526_exam2 [Compatibility Mode]

8/6/2019 526_exam2 [Compatibility Mode]

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Cognitive and personality functioning

What are meaningful ways to integrate these two

pieces of information? What interpretations might one make for high IQ individuals

relative to low IQ individuals re: personality? Overlap with maturity? Less complex presentations?

What PD is associated with extremist thinking (splitting), inability torecognize subtleties?

Other implications? Ease of use for clients, alternative test format, wider range of

responses (variability), alternative approach to detectingpathology, difficult for client to identify socially desirable orundesirable responding, theory based

Defensiveness strategies (see MMPI-2)?


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Projective test/technique

MMPI/MMPI-2 is most frequently used test in inpatient settings

Rorschach & TAT are not too far behind

Advantages of projectives?

Disadvantages of projectives?

Administration and scoring is generally less standardized so reliabilityand validity are compromised


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Minimal criteria for a test Standardized administration

Rorschach has numerous administration procedures(Bleck, Klopfer, Exner, etc.)

Standardized scoring

Rorschach has numerous scoring approaches (Bleck,Klopfer, Exner, etc.)

Standard of comparison for interpretations (norm group)

Minimal information with regard to representative

norms


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Rorschach Exner Exners (1987) scoring system involves an

attempt to increase validity by objectifying thescoring, increasing the number of responses(14), and standardizing the administration

This has resulted in significant improvements inthe tests reliability and validity

In a meta-analysis, Hiller et al. (1999) found theRorschach (using Exners scoring) to have larger

validity coefficients than the MMPI-2 for studiesusing objective criterion variables


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Exners scoring system Location part of the blot

W, D, d, S, (WS) How common is the location (normative comparisons

from manual)

Determinant what led to response

Form, Color, FC or CF, Movement, etc. Evaluate form quality (normative decision based on

manual of responses). Low F+% = psychosis/poorreality contact

Content focus on what specifically Human or animal, whole or detail, nature, etc.

Populars determines normative responding


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Other projective tests

TAT (Thematic apperception test, Murray)

Stimuli are less ambiguous than the ink blots

Tell a story, though little standardization re: which pictures to be used,scoring (typically a content analysis), etc.

Used extensively with less literate pops like children (CAT), geriatric pops(GAT), non-English speaking individuals, etc.

Draw-a-figure test (figure drawings)

Person, family, house, tree, etc. all are interpreted as you

Minimal standardization for scoring

Sentence completion

Sentence stems like Mom is, Life, etc. largely scored for a thematic

standpoint

Bender-Gestalt (the same test used for neuropsychological screens)

Copying figures and making personality interpretations


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Test or technique? Review articles and come up with an opinion. Come ready to

debate/discuss.

On Tuesday/Thursday?


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Assessment of malingering

What is malingering? What must it include?

Intentional? Awareness? Personal gain?

Very complex phenomenon that may change over time

e.g., A lie (or lies) that become real/true for the individual over time,or a truthful statement that becomes a lie.

Most statements cant be categorized as one or the other, and typicallyinvolve aspects of both

Berry et al (1995) suggest that faking good and faking bad are distinctconstructs (not opposite ends of the same continuum)

Harder to detect specific faking vs. general faking

Content nonresponsivity (CNR) random responding, all true or all false

Content response faking (CRF) fake good or bad; research suggests thatthese may be independent dimensions (client may fake good on someparts and fake bad on others)

Should always be considered (in some form) when there arecontingencies for the patient


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Classifications of Misrepresentation

Are symptoms under conscious control? Are physical/psychologicalsymptoms motivated by internal or external gains?

Factitious Disorders intentional production of symptoms (feigning)that are motivated by internal gains

Motivation is to assume the sick role as there are no externalincentives for the behavior (e.g., economic gain, avoiding legalresponsibility, etc.)

Somatoform disorder unintentional (i.e., unconscious) productionof symptoms for internal gains

Malingering intentional production or exaggeration of symptoms(i.e., conscious) motivated by external incentives

Lack of cooperation during the evaluation, presence of ASPD,discrepancy between self-reported data and objective findings,medicolegal context for referral (e.g., attorney, police, etc.)

Note: Exaggeration rather than fabrication makes differential verydifficult


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Pros and Cons of Malingering Dx

What are the costs of labeling someone a malingerer Questions all present and future clinical presentations

What are the limits of our measures to make this differential? After weighing the strength of any claim of malingering (relatively

weak given the limits of our measures) and the costs of making anerroneous judgment, we need to act very carefully

Use converging, independent evidence to make any determinations e.g., objective inventories like the MMPI-2, strong contextual factors (i.e.,

to provide the motive and baserates), interview, low probabilitybaserates for responding (e.g., incorrect on all options when this wouldbe well below chance responding), and response to the evaluatorsfeedback (e.g., Actually, youre doing quite well followed bydecrements in performance)


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Mind of a murderer the Bianchi tapes

Identify the circumstances that could be seen as contingencies formalingering (reinforcers for malingering)

Why would that particular malingering behavior be manifested?

How could client have obtained the information necessary toprovide the malingering profile? Any evidence that this informationwas obtained?

Any indications of malingering in his presentation? (Be objective)

What are some reasons why he might not be malingering? Predict response sets in advance of testing (vs. scoring in hindsight)

What pattern of responses do you predict for the Rorschach?

What pattern of responses would you predict for the MMPI-2?

Whats your call?


