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Introduction to Psychological assessment and psychodiagnosis

 Process of gathering and integrating of


psychological data for psychological evaluation,
through the use of tests, interviews, case
studies, behavioral observation, and specially
designed apparatuses and measurement
procedures.

 Psychological assessment starts with the referral


question.
 Any of various methods used to discover the
factors that underlie behavior, especially
maladjusted or abnormal behavior.
 The branch of clinical psychology that
emphasizes the use of psychological tests and
techniques for assessing mental illness.
 A diagnostic technique for the determination of
underlying factors in behavior.
 A psychological test is a measuring
instrument that has following defining
characteristics;
 A psychological test is a sample of behavior
 The sample is obtained under standardized
conditions.
 There are established rules for scoring or obtaining
quantitative information from the behavior sample.
 The process of measuring of psychology-related
variables by means of devices or procedures designed
to obtain samples of behavior.

 Psychological constructs are informed, scientific idea


developed or generated to describe or explain
behavior and it is assumed that constructs can be
measured. E..g.
▪ Intelligence
▪ Personality
▪ Anxiety
▪ Job satisfaction
 Psychometrics
 The science of psychological measurement

 Psychometric Quality
 Norms
 Reliability
 Validity
1. Psychological constructs, states, & traits exist.

2. Psychological constructs, states, & traits can be


quantified and measured.

3. Various approaches to measuring aspects of the


same thing can be useful.

4. Assessment can provide answers to some of life’s


most momentous questions.
5. Assessment can pinpoint phenomena that require
further attention or study.

6. Various sources of data enrich and are part of the


assessment process.

7. Various sources of error are part of the assessment


process.

8. Tests and other measurement techniques have


strengths and weaknesses.
9. Test-related behavior predicts non-test-related
behavior.

10. Present-day behavior sampling predicts future


behavior.

11. Testing and assessment can be conducted in a fair


and unbiased manner.

12. Testing and assessment can benefit society.


To help solve problems by providing information
and recommendations relevant to making the
optimum decisions related to the client.

 Integrating a wide variety of information including


specifics of the problem, client resources, a client’s
personal characteristics, and environmental
circumstances.

 Recommend general and specific treatment


interventions
 The general purpose of assessment is to identify the
most relevant client characteristics or symptom
behaviors and match these with optimal
interventions.

 Gordon Paul (1967) stated this agenda with a


question: “What treatment, by whom, is most
effective for this individual with that specific
problem, and under which set of circumstances?”
 Classification

 Description

 Prediction
 Diagnoses
 DSM- 5/ICD-10

 Criticisms of Diagnoses
 Association with medical model
 Variable reliability
 Negative social stigma
 Use of a diagnostic label to describe a human
being’s behavior or emotional problem implies
an understanding of the problem that is often
not there.

 Categorization facilitates research

 Diagnostic labels can facilitate treatment

 Diagnostic labels can facilitate communication


 Dimensional, comprehensive description of
the individual.
 Person by situation, environment

 Psychological assessment
 generates research hypotheses
 Facilitate treatment planning
 Evaluate treatment outcome
 To make some prediction about a person’s future
behavior.

 Prediction terms:
 True positive
 False positive
 True negative
 False negative
 Sensitivity
 Specificity
 True positive ( prediction that a certain behavior
will occur and it does)

 False positive (prediction that a certain behavior


will occur and it does not)

 True negative (prediction that person will relapse


and the person does)

 False negative (prediction that person will relapse


but the person stays sober)
 Sensitivity
▪ Is the probability that certain behavior is predicted to
occur and it actually does.

 Specificity
▪ Is the probability that when a behavior is predicted not to
occur and it does not.
 The Base Rate Problems
 Low base rate problems are difficult to predict
 Low base rate problems tend to be overpredicted
(many false positives)
 Clinical (or subjective) method – clinician
constructs a model to explain client’s behavior
and predict future behavior

 Statistical (or quantitative or actuarial) –


people are classified based upon the
characteristics they share with others. They are
expected to behave the way similarly classified
people behave
 Paul Meehl (1954) Clinical versus Statistical Prediction:
A Theoretical Analysis and Review of the Literature
 “in all but one…the predictions made actuarially were
either equal to or superior to those made by the
clinician”

 Jack Sawyer (1966)


 Statistical superior to clinical approach to prediction
 Clinicians could not improve upon actuarial prediction
 Methodologically weak studies

 Not Expert Judges

 Findings not cross-validated

 Poor Ecological Validity


 Clinical approach is necessary in situations for
which no statistical equations have been
developed.

