1. Assessment and Diagnosis
Chapter 3

2. Chapter Outline Clinical Assessment Assessment Instruments
Diagnosis and Classification

3. Clinical Assessment
Process of gathering information about a person and his/her environment to make decisions about the nature, status, and treatment of psychological problems
-Begins with a set of referral questions
-Questions determine goals of assessment
-Selection of appropriate psychological tests and measurements

4. Differential diagnosis is a process in which a clinician weighs how likely it is that a person has one diagnosis instead of another.
Goals of Assessment
Deciding what assessment procedures and instruments to administer
When conducting an assessment, it is important to take into consideration the age, developmental level, and cultural implications of the test- taker.
Screening (identify psychological problems or predict the risk for future problems)
Diagnosis (identification of illness)
Description
Treatment plan (individual’s plan of care to meet mental health needs)
Outcome evaluation

5. The Usual Properties of Assessment Instruments Are…
Standardization
Normative comparisons
Self-referent comparisons
Reliability
-Test-retest reliability
-Interrater agreement
Validity
-Construct, criterion, concurrent, predictive
These are important in reviewing the psychometric properties of instruments to ensure a clinician’s confidence in the testing results.

6. Developmental and Cultural Considerations
Age
Developmental status
People involved in testing
Nature of test chosen
Testing environment
Cultural factors
“Cultural fair”

7. Assessment Instruments – Informed Consent prior to any type of assessment
Self-report measures (ask patients to evaluate their own symptoms)
Clinician-rated measures (clinician rates symptoms)
Subjective responses vs. objective responses
Types of assessments
-Clinical interviews
-Psychological tests
-Behavioral Assessments
-Psychophysiological Assessments
Remember a patient’s “perception is their reality” when they report information related to the assessment.

8. Self-Report Measures
Is a type of survey/questionnaire in which patients read the question and select a response by themselves without interviewer interference.
Usually administered at the beginning of treatment, and depending on the treator, throughout the treatment process.
These measures will be useful in determining the patients’ symptoms’ severity. In addition, these measures will be helpful through the course of treatment, evaluating how well the intervention is working.

9. Clinical Interviews
Conversation between an interviewer and a patient, the purpose of which is to gather information and make judgments related to assessment goals
Purpose of interviews (screening, diagnosis, treatment planning, or outcome evaluation)
Types of interviews
-Unstructured (open-ended questions that allow flexibility and close ended questions)
-Structured (asking a standard set of questions, typically for diagnostic purposes)

10. Psychological Tests
Personality tests (psychological test that measures personality characteristics)
Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) – over 500 items
Nine clinical subscales: hypochondriasis, depression, hysteria, psychopathic deviance, masculinity-femininity, paranoia, psychasthenia, schizophrenia, & hypomania
The Million Clinical Multiaxial Inventory (MCMI)
Tests for specific symptoms

11. Neuropsychological Testing
Used to detect impairment in cognitive functioning
Measures: memory, attention and attention, motor skills, perception, abstraction, and learning abilities
Halstead-Reitan Neuropsychological Battery (Reitan & Davidson, 1974)
Wisconsin Card Sorting Test (WCST)
Bender Visual Motor Gestalt Test

12. Mini Mental State Exam
A brief 30-point questionnaire used to screen for cognitive impairment.
Commonly used to screen for dementia, to estimate the severity of cognitive impairment, and to follow the course of cognitive changes in an individual over time.
It is also used by mental health clinicians at intake, in order to test how oriented or disoriented a patient is, and how their cognition is affected by their symptoms.

13. Intelligence Tests Used to measure intelligence quotient (IQ)
The average IQ is 100 (mean) and the standard deviation is 15. So if someone has an IQ of 130 that means their IQ is two standard deviations above the mean.
Used to measure intelligence quotient (IQ)
Intelligence Quotient (a source of cognitive functioning that compares a person’s performance to his or her age-matched peers)
Stanford-Binet Intelligence Scale
Wechsler Adult Intelligence Scale (WAIS-IV; Wechsler, 2008)
Wechsler Intelligence Scale for Children (WISC-IV, 7-16 years)
Wechsler Preschool and Primary Scale of Intelligence (WPPS-III, 2½-7 years)
The origin of the IQ test began in France, by Alfred Binet and Theodore Simon, who were commissioned by the French government to create a test to predict academic success. During WWI, the IQ test was used as a way to determine the ranks of soldiers, and who was to become a commander, and who was to fight at enemy lines.
In 1960s, the test developed by David Wechsler, the Wechsler Adult Intelligence Test (WAIS) became more popular, and to this day is the most commonly used IQ test.

