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Assessment and Classification of Abnormal Behavior Diagnosis and Assessment All psychological assessment has two goals. The first is description, the rendering of an accurate portrait of personality, cognitive functioning, mood, and behavior. The second goal is prediction Clinical assessment often includes diagnosis, in which the person’s problems is classified within one of a set of recognized categories of abnormal behavior and is labeled accordingly. The Classification of Abnormal Behavior All science orders the objectives of their study by identifying critical similarities among them and sorting them into groups according to those similarities. Mental Health professionals classify mental disorder according to patterns of behavior, thought, and emotion. The Diagnostic and Statistical Manual of Mental Disorders was initially published in 1952 by the American Psychiatric Association (APA). Since the initial publication, DSM has undergone several publications: DSM- II, DSM-III, DSM III-R, DSM- IV, and DSM-IV TR (Text Revised), which contains updates the description of what is known about each disorder based on research conducted since the publication of DSM-IV. The DSM provides the foundation for diagnosing mental disorders. The assessment decides which diagnosis seems most likely, consults the criteria for that disorder, and then determines which criteria the patient actually meets. If the patient satisfies the minimum number of criteria specified by the DSM for that disorder, and if other choices have been eliminated, that is the patient’s diagnosis. The purpose of assessment is to supply a description of the patient’s problem, along with a prognosis, or prediction of its future course. The major criticism of diagnosis has to do with the use of the medical model as the foundation of diagnosis. In addition to this criticism there are four other criticism of DSM diagnosis: (2) DSM diagnosis is overly inclusive, it discounts the gradations between normal and abnormal, in that it falsifies behavior by implying that most abnormal behavior is qualitatively different from normal behavior; (3) diagnosis gives the illusion of explanation; and (4) diagnostic labeling can be harmful to people. DSM-IV-TR attempts to address these concerns. o Specific Diagnosis Criteria – the criteria for diagnosis are highly detailed and specific, including the following Essential features Associated features Diagnostic criteria Differential diagnosis Fives Axes of Diagnosis – the second important features off DSM-IV-TR is that it requires the diagnostician to give a substantial amount of information about patients evaluating them on five axes or area of functioning o Axis I – Clinical syndromes o Axis II – Personality disorders or mental retardation o Axis III – General medical disorders o Axis IV – Psychosocial and environmental problems. o Axis V – Global assessment of functioning Reliability and Validity Reliability is a measure of the consistency of an instrument to produce the same results repeatedly. There are three criteria for reliability in psychological assessment o Internal consistence o Test-retest reliability o Interjudge reliability Validity refers to the extent to which the test measures what it is suppose to measure. There are two types of validity in psychological assessment o Descriptive validity is the degree to which it provides significant information about the current behavior of the people being assessed Co-morbidity suggests that they may meet the diagnostic criteria for more than one Axis I disorder o Predictive Validity indicates that the assessment tool describes the person’s behavior Problems in Assessment o The personal manner of the interviewer may affect the outcome of the assessment. This can include the interpretation of the data (people find what they are looking for), and pragmatic considerations. Methods of Assessment Assessment techniques fall into four general categories: the interview, psychological tests, laboratory tests, and observation in natural settings. The Interview, which consists of a face-to-face conversation between participant and examiner, is the oldest and most commonly used method to gather information about the presenting problem. o Structured vs. non-structured o Mental Status Exam o Psychological Tests Intelligence tests Stanford-Binet. The Stanford-Binet Intelligence Scale began in 1916 when Lewis M. Terman completed his American revision of the 1908 Binet-Simon Scale. At that time it was called the Stanford Revision of the Binet-Simon Scale. The most recent addition of the Stanford-Binet Intelligence Scales (SB5) includes comprehensive coverage of five factors--Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual-Spatial Processing, and Working Memory and the ability to compare verbal and nonverbal performance. The Stanford-Binet Intelligence Scales, with its lower floor and higher ceiling, is diagnostically appropriate for children at the extremes of mental ability. It can be used to evaluate levels of mental retardation and intellectual giftedness. Wechsler Intelligence Scales. All of the Wechsler scales are divided into six verbal and five performance subtests. The complete test takes 60-90 minutes to administer. Verbal and Performance IQs are scored based on the results of the testing, and then a composite Full Scale IQ score is computed. o Wechsler Adult Intelligence Scale – III (WAIS-III) Verbal WAIS scales 1. Information: 29 questions - a measure of general knowledge. 2. Digit Span: Subjects are given sets of digits to repeat initially forwards then backwards. This is a test of immediate auditory recall and freedom from distraction. 3. Vocabulary: Define 35 words. A measure of expressive word knowledge. It correlates very highly with Full Scale IQ 4. Arithmetic: 14 mental arithmetic brief story type problems. tests distractibility as well as numerical reasoning. 