HOW TO READ PSYCHOLOGICAL EVALUATIONS

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					 HOW TO READ
PSYCHOLOGICAL
 EVALUATIONS
       A PRIMER FOR
     Maricopa County CASA

Lawrence M. Sideman, Ph.D., LPC, LISAC
        HOW TO READ
  PSYCHOLOGICAL EVALUATIONS
           Disclaimer
The information contained in this presentation is offered for
educational purposes only and is presented without
guarantee or assurances of any kind. Some of the
information is the presenter’s opinion and may not
completely correspond with practices by all psychologists.

The value of some of this information may be time limited.
The field of psychology and standards of practice are
constantly evolving. Participants are encouraged to seek
consultation from a licensed psychologist and/or other
professional before making decisions that may impact
people’s lives.
          HOW TO READ
    PSYCHOLOGICAL EVALUATIONS
                         Agenda
   Introductions
   Behavioral Health Services (What)
   Behavioral Health Services (Who)
   Purposes of Psychological Evaluations
   Domains Covered in Psychological Evaluations
   Types of Assessment Tools
   Common Psychological Tests Used
   Common Diagnoses
   Questions & Answers
          HOW TO READ
    PSYCHOLOGICAL EVALUATIONS


   Introductions

   Have you ever taken a psychological test?
PSYCHOLOGICAL EVALUATION
           DESIRED ELEMENTS



      PERSONAL HISTORY

        Family History
        Medical and Psychological History

        Education and Employment

        Alcohol and Drug Use

        Legal History
    BEHAVIORAL HEALTH SERVICES
              (What)
   Counseling & Psychotherapy

   Psychosocial Evaluation

   Psychiatric Evaluation

   Medication Monitoring/Management

   Psychological Evaluation
    BEHAVIORAL HEALTH SERVICES
              (WHO)


   Ph.D., MD/DO, MA/MS, MSW, BA/BS, AA

   Psychologist, Psychiatrist, LAC/LPC,
    LASW/LISW, LAMFT/LIMFT,
    LASAC/LISAC, BHT, Paraprofessional
    PSYCHOLOGICAL EVALUATION
             (WHO)
   An evaluation done by a psychologist
   A non-medical doctoral practitioner trained in
    diagnosis & non-medical treatment of mental
    disorders, including major mental illness
   Degrees: Ph.D. Psy.D. Ed.D
   Uniquely trained in the use of psychological tests
   Designation: Psychologist
           PURPOSES OF
    PSYCHOLOGICAL EVALUATIONS
   Answer the referral question(s)
   Describe individual in terms of current
    emotional, intellectual, & behavioral functioning
    (ability to parent; to protect, etc.)
   Provide referral with additional information
   Create a record of assessment for future use
   Recommend specific course(s) of action
   Provide meaningful baseline information for
    evaluating progress after interventions
   Serve as a legal document
        DOMAINS COVERED IN
    PSYCHOLOGICAL EVALUATIONS
   Identifying Information
   Reason(s) for Referral
   Tests Administered
   Background Information
   Test Results
   Summary
   Diagnostic Impressions (DSM-IV-TR)
   Treatment Recommendations
     IDENTIFYING INFORMATION
   Name
   Age
   Date of Birth
   Gender
   Ethnicity
   Primary Language
   Educational Level
   Date of Report
   Evaluator
       REASON(S) FOR REFERRAL
       Determines the focus of the evaluation
   Ability to care for child
   Emotional factors impinging on parenting
   Presence of underlying psychological dx
   AODA issues
   Domestic Violence
   Readiness for reunification
   Intellectual Capacity
   DTO/DTS risk
          TESTS ADMINISTERED

   Clinical Interview (Structured/Unstructured)
   Checklists
   Observations
   Mental Status Exam
   Intelligence Tests
   Objective Personality Tests
   Projective Personality Tests
   Tests for Specific Disorders
           TESTS ADMINISTERED

                 Clinical Interview

   Structured Clinical Interview for
    DSM-IV-TR (SCID)

   Psychiatric Diagnostic Interview (PDI)

   Schedule for Affective Disorders &
    Schizophrenia (SADS)
          TESTS ADMINISTERED

                    Checklists

   Child Behavior Checklist (CBCL)
   Symptom Checklist 90 (SCL-90-R)