14. Wechsler Adult Intelligence Scale (WAIS-IV)
Currently in its fourth edition
Adapted from the tests that the US Army used.
Produces four index scores
Verbal Comprehension Index (VCI)
Working Memory Index (WMI)
Perceptual Reasoning Index (PRI)
Processing Speed Index (PSI)

15. WAIS-IV CONTD. Verbal Comprehension Index Working Memory Index
Vocabulary (timed)
Comprehension (timed)
Why do plants need water?
Similarities
How are an apple and orange similar?
Reading rate (timed)
Working Memory Index
Digit Span
“46”, “583”, “6835”, “79248”
backwards
Arithmetic

16. WAIS-IV CONTD. Perceptual Reasoning Index Visual puzzles
Arrange a set of blocks so that they reproduce a design
Matrix reasoning
Choose which pattern logically follows after a set of patterns

17. WAIS-IV CONTD. Processing Speed Index Trails making (timed)
Making a trail
An easier version of this test, Trails A, only has numbers, and the test taker is supposed to make a trail starting from the smallest number, ending in the largest one. In this example you are seeing, Trails B, the test taker is supposed to make a trail, starting with the smallest number, than going to the first letter of the alphabet, then to the next number. For example, the trail is supposed to start with 1, then go to A, then go to 2, and then go to B.

18. Projective Tests
Tests derived from psychoanalytic theory in which people are asked to respond to ambiguous stimuli
Rorschach Inkblot Test (Rorschach, 1921)
Thematic Apperception Test (TAT; 1935)
-Consists of 31 black-and-white pictorial cards and the patient is asked to make up a story about the image
-The patient is exposed to ambiguous stimuli and then projects a unique interpretation onto them that reflects his/her underlying unconscious processes and conflicts.
The way the individual makes sense of these ambiguous images gives us an idea about how they make sense of the world and interpret their observations. The tester is able to get a picture of tendencies that the individual might have according to their interpretations.
It is important to note that an individual’s respond to one card cannot be indicative of a personality type or diagnosis. They only make sense if interpreted together, and alongside other measures.

19. The Rorschach Inkblot Test
Examine the Evidence: It’s important to remember 25% of the CS scores are not considered reliable, “the norms” published by Exner is extremely outdated (from the 1970s and 1980s), and adequate validity only exists for 20 of the 180 CS scores. Conclusion: There continues to be critics and advocates for the utility of the Rorschach; however no sound empirical data exists.
Fact: 75% of the Exner’s Comprehensive System (CS) scores warrant internal validity which is based on sums of individual scores.
Not necessarily a diagnostic tool, but used to gain more insight into individual’ inner world, and thought processes.
Some previous studies found that validity increases when clinicians use their clinical judgment to incorporate the Rorschach results with information gathered from other sources.

20. Behavioral Assessment
The goal of behavioral assessments is to understand behavior within the context of learning, “learned behavior.”
Behavioral Assessment
Functional analysis – where a clinician identifies causal links between behavior and environment
Self-monitoring – a patient records and observes his or her own behavior (advantage: not retrospective)
Behavioral observation – measurement of behavior by a trained observer. (event recording or interval recording in a natural or analogue fashion)
Behavioral avoidance tests – strategies used to assess avoidance behavior

21. Psychophysiological Assessment
Assessment strategies that measure brain and nervous system activity
Electroencephalography (EEG, a noninvasive procedure that measures and records brainwaves) sleep, comatose, and relaxation states
Electrodermal activity (EDA, measures changes in electrical conductance produced by increased or decreased sweat gland activity) formerly called Galvanic Skin Response
Biofeedback (trains patients to recognize and modify physiological signals)