Chapter 3

1. Chapter 3 Assessing and Diagnosing Abnormality

2. Assessment: the process of gathering information about people’s symptoms and the possible causes of these symptoms. Information gathered in an assessment is used to determine the appropriate diagnosis for a person’s problems. • Diagnosis: a label for a set of symptoms that often occur together.

3. Considerations in Assessment Tools • Validity: Accuracy • Face validity • Content validity • Concurrent validity • Predictive validity • Construct validity • Reliability: Consistency • Standardization

4. Types of Validity

5. Types of Reliability

6. The Clinical Interview • Intake interview (mental status exam) • Appearance, behavior, thought processes, mood & affect, intellectual functioning, orientation • Structured Interview • Standard series of questions are asked

7. Questionnaires • Symptom Questionnaires • These questionnaires may cover a wide variety of symptoms, representing several different disorders • Personality Inventories • Questionnaires meant to assess people’s typical ways of thinking, feeling, and behaving • Minnesota Multiphasic Personality Inventory (MMPI) is the most widely used personality inventory (now MMPI-2)

8. MMPI

9. Behavior Observations and Self-Monitoring • Behavior Observation • Example: Watching a child interact with another child to see what provokes him or her • Self-Monitoring • Example: Asking a client to keep track of the number of times per day he or she engages in a specific behavior such as smoking a cigarette

10. Intelligence Tests • Used to measure an individual’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected • Used in schools to identify “gifted” children and those with intellectual difficulties. • Used in occupational settings and the military to evaluate adults’ capabilities for certain jobs or types of service. • Some examples: Wechsler Adult Intelligence Scale, the Stanford-Binet Intelligence Test, and the Wechsler Intelligence Scale for Children.

11. Criticisms of Intelligence Tests • Little consensus as to what is meant by intelligence • Biased toward middle- and upper-class educated European Americans

12. Neuropsychological Tests • Used to detect specific cognitive deficits such as a memory problem, as in dementia • Example: Bender-Gestalt

13. . Bender-Gestalt Test

14. Brain-Imaging Techniques • Computerized tomography (CT): an enhanced X-ray procedure • Positron-emission tomography (PET): a picture of activity in the brain. Requires injecting the patient with a harmless radioactive isotope • Single photon emission computed tomography, or SPECT: similar to PET except that it is less accurate and less expensive • Magnetic resonance imaging (MRI): involves creating a magnetic field around the brain that causes realignment of hydrogen atoms in the brain

15. Psychophysiological Tests • Alternative to and less direct than MRI, CT, PET, and SPECT to detect changes in the brain and nervous system that reflect emotional and psychological changes. • Electroencephalogram (EEG) • Measures electrical activity along the scalp produced by the firing of specific neurons in the brain. • Used most often to detect seizure activity in the brain, and can also be used to detect tumors and stroke. • When EEG patterns over brief periods (such as half second) are recorded in response to specific stimuli, such as the individual viewing an emotional picture, these EEG patterns are referred to as evoked potentials or event-related potentials. • Clinicians can compare an individual’s response to the standard response of healthy individuals. • Heart rate and respiration are highly responsive to stress and can be easily monitored. Sweat gland activity, known as electrodermal response (formerly called the galvanic skin response) can be assessed with a device that detects electrical conductivity between two points on the skin, which can reflect emotional arousal. • Difficult to administer, resulting in low validity and reliability.

16. Projective Tests • Based on the assumption that, when people are presented with an ambiguous stimulus, such as an oddly shaped inkblot or a captionless picture, they will interpret the stimulus in line with their current concerns and feelings, their relationships with others, and conflicts or desires. (Projection) • Examples: • Rorschach Inkblot Test • Thematic Apperception Test (TAT) • The Sentence Completion Test • Draw-A-Person Test

17. Challenges in Assessment • Resistance and Inability to Provide Information • Evaluating Children • Difficulties in communication and reporting • Evaluating Individuals across Cultures • Language barriers • Different cultures experience different psychological disorders differently

18. Diagnosis

19. The Diagnostic and Statistical Manual of Mental Disorders IV Clinical disorders Axis I Personality disorders Mental retardation Axis II General medical conditions Axis III Psychosocial and environmental problems Axis IV Global assessment of functioning Axis V

20. Continuing Concerns About the DSM-IV-TR • Considering the Continuum • Differentiating Mental Disorders from Each Other • Addressing Cultural Issues • The Dangers of Diagnosis

21. Assessment: Biopsychosocial Integration