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Chapter 17

Psychology 2080A/B Chapter 17.doc

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Western University
Psychology 2080A/B
Hayden Woodley

Psychology 2080- Chapter 17- Testing in Health Psychology and Health Care • today more than 5% of all psychologists are directly employes by hospitals, medical centers and clinics main function is to use and interpret measurement instruments • • this chapter focuses on three areas: neuropsychological assessments, anxiety and stress assessment and quality of life assessment Neuropsychological Assessment Clinical Neuropsychology • scientific discipline that focuses on psychological impairments of the central nervous system and their remediation • Clinical neuropsychology is defined as the scientific discipline that studies the relationship between behaviour and brain functioning in the realms of cognitive, motor, sensory, and emotional functioning • the activities of these people include the identification, multivariate quantification and treatment of diseases of the brain and spinal cord • overlaps neurology, psychiatry, and psychometric testing in the following ways • neurology and CN-> both focus on perceptions and sensations on motor movements • psychiatry--> both study mood and adaptation to psychosocial situations • psychometrics--> both use psychological testing • but differs from these because it is specialized, focussing on attention, memory, learning, language, communication, spatial, cognitive flexibility • it attempts to relate brian dysfunction and damage to observable and measurable behavioural functioning • has benefited from advances in neuro-imaging • can see diseases in the brain of living people • found that peoples brain structures and organization are very different • they now believe that peoples results on neuropsychological tests gives then clues about which part of the brain to examine • and they’re good for characterizing the effects of serious medical conditions, such as HIV that might influence brain and behaviour • despite these major advancements of the imaging of the brain, neuropsychology is able to detect problems that are often missed even with the latest devices • and it can detect Alzheimer’s disease and other clinical problems in the earliest stages and tests are now used to detect a wide range of clinical problems • it remains the primary method to diagnose the effects of minor traumatic injury • motivation or desire to do well can greatly affect performance • now have MRI and CT scanning to look at brain of living people • neuropsychologists are quite specialized, some work with development, some work with adults, or older adults • focus mainly on brain dysfunction, but some working on interventions for people who suffer brain injuries • also how cognitive processes are affected by mental illness and alcohol and abuse or serious diseases, AIDS • some use specific tests but some prefer specific tasks derived from experimental psychology • and can be used to evaluate memory • capacity for short term memory is limited (need repetition) • but capacity for long term memory is large tools to evaluate memory --> Wechsler memory scale- revised (WMS-R) and Memory • assessment scales (MAS) and RANDT memory test (RMT) and the Luria- Nebraska battery • short term memory best assessed using verbal tests these include the immediate recall span, the digit span and several word tests • • test short term memory through stories or lists of unrelated words • alcoholic dementia--> dysfunction of the visuospatial skills • Huntington’s Disease: perform much better on recognition than people with Alzheimer's • people who don’t drink have much better immediate recall, delayed recall and recognition • gets better the longer you’re off alcohol • but chronic alcohol can be permanent • new research also challenges the idea that functional problems are related to specific locations within the brain • new evidence suggests that complex cognitive, perceptual, and motor functioning are determined by neural systems rather than specific single structures • one of the most studied areas of neuropsychology is the identification of deficits in the left and right hemispheres of the brain • approx. 2/3 of left handed people have language organized on the left side of the brain and only 20% have it on the right • neuropsychological tests can be used to diagnose motor problems • such as problems drawing pictures if they suffered damage to the right hemisphere and they are skilled at recognizing which aspects of the information-processing systems • may be damaged • information storage and retrieval are related but not the same • recognition can be evaluated using MC tests Developmental Neuropsychology • sometimes when child is not performing as they should be in school, they use neuropsychological testing as a baseline to see whats up, especially if they kid has a mental illness that could change their brain over time • assessment of children has unique problems though • earlier brain injury might be missed until the child reaches an age where they are challenged with new types of behaviour • also problem with brain plasticity • recovery is good but not always complete and these problems can be hard to treat and recognize • neuropsychological tests vary widely for children • one area tests general development and adaptive functioning • Child development inventory, child behaviour checklist, reynolds depression scale and Children’s state-trait anxiety scale • a second group of measures estimates attention and executive function • these tests typically evaluate functioning related to several different aspects of information processing • the Trail Making Tests, scatter sequential numbers around different locations on a sheet of paper • the child is asked to draw lines to connect numbers in a sequence • part B of the test adds scattered sequential letters and the child must start at 1, go to A, then go to 2 then B and so on • the test evaluated several cognitive skills including attention, sequencing, and thought processing • attention and executive function are believed to be separate executive functioning includes volition such as forming and executing a goal, planning, • and taking action to complete a task • it also includes the self control and self monitoring to complete the task • 4 different factors of mental processing and related them to specific anatomical regions in the brain • one factor is focus execute • this refers to child's ability to scan information and respond in a meaningful way • a second factor is sustain which describes the child’s capacity to pay close attention for a defined interval of time • the third factor is encode and is related to information storage, recall and mental manipulation • the final factor is called shift, refers to the ability to be flexible • different neuropsychological tests are used to asses each of these four factors the study of child brain dysfunction is very important • • problems appearing in speech and reading are known as learning disabilities • Dyslexia: specific reading disorder characterized by difficulties in decoding single works • hard to say how many kids have this • 4 % of school ages children and approx. 