Clinical Testing Notes PDF

612 clinical testing notes introduction 1. multiple sources of data for intensive study of individual cases (interviewing and case history to build an integrated picture of individual; safeguard from gener...

612 clinical testing notes introduction 1. multiple sources of data for intensive study of individual cases (interviewing and case history to build an integrated picture of individual; safeguard from generalization of isolated test scores.) 2. that also explains continued use of tests w bad psychometric properties because they have stuff to back it up. also why experiences clinician needed because they know how to deal with it 3. good clinical psychologists focus on hypothesis formation and testing and treat each information (past event, a comment, test score) as something that will confirm or deny the hypothesis. this is why clinicians are more receptive to psychometrically crude tests. diagnostic use of intelligence tests pattern analysis of test scores 1. other than using intelligence tests for assessment of general intellectual functioning, pattern/profile of test scores may also indicate psychopathology. 2. not all psychological issues affect all brain functioning → e.g. neurotic anxiety may impair functioning on certain tests while leaving performance on others unimpaired. 3. Wechsler scales are good for profile analyses cus subtest scored are expressed in directly comparable standard scores 4. Wechsler described diagnostic uses of his scales too. 3 specific major procedures: 1) scatter (extent of variation among individual’s scores on all subtests) 2) deterioration index (difference between “hold” tests, ones that are resistant from pathology or old age and “don’t hold” 612 clinical testing notes 1  tests, ones that are susceptible to decline) 3) score patterns associated with a specific syndrome like schizophrenia, anxiety etc. 5. add from mariam qualitative observations 1. individual intelligence test → objective information in form of IQ scores with high reliability and validity → less objective, semi-quantitative pattern analysis. → qualitative level as irregularities of performance are scored. each subtest have interpretative framework with data summaries and discussion of data clinical got w.r.t both intellectual and personal characteristics. 2. diagnostic tests cannot be employed routinely since they are not applicable to all individual cases and need to be interpreted in light other information. also they’re idiosyncratic meaning unique 3. tests responses may also give important information. (e.g. overelaboration & a lot of self-reference being indicators of personality disorders). analysis of errors and correct responses → problem solving approaches, conceptual development. general behavior in testing situation(motor, speech, emotionality) Neuropsychological tests neuropsychological tests 1. instruments especially for measuring organicity or brain damage. detect impairment from multiple causes, for qualitative observations, some with standardized procedures and norms, some not, some with empirical data. mainly based in gestalt psych 2. memory. spatial relation (hand motor co-ordination, time etc.) and abstraction/concept formation are biggest indicators of impairment 612 clinical testing notes 2  3. a lot of impact on how early the diagnosis is made. Benton Visual Retention test: 10 cards with 1/+ simple geometric figures. each card shown 10 seconds & client draws it immediately. Requires spatial perception, immediate recall and visuomotor reproduction. - scoring: correct no. of reproductions and no. of errors (more info can be seen from the types of errors). falling below a certain no. of points = clinically significant - high interscorer reliability (.95) - 3 equivalent forms of 10 drawings (.80s) - a perception problem can be as small as dots not connecting - interpretation: comparing with “normal” score for given age/intel level - corroborative information needed with history Bender Visual Motor Gestalt test: detection of brain damage. 9 simple designs shown one at a time to be copied - drawing errors that were significantly different between normal and abnormal samples was used to make kind of an objective scoring key - scorer reliability of.90. normative sample is restricted - performance of this test is significantly related to amt of education and not with drawing ability. - elaborate testing conditions (putting eraser on board and not handing it) - under 10 year old, it can also predict intelligence methodological problems in diagnosis of brain damage 1. Kurt Goldstein: intellectual impairment symptoms described by him: diminution in abstract thought ability & tendency to respond to irrelevant stimuli that disrupt normal perception. so like. psychotic symptoms? 2. brain injured child: for children, the same adult syndrome pattern for those kids who experienced brain injury due to trauma or infection before, during or right after birth. it clarified a pattern of intellectual and emotional disorders 3. Reitan research: left hemisphere lesions → lower verbal score on Wechsler. vice versa for other + in the group that had lesions in both hemispheres 612 clinical testing notes 3  4. varying behavioral effects with respect to: age (preschoolers had impairment in all cognitive functions), learning and intellectual development prior to injury. issues in language development or attention cause issues in acquisition of other abilities. intellectual impairment may be an indirect result of brain damage. e.g. personality disorders being caused due to frustrations and interpersonal difficulties as a result of brain damage. chronicity (amt of time passed since injury causing more physiological changes or behavioral recovery through compensatory adjustments) 5. cerebral palsy (indirect effect) if lesions spread to cortical areas→ motor/intellectual deficits. usually the lesions stay in subcortical areas → motor handicaps. if severe then it interferes in development of reading/writing and motor activities. now the cause of intellectual retardation is caused by educational and social handicaps. (special education is helpful) 6. history is important because same disorders (same diagnostic test performance) in one person may be due to brain damage and experiential to another. neuropsychological batteries 1. flexible battery approach: combination of tests for assessing skills and deficits, tailored to presenting problems. limitations: duplications of functions and critical areas being overlooked, not comparable with regards to norms and score scales, lack of empirical data on interrelations. 