CLINICAL VS. BEHAVIOR ASSESSMENT

Assessment  Procedures  

Informal  Tes3ng  

Ability  Tes3ng  

The  Clinical  Interview  

Personality  Tes3ng  

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Defining Clinical Assessment

• The process of assessing the client through multiple methods, including:

•  the clinical interview (see Chapter 12)

•  the administration of informal assessment techniques (Chapter 10), and

•  the administration of objective and projective tests (this chapter)

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Defining Clinical Assessment (Cont’d) •  Clinical assessment can do the following:

•  Helps client gain greater insight

•  Aid in case conceptualization and diagnostic formulations

•  Assist in the decision-making concerning psychotropic medications

•  Assist in treatment planning

•  Assist in court decisions (e.g., custody decisions; testing a defendant in a child molestation case)

Defining Clinical Assessment (Cont.) • Assist in job placement decisions (e.g., high security jobs)

• Aid in diagnostic decisions for health related problems (e.g., Alzheimer’s)

• Identify individuals at risk (e.g., to identify students at risk for suicide or students with low self-esteem)

OVERVIEW OF BEHAVIORAL ASSESSMENT

Focus: Standardized Assessments

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Objective Personality Testing

• Definition: A type of personality assessment that uses paper-and-pencil tests, often in multiple-choice or true/false formats, to assess various aspects of personality

•  Each objective personality test measures different aspects of personality based on the specific constructs defined by the test developer

Behavior Assessment . . . • Places an emphasis on what the examinee does. Many other forms of assessment emphasize what the examinee has: attributes, traits, character, etc. . .

• Feelings, thoughts, and other covert activities are behavior, even though you cannot observe them directly

What is Behavior Assessment? • A paradigm

• A way of thinking about and, • Using assessment data

• Yields hypothesis about people and their environments

• Stresses hypothesis about behavior itself

Behavior Assessment (Cont.) • Stresses person-environment interactions leadind fairly

directly to intervention

• Multi-method and multimodal approaches to gather information about the existence and frequencies of behavior in multiple settings

Behavior Assessment

• Person-environment Interactions • Stresses that behaviors or conditions are a result of the interaction

Methods of Standardized Behavioral Assessment

• “Helper” Ratings • Self Report Inventories • Behavior Rating Scales • Direct Observation and Recording • Psychophysiological Assessment

Self-Reports • Relies on an individual’s responses to a set of standardized questions

• Objective scoring system and a normative reference group

• Quantifies reports of cognitions, attitudes, feelings and behavior

Self-Report –Cont.

• Particularly important in diagnosing anxiety disorders, depression and other conditions with a strong internal component

• Have a broad and narrow concepts • “Omnibus” vs. “narrow”

COMMON “OBJECTIVE” MEASURES

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Common Objective Personality Tests

• Many of the tests we will examine were identified as one of the most frequently used tests (see Table 1, p. 106, Intro to Section III).

•  For a list of the tests reviewed in the book , and their general purpose see Table 9.1, p. 188

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(MMPI-2) Minnesota Multiphasic Personality Inventory - 2

• Most widely used personality test • Developed in 1942, revised in 1989 •  90 minutes to take the 567 items •  Interpretation requires grad testing and psychopathology courses

•  Provides six validity scales, ten basic (clinical) scales, and fifteen content scales

• Most commonly used scales: 3 validity scales and ten basic scales (Figures 9.1 and Table 9.2, pp. 189-190)

•  Adolescent version also exists: MMPI-A •  Important to understand the meaning of each scale

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MMPI-2 (Cont’d)

•  A high L (Lie) score: Not necessarily lying; means client has trouble admitting faults--makes test suspect

•  Basic Scales useful in diagnosis and treatment planning •  Patterns of responses, as opposed to specific scales, often

used in making decisions •  “Clinical significance” is a T score of 65 or greater. •  The Content Scales:

•  15 specific traits such as anxiety, fears, anger, cynicism, low self-esteem

•  useful in creating more detailed perspective •  Reliability estimates on different scales: .37 to .92 •  High intercorrelations among some scales (shared items?)

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(MCMI-III) Millon Clinical Multiaxial Inventory (3rd ed.)

•  Second most used objective personality test •  Designed to assess DSM-IV-TR personality disorders and

clinical symptomatology (axis II) •  Adolescent version also exists •  175 true/false items take 25 minutes •  Has six different major scales (Table 9.3, p. 192)

•  Clinical Personality Pattern Scales •  Severe Personality Pathology Scales •  Clinical Syndrome Scales •  Severe Clinical Syndrome Scales •  Modifying Indices •  Validity Index

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MCMI-III (Cont’d)

• Uses Base Rate (BR): Converts raw score to a more meaningful standardized score •  Sets median for non-psychiatric individuals at 35, and 60 for

psychiatric population. •  A BR of 75 indicates that some of the features are present

while a BR of 85 indicates that the trait is clearly present

• Reliability ranges from .67 to .90 •  Scales have been correlated with several other scales such as the MMPI and the BDI

• Other studies demonstrated predictive validity for the instrument with DSM-IV-TR diagnoses

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PAI Personality Assessment Inventory

•  Aids in making clinical diagnoses, screening for psychopathology, and assist in treatment planning

•  18 and older

•  344 items; 50-60 minutes

•  4-point ordinal scale: false, slightly true, mainly true, very true

• Hand scored, computer scored, or sent in

•  4 validity scales, 11 clinical scales, 5 treatment sclaes, 2 interpersonal scales

•  T-scores (see Table 9.4, p. 194)

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PAI (Cont’d)

• Reliability: Most scales show descent reliability estimates •  Exceptions to reliability: Inconsistency and Infrequency scales—low

• Numerous studies seem to show concurrent validity on a number of the scales

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(BDI-II) The Beck Depression Inventory - II •  BDI-II developed in 1996 •  21 questions on 0 to 3 scale, 10 minutes •  If 2 or 3 on items 2 (hopelessness) and 9 (suicidal ideation)—red flag

•  Cut-off scores to measure depression (see Table 9.5, p. 194)

•  Scores related to groups of depressed and non-depressed individuals

• High reliability estimates (in .90s) •  Convergent validity with original BDI and discriminant validity with other disorders

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(MBTI) Myers-Briggs Type Indicator

• Most widely used personality assessment for normal functioning (for adolescent through adults)

•  Based on Jung’s work, following characteristics were derived: extroverted or introverted, sensing or intuiting, thinking or feeling.

