PSY341H1 Lecture Notes - Lecture 3: American Psychiatric Association, Intellectual Disability, Factor Analysis

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Published on 27 Sep 2012
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PSY341H1S Lecture 3: Assessment
There are only two professions that can use the DSM-IV TR: physicians and psychiatrists
DSM-IV TR is the assessment used in Canada and the United States, published by
American Psychiatric Association, a group of physicians (mainly psychiatrists)
There is a significant overlap. If you are getting diagnosed in Ontario, for i.e., you need to
get diagnosed by ICD as well
In each of the categories of DSM-IV TR is called NOS (not otherwise specified) it is very
easy to ID abnormal behavior but it is hard to categorize with definitions
NOS decreases validity and increases misdiagnosis, however
What would you want to consider when making a good categorization system for mental
disease?
1. Categorizes are clearly defined
One problem with this is that here is a significant overlap in categorical symptoms from
one disorder to another
2. The categories exist
Meaning symptoms are seen to occur together all the time; we can use factor analysis or
consensus opinion from experts to decide whether they do or don’t
3. Reliability
Test-retest and inter-rater
4. Validity
Categories are clearly defined from one another; not so with DSM-IV TR because there is
significant symptom overlap
5. Clinical utility
Polygraph has good utility but poor validity, therefore it would not be good to use in
disorder assessment
DSM-IV TR and IC are derived from consensus and other systems are statistically derived
DSM-IV TR first had only 2 categories relating to child disorders, but expanded later;
today it has 10
The categories of disorders will not be on the test; they will be introduced after the
first midterm
DSM-IV TR provides diagnosis on 5 dimensions/axis
Advantages of diagnosis:
a. selection of treatment
b. helps in the research of mental disorders
c. comfort in knowing that you have something others have and act the way that you do
Disadvantages of diagnosis:
a. restricted
b. misdiagnosis
A diagnosis should not be static, because it could change due to the fact that an assessment
should be ongoing (unfortunately, many do not acknowledge this)
3 Types of Assessment:
1. The interview
Utilizes verbal questions and replies. Structured and unstructured questions are used as
well.
Most common in adults
Questions asked based on the referral: a big problem with the interview, and thus will ask
more detailed questions about compliant and little/no questions about history
Establishing rapport with children is much harder than it is for adults, therefore they prefer
to do interviews in non-stressful environments, i.e. a playful environment that provides
play materials and movement to assess child’s anxiety levels
Not good for assessing mental retardation, autism, and other conditions wherein children
may not be verbal
Clinician must listen carefully and only note the important information
2. Testing
More formal, and there are 2 types of tests: cognitive tests and projective tests
The psychological assessment
Looks at cognitive functioning and emotional functioning
Exclusive domain for psychologists
PPVT: Peabody Picture Vocabulary Test
Relatively high correlation between PPVT and WISC in younger children
Bayley Scale: looks at whether or not the child has reached developmental milestones;
assumed relation between reaching developmental milestones sooner than the norm and
prototypical and later IQs
Personality tests, often referred to ask projective tests. They use ambiguous stimuli
wherein individuals are able to respond freely to
Most common:
a. Rorschach Inkblot Test
b. Thematic Apperceptions Test
c. Children’s Apperceptions Test (not widely used)
3. Observational
Can be structured or unstructured; just looking at behavior
Most common in children
Stages of Assessment
a. The referral
Seeking help may be hard due to the parents. The nature of the referral is important
Can be likened in a hospital (parent bringing child to doctor’s office and doctor may refer
the parent/child to a psychologist or psychiatrist
The child’s motivation is important to note as well. May consider themselves as unloved
or blamed. This information should also be provided in the referral.
Rapport is important in assessment as well. If you do not have good rapport, you are not
going to get good information from the patient (particularly with older adults and children)
Poor motivation leads to poor prognosis
Threats and punishments will lead to an increase in motivation
b. The assessment
The most useful technique of assessment with children is observation because they’re not
as verbally sophisticated as adults so they can’t tell you what they’re thinking/feeling as
well
Requires very little verbal interaction but does require the correct training to gather
information and may yield most information from all the methods
2 warnings for using observational method: you are observing the behavior in one place at
one time (behavior is changeable across time and situations). You could commit observer
bias, because you are given a referral, you think it’s disorder X so what you end up
looking for is disorder X
Evaluation apprehension may occur
5 Categories for Observation Behavior
a. general appearance and attire of parents and child (deformities, scars, bruises, clothing,
extreme thinness, does their appearance fit their age)
b. emotional gestures and facial expressions (subtle body language, mainly looking for
expressions relating to fear and anxiety because they may indicate a lack of motivation to
participate and poor rapport). Emotions are easy to detect and interpret but attention must
be paid
c. gross and fine motor acts (big/small sophisticated movements). This is an area of
response governed by chemical, brain, psychological and physiological functioning. For
example, being extremely over/underactive (drugs, chemical imbalances, underlying
neurological condition, psychosis?)
d. the quality of relationships between child and parent (important for axis 4 and 5)
e. structure of verbalization