 Unforeseen circumstances impair the efficiency


of the formula.

 Rare, unusual events of highly individualized


nature are to be predicted.

 Clinician as data-gatherer
 Stage I: Planning the Assessment

 Stage II: Data Collection

 Stage III: Processing Assessment Data

 Stage IV: Communicating Assessment


Findings

Copyright ©Allyn & Bacon 2005


 Interviews
 Norm-referenced tests
 Observations
 Informal assessment methods
 Life records
 Clinical Judgment

 Computer assisted assessment


 Preconceived Notions
 Confirmation Bias
 Hindsight Bias
 Overconfidence
 Recall successes
 Only examining certain types of cases
 Self-fulfilling prophecy
 Search for alternative explanations

 Understand the impact of base rates

 Decrease reliance on memory


 Professional time savings
 Test administration consistency
 Rapid turnaround time between test
administration and scoring
 Scoring accuracy
 Data analysis
 Assessment of special populations
 Goals
 Address the referral question
 Improve understanding
 Impact client
 Provide a written record
 A legal document
 Include all relevant information

 Delete irrelevant or damaging information

 Avoid undue generalizations

 Use behavioural referents

 Communicate clearly

 Eliminate biased terms


 Identifying Information
 Reason for Referral
 Background Information
 Behavioural Observations
 Assessment Results and Interpretation
 Summary
 Recommendations
 Clinical Interviewing
 Intake
 Case history
 Diagnostic
 MSE

 Intellectual assessment
 Personality assessment
 Behavioral assesment
 The central role of clinicians conducting
assessments should be to answer specific
questions and aid in making relevant
decisions.

 They must be able to integrate a wide range of


data and bring into focus diverse areas of
knowledge.

 An expert in human behavior who must deal


with complex processes and understand test
scores in the context of a person’s life.
 The clinician must have an awareness and
appreciation of multiple causation, interactional
influences, and multiple relationships.

 As Woody (1980) has stated, “Clinical


assessment is individually oriented, but it always
considers social existence; the objective is
usually to help the person solve problems.”
 Clinicians should be familiar with core knowledge
related to measurement and clinical practice. This
includes descriptive statistics, reliability, validity,
normative interpretation, selection of appropriate tests,
administration procedures, variables related to
diversity, testing individuals with disabilities, and an
appropriate amount of supervised experience.
 Should have basic knowledge related to the demands,
types of referral questions, and expectations of various
contexts—particularly employment, education,
vocational/career, health care (psychological,
psychiatric, medical), and forensic.
 Furthermore, clinicians should know the main
interpretive hypotheses in psychological
testing and be able to identify, sift through, and
evaluate a series of hypotheses to determine which
are most relevant and accurate.
 For each assessment device, clinicians must
understand conceptually what they are trying to
test.
 For example, the concept of intelligence, as represented
by the IQ score, can sometimes appear misleadingly
straightforward.
 All information about the client should be
integrated with relevant general coursework,
including abnormal psychology, the psychology of
adjustment, clinical neuropsychology,
psychotherapy, and basic case management.

 The goal of assessment is not merely to describe


the person, but rather to develop relevant answers
to specific questions, aid in problem solving, and
facilitate decision making.
 Practicing psychologists spend 10-25% of their
time in conducting psychological assessment.

 Assessment is done through


 Structured and unstructured interview
 Behavioral observation
 Observation of interpersonal interactions
 Neuropsychological assessments
 Behavioral assessments
 WAIS
 MMPI
 RT
 BGT
 TAT
 Projective drawings (DPT)
 WMS
 BDI
 MCMI
 CPI
 Source; (Camera et. Al 2000)
 Relative decrease in the use and status of
projective test because of
 Complex scoring norms,
 Subjectivity of scoring
 Poor predictive utility
 Inadequate validity
 Greater time and lack of cost effectiveness
 Increase use of behavior rating scales,
structured and diagnostic interviews

 Development of neuropsychological
assessments and increasing use

 Use of holistic approach in assessment


 Theoretical Orientation
 1. Do you adequately understand the theoretical
construct the test is supposed to be measuring?
 2. Do the test items correspond to the theoretical
description of the construct?

