on observable, quantifiable measures

12. The Psychometric Evaluation 2. The process of the assessment procedure: 2. The process of the assessment procedure: a. Individual versus group tests. Individually administered tests yield better understanding of the individual patient. Group tests, while more time efficient, may be less informative in understanding an individual b. Potential ability versus typical performance: what an individual can do vs what he typically does

13. The Psychometric Evaluation 2. …..process of the assessment procedure: 2. …..process of the assessment procedure: c. Objective versus Projective tests i. Objective tests are highly standardized for administration, scoring and interpretation and are usually highly structured in format. All response possibilities are obvious and scorers can agree on the result ii. Projective tests, in contrast, are less structured and allow greater leeway for expressing individuality and important individual dynamics. These tests are based on the projective hypothesis, revealing unconscious issues and aspects of his personality and cognitive style

14. The Psychometric Evaluation Major Psychological tests Major Psychological tests A. Tests of intellectual ability (eg, Wechsler, and Stanford-Binet Scales) B. Achievement tests (eg, WRAT, SAT, USMLE) C. Tests of personality functioning (eg, MMPI, Rorschach, TAT, Sentence completion, projective drawings, etc) D. Vocational tests E. Neuropsychological assessment

15. The Psychometric Evaluation Major Psychological Tests A. Tests for intellectual ability -1 of 14 A. Tests for intellectual ability -1 of 14 Intelligence Intelligence is an individual’s ability to adapt and constructively solve problems in the environment. It is a multidimensional performance construct, which includes: The capacity to acquire, store, access and manipulate information The ability to learn from experience Insight; Abstract reasoning The capacity to adapt to new situations, and The ability to focus and sustain direction in activities

16. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -2: A. Tests of Intellectual Ability -2: Measured intelligence tends to be quite stable after adolescence, and test-retest reliabilities are quite high, even in young children. However IQ is not static and may change considerably in children over a period of years

17. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -3: A. Tests of Intellectual Ability -3: Basic definitions Basic definitions Chronologic age (CA) is a persons actual age in years Mental Age (MA) is the age level of intellectual functioning of an individual (the age at which an average person reaches the same ability) Intelligence quotient (IQ) is the ratio of MA to CA times 100 (ie IQ = MA/CA x 100)

18. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -4: A. Tests of Intellectual Ability -4: Intelligence Quotient (IQ) Genetics play a major role in determining IQ. IQ is relatively stable throughout life. An individuals IQ remains essentially the same in old age as in childhood, in the absence of brain disease Influences on IQ test scores may include cultural background and emotional response to testing situations

19. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -5: A. Tests of Intellectual Ability -5: Mental retardation-1 Normal or average IQ in a given population is within the range 90-109 The standard deviation in IQ scores is 15. More than two standard deviations below the mean (ie, an IQ of 70 or less) is considered mental retardation

20. IQ Ranges & Distribution IQDescriptorApproximate Percentage Percentile range ≥ 130Very superior2%98-100 120-129Superior7%91-98 110-119High average16%75-90 90-109Average50%25-95 80-89Low average16%10-25 70-79Borderline7%2-9 < 70Mentally retarded2%0-2

21. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -6: A. Tests of Intellectual Ability -6: Mental Retardation-3 The most common genetic causes of mental retardation are Down Syndrome and Fragile X syndrome. Other causes include factors affecting mother or fetus such as infections (eg rubella), metabolic factors affecting mother or fetus, and substance abuse,

22. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -7: A. Tests of Intellectual Ability -7: Mental Retardation-4 Down syndrome: Typically, the nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21. This additional genetic material alters the course of development and causes the characteristics (qv) associated with Down syndrome

23. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -8: A. Tests of Intellectual Ability -8: Mental Retardation-5 Fragile X: Fragile X syndrome is a genetic condition involving the X chromosome and causing a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females

24. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -9: A. Tests of Intellectual Ability -9: Wechsler Intelligence Tests In contemporary practice the most widely used individually administered intelligence measure performance in several different areas. The Wechsler intelligence scales serves as a good example

25. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -10: A. Tests of Intellectual Ability -10: Wechsler Intelligence Tests The currently used tests are: Wechsler Adult Intelligence Scale – (WAIS-III) Wechsler Intelligence Scale for Children – (WISC- III); children 6-16½ years Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R); children 4-6½ years The scales of Wechsler intelligence tests are adapted for age

26. The Psychometric Evaluation Major Psychological Tests Wechsler Intelligence Tests The WAIS-R and the WISC-R are each divided into 2 sections, verbal and performance Each section has its separately computed intelligence quotient (IQ) Each sections is further divided into 11 normalized subtests Verbal section: general information, comprehension, similarities, arithmetic, digit span and vocabulary Performance section: digit symbol, block design, picture completion, object assembly and picture arrangement

27. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -13: A. Tests of Intellectual Ability -13: Vineland Social Maturity Scale The Vineland Social Maturity Scale is a non- projective personality measure designed to help in the assessment of social competence (ie, to evaluate skills for daily living)

28. The Psychometric Evaluation Major Psychological Tests A. Tests of Intellectual Ability -14: A. Tests of Intellectual Ability -14: The Stanford-Binet Scale is used with individuals ages 2 thru 18 (best in the under 6): To test general intellectual ability, To assess giftedness, and to address educational placement issues Comprises 142 brief tests, sampling a variety of skills Content arranged in age-appropriate levels Best used with very young, very impaired or very bright

29. The Psychometric Evaluation Major Psychological Tests B. Achievement tests -1 of 2: B. Achievement tests -1 of 2: Measurement of achievement is the evaluation of mastered information and skills that have been part of specific instruction. These tests: Are widely used in the education system but may be useful also in counseling and industry and may be included as part of neuropsychological batteries does not assess aptitude or future performance

30. The Psychometric Evaluation Major Psychological Tests B. Achievement tests -2: B. Achievement tests -2: Examples of Achievement tests: Wide-Range Achievement Test (WRAT) Stanford Achievement test Iowa Test of Educational Development California Achievement test Peabody Individual Achievement Test

31. The Psychometric Evaluation Major Psychological Tests C. Tests of Personality functioning -1 of 3: C. Tests of Personality functioning -1 of 3: MMPI: An objective self-report test for obtaining diagnostic, clinical information on psychiatric and medical patients and in research. (the most [ab]used) Often utilized in forensic evaluations, in assessment of treatment outcomes, substantive issues of malingering and in evaluating psychological determinants of chronic pain Rorschach Inkblot Test: is the major projective test of personality assessment The Rorschach is used to assess personality dynamics and organization as well as cognitive style

32. The Psychometric Evaluation Major Psychological Tests C. Tests of Personality functioning -2: C. Tests of Personality functioning -2: TAT: Used in assessment of personality functioning A way of evaluating drives, emotions, sentiments and conflicts of which an individual may be unaware Sentence completion test: An economical way of surveying a patient’s thoughts, feelings, motivations, and behavior along a number of psychological dimensions

33. The Psychometric Evaluation Major Psychological Tests C. Tests of Personality functioning -3: C. Tests of Personality functioning -3: Projective drawings: These types of procedures are used more to assess personality adjustment than aspects of intelligence Other tests of personality functioning: Beck Depression Inventory The Sixteen Personality Factors Inventory The Symptom Checklist-90 Milton Clinical Multiaxial Inventory

34. The Psychometric Evaluation Major Psychological Tests D. Vocational Tests: D. Vocational Tests: Infrequently used in medical settings Tests of aptitude and ability; used in career counseling Information may be yielded on general interest areas and on interest areas that are analogous to various occupations

35. The Psychometric Evaluation Major Psychological Tests E. Neuropsychological assessment: E. Neuropsychological assessment: The evaluation of brain injury and dysfunction in humans through the use of psychological tests has become a specialty of psychology The major approaches to assessment have been through the use of standardized batteries eg, Halstead-Reitan Neuropsychological Test Battery (HRB)

36. The Psychometric Evaluation Major Psychological Tests E. Neuropsychological assessment -2: E. Neuropsychological assessment -2: The Halstead-Reitan Neuropsychological Test Battery (HRB) addresses questions of the presence, absence, and localization of brain dysfunction. Prognostic and rehabilitative statements are often made on the basis of HRB and other supplementary neuropsychological tests