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Chapter Three
Assessment and Classification of
Abnormal Behavior
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Reliability
• The degree to which a test yields the same results repeatedly under the same circumstances.– Test-Retest reliability: whether a test yields the same
results for the same person at different points in time.– Internal consistency: whether different parts of the
same time yield similar results.– Interrater reliability: whether different raters or judges
of a test yield the same results
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Validity
• Extent to which a test measures what it is intended to measure.– Predictive validity: The ability of a test to predict a person’s
behavior, responses or performance.– Criterion validity: The ability of a test to measure and/or predict
behavior, response or performance on a particularly criterion.– Construct validity: Extent to which a test is related to the
construct it is intended to measure, compared to other established measures of that construct.
– Content validity: Extent to which a test includes items that measure the content the test is intended to measure.
• Standard administration: following common rules and procedures when administering a test; improves reliability and validity.
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Assessment of Abnormal Behavior
• Assessment: Process of gathering information and drawing conclusions about the traits, skills, abilities, emotional functioning, and psychological problems of the individual, generally for use in developing a diagnosis Four primary means of assessment:– Observations– Interviews– Psychological Tests and Inventories– Neurological Tests
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Observation of Abnormal Behavior
• Naturalistic Observation:– Conducted in a natural setting– Vary in degree of structure– Less structured observations require more interpretation on the
part of the observer• Laboratory (Controlled, Analogue):
– Researchers may give directions or tasks to participants– Vary in degree of structure
• Two areas of caution when conducting observations:– Check the validity of observation against other measures– Try to minimize impact of observer on participant’s behaviors
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Interviews
• Involve assessment of verbal and nonverbal behavior, as well as process (how the client communicates) and content (what the client talks about).
• Standardization: common procedures are followed– Formal standardized interview: a checklist of questions, with
scales for rating answers, is given to each client. Examples: • Composite International Diagnostic Interview• Mental Status Exam• Structured Clinical Interview for DSM IV TR
• Errors: The structure and process of the interview, the ability of the client to accurately and subjectively provide information about himself, and the interviewer’s ability to accurately and subjectively record information may introduce errors.
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Psychological Tests & Inventories
• Standardized instruments used to assess:– Personality – Maladaptive behavior – Development of social skills – Intellectual abilities – Vocational interests – Cognitive impairment– Personality dynamics & conflicts
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Projective Personality Tests
• Test taker is presented with ambiguous stimuli and is asked to respond to them in some way– Rorschach Technique– Thematic Apperception Test (TAT)– Sentence-Completion Test– Draw-a-Person
• Problems: – Reliability – Validity – Subjectivity
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Psychological Tests and Inventories
• Psychological Tests and Inventories:– Provide a standard situation to elicit certain types of responses– Allow comparison of individual responses with standardized
norms• Projective Personality Tests: Present the test-taker with
ambiguous stimuli and assume her will project his attitudes, motives and personality in his description.– Rorschach Inkblot Test: developed by Hermann Rorschach,
1921; most used scoring system developed by Exner, 1983)– Thematic Apperception Test: set of ambiguous pictures– Sentence Completion Test: ex: “My ambition….”– Draw a Person Test: and make up a story
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Self-Report Inventories
• Test taker answers specific written questions or selects specific responses from a list of alternatives
• Minnesota Multiphasic Personality Inventory (MMPI & MMPI-2)
• Beck Depression Inventory
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Self-Report Inventories
• Required test takers to answer specific written questions or select specific answers from a list of alternatives
• Minnesota Multiphasic Personality Inventory (MMPI –2)– Yields ratings on ten clinical scales (used for diagnosis) and ten
validity scales (to measure the client’s honesty, confusion, etc.)– Best interpreted as a unit, rather than as single scales– Assesses both clinical disorders and personality
• Limitations of personality inventories include:– Forces individuals to choose between answers that may not
accurately describe them– Respondents may adopt response “strategies,” such as
responding to similar items in similar ways– May be inaccurate across cultural groups
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Figure 3.1: The Ten MMPI-2 Clinical Scales & Sample MMPI-2
Test Items
Adapted from Dahlstrom & Welsh (1965)
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Intelligence Tests
• Primary functions:– Obtain Intelligence quotient (IQ), or estimate
of current level of cognitive functioning – Assess intellectual deterioration in psychotic
disorders
• Secondary function:– Provide clinical data
• Wechsler Scales & Stanford-Binet Scales
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Criticisms of Intelligence Tests
• Popularized as measuring innate intelligence, actually reflect cultural & social factors
• Predictive validity
• Disagreement over criterion variables
• Miss multidimensional attributes of intelligence
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Intelligence Tests
• Functions: to obtain an estimate of the person’s current level of cognitive functioning, to assess intellectual deterioration present in psychotic disorders, and to examine the person’s behavior during the testing event.