80% of children with a learning disability • law now says these kids get individual learning programs • learning disabilities represent a major public health problem • so important to define sub categories, developing procedures to identify them and instituting methods for helping children over come them • also used to see if people are faking an illness • people exaggerated brain injury it get better benefits at work • all subjects completed the WAIS • made a equation that separated malingerers from those who were not exaggerating • can be used to determine the seriousness of concussions among athletes • one application of CN is concussion resolution index (CRI) to track recovery following sports related injury • made up of 6 subtests including reaction time, visual recognitive and speed of information processing • also studying the cognitive consequences of earlier brain lesions • high risk infants show trouble in tasks by the time they are 3 • other studies focus on recovery from accidents and traumas • neuro-psychological tests show these people have some intellectual difficulties that neurology doesn’t show • they want to understand brain-behaviour relationships in children extensive diagnostic procedures for identifying learning disabilities such as speech • disorders • and attempted to link specific medical problems such as birth complications and prematurity to later intellectual function finally hey have attempted to identify the cognitive consequences of early brain disease • and injury • hard field because it has so many levels of assessment • 7 step problem in rehabilitation plans first step- application of formal tests to determine the nature of the problem 2- assessment of the environment (school demands and such) 3/4- require the formulation of treatment plans including short and long term consequences of the the brain problem and chances intervention will make a difference 5- availability of resources 6- development of a realistic treatment plan that considered information in 1-5 7- ongoing relationship between neuro-psychological assessment and intervention on going assessment Adult Neuropsychology • many different approaches to identifying the consequences of brain injury in adults • perhaps the 2 best known approaches involve administration of the Halstead- Reitan and Luria-Nebraska test batteries Halstead-Reitan Neuropsychological Battery 1935 Ward Halstead realized that determining inadequacy in brain function required a • wide range of tests that measured characteristics and abilities beyond those triggered by existing psychological tests • when evaluated with the Halstead- Reitan they also used a full Minnesota Multi phasic Personality Inventory (MMPI) to evaluate their emotional state in response to the medical situation • also included a full WAIS • available for children and adults • many studies validate the HR test • most studies show that performances on specific subtests is associated with dysfunction in one of the two hemispheres • battery can locate tumors or lesions on the right or left side also or front or back • by studying performance in a systematic way, neuropsychologists have been able to provide important information about the location and the impact of brain problems • critics say the major advantage of the test may not be worth the effort in applying all the measures • the battery can assist in localizing injury in the right or left • but this may be meager in comparison to the hours it takes to complete the test • new methods of brain imaging may be more efficient for locating injury • tried to find specific areas within the brain that correspond to particular behaviours • fixed quantitative battery - psychologists follow a set process Luria- Nebraska Neuropsychological Battery Luria saw the brain as a functional system, with a limited number of brain areas involves • in each behaviour • introduced pluripotentiality- that any one center in the brain can be involved in several different functional systems • one center may be involved in both visual and tactile senses • multiple systems could also be responsible for the same behaviour • if a child’s injury affects one area, then another may take over good for when severely disabled people who have multiple health problems cannot • complete traditional psychological tests • amount of time on one patient varied • hard for others to repeat the same steps Luria used to reach conclusions about particular patients • Lurias opinion was the only validity for the test • even though her procedures were important they did not meet the psychometric standards of many US psychologists • to face this Golden developed a standardized version of Luria’s procedures • because known as the Luria-Nebraska Neuropsychological Battery • 269 itms that can be administered in 24 hours 11 subsections • • and there is a test for children now • the inventory is scored finding a standardized performance level for ech 11 subtests • 3 more scores are reported • studies show this test can make fine distinctions in neuropsychological functions • many of these studies used the battery to estimate the area of a brain damaged by a tumor or lesion • in many of these studies, confirmation is made by surgery or CT scan • in one study test localized 22 of 24 RH and 29 of 36 LH cases • has serious critics however scores above top straight line indicate serious problems • • damage often associated with damage to the temporal lobe • qualitative approaches allow greater flexibility in assessment process The California Verbal Learning Test (CVLT) • many factors determine performance on a given task • one needs to know what aspects of the information processing system are defective and which are functioning well • important for designing rehabilitation programs • CVLT is a new approach that builds on research in psychological testing, cognitive psychology, and computer science • test determines how errors are made in learning tasks • the intent is to identify different strategies, processes and errors that are associated with specific deficits • attempts to link memory deficits with impaired performance on specific tasks for people who have known neurological problems • assess various variables, including recall and recognition, semantic and serial strategies and learning errors in recall and recognition • told they are going shopping, told to remember 16 item list • tells a great deal of info about learning across tasks • anxious people may do badly on the first few then improve • inconsistent recall indicated amnesia • can be done on paper or with a microcomputer • computer assists test administrators , speeds up scoring • correlates well with other memory measures (Weschler) • the diversity of deficits could not be identified by more traditional psychometric t
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