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Chapter 4

Ch. 4 Psychological Assessment and Research Methods.docx

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PSYC 3230
James Alcock

4. Psychological Assessment & Research Methods Monday, January 28, 2013 9:00 AM Learning Objectives 1. Differentiate between psychological testing and psychological assessment and describe the importance of this distinction. 2. Explain the importance of reliability and validity in clinical assessment. 3. Describe the strengths and weaknesses of clinical versus actuarial prediction. 4. Compare and contrast structured versus unstructured interviews and describe circumstances in which you might want to favor one format over the other. 5. Define what an "experiment" is and explain what differentiates it from non-experimental research methods. 6. Explain why it is important to consider clinical significance in addition to statistical significance. Assessment  An accurate diagnosis provides a shorthand description of many important attributes of a patient and allows some predictions about the individual's development  This diagnosis usually results from a psychological assessment-- a systematic gathering and evaluation of information pertaining to an individual with suspected abnormal behavior  A diagnosis is only as good as the assessment on which it is based, and the assessment, in turn, is only as good as the tools used to carry it out  Psychological assessment provides a comprehensive understanding of an individual, not just a single score  Assessments are usually thought of in relation to diagnosis, though they may also have other specific purposes such as in IQ test used to guide school placement  A good assessment tool depends on two things: 1. An accurate ability to measure some aspect of the person being assessed 2. Knowledge of how people in general fare on such a measure, for the purpose of comparison (this knowledge is derived from research) Assessment tools: Striving for the whole picture  The most useful understanding of a patient draws on a combination of procedures that shed light on a range of different aspects of an individual's functioning Reliability and validity  To be useful, any test must be both reliable and valid  Several types of reliability are particularly important for psychological tests o Test-retest reliability-- the degree to which a test yields the same results when it is given more than once to the same person o Alternate-form reliability-- a different form of the same test is prepared o Internal consistency-- the degree of reliability within a test (i.e., to what extent to different parts of the same test yield the same results?)  One measure of internal consistency is split-half reliability-- which is often evaluated by comparing responses on odd-numbered test items with responses on even- numbered test items  Another measure of internal consistency is a coefficient alpha-- calculated by averaging the intercorrelations of all items on a given test  A reliable measure may be of little value if it is not valid o Face validity-- the user of a test believes that the items on the test resemble the characteristics associated with the concept being tested for o Criterion validity-- an attribute of a test, when it gives higher scores to people already known to have a greater ability in the area it tests. The concept arises because some qualities are easier to recognize than to define completely, such as artistic ability o Construct validity-- the validity of a test assuming a specific theoretical framework that relates the item the test measures, often rather abstract, to some other item that is more easily assessed. If the two sets of measurements correlate, the test is said to have construct validity Clinical versus actuarial prediction  How does one evaluate and interpret a collection of data-- interviews, case histories, responses to tests-- to describe the patient, make predictions, and come to decisions?  Clinical approach-- an approach to evaluating and interpreting the data on patients, making predictions, and coming to decisions that relies on the clinician's experience and personal judgment, guided by intuition and honed with professional experience rather than by formal rules  Actuarial approach-- an approach to evaluating and interpreting the data on patients, making predictions, and coming to decisions that relies exclusively on statistical procedures, empirical methods, and formal rules  Research evidence favors the actuarial approach, suggesting that it tends to be much more efficient in terms of making predictions in a variety of situations (e.g., relapse, dangerousness, improvement in therapy, success in university) Biological assessment  Many medical conditions can also affect behavior; therefore, it is important that a general physical examination be conducted as part of an assessment for psychological disorders Brain imaging techniques  The central nervous system has been the focus of considerable research in the attempt to understand the causes of psychopathology  EEG-- uses electrodes placed on various parts of the scalp to measure the brain's electrical activity o Can detect seizure disorders, brain lesions, and tumors  Neuroimaging techniques can provide both structural and functional information concerning the physiological health of the central nervous system  Computed tomography (CT) o Computerized axial tomography (CAT) scan-- a brain imaging technique in which a narrow band of X-rays is projected through the head. The X-ray source and detector rotate very slightly and project successive images. The exposures are combined by a computer to produce a highly detailed cross-section of the brain o Tomography-- a two-dimensional image of cross-section of the brain o CT scans have confirmed a number of ideas about how the brain works in abnormal psychology (e.g., schizophrenia involves cortical atrophy)  Magnetic resonance imaging (MRI) o Magnetic resonance imaging (MRI)-- a non-invasive technique, developed in the early 1980s, that reveals both the structure and the functioning of the brain o fMRI-- a recent modification (early 1990s) of MRI which provides a dynamic view of metabolic changes occurring in the active brain  Positron emission tomography (PET) o Positron emission tomography (PET)-- a combination of computerized tomography and radioisotope imaging  While CT scans and MRIs can produce a static image of the brain's anatomy, PET scans and fMRIs produce a dynamic image of the functioning brain  Clinicians often use CT or MRI in addition to PET scans to determine the cause of structural abnormalities, such as reduced blood flow Neuropsychological testing  Neuropsychological assessments are used to determine relationships between behavior and brain function  Bender Visual-Motor Gestalt Test-- the oldest and most commonly used of neuropsychological assessments often used to screen children for neuropsychological impairment. The test consists of a series of nine cards containing lines and shapes drown in black on a piece of white cardboard. Children are asked first to copy the images on another card and then to draw them from memory. Errors in reproducing these lines and shapes may indicate neuropsychological problems