1. Chapter 4 Clinical Assessment and Diagnosis
ABNORMAL PSYCHOLOGY SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 4
Clinical Assessment and Diagnosis
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2. The Basic Elements in Assessment
Identification of presenting problem
Situational or pervasive?
Duration?
Prior attempts to help or treat?
Self-defeating or resourceful?
How does problem impact social roles?
Does problem match any DSM-5 disorder criteria?
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3. The Relationship Between Assessment and Diagnosis
Classification of presenting problem
Treatment planning
Knowledge of range of diagnostic problems
Insurance payment
Knowledge of range of diagnostic problems in client population, which dictate needs for facilities
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4. Taking a Social or Behavioral History
Good assessment includes social history noting:
Personality factors
Social context
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5. Ensuring Culturally Sensitive Assessment Procedures
Awareness of increasing population diversity
APA ethical code related to cultural competence
Cultural variables inclusion
U.S. population has grown increasingly diverse in recent years
It is critical for practitioners to conduct culturally competent assessment
APA ethical code addresses need for cultural competence
Cultural variables can include ethnicity, language, SES, gender, and others
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6. Influence of Professional Orientation
May determine assessment techniques
Does not limit clinician to one type of assessment
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7. Reliability, Validity, and Standardization
Psychological Assessments are:
Reliable
Valid
Standardized
Reliability: assessment measure produces same result every time it is used
Validity: assessment measures what it aims to measure
Standardized: assessment is consistent and fair for all persons taking assessment; allows for comparison to normative sample
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8. Trust and Rapport Between the Clinician and the Client
Importance of trust and rapport
Impact on assessment process
For psychological assessment to proceed effectively, the client must feel comfortable with the clinician
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9. Assessment of physical organism incorporates:
General physical examination
Neurological examination
Neuropsychological examination
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10. General Physical Examination
Many psychological problems have physical components either as
Causal factors
Symptom patterns
Therefore, it is often important to include a medical examination in the psychological assessment
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11. Neurological Examination
Neurological tests aid in determination of
site of organic brain disorder
extent of organic brain disorder
If organic brain damage is suspected, neurological tests can aid in determining the site and extent of organic brain disorder
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12. Neurological Examination
Neurological examination may include:
EEG
CAT scan
MRI
PET scan
fMRI
EEG: graphical record of brain’s electrical activity
CAT scan: uses X-ray technology to provide images of brain structures that may be damaged or diseased
MRI: uses magnetic imaging to measure oxygen flow (using water content) in brain; produces sharper images than CAT scan
PET scan: tracks metabolic activity of specific compounds, such as glucose; can reveal problems that are not necessarily anatomical in nature
fMRI: measures changes in oxygen (blood flow) while patient undergoes a task; can map psychological activity to specific regions in the brain
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13. Neuropsychological Examination
Involves use of expanding array of testing devices
Measures cognitive, perceptual, and motor performance
Provides clues to extent and location of brain damage
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14. Neuropsychological Examination
Halstead-Reitan Battery
Halstead Category Test
Tactual Performance Test
Rhythm Test
Speech Sounds Perception Test
Finger Oscillation Task
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15. Psychosocial Assessment
What role does psychosocial assessment attempt to provide?