5. Comprehension: 16 questions which focus on issues of social awareness. 6. Similarities: A measure of concept formation. Subjects are asked to say how two seemingly dissimilar items might in fact be similar. Performance WAIS scales 7. Picture Completion: 20 small pictures that all have one vital detail missing. A test of attention to fine detail. 8. Picture Arrangement: 10 sets of small pictures, where the subject is required to arrange them into a logical sequence. 9. Block Design: Involves putting sets of blocks together to match patterns on cards. 10. Digit Symbol: Involves copying a coding pattern. 11. Object Assembly: Four small jig-saw type puzzles. o o Wechsler Intelligence Scale for Children III (WISC-III) Wechsler Preschool and Primary Scale of Intelligence – Revised (WPPSI-R) o Projective Personality Tests Rorschach Psychodiagnostic Inkblot Test The Thematic Apperception Test (TAT). The TAT consists of 31 pictures that depict a variety of social and interpersonal situations.The subject is asked to tell a story about each picture to the examiner. Of the 31 pictures, 10 are gender-specific while 21 others can be used with adults of either sex and with children. o Self-Report Personality Inventories The MMPI-2. The MMPI-2 test’s contemporary normative sample and extensive research base help make it the gold standard in assessment for a wide variety of settings. The test can be used to help: Assess major symptoms of social and personal maladjustment; Identify suitable candidates for high-risk public safety positions; Support classification, treatment, and management decisions in criminal justice and correctional settings; Give a strong empirical foundation for a clinician's expert testimony; Assess medical patients and design effective treatment strategies, including chronic pain management; evaluate participants in substance abuse programs and select appropriate treatment approaches; support college and career counseling recommendations; and provide valuable insight for marriage and family counseling. o Sample MMPI-2 Report Psychological Test for Neuropsychological Impairment Bender Visual-Motor Gestalt Test. The Bender Visual Motor Gestalt test (or Bender-Gestalt test) is a psychological assessment used to evaluate visual-motor functioning, visual-perceptual skills, neurological impairment, and emotional disturbances in children and adults ages three and older. Halstead Reitan Neuropsychological Battery. The Halstead-Reitan Neuropsychological Test Battery (HRNB) was developed to predict the presence of brain damage while offering a comprehensive view of a patient’s individual functions. The purpose of this battery is to provide the clinician with a database for inferring the nature, location, and extent of the structural changes in the brain that may underlie and explain the pattern of intact and impaired functions derived from the measures and qualitative information yielded by the battery. The present battery consists of 10 tests which have been shown empirically to best discriminate between normals and patients with documented cortical damage. Laboratory o Electroencephalogram o Positron Emission tomography (PET) o Magnetic Resonance Imaging (MRI) Cultural Bias in Assessment Biases based on language, ethnicity, and culture have been long know to compromise the accuracy of psychological assessment. o LEARNING OBJECTIVES 1. Define the term psychodiagnosis and describe its functions. 2. Identify the characteristics of good tests, including reliability and validity. 3. Define reliability, and differentiate among test-retest, internal, and interrater reliability. Define validity, and differentiate among predictive, criterion-related, construct, and content validity. 4. Define assessment and discuss its role in clinical psychology. Describe and discuss various psychological assessment techniques and their strengths and limitations, including observation of behavior, clinical interviews, and tests and inventories. 5. Describe the nature and purposes of projective personality tests, including the Rorschach, Thematic Apperception Test (TAT), sentence-completion test, and draw-a-person test. Discuss the strengths and weaknesses of projective tests. 6. Describe the nature and purposes of self-report inventories, including the Minnesota Multiphasic Personality Inventory (MMPI-2). Discuss the strengths and weaknesses of personality inventories. 7. Describe the purposes and characteristics of the Wechsler and Stanford-Binet intelligence tests and the Kaufman Assessment Battery for Children (K-ABC). Discuss the strengths and limitations of these tests. 8. Describe methods for assessing cognitive impairments due to brain damage (organicity), including the WAIS-R, Bender-Gestalt Visual-Motor Test, HalsteadReitan Neuropsychological Test Battery, and Luria-Nebraska Neuropsychological Battery. 9. Describe neurological procedures for detecting brain damage, including CAT and PET scans, EEGs, and MRIs. 10. Discuss ethical issues involved in assessment, particularly how cultural differences may influence clinical judgments. 11. Explain the goals of classifying abnormal behaviors and review the history of classification systems. Discuss how validity problems have been raised and dealt with. 12. Describe the characteristics of the DSM-IV-TR, including its five axes, the broad categories of mental disorders, and how the DSM-IV-TR places diagnosis in a cultural context. 13. Discuss the objections to the DSM classification system and the arguments supporting its use. 14. Describe four problems associated with classification and labeling and the research related to these problems. Discuss how the findings of Rosenhan (1973) relate to the impact of labeling.
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