                    Observations
   During Evaluation
   By Collaterals
     COLLATERAL INFORMATION
             DESIRED ELEMENTS
   Dependency Petition
   Judicial Review
   Court Pleadings
   Police Reports
   Arrest Records
   Medical/Psychological Records
          TESTS ADMINISTERED


                Mental Status Exam
Assesses:

   Affect (feelings/moods)

   Behavior

   Cognition (awareness, memory, delusions,
    hallucinations, psychosis, judgment, insight)
          TESTS ADMINISTERED
                 Intelligence Tests

   Wechsler Adult Intelligence Scale
    (WAIS-III)

   Wechsler Intelligence Scale for Children
    (WISC-IV)

   Stanford-Binet
          TESTS ADMINISTERED
           Objective Personality Tests

   Minnesota Multiphasic Personality Inventory
    (MMPI-2)

   Millon Clinical Multiaxial Inventory (MCMI-III)

   California Psychological Inventory (CPI)
         TESTS ADMINISTERED
           Projective Personality Tests

   Rorschach Inkblot Test

   Thematic Apperception Test (TAT)

   Projective Drawings

   Sentence Completion Test
         TESTS ADMINISTERED
           Tests for Specific Disorders

   Beck Depression Inventory (BDI)
   Beck Anxiety Inventory (BAI)
   Addiction Severity Index (ASI)
   Michigan Alcohol Screening Test (MAST)
   Substance Abuse Subtle Screening Inventory
    (SASSI-3)
   Psychopathy Checklist (PCL-R)
BACKGROUND INFORMATION

   Relevant psychological context of the client

   Places assessment results within a context

   May include hx, culture, gender, early
    experiences, developmental hx, medical hx,
    educational/occupational hx, family
    constellation, etc.
                 TEST RESULTS
   Includes behavioral observations, ease of
    establishing/maintaining rapport,
    communication, response to failures, response
    to feedback/successes, attention span,
    distractibility, activity level, anxiety level, mood,
    impulsivity/reflectivity, problem-solving
    strategy, attitude toward testing process, attitude
    toward examiner, attitude toward self, unusual
    mannerisms or habits, motivation, persistence,
    frustration, etc.
   Provides a comprehensive picture of the
    individual, not the test scores
                TEST RESULTS
Common topics include:

   Client’s level of psychopathology
   Dependency
   Hostility
   Sexuality
   Interpersonal relationships
   Adequacy of judgments
   Relative degree of insight
                   SUMMARY


   Integrates test data & history

   Describes the personality of the client

   Reader should be able to describe the client

   Integrates key points from each part of
    evaluation
       DIAGNOSTIC IMPRESSIONS

   Utilizes DSM-IV-TR multiaxial diagnosis

   A diagnosis may be qualified with initial,
    deferred, principal, additional/comorbid,
    rule out, provisional, etc.

   Considers the setting of the individual
       DIAGNOSTIC IMPRESSIONS
             DSM-IV-TR
   Axis I Acute Mental Illness/Syndromes
   Axis II Personality Disorders
              Mental Retardation
   Axis III Medical Problems
   Axis IV Psychosocial Stressors
   Axis V Global Assessment of Functioning
             GAF Scale = 0-100
   Midrange GAF ratings of 51-60 indicate
    moderate symptoms and ratings of 41-50
    indicate serious symptoms
       DIAGNOSTIC IMPRESSIONS
           Disruptive Disorders
   Conduct Disorder

   Oppositional Defiant Disorder

   Intermittent Explosive Disorder

   Attention-Deficit/Hyperactivity Disorder
       DIAGNOSTIC IMPRESSIONS
           Disruptive Disorders
                 Conduct Disorder
   Childhood “equivalent” of ASPD

            Oppositional Defiant Disorder
   Multiple behaviors of not following rules

           Intermittent Explosive Disorder
   Periodic intense or violent anger outbursts
       DIAGNOSTIC IMPRESSIONS
           Disruptive Disorders
      Attention-Deficit/Hyperactivity Disorder

   Clinical management: Combination of somatic
    (medication) therapy & behavioral management
       DIAGNOSTIC IMPRESSIONS
        Substance-Related Disorders

   Abuse – Maladaptive pattern leading to
    impairment or distress by failure to fulfill major
    role obligations at work, school, or home

   Dependence – Tolerance & withdrawal
       DIAGNOSTIC IMPRESSIONS
    Schizophrenia & Other Psychotic Disorders

