1
Q
Why should we assess?
A
- classification
- facilitate decision making
- evaluation
- data collection
What about psychological assessment?
- a psychological assessment ( as described by the APA) is…
- the gathering and integration of data to evaluate a person’s behaviour, abilities, and other characteristics, particularly for the purpose of making a diagnosis or treatment recommendation.
- - Psychologists assess diverse psychiatric problems (e.g., anxiety, substance abuse) and nonpsychiatric concerns (e.g., intelligence, career interests) in a range of clinical, educational, organizational, forensic, and other settings.
- Assessment data may be gathered through interviews, observation, standardized tests, self-report measures, physiological or psychophysiological measurement devices, or other specialized procedures and apparatuses.
2
Q
How is psychological assessment different?
A
devices, or other specialized procedures and apparatuses.
How is Psychological Assessment Different?
- Systematic: not just doing one test: you need multiple need different ways to look at it.
- Driven by assessment questions/ goals.
- Develop and evaluate iterative hypotheses.
- Consider multiple sources of information.
* Integrate ↑ information in drawing conclusions.
o Typically consult clients regarding the accuracy of conclusions.
3
Q
what is the purpose of assessment?
A
- Assessment-focused services
▪ Stand-alone
▪ Answer basic questions and provide recommendations
▪ Opinion regarding changes in functioning
▪ Conclusions and recommendations may have ↑ consequences
▪ Need to consider the context of referral - ▫ Intervention-focused assessment services
▪ First step in intervention
▪ Use to determine appropriate interventions, evaluate progress etc.
Screening
- Identify individuals with/ at risk of developing relevant problems.
Diagnosis
- Integrate data on current symptoms, and compare with diagnostic criteria
▫ Case Formulation
- Develop a comprehensive conceptualization of psychological functioning
▪ Put the client in the context
- Prognosis/prediction
- Predict the future course of psychological functioning
- Difficult – must weigh time/cost of prediction, cost/consequences of making the wrong call
- Influenced by base-rate
4
Q
What is sensitivity & specificity, and what are the differences?
A
Sensitivity
* ▪ True positives/(true positives + false negatives)
* ▪ How often can you accurately detect that _ is present?
* ▪ e.g., how well can you detect who has/will develop an eating disorder
Specificity
* ▪ True negatives/(true negatives + false positives)
* ▪ How often can you accurately detect that _ is not present?
* ▪ e.g., how well can you detect who does not/will not develop an eating disorder
Trade-off
- Consider relative costs
5
Q
what should you consider about treatment
A
- ▫ Treatment planning
o ▪ Purpose of most assessment
o ▪ Decide which treatment will likely be most effective given client characteristics/context
▫ Problem identification
▫ Set treatment goals (short-term and long-term)
▫ Identify treatment strategies/tactics with established effectiveness - ▫ Develop a treatment plan in collaboration with the client
- Treatment monitoring
o ▪ Crucial to effective treatment
o ▪ Use formal assessment tools
o ▪ Alter course as needed - ▫ Treatment evaluation
o ▪ Compare outcome data with intake data
o ▪ Look at individual clients, clinician, clinics, therapy
o ▪ Helps set expectations, build informal norms, alert to problems
6
Q
testing vs. assessment
A
- ▫ Psychological testing
o ▪ A particular device is used to gather a sample of behavior in a specific domain
o ▪ A score is assigned to the resulting sample
o ▪ This score is compared with the scores of other people in order to interpret it - ▫ Tests meet standards of standardization, reliability, validity, and norms
- ▫ Assessment is more complex, multifaceted
o ▪ Integrate many sources of information
o ▪ Develop a coherent, unified description of the client/client’s experience
o ▪ Tests are just part of the assessment
7
Q
what is reliability
A
- ▪ Consistency of the test
- ▪ Internal consistency, test-retest, inter-rater
- ▪ Specific to purpose and population
- ▪ Requirements vary but expectations higher for clinical use
8
Q
what is validity
A
- ▪ Whether the test measures what it is supposed to
- ▪ Content, concurrent, predictive, discriminant, incremental
- ▪ Applies to whole tests and to subscales
- ▪ Specific to purpose and population
- ▪ Consider whether likely to be useful for particular client
9
Q
what are norms
A
- ▪ Compare scores to normative sample to interpret
- ▪ Consider how client’s score relates to cut-off, distribution
Percentiles, standard scores, developmental norms
▪ Consider quality and appropriateness of normative sample
10
Q
what are important ethical principles?
