The Clinician’s Toolbox II Assessment

Reliability & Validity  Tests must be valid and reliable to be useful  Reliability  Consistency with which individuals respond to test stimuli  Several known ways to evaluate reliability  Validity  The extent to which an assessment measures what it is supposed to measure  Several known forms of validity

Reliability  Test-retest reliability  An index of the consistency of test scores across some period of time  Equivalent forms reliability  An index of the consistency of test scores across time without “practice effect”  Split-half reliability  Index of the internal consistency of the test  Internal consistency  Preferred index of internal consistency; all possible split-half correlations is computed  Inter-rater or inter-judge reliability  Index of degree of agreement between to or more raters or judges

Validity  Content validity  The degree to which a group of test items actually covers the various aspects of the variable under study  Predictive validity  The degree to which test scores can predict (correlate with) behavior or test scores observed or obtained at some later point  Concurrent validity  The extent to which test scores are correlated with a related, but independent set of test scores or behaviors  Construct validity  The extent to which test scores are correlated with other measures or behaviors in a logical and theoretically consistent way  Involves demonstrating both convergent and discriminant validity

Cognitive Testing: An umbrella term  General intelligence  Neuropsychological functioning  More specific cognitive skills  Visual and motor memory  Language skills  Pattern recognition skills  Finger dexterity  Visual-perceptual skills  Academic skills  Motor functions

Intelligence Testing  First used to evaluate children to  Help them maximize their educational experience  Teacher’s develop appropriate curriculum with special needs  Screen military recruits  Still used for all of the above and  Vocational planning  Assessing learning disabilities  Determining eligibility for gifted and specail ed programs  Brain-behavior relationships and functional problems  Overall cognitive strengths and limitations

Intelligence Defined?  What is intelligence?  No single definition of intelligence that experts agree upon  Influential theories  Spearman  Thurstone  Cattell  Guilford  Piaget  Sternberg  Gardner  Goleman

Intelligence Measured  Most popular and most frequently administered are the Wechsler Scales  Wechsler Adult Intelligence Scale (WAIS III)  WAIS-R as a Neuropsychological Instrument (WAIS-RNI)  Wechsler Intelligence Scale of Children (WISC-IV)  Wechsler Primary and Preschool Scale-Revised (WPPSI-R)  Stanford-Binet V  Kaufman Assessment Battery  Woodcock-Johnson Psychoeducational Battery III

Wechsler system  Verbal subtests  Information  Similarities  Arithmetic  Vocabulary  Comprehension  Digit span  Letter-number sequencing  Performance subtests  Picture arrangement  Picture completion  Block design  Object assembly  Matrix reasoning  Digit symbol  Symbol search

Wechsler System  Mean score of 100; SD of 10 (15 in WISC and WPPSI)  average range  < 70 is in mentally deficient range  > 130 is in the very superior range  Individual tests have a mean score of 10; SD of 3  All form the basis for subtle observations about relative strengths and limitations  Observe patterns of scores  Interpreted in the context of other test results and variety of biopsychosocial factors

Intelligence and Ethnicity  Kaufman Assessment  KABC; KAIT  Sequential processing  Simultaneous processing  Mental processing composite  Achievement  Mean 100; SD 15  System of Multicultural Pluralistic Assessment (SOMPA)  Especially designed for children from ethnic minority groups  Nine different measures of cognitive functioning  Includes a structured interview with parents

Neuropsychological Testing  Assess brain-behavior skills  Abstract reasoning  Memory  Visual-perceptual  Attention  Concentration  Gross and fine motor coordination  Language functioning  Halstead-Reitan & Luria-Nebraska  6-8 hours to administer

Questions & Controversies  Are we born with a certain IQ?  16-64% of the variance in intellectual ability is due to genetic influence (Hale, 1991; Sattler, 1988; 1992)  Biopsychosocial influences associated with intelligence or at least IQ scores  Are IQ scores stable?  Very young; very long time – less stable  Are IQ scores biased?  Validity does not vary from group to group on Wechsler or Stanford-Binet; tests can be misused.

Personality Tests  Observe and describe the structure and content of personality – the characteristic ways an individual thinks, feels, behaves, and interacts  Clarifies  Diagnoses  Problematic patterns of behavior  Intra and interpersonal dynamics  Treatment implications  Can be objective or projective

Measuring Personality & Psychological Functioning  Objective testing  Specific questions or statements to which the person responds by using specific, fixed answers or a rating scale  Scores tabulated and compared to reference groups  Projective testing  Ambiguous or unstructured stimuli to which client is asked to respond freely.  Unconscious or conscious needs, motives, interests, dynamics are projected onto ambiguous stimuli revealing internal dynamics or personality  More challenging to score and interpret than objective

Objective Tests  Minnesota Multiphasic Personality Inventory (MMPI; MMPI-2)  Millon Multi-Axial Inventory III (MCMI-III)  16 Personality Factors (16PF)  NEO Personality Inventory (NEO-PI)

Projective Tests  Rorschach Inkblot  Thematic Apperception Test (TAT)  Projective Drawing Tests  Draw-A-Person  Draw-A-House  Draw-A-Tree  Draw-A-Family  Sentence completion tests

Questions & Controversies  Are personality results assessed through testing stable?  Person-situation interaction appears to be in play  Are projective tests reliable and valid?  When purpose is to know, understand, and describe.  Some research shows support for psychometric properties of Rorschach  Are personality tests appropriate for ethnic minority groups members?  Should personality and psychological functioning tests be used in employment decisions?  Not designed for this;  Some argue still useful;  Specific tests developed for this

Clinical Judgment  Ultimately, clinician uses  Judgment  Impressions  Experience  Data  Examines all the pieces of the puzzle  Theoretical framework  Prior experience  Clinical training  Intuitions  Managed care insurance companies  Highly specific assessment tool  Objectify target symptoms