   1% of population
   Peak onset: Late teens, early 20’s
   Characteristic symptoms:
    -Delusions
    -Hallucinations
    -Disorganized speech
    -Grossly disorganized or catatonic behavior
    -Negative symptoms: Flat/blunted affect,
     alogia (speechlessness), apathy, anhedonia
       DIAGNOSTIC IMPRESSIONS
            Mood Disorders

            Major Depressive Disorder
   Depressed mood most of the day, nearly every
    day. For a child, can be irritable mood
   Markedly diminished interest or pleasure in all,
    or almost all, activities most of the day, nearly
    every day
   Significant wt. loss or wt. gain (5% or more of
    body weight), or decrease or increase in appetite
       DIAGNOSTIC IMPRESSIONS
            Mood Disorders
            Major Depressive Disorder
   Insomnia or hypersomnia

   Psychomotor agitation or retardation

   Fatigue or loss of energy

   Feelings of guilt or worthlessness or excessive or
    inappropriate guilt (delusional guilt)
       DIAGNOSTIC IMPRESSIONS
            Mood Disorders
            Major Depressive Disorder
   Diminished ability to think or concentrate, or
    indecisiveness
   Recurrent thoughts of death, recurrent suicidal
    ideation, without a specific plan, or a suicide
    attempt, or a specific plan for committing
    suicide
   Symptoms cause significant distress or
    impairment in functioning
       DIAGNOSTIC IMPRESSIONS
            Mood Disorders
                  Bipolar Disorder
   Distinct period of abnormally and persistently
    elevated, expansive, or irritable mood, lasting at
    least 1 week
   During the period, 3 or more are present:
    -Inflated self-esteem or grandiosity
    -Decreased need for sleep (feels rested after
     only 3 hrs)
    -Hyper-talkative or pressured speech
       DIAGNOSTIC IMPRESSIONS
            Mood Disorders

                  Bipolar Disorder
   Flight of ideas or experience of racing thoughts
   Distractibility
   Increase in goal-directed activities
   Excessive involvement in pleasurable activities
    that have a high potential for painful
    consequences (spending sprees, sexual
    indiscretions, foolish business investments)
       DIAGNOSTIC IMPRESSIONS
            Mood Disorders

               Dysthymic Disorder

   “Chronic, low grade depression”
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders
              Panic Attacks/Disorder
   Palpitations
   Sweating
   Trembling or shaking
   Sensation of shortness of breath
   Feeling of choking
   Nausea or abdominal distress
   Feeling dizzy, unsteady, lightheaded, faint
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders

              Panic Attacks/Disorder
   Derealization (unreality) or depersonalization
    (detached)
   Fear of losing control or going crazy
   Fear of dying
   Paresthesias (numbness, tingling)
   Chills or hot flashes
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders

                   Agorophobia
   Anxiety about being in places or situations from
    which escape might be difficult or embarrassing,
    or in which help may not be available in an
    unexpected situation or situation that may lead
    to panic
   Situations are avoided or endured with marked
    distress, or require presence of a companion
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders

                   Specific Phobia
   Marked or persistent fear that is excessive or
    unreasonable, cued by the presence or
    anticipation of specific object or situation:
   Flying
   Heights
   Animals
   Receiving an injection or seeing blood
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders

                   Social Phobia
   Marked or persistent fear of 1 or more social or
    performance situations in which one is exposed
    to unfamiliar people or to possible scrutiny by
    others. Fear that s/he will act in a way (or show
    anxiety sx) that will be humiliating/embarrassing
   Exposure to the feared social situations almost
    invariably provokes anxiety/panic
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders

                   Social Phobia
   Recognize fear is excessive or unreasonable

   Feared social or performance situations are
    avoided/endured with intense anxiety/distress

