Assessment & Diagnosis

9/27/09 PSYC 3553 – Psychopathology Week 4: Assessment and Diagnosis • September 29, 2009 1 What is assessment? •  Goals of clinical assessment: •  How and why a person is behaving abnormally •  How that person may be helped •  Also may be used to evaluate treatment progress •  Focus is idiographic – on an individual person Characteristics of Assessment Tools •  Standardization •  A test is administered to a large group, and their performance serves as a common standard (norm) against which individual scores are judged •  The “standardization sample” must be representative •  One must standardize administration, scoring, and interpretation 1 9/27/09 Characteristics of Assessment Tools •  Reliability: The consistency of a test •  Test–retest reliability •  Interrater reliability •  Validity: the accuracy of the test results •  Face validity •  Predictive validity •  Concurrent validity Are Classifications Reliable and Valid? •  Reliability: different diagnosticians agreeing on diagnosis using same classification system •  DSM-IV: greater reliability than previous editions •  Used field trials to increase reliability •  Validity: accuracy of information diagnostic categories provide •  DSM-IV has greater validity than any previous edition •  Conducted extensive lit reviews and field studies I. Clinical Interviews •  Face-to-face encounters •  Often the first contact between a client and a therapist/assessor •  Used to collect detailed information, especially personal history, about a client •  Allow the interviewer to focus on whatever topics they consider most important 2 9/27/09 II. Psychological Tests • Six categories of psychological tests 1.  Projective tests 2.  Personality Inventories 3.  Response Inventories 4.  Psychophysiological Tests 5.  Neurological/neuropsychological Tests 6.  Intelligence Tests II. Psychological Tests   Projective tests: Interpret characteristics onto vague & ambiguous stimuli or follow open-ended instruction •  Strengths and weaknesses: • Helpful for providing “supplementary” information • Rarely demonstrated much reliability or validity • May be biased against minority ethnic groups Example: The Rorschach Inkblot 3 9/27/09 Example: Thematic Apperception Test Example: Sentence-Completion Test •  “I wish ___________________________” •  “My father ________________________” Example: Draw-a-Person Test •  “Draw a person” •  “Draw another person of the opposite sex” 4 9/27/09 II. Psychological Tests   Personality inventories - self-report questionnaires   Focus is on behaviors, beliefs, and feelings   Ask how similar/dissimilar a person is to a set of statements • Strengths and weaknesses: • Objectively scored and standardized • Although more valid than projective tests, often we cannot directly examine trait Example – The MMPI 5 9/27/09 II. Psychological Tests   Response inventories • Usually based on self-reported responses • Focus on one specific area of functioning •  E.G., emotion, social skills, cognition • Strengths and weaknesses: •  Have strong face validity •  Rarely careless/inaccurate questions •  Few subjected to careful procedures II. Psychological Tests   Psychophysiological tests • Measure physiological response as an indication of psychological problems • Most popular is the polygraph (lie detector) • Strengths and weaknesses: • Require expensive equipment that must be tuned and maintained • Physical evidence for psychological symptoms II. Psychological Tests   Neurological tests: direct assessment brain function   Neuropsychological tests: indirect assessment via cognitive, perceptual & motor function 6 9/27/09 Example: Bender Visual-Motor Gestalt II. Psychological Tests   Intelligence tests • Designed to measure intellectual ability • Assess both verbal and non-verbal skills • Generate an intelligence quotient (IQ) • Strengths and weaknesses: • Highly standardized, reliable and valid • Influences on performance…cultural factors Clinical Observations •  Naturalistic observations •  Occur in everyday environments: homes, schools… •  Analog observations •  If impractical, conduct observations in artificial settings •  Self-monitoring •  People observe themselves and carefully record the frequency of certain behaviors, feelings... 7 9/27/09 Clinical Observations •  Strengths and weaknesses: •  Different observers focus on different aspects? •  Careful training and use of observer checklists •  “Overload,” “observer drift,” and observer bias •  Client reactivity may also limit validity •  Observations may lack cross-situational validity Treatment: How Might Clients Be Helped? •  Treatment decisions: begin with assessment info & diagnosis to determine treatment plan •  Other factors: therapist’s orientation, current research, empirical support, evidence-based treatment •  Difficult question to answer: •  How do you define success? •  How do you measure improvement? •  How do you compare treatments – differing in range, complexity, skill, knowledge The Effectiveness of Treatment •  Is therapy generally effective? •  … more effective than no treatment or placebo •  In one study, average person in treatment was better off than 75% of untreated •  Consumer Reports found that “consumers” of therapy found it to be helpful or at least satisfying •  Can therapy can be harmful? Has potential… •  Studies report ~5% get worse with treatment 8 9/27/09 The Effectiveness of Treatment •  Are particular therapies effective for particular problems? •  Studies now conducted to examine efficacy of specific treatments for specific disorders: •  Recent studies focus on the effectiveness of combined approaches •  Drug therapy combined with certain forms of psychotherapy – to treat certain disorders 9