CLINICAL VS. BEHAVIOR ASSESSMENT

CLINICAL VS. BEHAVIOR ASSESSMENT

Informal Tes3ng Personality Tes3ng Assessment Procedures Ability Tes3ng The Clinical Interview

3 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)

4 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

7 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

16 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

(MMPI-2) Minnesota Multiphasic Personality Inventory - 2 17 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

18 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?)

(MCMI-III) Millon Clinical Multiaxial Inventory (3 rd ed.) 19 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

20 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

PAI Personality Assessment Inventory 21 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)

22 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

(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 23

(MBTI) Myers-Briggs Type Indicator 24 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

(16PF) 16 Personality Factors Questionnaire 25 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)

26 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

Big Five Personality Traits and the NEO-PI-R & NEO-FFI 27 Research by Thurstone and many others suggest a fivefactor 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

28 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

29 (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 selfesteem 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

(SASSI) Substance Abuse Subtle Screening Inventory 30 Two versions: Adult & Adolescent (SASSI-3 & SASSI-A2) Suggests substance dependency with 93+% accuracy SASSI-3 30 minutes to take, 5 to score 1 st section: 67 subtle T/F items 2 nd 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

31 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

32 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