A
- Protecting test security College Code of Conduct)
- ▫ Knowledge of test properties, proper use and interpretation, and limitations (College Code of Conduct)
- ▫ Acknowledge limitations of conclusions (III.8)
- ▫ Acknowledge the source of interpretive statements (College Code of Conduct)
11
Q
▫ Which of the following would be considered an open question (as opposed to a closed question)?
A
- Where did you grow up?
- b) Did you experience heart palpitations?
- c) When did these problems start?
- d) What was going on for you at the time? *
- e) Did your boss get angry at you?
12
Q
Which of the following is an element of effective active listening?
A
- a) Paraphrasing
- b) Summarizing
- c) Asking questions
- d) Using reflections
- e) All of the above *
13
Q
What are the limits of confidentiality (and relevant laws) ?
A
- imminent risk of harm to self or others (college code of conduct)
- child abuse/ neglect (child, family, and community service act)
- unsafe to drive (motor vehicle act)
- court order (but not necessarily subpoena, college code of conduct)
- multidisciplinary/ hospital settings:
o team
o file audits.
14
Q
Interviews vs. conversations
A
- Different contexts and structure
- Different tone
- Interviews are confidential.
- Different purpose and focus
- Differ in the level of self-disclosure.
- Differ in how to approach painful topics.
- Differ in record keeping.
15
Q
What are the three types of interviews?
A
- unstructured
- semi-structured
- structured
16
Q
What are unstructured interviews?
A
- standard clinical interview
- Create a safe environment.
- Structure sessions to ensure that cover relevant topics.
o Clinician decides what to cover.
Presenting problem(s), past problems
Treatment history (including current medications)
Medical conditions
Psychosocial history (e.g., childhood, school, work, relationships)
Goals/ expectations for treatment
o Ask about difficult topics (e.g., suicidality)
o Very flexible
17
Q
what are semi-structured interviews?
A
- Specific format, a specific sequence
- Start with a fixed set of questions.
- There is some flexibility (can ask additional questions)
- Often include screening questions
o Ask follow-up questions based on responses. - Explicit decision rules
- Broad coverage
- Clearly follow diagnostic criteria
- Improves diagnostic reliability and inter-rater reliability.
- Can be long.
Examples
- Structured clinical interviews for Axis I Disorders (SCID), SCID-CV (common conditions only), SCID-II
o Parallels DSM Criteria
o Anxiety Disorders Interview Schedule (ADIS)
o Yale-Brown Obsessive-Compulsive Scale (YBOCS)
o Yale-Brown Obsessive Compulsive Scale_ Body Dysmorphic Disorder (YBOCS_BDD)
18
Q
What are structured interviews?
A
- Asked a fixed set of questions in a fixed sequence
- No deviating from standardized questions
- More common in research and hospital settings
- Efficient
Example: - M.I.N.I International Neuropsychiatric Interview (MINI: can also use as semi-structured)
- Trade-off = flexibility vs. control
19
Q
how would you ask about suicidality directly?
A
- ▪ Suicidal thoughts (frequency, intensity, duration)
- ▪ Nature of thoughts (general, concrete)
- ▪ Whether they have a plan (how concrete/specific)
- ▪ Access to means
- ▪ Intent to act on thoughts
- ▪ Do they think they could follow through
- ▪ Why they consider suicide to be an option
- Hopelessness - ▪ Past attempts
- ▪ Past self-harm
- ▪ What has stopped them
- ▪ Available supports
20
Q
How would you interview couples?
A
- Focus on one client, couple, or family member
- Must make space for both people to talk and engage with both partners
- Look for differences in perspective, interpretation
- Observe how they interact
- May need to structure the conversation for the,
- May also, indeed, individual
21
Q
How would you interview families?
A
Interviewing family
- Need to establish rapport with several people
o Attend to each person at some point
- Set expectations upfront
- May need to cut people off
- Normalize (and validate) differences in perspective
22
Q
how would you interview older adults?
A
- Be aware of problems in daily living
- Health problems may play a bigger role in the presentation
- Also, medications
- Concerns may focus on the loss of autonomy, caregiver relationships, bereavement, mortality
- Make sure to be aware of the purpose of services, establish informed consent/assent
- ▫ Be sensitive to potential cognitive impairments, differences in style/experiences
- ▫ May need to involve caregivers
- ▫ Screen for maltreatment
23
Q
how would you interview children?
A
- Kids can provide useful information
- Observe how to interact with you
- Explain the purpose of the assessment
- Adapt approach
o Make sure understandable
o More flexible
o Consider developmental appropriateness.
o Consider awareness of time
o Ask questions to clarify, build rapport
o Alter style
24
Q
what are some key observations to make during interviews?
