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Chapter Three

Assessment and Classification of

Abnormal Behavior

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Reliability

• The degree to which a test yields the same results repeatedly under the same circumstances.– Test-Retest reliability: whether a test yields the same

results for the same person at different points in time.– Internal consistency: whether different parts of the

same time yield similar results.– Interrater reliability: whether different raters or judges

of a test yield the same results


Validity

• Extent to which a test measures what it is intended to measure.– Predictive validity: The ability of a test to predict a person’s

behavior, responses or performance.– Criterion validity: The ability of a test to measure and/or predict

behavior, response or performance on a particularly criterion.– Construct validity: Extent to which a test is related to the

construct it is intended to measure, compared to other established measures of that construct.

– Content validity: Extent to which a test includes items that measure the content the test is intended to measure.

• Standard administration: following common rules and procedures when administering a test; improves reliability and validity.


Assessment of Abnormal Behavior

• Assessment: Process of gathering information and drawing conclusions about the traits, skills, abilities, emotional functioning, and psychological problems of the individual, generally for use in developing a diagnosis Four primary means of assessment:– Observations– Interviews– Psychological Tests and Inventories– Neurological Tests


Observation of Abnormal Behavior

• Naturalistic Observation:– Conducted in a natural setting– Vary in degree of structure– Less structured observations require more interpretation on the

part of the observer• Laboratory (Controlled, Analogue):

– Researchers may give directions or tasks to participants– Vary in degree of structure

• Two areas of caution when conducting observations:– Check the validity of observation against other measures– Try to minimize impact of observer on participant’s behaviors


Interviews

• Involve assessment of verbal and nonverbal behavior, as well as process (how the client communicates) and content (what the client talks about).

• Standardization: common procedures are followed– Formal standardized interview: a checklist of questions, with

scales for rating answers, is given to each client. Examples: • Composite International Diagnostic Interview• Mental Status Exam• Structured Clinical Interview for DSM IV TR

• Errors: The structure and process of the interview, the ability of the client to accurately and subjectively provide information about himself, and the interviewer’s ability to accurately and subjectively record information may introduce errors.


Psychological Tests & Inventories

• Standardized instruments used to assess:– Personality – Maladaptive behavior – Development of social skills – Intellectual abilities – Vocational interests – Cognitive impairment– Personality dynamics & conflicts


Projective Personality Tests

• Test taker is presented with ambiguous stimuli and is asked to respond to them in some way– Rorschach Technique– Thematic Apperception Test (TAT)– Sentence-Completion Test– Draw-a-Person

• Problems: – Reliability – Validity – Subjectivity


Psychological Tests and Inventories

• Psychological Tests and Inventories:– Provide a standard situation to elicit certain types of responses– Allow comparison of individual responses with standardized

norms• Projective Personality Tests: Present the test-taker with

ambiguous stimuli and assume her will project his attitudes, motives and personality in his description.– Rorschach Inkblot Test: developed by Hermann Rorschach,

1921; most used scoring system developed by Exner, 1983)– Thematic Apperception Test: set of ambiguous pictures– Sentence Completion Test: ex: “My ambition….”– Draw a Person Test: and make up a story


Self-Report Inventories

• Test taker answers specific written questions or selects specific responses from a list of alternatives

• Minnesota Multiphasic Personality Inventory (MMPI & MMPI-2)

• Beck Depression Inventory


Self-Report Inventories

• Required test takers to answer specific written questions or select specific answers from a list of alternatives

• Minnesota Multiphasic Personality Inventory (MMPI –2)– Yields ratings on ten clinical scales (used for diagnosis) and ten

validity scales (to measure the client’s honesty, confusion, etc.)– Best interpreted as a unit, rather than as single scales– Assesses both clinical disorders and personality

• Limitations of personality inventories include:– Forces individuals to choose between answers that may not

accurately describe them– Respondents may adopt response “strategies,” such as

responding to similar items in similar ways– May be inaccurate across cultural groups


Figure 3.1: The Ten MMPI-2 Clinical Scales & Sample MMPI-2

Test Items

Adapted from Dahlstrom & Welsh (1965)


Intelligence Tests

• Primary functions:– Obtain Intelligence quotient (IQ), or estimate

of current level of cognitive functioning – Assess intellectual deterioration in psychotic

disorders

• Secondary function:– Provide clinical data

• Wechsler Scales & Stanford-Binet Scales


Criticisms of Intelligence Tests

• Popularized as measuring innate intelligence, actually reflect cultural & social factors

• Predictive validity

• Disagreement over criterion variables

• Miss multidimensional attributes of intelligence


Intelligence Tests

• Functions: to obtain an estimate of the person’s current level of cognitive functioning, to assess intellectual deterioration present in psychotic disorders, and to examine the person’s behavior during the testing event.