 Practical Considerations
 1. If reading is required by the examinee, does his or her
ability match the level required by the test?
 2. How appropriate is the length of the test?
 Standardization
 Is the population to be tested similar to the population
the test was standardized on?
 Was the size of the standardization sample adequate?
 Have specialized subgroup norms been established?
 How adequately do the instructions permit
standardized administration?
 Reliability
 Are reliability estimates sufficiently high (generally around .90
for clinical decision making and around .70 for research
purposes)?
 What implications do the relative stability of the trait, the
method of estimating reliability, and the test format have on
reliability?

 Validity
 What criteria and procedures were used to validate the test?
 Will the test produce accurate measurements in the context and
for the purpose for which
you would like to use it?
 Reliability
 Test –retest reliability
 Alternate forms
 Split half reliability
 Inter scorer reliability

 Validity
 Content Validity (Face validity)
 Criterion related validity (Concurrent and face validity)
 Construct Validity
 A test can never be valid in any absolute sense because,
in practice, numerous variables might affect the test
results.
 A serious issue, then, is the degree of validity
generalization that is made. This generalization
depends on the similarity between the population used
during various stages of test construction and the
population and situation that it is being used for in
practice.
 Validity in clinical practice also depends on the extent
to which tests can work together to improve each
other’s accuracy.
 Incremental validity: Some tests improve accuracy
with increasing numbers of data
 conceptual validity: Another important
consideration is the ability of the clinician to
generate hypotheses, test these hypotheses, and
blend the data derived from hypothesis testing into
a coherent, integrated picture of the person.
 Maloney and Ward (1976) refer this approach as
conceptual validity because it involves creating a
conceptually coherent description of the person.
 Incremental Validity is used to determine if a new
psychological measure will provide more
information than measures that are already in
use. If a new test doesn't provide any new
information than the current, simpler measures are
already providing then the new test is unnecessary
and doesn't need to be used.

 For a test to be considered useful and efficient, it


must be able to produce accurate results above and
beyond the results that could be obtained with
greater ease and less expense.
 Psychological test might indeed demonstrate
incremental validity by increasing the relative
proportions of accurate diagnoses, or hit rates,
by 2%.

 Practitioners need to question whether this


small increase in accuracy is worth the extra
time involved in administering and
interpreting the test.
 It would seem logical that the greater the
number of tests used, the greater would
be the overall validity of the assessment
battery.

 However, research on psychological


tests used in clinical practice has often
demonstrated that they have poor incremental
validity.
 Highly relevant method in clinical practice

 Conceptual validity focuses on individuals with


their unique histories and behaviors. It is a means
of evaluating and integrating test data so that the
clinician’s conclusions make accurate statements
about the examinee.

 Conceptual validity is concerned with


testing constructs, but in these constructs relate to
the individual rather than to the test itself.
 In determining conceptual validity, the examiner
observe, collect data, and form a large number of
hypotheses.

 If these hypotheses are confirmed through


consistent trends in the test data, behavioral
observations, history, and additional data sources,
the hypotheses can be considered to represent
valid constructs regarding the person.
 The focus is on an individual’s specific situation,
and the data are derived from a variety of sources.
The conceptual validity of the constructs is based
on the logicalness and internal consistency of the
data.
 Conceptual validity produces constructs as its end
product. Its aim is for these constructs to provide
valid sources of information that can be used to
help solve the unique problems that an individual
may be facing.
 Clinical judgment is a special instance of
perception in which the clinician attempts to
use whatever sources are available to create
accurate descriptions of the client.

 These sources may include test data, case


history, medical records, personal journals,
and verbal and nonverbal observations of
behavior.
Relevant issues and processes involved in
clinical judgment are;
 Data gathering,
 Data synthesis,
 the relative accuracy of clinical versus
statistical/actuarial descriptions, and
 Judgment regarding a psychological report.
 One of the most essential elements in gathering
data from any source is the development of an
optimum level of rapport.

 Rapport increases the likelihood that clients will


give their optimum level of performance. If
rapport is not sufficiently developed, it is
increasingly likely that the data obtained from
the person will be inaccurate.
 Another important issue is that the interview itself is
typically guided by the client’s responses and the
clinician’s reaction to these responses.