A
- Observe relevant behaviour during the interview (e.g., attention, impulsivity, activity level, interpersonal behaviour)
- Behaviour may be reactive.
- May supplement with naturalistic observations
o Home
o Schools - Use to generate hypotheses and combine with other assessment data.
- Rarely use standardized observational coding systems.
25
what is the Flynn Effect?
- IQ scores on the rise
- The greatest increase in visuospatial abilities in developing countries.
- Possible reasons:
o Factors related to the tests (unlikely)
o Genetic factors factor (40-80% genetic)
o Educational improvements
o Other environmental factors
o Epigenetic effects
26
How would we define intelligence?
- Definitions range from broad (e.g., ability to learn/adapt) to narrow (e.g., ability to engage in abstract thinking)
- Have moved from an interest in academic performance to the context of life more generally
- Wechsler:
o Capacity to act purposefully, think rationally and deal effectively with his/her environment.
o Involves a range of problem-solving skills acquired through education and life experience.
- Current theories:
o Intelligence = combination of abilities in multiple areas of life ▫ Most tests are limited in scope
27
what are some models of intelligence?
- Factor models
o Multiple factors at the same level
- Hierarchical model
o Lower-order and higher-order factors
- Information processing model
o Focus on processes and operations that reflect how the brain handles information.
- Disconnect between theories of intelligence and how we assess intelligence
28
what is Spearman's "g"?
- Looked at intercorrelations among sensory tests
- Two-factor model
All intellectual activities share a common core
“G” OR “GENERAL FACTOR”
More highly correlated = more g
o Also, specific factors unique to task (i.e., “s”)
o Performance on task = g +s
- Not hierarchical
- The idea of “g” is retained in most theories of intelligence.
29
what are Thurstone’s Primary Mental Abilities
- Ealy alternative to Spearman’s model
- Many abilities measured is not highly correlated
o Influenced by something other than “g”
- ▫ Primary mental abilities:
o ▪ Spatial orientation, perceptual speed, numerical ability, associative memory, verbal comprehension, word fluency, reasoning, deduction, and induction
o ▪ Relatively distinct
o ▪ Overlap = “g”
- ▫ Developed a measure of intelligence based on model
30
what is the Catell-Horn-Carroll Theory
- Existing tests too focused on verbal academic tasks
- Fluid vs. Crystallized intelligence
o Fluid: the ability to solve novel problems; innate potential
o Crystallized: what we have learned from education and life experiences
* ▫ 3 levels: “g”, broad, narrow
* ▫ Is reflected (to some extent) in Wechsler scales
31
what is Sternberg's Triarchic theory
* ▫ Rather than “g”, 3 interrelated elements:
o ▪ Componential: executive functioning, problem-solving, knowledge acquisition
o ▪ Experiential: problem-solving when faced with novelty/unfamiliarity
o ▪ Context: ways of interacting with the environment (adaptation, alteration of the environment, selection of a different environment)
* ▫ Need to consider learning history and environment in understanding intelligent behaviour
32
What is emotional intelligence?
- Ability to perceive, understand, and regulate emotions
- Many different definitions, many measures
- Ability-based measures similar to intelligence tests
o e.g., Mayer-Salovey-Caruso Emotional Intelligence Test
o Perception of emotion, use of emotional information in thinking, understanding emotions, managing emotions
- Does relate to better social outcomes, achievement, well-being, and adjustment.
- Not assessed in standard intelligence tests
33
what afre the Weschler scales?
- Motivation = clinical utility
- Introduced scaled scores (previously compared chronological and mental age)
- MEAN = 100, SD = 15)
- ▫ Widely used
- ▫ Several tests:
o ▪ Wechsler Adult Intelligence Scale (WAIS-IV)
o ▪ Wechsler Intelligence Scale for Children
(WISC-V)
o ▪ Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV)
o ▪ Wechsler Abbreviated Scale of Intelligence (WASI-II)
- ▫ Canadian adaptations available
34
What is the structure like in the Weschler scales?
- Full Scale IQ (FSIQ; “g”)
o Verbal Comprehension Index
Perceptual Reasoning Index
Working Memory Index
Processing Speed Index
* ▫ Formerly VIQ and PIQ
* ▫ Good norms (in the USA)
o Large, representative samples
* ▫ Some questions culture bound
* ▫ Use Canadian adaptation!
35
What is The WAIS-IV (Weschler adult Intelligence Scale) ?
* ▫ Ages 16-90
* ▫ See the textbook for a description of subscales
* ▫ High reliability (internal consistency
* ▫ Good validity data
o ▪ Correlates highly with the WAIS-II, so much of the older validity data is still relevant
o ▪ Validity is specific to a purpose, population
* ▫ Canadian normative sample
o ▪ > 1000 adults
o ▪ Representative sample
36
What is the WISC-V?