• The Wechsler Adult Intelligence Scale (also available in forms appropriate for children 6 to 16 (WISC) and 4 to 6 (WPPSI)) and the Standford Binet Scales are the most commonly used today.

• The Kaufman Assessment Battery for Children (K-ABC) used to evaluate the intelligence and achievement of children 2.5 to 12.5– Used with both general and special populations, as well as with

exceptional children– Less culturally dependent than other intelligence tests


Criticisms of IQ tests

• IQ tests measure cultural and social factors rather than intelligence.– The Bell Curve (Hernstein & Murray, 1994) argued that IQ

scores are determined by heredity, and that “social and status differences between intellectually different classes are therefore difficult to overcome,” (in Sue, Sue & Sue 2003, 83).

• The ability of IQ tests to predict future achievement or behaviors has been questioned.

• Researchers disagree about what future achievements or behaviors IQ scores predict.

• Intelligence may be too multifaceted to be measured thoroughly and accurately by intelligence tests.


Tests for Cognitive Impairment

• Unusual results on intelligence tests may reveal impairments

• The Bender-Gestalt Visual Motor Test involves copying 9 figures (see pg. 85)

• The Halstead-Reitan Neuropsychological Test is used to identify the type and location of brain damage and involves 11 tests of sensorimotor, cognitive, perceptual and attention abilities.

• Luria-Nebraska Neuropsychological Battery: takes less time and is more standardized than the Halstead-Reitan; tests similar abilities to identify the type and location of brain damage.


Figure 3.2: The Nine Bender Designs

Bender (1938)


Neurological Tests

• CAT scan: Computerized Axial Tomography

– Sophisticated X-Ray producing a 3-D picture of the brain

• PET scan: Positron Emission Tomography– Shows which areas of the brain are most actively

metabolizing a radioactive substance– Enables study of the biochemical and physiological

functioning of the brain• MRI: Magnetic Resonance Imaging

– Creates a magnetic field around the brain to produce a clear picture of brain tissues, including blood flow


The Ethics of Assessment

• Issues involve:– Confidentiality of records– Invasion of clients’ privacy– Cultural bias– Unethical testing practices– Accuracy of tests– Whether computer testing is accurate or

ethical


The DSM IV TR

• Consists of 5 Axes (areas a clinician can consider in making a diagnosis)– Axis I – Clinical disorders an other conditions that may be a focus of

clinical attention. Does the client have a clinical disorder? If so, which one(s)?

– Axis II – Personality disorders and mental retardation. Does the client have a personality disorder or some form of mental retardation? If so, which one?

– Axis III – General medical conditions. Does the client have a medical condition that could be relevant to treatment?

– Axis IV - Psychosocial and environmental problems. Are there (or have there been) any psychosocial or environmental conditions that could be a focus of treatment?

– Axis V - Global Assessment of Functioning. What is the client’s current level of functioning? Based on severity and degree of impairment; scale of 0-100.


Figure 3.3: Lifetime & One-Year Prevalence Rates for Mental Disorders

Data from Robins, Locke & Regier (1991)


Evaluation of DSM Classification System

• DSM-IV-TR has stronger reliability & validity than previous editions

• Criticisms:– Strong medical orientation rather than social &

interpersonal– Distinctions in some disorders overlook

difference in degree of severity– Question usefulness for research

• Objections to classification & labeling


Checkpoint Review

• How are mental health problems categorized or classified?

• What are some criticisms of the classification system?


Evaluation of the DSM Classification System

• Some question its reliability and validity• Some feel the DSM is too biologically and medically

oriented, considered more than half the included disorders have no known or presumed organic cause.

• Some argue that political and practical factors affect the DSM

• Some argue that diagnostic categories are less useful than study of symptoms or dimensions of symptoms.

• However, although there are alternatives to the DSM, the widespread use of the DSM makes it convenient and useful.


Potential Dangers of Labeling

• Diagnostic labels place people in a category of abnormal, which implies they are qualitatively different than “normal” individuals.

• A label can encourage others to interpret the person as pathological

• A label can cause others to treat the person differently• A label can become a self-fulfilling prophecy• A label may prevent the client and clinician from finding

more helpful, comprehensive information about the client

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