• The Wechsler Adult Intelligence Scale (also available in forms appropriate for children 6 to 16 (WISC) and 4 to 6 (WPPSI)) and the Standford Binet Scales are the most commonly used today.
• The Kaufman Assessment Battery for Children (K-ABC) used to evaluate the intelligence and achievement of children 2.5 to 12.5– Used with both general and special populations, as well as with
exceptional children– Less culturally dependent than other intelligence tests
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Criticisms of IQ tests
• IQ tests measure cultural and social factors rather than intelligence.– The Bell Curve (Hernstein & Murray, 1994) argued that IQ
scores are determined by heredity, and that “social and status differences between intellectually different classes are therefore difficult to overcome,” (in Sue, Sue & Sue 2003, 83).
• The ability of IQ tests to predict future achievement or behaviors has been questioned.
• Researchers disagree about what future achievements or behaviors IQ scores predict.
• Intelligence may be too multifaceted to be measured thoroughly and accurately by intelligence tests.
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Tests for Cognitive Impairment
• Unusual results on intelligence tests may reveal impairments
• The Bender-Gestalt Visual Motor Test involves copying 9 figures (see pg. 85)
• The Halstead-Reitan Neuropsychological Test is used to identify the type and location of brain damage and involves 11 tests of sensorimotor, cognitive, perceptual and attention abilities.
• Luria-Nebraska Neuropsychological Battery: takes less time and is more standardized than the Halstead-Reitan; tests similar abilities to identify the type and location of brain damage.
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Figure 3.2: The Nine Bender Designs
Bender (1938)
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Neurological Tests
• CAT scan: Computerized Axial Tomography
– Sophisticated X-Ray producing a 3-D picture of the brain
• PET scan: Positron Emission Tomography– Shows which areas of the brain are most actively
metabolizing a radioactive substance– Enables study of the biochemical and physiological
functioning of the brain• MRI: Magnetic Resonance Imaging
– Creates a magnetic field around the brain to produce a clear picture of brain tissues, including blood flow
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The Ethics of Assessment
• Issues involve:– Confidentiality of records– Invasion of clients’ privacy– Cultural bias– Unethical testing practices– Accuracy of tests– Whether computer testing is accurate or
ethical
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The DSM IV TR
• Consists of 5 Axes (areas a clinician can consider in making a diagnosis)– Axis I – Clinical disorders an other conditions that may be a focus of
clinical attention. Does the client have a clinical disorder? If so, which one(s)?
– Axis II – Personality disorders and mental retardation. Does the client have a personality disorder or some form of mental retardation? If so, which one?
– Axis III – General medical conditions. Does the client have a medical condition that could be relevant to treatment?
– Axis IV - Psychosocial and environmental problems. Are there (or have there been) any psychosocial or environmental conditions that could be a focus of treatment?
– Axis V - Global Assessment of Functioning. What is the client’s current level of functioning? Based on severity and degree of impairment; scale of 0-100.
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Figure 3.3: Lifetime & One-Year Prevalence Rates for Mental Disorders
Data from Robins, Locke & Regier (1991)
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Evaluation of DSM Classification System
• DSM-IV-TR has stronger reliability & validity than previous editions
• Criticisms:– Strong medical orientation rather than social &
interpersonal– Distinctions in some disorders overlook
difference in degree of severity– Question usefulness for research
• Objections to classification & labeling
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Checkpoint Review
• How are mental health problems categorized or classified?
• What are some criticisms of the classification system?
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Evaluation of the DSM Classification System
• Some question its reliability and validity• Some feel the DSM is too biologically and medically
oriented, considered more than half the included disorders have no known or presumed organic cause.
• Some argue that political and practical factors affect the DSM
• Some argue that diagnostic categories are less useful than study of symptoms or dimensions of symptoms.
• However, although there are alternatives to the DSM, the widespread use of the DSM makes it convenient and useful.
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Potential Dangers of Labeling
• Diagnostic labels place people in a category of abnormal, which implies they are qualitatively different than “normal” individuals.
• A label can encourage others to interpret the person as pathological
• A label can cause others to treat the person differently• A label can become a self-fulfilling prophecy• A label may prevent the client and clinician from finding
more helpful, comprehensive information about the client