Psychological Assessment concepts

Overview

• Assessments, reliability and validity plus the DSM are key topics
• Clinical interviews, psychological tests, behavioural assessments and neuropsychological and neuroimaging assessments will be reviewed

Assessing Mental Health Disorders

• The approach to assessment depends on the theoretical orientation of the psychologist

Theoretical orientations:

• Cognitive (31%)
• Eclectic-integrative (22%)
• Psychodynamic (18%)
• Behavioral (15%)
• Humanistic (4%)

Reliability and Validity

• Reliability refers to the consistency of measurement
• Inter-rater reliability is the degree to which two independent observers or judges agree
• Test-retest reliability measures the extent to which people being observed twice or taking the same test twice score in generally the same way
• Alternate-form reliability uses two forms of a test
• Internal Consistency Reliability assesses if the items on a test are related to one another
• Validity refers to whether a measure fulfills its intended purpose
• Content validity refers to whether a measure adequately samples the domain of interest
• Criterion validity is evaluated by determining whether a measure is associated in an expected way with some other measure (the criterion)
• Construct validity is a test or measure of some characteristic or construct that is not simply defined (Cronbach & Meehl, 1955)

Psychological Assessment

• Psychological assessment techniques determine cognitive, emotional, personality, and behavioral factors in psychopathological functioning

Kinds of Psychological Assessments

• Clinical interviews
• Psychological tests
• Projective tests
• Personality tests
• Intelligence tests
• Behavioral Assessment Techniques
• Biological Assessments

Clinical Interviews

• Clinical Interviews are the most common method, requiring skill and empathy to establish rapport
• Unstructured Clinical Interviews demonstrate spontaneity and conversational style
• (Semi) Structured Clinical Interviews use questions set out in a prescribed fashion to collect standardized information (Ex. DSM-5 diagnoses)
• With adequate training of clinicians, inter-rater reliability for structured interviews is generally good (Blanchard & Brown, 1998)
• The Clinical Interview includes identifying data, description of the presenting problem(s), psychosocial history, medical/psychiatric history and medical problems/medication

Psychological Tests

• Provides a structured method of assessment
• Usually standardized on large numbers of subjects
• Compares results from people who are free of psychological disorders with those who have diagnosable psychological disorders to understand response patterns indicative of abnormal behavior.

Projective Tests

• Ambiguous stimuli onto are used to project the examinee's personality and unconscious motives
• These indirect methods of assessment may offer clues to unconscious processes
• The Rorschach Test was developed by Swiss psychiatrist, Hermann Rorschach (1884-1922)
• Clinicians form interpretations based on the content and the form of the responses using of 10 inkblots, shown one by one, looking at themes, images, style of responses
• The Thematic Apperception Test (TAT) describe what is happening in each scene, what led up to it, what the characters are thinking and feeling, and what will happen next
• Evaluations include reliability and validity, but with skill, they can provide meaningful results and might reduce socially desirable responses

Minnesota Multiphasic Personality Inventory (MMPI)

• Self-report questionnaires assess habitual tendencies
• Individual scales comprise of items that tend to be answered differently by members diagnostic groups
• For instance, those diagnosed with schizophrenia or depression are compared to members of reference groups
• 10 scale scores considered together generate a profile from 0 to 120
• Evaluations include well researched assessments that are simple to administer, and are reliable and valid better than projective tests
• Can get additional information from clients, are only as valid as the criteria that were used to validate them which may have cultural limitations and response bias
• The information provided does not necessarily change how a client will be treated and may not improve their outcome

Intelligence Tests

• Alfred Binet (1857–1911) and Theodore Simon developed that first formal intelligence test
• Mental Age (MA) represents the child's overall level of intellectual functioning using an Intelligence Quotient (IQ)
• Intelligence is relevant in some types of abnormal behavior
• They are Widely used, standardized, with reliability and validity
• Evaluations: non-related factors can influence test performance and an analysis in accordance to norms that are applicable to their geographical, cultural, and racial backgrounds must be applied
• The definition of “intelligence" must be a consideration