• Myers and Briggs added judging or perceiving •  See Figures 9.2 and 9.3 (pp. 196 and 197) •  Evidence for validity of separate scales, but weaker for synergistic combination of four scales

•  90% of people agree with the results

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(16PF) 16 Personality Factors Questionnaire

•  Based on Raymond Cattell’s 16 primary personality components

• Not pathology, describes human behavior •  185 items, 45 minutes •  16 Primary Factors on bipolar scale (see Table 9.6, p. 198) •  Uses sten scores (average: 4-7) •  1-3 left of bipolar scale, 8-10 right of bipolar scale

•  5 Global Factors are combinations of the primary factors (see Table 9.7, p. 199)

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16PF (Cont’d)

•  3 Validity Scales •  Impression management: measures social desirability and faking

good (high score) or faking bad (low score) •  Infrequency scale: responding unusually (problems with reading

comprehension, random responding, or making “right” impression •  Acquiescence: random responding, misunderstanding items,

difficulty evaluating self •  Reliability: ranges from .60s to mid .80s •  Validity: Factor analysis confirms items •  Validity: Convergent and other validity shown

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Big Five Personality Traits and the NEO-PI-R & NEO-FFI

• Research by Thurstone and many others suggest a five-factor model of personality •  Openness, Conscientiousness, Extraversion, Agreeableness,

Neuroticism (see pp. 199-200)

• NEO Personality Inventory measures these 5 factors each of which has 6 facets (see Table 9.8, p. 201) •  240 items, 17 years and older •  5 point Likert-type scale: strongly disagree to strongly agree •  Uses T-Scores •  Narrative describing personality style

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Big Five Personality Traits and the NEO-PI-RI & NEO-FFI

• NEO PI-R •  Reliability: high for five factors, .56-.90 for facets •  Much convergent, discriminant, and concurrent validity over a

number of different studies

• NEO-FFI: Shortened version •  60 items •  15 minutes •  Test worthiness lowered due to the fact that it’s a shorter version

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(SEI) Coopersmith Self-Esteem Inventory •  Measures self-esteem for children 8 – 15, in four areas:

1. general self (24 items) 2. self in relation to peers (8 items) 3. self in relation to parents (8 items) 4. self in relation to school (8 items)

•  Total score: Multiply by two the total number of positive self-esteem items chosen by the child.

•  Reliability: 87 to .90, but information dates back to early 1970s •  Validity studies are dated and some are questionable •  Given to students in many settings--broad ethnic comparisons •  Generally, mean scores ranged from the mid-50s to the

mid-70s, and standard deviations were between 12 and 20

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(SASSI) Substance Abuse Subtle Screening Inventory

•  Two versions: Adult & Adolescent (SASSI-3 & SASSI-A2) •  Suggests substance dependency with 93+% accuracy •  SASSI-3

•  30 minutes to take, 5 to score •  1st section: 67 “subtle” T/F items •  2nd section: 26 “overt” alcohol and other drugs related

questions rated on 4-point scale •  Nine subscales: face valid alcohol, face valid other drugs,

symptoms, obvious attributes, subtle attributes, defensiveness, supplemental addiction scale, family vs. controls, and correctional

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SASSI (Cont’d)

" SASSI-3

n Patterns of subscale responding helps in diagnosis, treatment planning, and validity of responses

n Reliability

w Particularly high for overall instrument (.93)

w Test-retest over two weeks ranges from .92-.100

n Validity: Criterion-related: Correlates with DSM-IV diagnoses

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Other Common Objective Personality Tests • There are dozens of common objective personality tests. Naming just a couple more: •  Taylor-Johnson Temperament Analysis

•  Assesses personality variables that effect social, family, marital, work, and other environments

•  The Marital Satisfaction Inventory

•  Assesses the severity and nature of conflict in a relationship

Measures for Children • Children’s Manifest Anxiety Scale (RCMAS or MAS)

• Achenbach Multi-axial System • Behavior Assessment Scale for Children (self-report)

Youth Self-Report (YSR) • Beck –Youth Version

DIRECT OBSERVATION

Direct Observation • Behavior is observed in a natural setting • Behavior is recorded or coded as it occurs • Impartial, objective observers record behavior

• Behavior is described in clear, crisp terms, requiring little or no inference by the observer

Psycho-physiological Assessment • Direct recording of physiologic changes in the body

•  Heart rate •  Brain activity

•  Involves some sort of equipment • Research base is growing Applications: • Stress • Anxiety • Seizure disorders • PTSD

Important Points • Convergence of data/procedures • Develop a process for evaluating behavior assessments • Read the manual • What type of assessment? Self-report? What is the theoretical orientation of the assessment?

• Examine the indexes/scales • What are they? How are they defined?

• How closely does it match diagnostic criteria?

Important Points (cont.) • How easy is it to give? How intrusive? • Read the independent reviews (MMYB) • Give it to a ‘normal’ subject first to see how it works . . .

• Examine the normative sample • Make sure you understand: how its given and scored!

FYI

Objective Personality/Behavior Assessment as an industry . . . .

$400 million per year