1. Assessing and Diagnosing Abnormality
Chapter 3
Assessing and Diagnosing Abnormality

2. Assessment: the process of gathering information about people’s symptoms and the possible causes of these symptoms. Information gathered in an assessment is used to determine the appropriate diagnosis for a person’s problems.
Diagnosis: a label for a set of symptoms that often occur together.

3. Considerations in Assessment Tools
Validity: Accuracy
Face validity
Content validity
Concurrent validity
Predictive validity
Construct validity
Reliability: Consistency
Standardization

4. Types of Validity Type Description Face Content Concurrent Predictive
Construct
Test appears to measure what it is supposed to measure.
Test assesses all important aspects of phenomenon.
Test yields the same results as other measures of the same behavior, thoughts or feelings.
Test predicts the behavior it is supposed to measure.
Test measures what it is supposed to measure and not something else.

5. Types of Reliability Type Description Test-Retest Alternate Form
Internal
Interrater or Interjudge
Test produces similar results when given at two points in time.
Two versions of the same test produce similar results.
Different parts of the same test produce similar results.
Two or more raters or judges who administer a test to an individual and score it come to similar conclusions.

6. The Clinical Interview
Intake interview (mental status exam)
Appearance, behavior, thought processes, mood & affect, intellectual functioning, orientation
Structured Interview
Standard series of questions are asked

7. Questionnaires Symptom Questionnaires Personality Inventories
These questionnaires may cover a wide variety of symptoms, representing several different disorders
Personality Inventories
Questionnaires meant to assess people’s typical ways of thinking, feeling, and behaving
Minnesota Multiphasic Personality Inventory (MMPI) is the most widely used personality inventory (now MMPI-2)

8. MMPI

9. Behavior Observations and Self-Monitoring
Example: Watching a child interact with another child to see what provokes him or her
Self-Monitoring
Example: Asking a client to keep track of the number of times per day he or she engages in a specific behavior such as smoking a cigarette

10. Intelligence Tests
Used to measure an individual’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected
Used in schools to identify “gifted” children and those with intellectual difficulties.
Used in occupational settings and the military to evaluate adults’ capabilities for certain jobs or types of service.
Some examples: Wechsler Adult Intelligence Scale, the Stanford-Binet Intelligence Test, and the Wechsler Intelligence Scale for Children.

11. Criticisms of Intelligence Tests
Little consensus as to what is meant by intelligence
Biased toward middle- and upper-class educated European Americans

12. Neuropsychological Tests
Used to detect specific cognitive deficits such as a memory problem, as in dementia
Example: Bender-Gestalt

13. Bender-Gestalt Test .

14. Brain-Imaging Techniques
Computerized tomography (CT): an enhanced X-ray procedure
Positron-emission tomography (PET): a picture of activity in the brain. Requires injecting the patient with a harmless radioactive isotope
Single photon emission computed tomography, or SPECT: similar to PET except that it is less accurate and less expensive
Magnetic resonance imaging (MRI): involves creating a magnetic field around the brain that causes realignment of hydrogen atoms in the brain

15. Psychophysiological Tests
Alternative to and less direct than MRI, CT, PET, and SPECT to detect changes in the brain and nervous system that reflect emotional and psychological changes.
Electroencephalogram (EEG)
Measures electrical activity along the scalp produced by the firing of specific neurons in the brain.
Used most often to detect seizure activity in the brain, and can also be used to detect tumors and stroke.
When EEG patterns over brief periods (such as half second) are recorded in response to specific stimuli, such as the individual viewing an emotional picture, these EEG patterns are referred to as evoked potentials or event-related potentials.
Clinicians can compare an individual’s response to the standard response of healthy individuals.
Heart rate and respiration are highly responsive to stress and can be easily monitored. Sweat gland activity, known as electrodermal response (formerly called the galvanic skin response) can be assessed with a device that detects electrical conductivity between two points on the skin, which can reflect emotional arousal.
Difficult to administer, resulting in low validity and reliability.

16. Projective Tests
Based on the assumption that, when people are presented with an ambiguous stimulus, such as an oddly shaped inkblot or a captionless picture, they will interpret the stimulus in line with their current concerns and feelings, their relationships with others, and conflicts or desires. (Projection)
Examples:
Rorschach Inkblot Test
Thematic Apperception Test (TAT)
The Sentence Completion Test
Draw-A-Person Test

17. Challenges in Assessment
Resistance and Inability to Provide Information
Evaluating Children
Difficulties in communication and reporting
Evaluating Individuals across Cultures
Language barriers
Different cultures experience different psychological disorders differently

18. Diagnosis

19. The Diagnostic and Statistical Manual of Mental Disorders IV
Clinical disorders
Axis I
Personality disorders
Mental retardation
Axis II
General medical conditions
Axis III
Psychosocial and environmental problems
Axis IV
Global assessment of functioning
Axis V

20. Continuing Concerns About the DSM-IV-TR
Considering the Continuum
Differentiating Mental Disorders from Each Other
Addressing Cultural Issues
The Dangers of Diagnosis

21. Assessment: Biopsychosocial Integration