▫Ages 6-16 (16 years, 11 months)
* ▫ Slightly different subscales (see textbook)
* ▫ Very good reliability (internal consistency), especially for FSIQ
* ▫ Good validity data
o ▪ Correlates with other measures of intelligence
o ▪ Low correlations with EI
* ▫ Canadian normative sample
▪ 1100 children
37
What is the WPPSI-IV?
Ages 2 years 6 months - 7 years 7 months
* ▫ Separate subtests and index scores for different age groups
o ▪ 2y 6m to 3y 11m = verbal comprehension, visual-spatial, and working memory
o ▪ 4y to 7y 7m = verbal comprehension, visual-spatial, fluid reasoning, working memory, processing speed
* ▫ Less emphasis on timed performance, verbal responses
* ▫ Good reliability and validity data, Canadian version available
38
What is the WASI-II?
▫ Ages 6-89
* ▫ Much shorter
* ▫ Provides a good estimate of FSIQ
o ▪ Verbal Comprehension Index (vocabulary, similarities)
o ▪ Perceptual Reasoning Index (block design, matrix reasoning)
* ▫ Use when full WAIS is not possible/necessary
39
How do we measure intelligence in babies?
▫ Difficult to estimate
* ▫ Some tests rely heavily on parent/caregiver reports
* ▫ Traditional tests consist largely of perceptual and motor responses
o ▪ , e.g., Bayley Scales of Infant Development
o ▪ Poor predictors of intelligence during childhood
▫ More relevant for low-scoring infants
▫ Largely used for screening
* ▫ Some focus on habituation-dishabituation
o ▪ e.g., Fagan Test of infant Intelligence
o ▪ Better predictor of childhood IQ
40
What is the Standford-Binet test?
* ▫ Ages 2-85
* ▫ Standardized to mean of 100, SD of 15
* FSIQ and composite factor scores
o Verbal and nonverbal IQ
o Fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, working memory
* Good reliability and validity
* ▫ Good normative data (for the USA only)
* ▫ No Canadian adaptation/norms
Scaled scores go higher and lower than Wechsler scores
- Can be useful for assessing giftedness, intellectual disability
41
What are the Kaufman Scales?
* ▫ Kaufman Assessment Battery for Children
* ▫ Kaufman Adolescent and Adult Intelligence Test
* Process-based, focus on how people learn
* ▫ Subscales quite different from Wechsler
o e.g., sequential processing, simultaneous processing, mental processing composite, achievement
Looks at the gap between achievement and potential
* ▫ Designed to be culturally fair, relevant to educational contexts
* ▫ Not widely use
42
What are Raven's Progressive Matrices?
* ▫ Ages 5.5 up
* ▫ Assesses visual inductive reasoning
* ▫ Standard, color, and advanced versions
* ▫ Good measure of “g”, fluid intelligence
* ▫ Non-verbal, doesn’t require manipulation of objects, minimal verbal instruction
o ▪ Good for people with language, hearing, or motor impairments
o ▪ More culturally fair than Wechsler scales
* ▫ Good reliability, decent validity data, international and local norms available (representativeness unclear)
* ▫ Provides limited information about strengths/weaknesses
43
What is cognitive assessment and why should we do it?
- Assess functioning in specific domains.
o Identify strengths and weaknesses
- Helpful in differential diagnosis, diagnosing neurocognitive disorders
- Helpful in treatment and discharge planning
- Primarily conducted by neuropsychologists
- Helpful to know about tests
- May be more relevant if working with certain populations or in certain settings
o Children
o Older adults
o Health psychology
44
What are neuropsychological assessments?
* Evaluate cognitive and behavioural functioning
* ▫ Integrate with intellectual, diagnostic, and personality assessments, medical findings (including imaging)
▫ Examine the brain by studying its behavioural products
o Specific cognitive deficits may indicate underlying pathology
- May reassess to examine change in functioning over time
- Use specialized tests
o Customize the battery based on the referral question
45
Which domains are assessed during an assessment?
- Orientation (Arousal) ▫ Sensation/Perception
o Attention/Concentration
o Motor Skills
o Verbal Functions/Language
o Visuospatial Organization
o Memory
o Judgment/Problem-Solving
o Symptom Validity Testing
46
Orientation (arousal)
- Assess overall level of consciousness/alertness
o Awareness of self and the world around them
o Relevant to performance
o Can be a symptom of a neurological or psychological problem
- If low, may have difficulty participating in evaluation, intervention, rehabilitation
- Examples:
o Galveston Orientation and Amnesia Test
Assesses confusion and amnesia
Simple questions (e.g., “ what is your name?”, “where are you now?”)