o Produces many false negatives o Clinicians can discriminate between unimpaired participants and those with neurological impairment approximately 77% of the time  Neuropsychological assessments now usually employ a battery of tests to identify not only the presence of cognitive and motor impairment but also the nature and area of neurological impairment  Other batteries of tests: the Halstead-Reitan and the Luria-Nebraska Psychological assessment Clinical interviews  The clinical interview is the most common assessment tool, used by almost every clinician  A psychological test is meaningless unless it is placed within the context of an individual's life; the clinical interview provides this contextual information  Clinicians ask about medical history, psychiatric history, age, marital status, family, education, lifestyle, and why the person is seeking consultation  Unstructured interviews o The main advantage of unstructured interviews is that they facilitate mutual trust, respect between clinician and patient, and rapport-- mutual understanding or trust between people o Major criticism: poor reliability and validity  Clinicians may tend to uncover only information that fits their theoretical orientation and confirms their hypotheses  Structured interviews o Structured interviews-- very specific in the order and wording of questions and in the rules governing the evaluation of responses (e.g., Diagnostic Interview Schedule, Version IV [DIS- IV]) o Although highly structured interviews may increase reliability, they tend to jeopardize rapport  Semi-structured interviews o As in the unstructured interview, the clinician has considerable leeway about what questions to ask, in what order, and with what wording o The questions are guided, however, by an outline that lists certain dimensions of the patient's functioning that need to be covered o Mental status examination-- the most frequently used semi-structured interview in psychiatric settings. Screens for patients' emotional, intellectual, and neurological functioning. Used in formal diagnosis or to plan treatment o The most used semi-structured interview to assess psychopathology is the Structured Clinical Interview for DSM-IV (SCID)  SCID-II assesses Axis II personality disorders Assessment of intelligence  Intelligence quotient (IQ)-- a test of judgment, comprehension, and reasoning invented by French psychologist Alfred Binet (1957-1911), in which a child's mental age, determined by the child's successful performance on age-grouped tests that had been normed, was divided by the child's chronological age, and the quotient multiplied by 100. Theoretically, IQ was a reflection of that person's performance compared with others of the same age  Stanford-Binet Intelligence Scales-- an intelligence test whose most recent version assesses four kinds of ability: verbal reasoning, quantitative reasoning, abstract/visual reasoning, and short- term memory. It produces separate scores for each of these functions as well as a global IQ score that summarizes the child's ability. Developed from the work of Binet  Wechsler Adult Intelligence Scale (WAIS)-- the most widely used IQ tests, designed to measure diverse aspects of intelligence. Developed by David Wechsler (1896-1981)  Of all psychological traits, IQ shows the most stability  There is no evidence that IQ is significantly related to other measures of success in life, such as income earned, physical or mental health, or general life satisfaction  IQ scores must be evaluated within the context of ethnic, age, gender, and culturally appropriate norms in order to increase validity Personality assessment  Personality assessments usually describe various characteristics that make up an individual's unique personality  Projective test o Projective test-- a type of psychological test that reveals information the person being tested cannot or will not report directly. Used to help clinicians form hypotheses about an individual's personality o Controversial, though still frequently used o Rorschach inkblot test-- the oldest and probably best known projective test. Based on the idea that people see different things in the same inkblot and that what they see reflects their personality. The blots are presented on separate cards and handed to the subject in a particular sequence  The Exner system developed in an attempt to increase reliability and validity by standardizing the scoring of responses o Thematic Apperception Test (TAT)-- a psychological test using drawings on cards depicting ambiguous social interactions. Those being tested are asked to construct stories about the cards. It is assumed their tales reflect their experiences, outlook on life, and deep-seated needs and conflicts. Validity and reliability of scoring techniques are open to the same criticisms as those of the Rorschach inkblot test o Projective tests lack reliability and validity  Personality Inventories o Minnesota Multiphasic Personality Inventory (MMPI)-- the most widely used objective test of personality. The adjective "multiphasic" means that it assesses many aspects of personality. The test contains 567 questions grouped to form 10 content scales plus additional scales to detect sources of invalidity such as carelessness, defensiveness, or evasiveness. The revised and updated version, called the MMPI-2, focuses primarily on Axis I disorders o Contrasted-groups method of ascertaining validity-- items were chosen only if people known to have the characteristic the scale is intended to measure responded differently to the item than did people who did not have that characteristic o Results of an MMPI-2 assessment do not constitute a diagnosis, but rather a profile of personality characteristics compared to psychiatric and non-psychiatric groups that may assist in forming a diagnosis o Millon Clinical Multiaxial Inventory (MCMI)-- an objective test of personality developed to help clinicians make diagnostic judgments within the multi-axial DSM system, especially in the personality disorders found on Axis II o A common response set is social desirability-- answering to make oneself look good o Person by situation interaction-- the impact of a person's surroundings on his or her behavioral characteristics, according to Walter Mischel's view that predicting a person's behavior requires knowledge of both the person's typical behavior patterns and the characteristics of the setting Behavioral and cognitive assessment  Some suggest that the best predictor future behavior is past behavior  Observational techniques o Behavioral clinicians try, whenever possible, to observe their patients' troubled behaviors directly o One form of behavioral observation employs behavior rating scales-- a preprinted sheet on which the observer notes the presence and/or intensity of targeted behaviors o In vivo observation-- A method used by behaviorally oriented therapists to determine how environmental variables affect a behavior of concern, in which a clinician may record a running narrative of events, using pencil and paper, video, or still camera, in the client's everyday environment o Analogue observational setting-- an artificial environment set up in an office or laboratory
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