Chapter 3 - Assessment & Diagnosis

• Classification = ordering & grouping

Advantages of Classification

• Means of communication

• Labels help to condense & order info

• To guide treatment strategies

• To facilitate research

• Etiology & progression of disorder

Disadvantages of Classification

• Self-fulfilling prophecies & stigma

- Rosenhan (1973)

- Pygmalion in the classroom (“bloomers”)

• Overlooking other important problems

- aspects not typical of a diagnosis

e.g., CD & depression

Disadvantages, cont.

• Automatically label those who seek help

• Focus on weaknesses vs. strengths

• Categories = less individual information

DSM-IV-TR

• The most widely used system

• Pros

- reliable

- based on research (validity)

- communication

- atheoretical

- multiaxial

DSM axes

I. Clinical disorders

II Personality/enduring problems

III. Medical problems

IV. Environment/psychosocial

V. Global assessment

DSM Cons• Disorders created by committee• Labels => stigma• Culture-bound• No treatment suggestions• No causes• Focus on problems• Most axes rarely used-> reduces person to one disorder

Reliability & Validity

Reliability - consistency

1. Internal consistency

- over all the items

2. Test-retest reliability

- over time

3. Interrater reliability

- over raters

Validity - test measures what it purports to1. Content - covers much of the trait2. Concurrent - correlates with other

measures of the trait3. Predictive - predicts other measures of

the trait{Concurrent & Predictive are both criterion}

4. Construct - test supports theory5. Face - looks like what it measures

Interviews Clinical interview

• First step

• Talk to client

• Not reliable across examiners

• Valid

• Good for rapport

• Nonverbal behavior

• Structured Interviews - decision trees

- for diagnosis

• Mental Status Exam - brief measure ofcognitive functioning

Intelligence Tests

Reasons to use

• Mental abilities affect other problems?

• Strengths & weaknesses

• General functioning

Problems

• Cultural bias

• IQ = small part of intelligence

Personality Tests

Objective & Projective

Objective Tests

• unambiguous

• reliably interpreted

• usually self-report

Multi-Trait Scales

MMPI - 567 items

• normed on psychiatric patients

• items distinguished patient groups

• 10 clinical scales & 3 validity scales

• patterns suggest disorders & malingering

Other multi-trait scales

• MCMI (personality disorders)

• Child Behavior Checklist

• Strong Vocational Interest Test

Single-trait self-report scales

• Many scales

ex. BDI

• Face-valid

• Good reliability & validity

Projective Tests • Ambiguous stimuli

-> responses reflect person• “Project” psyche onto stimuli• Given by trained person• Interpretations differ (? reliability)• ?Validity• Difficult to research• Used for getting ideas

Rorschach Inkblot Test

• Scoring system (reliability)

• More validity research

• Good for psychosis

Thematic Apperception Test -TAT

• Ambiguous scenes

• Pattern of responses

• Scoring system seldom used

• Not reliable (subjective)

• Suggests ideas

Incomplete Sentence Blank

Neuropsychological Tests

• Brain damage & deterioration

• Measures cognitive processes perception, memory, attention

• Includes IQ testing

Behavioral Assessment

Focus on problem behavior

• Antecedent conditions

• Problem description

• Person’s response

• Result of response

Leads to treatment

• Self-rating

- person monitors own behavior

• Analogue Measures

- simulate the problem in clinic/laboratory