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York University
PSYC 3140
Joel Goldberg

Chapter 4 Assessment is the process of gathering information about people's symptoms and the possible causes of those symptoms Adiagnosis is a label attached to a set of symptoms that tend to occur together GATHERING INFORMATION Symptoms and History ask about his current symptoms, including their severity and chronicity try to ascertain how much the symptoms are interfering with ability to function in the various domains of life The criteria for diagnosing most psychological disorders require that the symptoms be severe and pervasive enough that they are interfering with the person's ability to function in daily life also be very helpful to know how he is coping with the stress of his life and his symptoms know about any recent events in persons life and whether onset of symptoms is tied to these life events symptoms that are triggered by a specific event often have a different prognosis and require different treatment from symptoms that arise spontaneously An individual's history of psychological problems is also important in the assessment It is also helpful to know an individual's family history of disorders Physiological and Neurophysiological Factors clinician should obtain complete physical examination to determine if client has any medical conditions that can create psychological symptoms biological tests can sometimes tell whether medical disease is causing psychological symptoms Clinicians also need to know about any drugs a client is taking to protect against interactions between those drugs and medications the clinician might prescribe Clinicians often assess their clients' cognitive functioning and intellectual abilities which can be relevant to making a differential diagnosis: a determination of which of several possible disorders an individual may have Sociocultural Factors Clients' social environment and cultural background can influence their symptoms Clinicians often ask about social resources clients have availablethe number of friends and family members they have contact with and the quality of their relationships with these people Social isolation can make much more difficult for people to overcome psychological problems An important step for clinicians working with a culturally diverse clientele is to obtain information on clients' sociocultural background It is also useful to know as much as possible about clients' socioeconomic status and occupation in their homeland because the contrast between their lives before and their current lives can be a source of difficulty Acculturation is the extent to which a person identifies with his or her group of origin and its culture or with the dominant, mainstream culture biculturalthey continue to identify with their culture of origin and celebrate it but also assimilate as necessary into the dominant culture acculturation can affect how clients talk about and present their problems, the kinds of stresses clients will be exposed to, and clients' responses to interventions a client who is acculturated to the mainstream Canadian culture will respond differently to certain suggestions a clinician makes, than will a client who remains identified with a culture in which authority figures are never questioned ASSESSMENTTOOLS Clinical Interviews Much of the information for an assessment is gathered in an initial interview, often called an intake interview or a mental status exam, The interview may be an unstructured interview, with only a few open-ended questions The clinician listens to the client's answers and observes how the client answers to obtain nonverbal indicators of what is bothering her may also interview client's family members Information from family members is especially important if the client is a child, because children cannot always state what they are feeling or thinking. some adults are so impaired that they cannot provide adequate information to the assessor structured interview-clinician asks respondent a series of questions about symptoms he or she is experiencing or has experienced in the past, interview is highly structured and standardized Several such structured interviews have been developed in recent decades, including the Diagnostic Interview Schedule, or DIS, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders or DSM One of the greatest limitations can be resistance on the part of the client who is being interviewed.(the individual being assessed does not want to be assessed or treated) may be highly selective in info provided, bias presentation of info, or even lie to the assessor Cognitive, Symptom, and Personality Tests Validity The accuracy of a test in assessing what it is aiming to measure is called its validity Atest is said to have face validity when the items seem to be measuring what the test is intended to measure Content validity is the extent to which a test assesses all the important aspects of a phenomenon that it purports to measure Concurrent validity is the extent to which a test yields the same results as other measures of the same behaviour, thoughts, or feelings Atest that has predictive validity is good at predicting how a person will think, act, or feel in the future Construct validity is the extent to which the test measures what it is supposed to measure, not something else altogether Reliability The reliability of a test is an indicator of the consistency of a test in measuring what it is supposed to measure Test-retest reliability is an index of how consistent the results of a test are over time Typically, measures of general and enduring characteristics should have higher test-retest reliability than measures of momentary, or transient, characteristics - researchers often develop two or more forms of a test, when people's answers to these different forms of a test are similar, the tests are said to have alternative form reliability When people's answers are similar in different parts of the same test, the test is said to have high internal reliability inter-rater reliability,or inter-judge reliability:different raters or judges who administer and score interview or test should come to similar conclusions when evaluating same people Neuropsychological Tests If the clinician suspects neurological impairment in a client, paper-and-pencil neuropsychological tests may be useful in detecting specific cognitive and fine-motor deficits frequently used neuropsychological test-Bender-Gestalt Test which assesses clients' sensorimotor skills by having them reproduce a set of nine drawings Bender-Gestalt Test good at differentiating people with brain damage, but it does not reliably identify the specific type of brain damage a person has Brenda Milner- study comparing the ability to complete a non-verbal task in people with cortical excisions and control participants without these excisions, the results demonstrated that those with right frontal and right fronto-central lesions had less ability to complete the task, thus suggesting that the skills relevant to the task are primarily related to this brain region Two of the most popular batteries are the Halstead-Reitan Test and the Luria Nebraska Test- These batteries contain several tests that provide specific information about an individual's functioning in several skill areas, such as concentration, dexterity, and speed of comprehension Brain-Imaging Techniques neuropsychological tests are being used in conjunction with brain-imaging techniques to identify specific deficits and possible brain abnormalities Computerized tomography (CT) is an enhancement of X-ray procedures-CT, narrow X-ray beams passed through head from variety of angles, amount of radiation absorbed by each beam is measured, and computer program constructs an image that looks like a slice of the brain. By taking many slices of the brain, the computer can reconstruct a three- dimensional image. The two major limitations: it exposes patients to X-rays, which can be harmful, and it provides only an image of the structure of the brain, rather than an image of the activity in the brain Positron-emission tomography (PET) can provide a picture of activity in the brain- requires injecting the patient with a harmless radioactive isotope, such as fluorodeoxyglucose (FDG)., PET scans can be used to show differences in the activity level of specific areas of the brain between people with a psychological disorder and people without a disorder PET show that serotonin
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