   Avoidance, anxious anticipation, or distress
    interferes with normal activities
     DIAGNOSTIC IMPRESSIONS
          Anxiety Disorders
       Obsessive-Compulsive Disorder
Obsessions:
 Recurrent/persistent thoughts, impulses, or
  images that are experienced as intrusive &
  inappropriate; cause marked anxiety or distress
 Thoughts, impulses, or images are not simply
  excessive worries about real-life problems
 Person attempts to ignore or suppress them with
  some other thought or action
 Recognizes that obsessions are from own mind
     DIAGNOSTIC IMPRESSIONS
          Anxiety Disorders
       Obsessive-Compulsive Disorder
Compulsions:
 Repetitive behaviors (hand washing, ordering,
  checking) or mental acts (praying, counting,
  repeating words silently) that one feels driven to
  perform in response to an obsession, or
  according to rules that must be applied rigidly
 Aimed at preventing/reducing distress or
  preventing dreaded event or situation, but are
  not connected in realistic way with what they are
  designed to neutralize/prevent, or are excessive
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders
         Post-Traumatic Stress Disorder
   One has been exposed to a traumatic event in
    which both of the following are present:
   Person experienced, witnessed, or confronted
    with event(s) that involved actual or threatened
    death or serious injury, or threat to the physical
    integrity of self or others
   Person’s response involved intense fear,
    helplessness or horror
     DIAGNOSTIC IMPRESSIONS
          Anxiety Disorders
        Post-Traumatic Stress Disorder
Persistent, intrusive re-experiencing of traumatic
  event:
 Dreams of the event(s)
 Intense psychological distress at exposure to
  internal or external cues that symbolize or
  resemble aspects of the event
 Physiological reactivity on exposure to internal
  or external cues
       DIAGNOSTIC IMPRESSIONS
            Anxiety Disorders
              Generalized Anxiety Disorder
   Excessive anxiety and worry
   The person finds it difficult to control the worry
    which is associated with 3 or more:
   Restlessness or feeling keyed up or on edge
   Being easily fatigued
   Difficulty concentrating
   Irritability
   Muscle tension
   Sleep disturbance
  DIAGNOSTIC IMPRESSIONS
        Paraphilias
 Exhibitionism
 Fetishism
 Frotteurism
 Pedophilia
 Sexual Masochism
 Sexual Sadism
 Transvestic Fetishism
 Voyeurism
 Paraphilia NOS
       DIAGNOSTIC IMPRESSIONS
           Adjustment Disorder
   Emotional or behavioral symptoms in response
    to identifiable stressors

   Within 3 months of stressors

   Marked distress in excess of that expected

   Significant social/occupational impairment
    - Acute – lasts < 6 months
    -Chronic – lasts > 6 months
     DIAGNOSTIC IMPRESSIONS
         Personality Disorders
Enduring pattern of inner experience & behavior
that deviates from the expectations of the person’s
culture manifested in:
 Cognition (perceiving & interpreting self, others,
  & events)
 Affectively (range, intensity, lability, &
  appropriateness of emotional response)
 Interpersonal functioning
 Impulse control
       DIAGNOSTIC IMPRESSIONS
           Personality Disorders
   Enduring, inflexible pattern of personality which
    is pervasive across broad range of personal &
    social situations
   Enduring pattern leads to significant distress or
    impairment in social, occupational, or other
    important areas of functioning
   Enduring pattern is stable & of long duration &
    onset can be traced back at least to adolescence
    or early adulthood
  DIAGNOSTIC IMPRESSIONS
      Personality Disorders
 Paranoid  Personality Disorder
 Schizoid Personality Disorder

 Schizotypal Personality Disorder

 Antisocial Personality Disorder

 Borderline Personality Disorder

 Histrionic Personality Disorder

 Narcissistic Personality Disorder
  DIAGNOSTIC IMPRESSIONS
      Personality Disorders
 Avoidant   Personality Disorder

 Dependent     Personality Disorder

 Obsessive-Compulsive     Personality Disorder

 Personality   Disorder NOS
  DIAGNOSTIC IMPRESSIONS
       Other Conditions
 Parent-Child  Relational Problem
 Partner Relational Problem
 Sibling Relational Problem
 Relational Problem NOS
 Physical Abuse of Child
 Sexual Abuse of Child
 Neglect of Child
 Physical Abuse of Adult
 Sexual Abuse of Adult
             TREATMENT
          RECOMMENDATIONS
   Specific ways to solve the referral question(s)
   Flows from test results discussed earlier
   Addresses referral questions & makes
    suggestions of strategies/interventions
   Recommendations should be prescriptive,
    positive, practical & possible to implement
   Recommendations should address an
    individual’s strengths
   Recommendations should be easy to understand
 PUTTING IT ALL TOGETHER

Interview      Collateral Data    Test Data
      \                             /

                     |
                    \/

            Clinical Impression
                      |
                     \/
            Recommendations
      HOW TO READ
PSYCHOLOGICAL EVALUATIONS



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