 A client’s responses might be nonrepresentative because


of factors such as a transient condition (stressful day, poor
night’s sleep, etc.) or conscious/unconscious faking.

 So, client’s responses need to be interpreted, however


these interpretations can be influenced by personality
theory, research data, and the clinician’s professional and
personal experience.
 Bias can potentially enter into this process
from a number of different directions,
including the types of questions asked, initial
impressions, level of rapport, or theoretical
perspective.

 Use of structured and unstructured interview


 Clinical judgments are subjected to different
errors.
 To increase accuracy, clinicians need to know
how errors might occur, how to correct these
errors, and the relative advantages of specialized
training.
 A possible source of inaccuracy is that clinicians
frequently do not take into account the base rate, or
the rate at which a particular behavior, trait, or
diagnosis occurs in the general population .
 A further source of error is that information obtained
earlier in the data collection process is frequently
given more importance than information received
later (primacy effect).
 Different starting points in the decision-making process
may result in different conclusions. This can be further
reinforced if clinicians make early judgments and then
work to confirm these judgments through seeking
supporting information.
 Perceptual accuracy of the examiner; influenced
by various factors (e.g. intelligence, culture,
experience etc.) and liable to errors especially in
subjective test interpretations.

 So, it would be logical to assume that the more


confidence clinicians feel regarding the accuracy
of their judgments, the more likely it would be
that their judgments would be accurate.
 “Clinicians are able to make reliable and valid
judgments for many tasks, and their judgments
are frequently more valid than judgments by
laypersons”

 In contrast, trained clinicians were no better


than laypersons in making judgments based on
projective test results and in making
personality descriptions based on face-to-face
interaction.
1. To avoid missing crucial information, clinicians
should use comprehensive, structured, or at least
semistructured approaches to interviewing. This
is especially important in cases where urgent
clinical decisions may need to occur.
2. Clinicians should not only consider the data that
supports their hypotheses, but also carefully
consider or even list evidence that does not
support their hypotheses. This will likely reduce
the possibility of hindsight and confirmatory
bias.
3. Diagnoses should be based on careful attention to
the specific criteria contained in the DSM or
ICD. This means not making errors caused by
inferences biased by gender and ethnicity.

4. Because memory can be a reconstructive process


subject to possible errors, clinicians should
avoid relying on memory and, rather, refer to
careful notes as much as possible.
5. In making predictions, clinicians should
attend to base rates as much as possible. Any
clinical predictions, then, are guided by this
base rate occurrence and are likely to be
improvements on the base rate.

6. Clinicians should seek feedback when


possible regarding the accuracy and
usefulness of their judgments.
7. Clinicians should learn as much as possible
regarding the theoretical and empirical material
relevant to the person or group they are assessing.
This would potentially help to develop strategies for
obtaining comprehensive information, allow
clinicians to make correct estimates regarding the
accuracy of their judgments, and provide them with
appropriate base rate information.
8. Familiarity with the literature on clinical judgment
should be used to continually update practitioners
on past and emerging trends.
Throughout the different phases of clinical
assessment, the clinician should integrate
data and serve as an expert on human
behavior rather than merely an interpreter
of test scores.
 Clinicians must understand the vocabulary,
conceptual model, dynamics, and expectations
of the referral setting in which they will be
working.

 Find whether referral question is intended for


global or specific assessment.
 Refer to the test manual and additional outside
resources.

 Familiarity with problems, operational


definitions of different terms, e.g. anxiety

 Have in-depth knowledge about the variables


they are measuring.
 Evaluate practical considerations, the
standardization sample, and reliability and
validity .
 Obtain knowledge about the client’s age, sex,
ethnicity, race, educational background,
motivation for testing, anticipated level of
resistance, social environment, and interpersonal
relationships.
 Finally, assess the effectiveness or utility of the
test in aiding the treatment process
 Obtain data from wide variety of sources like
 Test scores
 Persona history
 Behavioral observations
 Interview data
 School records,
 Previous medical and psychological records
 Police reports
 Parent’s or teacher’s report
 This process generally follows a sequence
of
 developing impressions,
 identifying relevant facts,
 making inferences, and
 supporting these inferences with relevant and
consistent data