Chapter 3 Assessing and Diagnosing Abnormality. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 3 2 Assessment: the process

Chapter 3

Assessing and Diagnosing Abnormality

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 32

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 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 Behavior Observation

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

Axis I Clinical disorders

Axis IIPersonality disorders

Mental retardation

Axis IIIGeneral medical conditions

Axis IVPsychosocial and

environmental problems

Axis VGlobal assessment of

functioning


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

Documents

Chapter 3 Assessing and Diagnosing Abnormality. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 3 2 Assessment: the process