2. neuropsychological batteries: measuring all significant neuropsychological skills, identifying and localizing impaired areas, differentiation among cerebral issues, helpful in rehab planning by revealing information regarding behavioral deficits. 3. Halstead-Reitan Neuropsychological Test Battery (HRB): developed by Reitan from Halstead’s work. takes like 6/+hours, flexibility in number and selection for tests to be administered. most use 11 for sensorimotor and perceptual tests and aphasia test. There’s also category test (deduce 612 clinical testing notes 4  general principals from info on slides) and trail making test (connect numbered dots). it also includes WAIS and MMPI in battery 4. Luria-Nebraska Neuropsychological Battery (LNNB): includes Luria’s theories and diagnostic procedures, takes about 2.5 hours on average. plus points: - providing fuller coverage of possible neurological deficits - specific-er identification of behavior deficits and precise-er localization of damaged areas. - more standardized in content, materials, administration (takes less time too) and scoring. - has no tests but has items added for their qualitative importance in diagnosis. - form 1 has 269 items - limitation: standardized version is too recent, so cross-validation of new empirically derived diagnostic scores is needed. Identifying specific learning disabilities problem learning changed behavior throughs practice 1. diagnosis of LD should happen only after removing educational and psychological deficits from the equation 2. LD specialists dgaf about etiology of LDs, they just want to know the specific pattern of behavioral disabilities to plan a program of remedial instructions, however knowing underlying causes can help us in diagnosis and enhance effectiveness of treatment program 3. children w LDs usually have above/normal intelligence + significant difficulty in learning 1/+ educational skills + associated behavioral symptoms (perceptual disorders of senses and poor integration from different sensory modalities → disruption of sensorimotor coordination) + deficiencies in memory, attention control and conceptual skills. 4. Aphasia: language disorder affecting language. receptive aphasia (inability to understand language) & expressive aphasia (issues in using language 612 clinical testing notes 5  meaningfully). - developmental aphasia (ability to use language not acquired in the first place) includes motor incoordination, temporal and spatial disorientation, difficulties in organizing activities and planning, impulsive hyperactivity. Can also cause aggression and other interpersonal problems as a result of daily life difficulties 5. Difficulties are ok at an early age but problem arises if issue persists with age, that’s why a developmental frame of reference is needed. assessment techniques 1. issues that arise in diagnosing LDs: (1) behavioral disorders associated with this condition. (2) individual differences in particular combination of symptoms (3) need for highly specific information regarding nature and extent of disabilities in each case 2. teachers can administer screening tests in classrooms. e.g., Slingerland’s Screening Test for Identifying Children with Specific Language Disability (8 test group battery), Myklebust’s Pupil Rating Scale (classroom observations). 3. regular achievement batteries with same purpose of focus on strengths and weakness through criterion-referenced analyses: Stanford Early Achievement Test (SESAT), Metropolitan Readiness Tests and CIRCUS. 4. Individual intelligence tests like SB, WISC, WPPSI and McCarthy scales give a global index for differentiation between MR but also give qualitative information regarding specific deficiencies (perception and recall of visual patterns, in copying forms, memory issues, language disorders etc.) However they need to be scored/interpreted by professionals 5. Tests for learning disabilities should not considered as psychometric instruments but should act as observational aid. They also have no norms because at most, they define the “normal”. they’re criterion-referenced tests cus they describe child deficiencies in specific terms 612 clinical testing notes 6  6. Illinois Test of Psycholinguistic Abilities (ITPA): 2to 10 years. based on Osgood’s model of communication process, it follows a 3D model of 1. channels: auditory-vocal, visual-motor 2. processes: receptive, organizing, expressive 3. levels: representational, automatic abilities are basically just an intersection of these (Grammatic Closure Test (auditory-vocal channel, organizing process, automatic level) limitation: culturally restricted + only for middle SES 7. Kaufman Test of Educational Achievement (K-TEA): some batteries are about aptitude, some about achievement. individually adminstered but can be done by a teacher dynamic assessment 1. use of a wide range of strategies from standardized tests to qualitative assessment for identification of learning problems, also helpful in developing interventions. 2. learning potential assessment: measuring capacity to learn an ability. first, individual is taught a task or how to solve a problem then tested. this tells us the capacity for generalization to other tasks 3. Reuven Feuerstein: lack of tools that help children with knowledge (cultural deprivation) are what causes cognitive (learning) difficulties. and that these kids can improve if given proper instruments too. this approach to intervention is used commonly today Behavior assessment nature of behavior modification 1. primary aim is problem behaviors and their remedy. 3 step process: 1) identification of target behavior 2) selection of treatment objectives & proper interventions 3) assessment of change in behavior assessment techniques 612 clinical testing notes 7  1. self reports: checklists, inventories, self-monitoring. Beck Depression Inventory, Behavior Assessment System for Children recording classroom behavior, Social Skills Rating System for classroom and family setting behavior 2. observations: parents, teachers, remedial staff, in either naturalistic or analogue setting like roleplay. these act as both objective and qualitative info 3. physiological measures: neuropsychological, cardiovascular, sexual functioning tests. however they may be inaccessible so they act as supplementary information evaluation Clinical judgment clinical judgment 1. use of experience and skills to interpret client’s behavior (contrast to objective methods using stats and tests). assessment of personality and behavior cannot be done in idiosyncratic manner through stats that draw generalizations 2. limitations: susceptible to bias (cultural etc.) to counter this, clinical and stats methods are used together for validation of each other Computerized clinical assessment computerized clinical assessment 612 clinical testing notes 8