Psychosocial assessment attempts to provide realistic picture of individual in interaction with his or her social environment
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16. Psychosocial Assessment
Three procedures commonly used in psychosocial assessments include:
Assessment interviews
Clinical observation of behavior
Psychological tests
Assessment interviews may be structured or unstructured
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17. Assessment Interviews
Face-to-face interaction
Structured interviews
Unstructured interviews
In face-to-face interaction clinician obtains information about client’s situation, personality, and behavior
Structured interviews restrict freedom to explore but increase reliability
Unstructured interviews allow for more exploration but decrease reliability
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18. Clinical Observation of Behavior
Clinical observation in natural environments
Clinical observations in therapeutic or medical settings
Use and purpose of rating scales
Ideally, clinical observation takes place in a natural environment, such as a child’s behavior in a classroom or at home
However, it often takes place at the clinic or hospital where the client seeks help
Rating scales can augment clinical observations of behavior and can increase reliability and validity
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19. Psychological Tests
Two general categories of psychological tests for use in clinical practice are
Intelligence tests
Personality tests
Two general categories of psychological tests for use in clinical practice are
Intelligence tests such as the WISC-IV and WAIS-IV
Personality tests
Projective personality tests
Objective personality tests
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20. Psychological Tests
Most commonly used intelligence tests include:
WISC-IV and Stanford-Binet (for children) and WAIS-IV (for adults)
These tests are individually administered and typically take 2-3 hours to administer, score, and interpret
Useful for when intellectual impairment or organic brain damage central to patient’s problem
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21. Projective personality tests
Psychological Tests
Projective personality tests
Unstructured stimuli are presented
Meaning or structure projected onto stimuli
Projections reveal hidden motives
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22. Projective personality tests include:
Psychological Tests
Projective personality tests include:
Rorschach Inkblot Test
Thematic Apperception Test
Sentence Completion Test
Rorschach is complicated, timely, and requires much training to administer. Also subjectiveness of interpretations gives it low reliability
Sentence completion tests slightly more structured than other two tests
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23. Psychological Tests
Objective personality tests
Examples
Advantages and limitations
The MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring straightforwardness
Objective personality tests have the benefits of being cost-effective and highly reliable
They have been criticized for being too mechanistic and requiring too much reading ability and cooperation
Actuarial procedures are used for MMPI and other scientifically constructed objective tests
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24. MMPI (now MMPI-2 and MMPI-A)
The MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring straightforwardness
Objective personality tests have the benefits of being cost-effective and highly reliable
They have been criticized for being too mechanistic and requiring too much reading ability (literacy) and cooperation
Actuarial procedures are used for MMPI and other scientifically constructed objective tests
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25. Profile of the MMPI-2 Validity Scales
See Figure 4.1
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26. Profile of the MMPI-2 Clinical and Supplementary Scales
See Figure 4.2
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27. Integration of Assessment Data
Developing integrated, coherent working model
Utilizing individual or team approach
Identifying definitive picture vs. discrepancies
Assessment data from various sources must be integrated into a coherent working model
Integration can be done by one mental health professional or a team
Sometimes, a definitive picture emerges
Sometimes, there are discrepancies that necessitate further assessment
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28. Ethical Issues in Assessment
Ethical issues in assessment include:
Potential cultural bias
Theoretical orientation of clinician
Under-emphasis on external situation
Insufficient validation
Inaccurate data or premature evaluation
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29. Classifying Abnormal Behavior
Complete the sentence below.
Classification involves attempts to delineate meaningful sub-varieties of _______ ________.
Classification involves attempt to delineate meaningful sub-varieties of maladaptive behavior
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30. Classifying Abnormal Behavior
Benefits of classification include:
Introduction of order
Communication establishment
Statistical research data use
Clarification of insurance issues
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31. Differing Models of Classification
Three basic approaches include:
Categorical approach
Dimensional approach
Prototypal approach
Three basic approaches include:
The categorical approach– a patient is healthy or disordered, but there is no overlap
The dimensional approach– the patient may fall along a range from superior functioning to absolutely impaired functioning
The prototypal approach– a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have
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32. Formal Diagnostic Classification of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders (DSM)
International Classification of Disease (ICD)
The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) are the two major classification systems in use
ICD is more commonly used in Europe
DSM is more commonly used in the U.S.
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33. Formal Diagnostic Classification of Mental Disorders
True or False?
The DSM is a categorical system.
False. DSM purports to be a categorical system, but it is in fact prototypal.
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34. Formal Diagnostic Classification of Mental Disorders
The DSM-5
More comprehensive and more subtypes of disorders
Allows for gender related differences in diagnosis
Provides structured interview regarding cultural influences
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35. Formal Diagnostic Classification of Mental Disorders
Need for diagnosis
Disadvantages of labeling
Mental health professionals should be aware of the downsides of labeling
It may close off further inquiry
Patients may play out the expectations of their “role”
Others may stigmatize the labeled person
Nevertheless, arriving at such a diagnosis is usually required before the commencement of clinical services
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