47
how would you assess sensation/ perception?
- Assess sensation (i.e., reception of stimuli) and perception (i.e., understanding what that stimuli is) to rule out problems
o May affect performance on other tests
o May indicate specific neurological problems
o Visual, auditory, and tactile
- Examples:
o Visual field exam
o Distinguish between similar words (e.g., first – thirst)
48
How would you assess attention/ concentration?
- Attention is critical to learning/memory
- Look at sustained attention (paying attention over a prolonged period) and selective attention (paying attention to more than one thing at a time)
- Examples:
o Mental control tasks – involve simple, overlearned information but require an adequate level of attention (e.g., serial sevens)
o Attention span – attend to verbal stimuli and repeat (e.g., digit span)
o Sustained attention (e.g., tap when hearing the number 4)
o Symbol Digit Modalities Test (scanning, visual tracking, sustained attention)
o d2 Test of Attention
49
how would you assess motor skills?
- Assess simple or complex motor skills/motor control
o Gradually more complex, require more integration of cognitive skills
- Examples:
o Gross motor – raise right hand
o Motor speed – touch thumb to forefinger as quickly as you can
o Fine motor – touch your thumb to each finger, one after the other
o Ability to perform and inhibit motor behavior – I clap once, you clap twice, now I clap twice, you clap once
o Graphomotor skills – copy shapes
o Test for motor apraxia by getting them to demonstrate simple skills
o Grip Strength
o Finger Oscillation/Finger Tapping Test
50
How would you assess verbal function/ language?
- Screen for intactness of language
o Ability to understand, expressive language
- Examples:
o Ability to comprehend simple and more complex commands (e.g., turn over the paper, hand me the pen, point to your mouth)
o Ask to define words
o Word and phrase repetition/sentence generation
o Verbal fluency (e.g., name all the animals you can think of)
o Visual naming
o Writing, reading, and spelling
o Token Test (follow commands that relate to tokens)
o Controlled Oral Word Association Test (verbal fluency via naming words that begin within a single letter; C, F, and L)
51
How would you asses visuospatial organization?
- Assess map skills, route finding, spatial integration and decoding, facial recognition
- Examples:
o Directional skills and mazes
o Clock drawing
o Motor-free constructional tasks
o Identify and compare faces, identify emotions
o Visual sequencing (more integration, higher-order processing)
o Bender Gestalt Test
o Rey-Osterrieth Complex Figure Test
52
How would you assess memory?
- Assess encoding (ability to put information into storage), retrieval
o Look for memory defects, memory disorders
- Immediate and delayed, verbal and visual, recall and recognition
- Often multiple trials
- Examples:
o Word lists
o Story recall
o Picture recall
53
what is the Weschler memory scale?
- Assesses episodic declarative memory
- Start with brief cognitive status test, flexible administration of subtests
- Immediate, delayed, visual, and auditory memory index scores
o Subtests described in textbook.
- Standardized to have a mean of 100, SD = 15
- Good reliability, good validity
o Can detect impairment, differentiate between groups
- Normed with the WAIS-IV
o American norms valid for Canadians
54
How would you assess judgement/ problem-solving skills?
- Ability to use abstract reasoning, generalize learning from one situation to another, and insight
- Examples:
o Proverb interpretation (e.g., you can’t judge a book by its cover)
o Similarities/differences or analogies (e.g., how are an eagle and a robin alike)
o Problem-solving tasks (e.g., what should you do if you can’t keep an appointment)
o Detecting absurdities
o Trail Making Test
o Wisconsin Card Sorting Test
o Tower of London
55
what do achievement tests measure?
- Assess academic and problem-solving skills, how much a person has profited from learning and experience compared with others (not potential)
o Most influenced by past educational achievement
- Useful in diagnosing learning differences
o Watch for notable discrepancies between IQ and achievement
- Can use to plan remediation
- Examples:
o Woodcock-Johnson Tests of Achievement
o Wide Range Achievement Test
o Wechsler Individual Achievement Test (WIAT)
56
what is The Wechsler Individual Achievement Test (WIAT) ?
- Canadian version available
- Can be used with Wechsler intelligence scales
o Easy identification of discrepancies
- Four composite scores (map onto main LDs):
o Reading, mathematics, written expression, oral language
o Subtests described in a textbook
o First, see if the individual has had an intervention and if with help it helps the LD or if they are still performing badly with intervention.
- Good reliability and validity
- Definitely use Canadian norms.
PSYC 391 D400: CLINICAL PSYCH
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