Assessing and Diagnosing Abnormality Chapter 3 Assessing and Diagnosing Abnormality

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.

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

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.

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.

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

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)

MMPI

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

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.

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

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

Bender-Gestalt Test .

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

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.

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

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

Diagnosis

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

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

Assessment: Biopsychosocial Integration