Behavioral Assessments

• Direct observation formally assesses an individual's thoughts, feelings, and behavior in specific situations
• It helps to get a more accurate picture of the behavior
• Considerations must be made to how you operationally define a behavior and observer response bias and if the behavior of interest might not happen
• Types:
• Naturalistic settings
• Analogue/similar setting
• Self-Monitoring

Psychophysiological Assessment

• Measures changes in the nervous system that reflect emotional or psychological events; taken directly from brain or other parts of the body
• Electroencephalogram (EEG) measures brain activity using electrodes placed on the scalp record electrical activity in the underlying brain area
• Abnormal patterns of electrical activity can help with assessment
• Electrocardiogram (ECG) measures heart rate using each heartbeat which generates spreading changes in electrical potential, which can be recorded by an electrocardiograph, or polygraph. Electrodes are usually placed on the chest
• Electro-dermal Responding uses Autonomic nervous system activity or skin conductance
• Anxiety, fear, anger, and other emotions increase activity in the sympathetic nervous system, boosting sweat-gland activity, measured determining the current that flows through the skin using electrodes on the hand
• Evaluations: useful in the identification of some disorders, in assessment of responses to emotional stimuli and biofeedback treatment, though equipment is expensive and they are be inaccurate and unreliable

Neuroimaging Assessments

• Brain structure and function are assessed using:
• Brain Structure Images include: CAT scan and MRI
• Brain Function Images: PET scan & fMRI

Neuroimaging – Brain Structure

• Computerized tomography (CT) scan aimes an X-ray beam at the head
• Resultant radiation is measured from multiple angles as it passes through, creating a three dimensional image of the brain
• Can reveal structural abnormalities in the brain
• Magnetic resonance imaging (MRI) does not require radiation and has provides higher quality images
• Person placed inside a large, circular magnet, that causes the hydrogen atoms in the body to move
• When the magnetic force is turned off, the atoms return to their original positions and thereby produce an electromagnetic signal, translated into brain tissue imagery

Neuroimaging – Brain Function

• Positron Emission Tomography (PET) scan uses a substance labeled with a short-lived radioactive isotope and injected injected into the bloodstream, emitting a positron that collides with an electron
• High-energy light particles shoot out from the skull in opposite directions and are detected by the scanner
• A computer analyzes recordings and converts them into a picture of the functioning brain depicting metabolic rates on the image
• Functional Magnetic Resonance Imaging (fMRI) determine parts of the brain that are activated during particular tasks
• Areas depicted in red become activated when a person thinks about performing certain gestures, such as using a hammer or writing with a pen, and when the person actually performs these gestures

Diagnosis and the DSM

• Classification & Diagnosis of Psychological Disorders help to more clearly define problems, provide a basis for communication and advancing scientific understandings.
• It is the first step to deciding on treatment
• Key concepts include diagnosis, classification, epidemiology, prevalence and comorbidity
• Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association:
  • The first DSM was published in 1952
  • DSM-III (1980) introduced multi-axial classifications
  • DSM-IV (1994) Dr. Allen Frances chaired the working group task force
  • DSM-5 (2013) introduces changes including elimination of multi-axial system
  • DSM-5-TR (2022) introduced various changes to the DSM-5-TR with goals to Address gaps in diagnoses, update criteria based on new research knowledge, reduce generic classifications and streamline/simplify diagnoses
• The DSM is descriptive of diagnostic features, and does not attempt to explain their origins or adopt any particular theoretical framework

Culture and Diagnosis

• Early editions of DSM were criticized for lack of consideration of culture and ethnicity
• DSM-IV-TR introduced culture-bound syndromes, patterns of abnormal behavior found within only one or a few cultures
• DSM-5 elaborated four specific themes to be considered in making cultural formulation:
  • Cultural identity
  • Cultural consideration of distress
  • Cultural features of vulnerability and resilience
  • Cultural features of the relationship between clinician and patient

Advantages and Disadvantages of the DSM System

• Advantages: designation of specific diagnostic criteria and prototypical approach helps matching a client's complaints and associated features with specific standards
• Disadvantages: premature or inaccurate assumptions, too many disorders and the risk of over-medicalization can occur, as well as the risk of stereotypes & labels

Questions covering key concepts in psychological assessment. Topics include clinical interviews, reliability, validity, and theoretical orientations, with a focus on understanding behavior through various assessment methods.