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Measures of malingering Berry et al

The pasta strainer and photo copy machine incident

MMPI-2: F, F-K (note: these two indices are not independent), VRIN

(random), TRIN (all true or all false), and Fb Also look for discrepancies between some of your subtle and obvious

supplemental scales (though this can also just assess sophistication inmalingering)

The D scale has also been used with some success, as the items appearto reflect a less sophisticated (popular) view of mental illness

MCMI evaluates random responding, low frequency responding,willingness to disclose information, debasement (willingness toendorse psychological problems), and desirability (unwilling toendorse psychological problems). Also as with the D scale of theMMPI, the well-being scale can likewise assess psychopathology


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Measures of malingering 2 continued

CPI (Cough, 1957) intended to assess personality in the normalpopulation

Has 3 validity scales: good impression (faking good), communality (itemswith either very high or very low endorsement frequency that assessesrandom responding), well-being (assesses fake bad)

Basic personality inventory (BPI: Jackson, 1989) contains 12 scaleseach with 20 T/F items. Research is limited on its utility for this.

Deviation scale is comparable to the MMPI-2 F scale

Personality assessment inventory (PAI: Morey, 1991) is a 344 items

4 validity scales: Inconsistency, infrequency, negative impressionmanagement and positive impression management

NEO-PI-R (Costa & McCrae, 1991) no effective validity index, soshould not be used in this context

16 PF also lacks adequate validity measures and should not be used


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Measures to specifically detect malingering

These measures should be administered when the referral questionspecifically implicates malingering and/or when there are substantial

contingencies to suggest that malingering is likely Structured Interview of reported symptoms (SIRS)

Has shown some promise, though it is susceptible to acquiescence andfalse positives (claiming malingering when it is not)

The M test is a 33 item T/F test with three scales: genuine symptomsof schizophrenia, atypical attitudes not characteristic of mentalillness, and bizarre and unusual symptoms rarely found in mentalillness

Showed some ability to differentiate patients from directed malingerers

and from suspected malingerers (Note: The problem with using the lattercriterion group as there is no definitive knowledge about thoseindividuals)


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Measures to specifically detect malinger. - 2

Test battery approach including WAIS-III and the MMPI-2 the moretests administered, the harder it is to present a consistent profile

This approach should use baserates for incorrect responses as theprimary means of classifying

Provide response options (typically no more than two) such that achance correct criterion can be calculated (e.g., 50% for a two itemversion) this should be no lower than 30% to avoid floor effects

Track responses over at least 30 trials (the more the better as thisminimizes chance outcomes).

Calculate the probabilities for deviations from .50 correct and apply it toclients correct response rate (i.e., what are the odds that they wouldhave missed as many as they did if they were truly guessing)

Evaluate responsiveness to your feedback (e.g., Youre actually notdoing that bad vs. Most people with your type of injury do better)

If less sophisticated malingering there will be an immediate andrelatively large response to your comments


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Who is your client?

Why is this question important in addressing the malingering issue?

If the suspected malingerer is your client who is undergoing therapy

with you (or someone else) to whom is your obligation and what are

the costs/benefits of undertaking an evaluation of malingering?

Does it help the therapeutic process? Focus on why one might be

deceptive to better understand clients behavior

If the client is the court, then to whom is your obligation and whatare the costs/benefits of undertaking an evaluation of malingering?

Question now is to determine if client is being deceptive/evasive.


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Assessing psychopathic personality

Psychopathic personality = behavior characterized by remorseful and

callous disregard for others and a chronic antisocial lifestyle. Thus,

most ASPDs are not necessarily psychopathic.

Drawing data from various sources (at least three)

In person interview

Testing

Independent historical information (anything that is not self report it is

important to note that other official records are not necessarily based on

anything other than self-report)

Although all three of the above are important in order to provide

converging evidence, the test data will be the strongest tool in court(due to its psychometric strengths)


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Assessment (Meloy & Gacono, 1995)

The Psychopathy checklist revised (Hare, 1991) 20 item test witha 4-point Likert scale response format. Largely intended for males

(little data on females) To be completed by the clinician after a clinical interview and review of

historical data (includes descriptors falling under a single dimension ofpsychopathy) e.g., impulsive, irresponsible, shallow emotions, etc.

Items must be scored in a particular sequence, with more structured

items first, followed by the least structured items (with the formercontributing to the latter)

Cutoff score of 30 or greater to define psychopathy, with higher scoresdenoting more extreme presentations

Adequate reliability and validity, though note the overlap between some

of the validity criteria and the info used to determine the score (e.g.,extent of criminal record is used for both)


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Assessment (Meloy & Gacono, 1995) p. 2

The Rorschach should still pursue the minimum number ofresponses (14 or more) as suggested by Exner (1986)

Include an assessment of defenses and object relations (both of whichappear to have modest reliability) that suggest more narcissism (self-references), violations of boundaries, etc. in the psychopathic personality(specific ratios from Exners scoring system are described)

MMPI-2 primary focus is on scale 4 (also content subscales drawn

from 4 be cautious with the latter) If administering scale 4 alone, note that you will not have the benefit of

the k correction. Thus, scores will be suppressed.

L and F will also predict psychopathy (tendency to be untruthful)

Cognitive abilities (e.g., WAIS-III) are unrelated to the presence ofpsychopathy, but may be informative as to the nature of thepresentation (e.g., level of sophistication, concordance withtraditional/normative concepts of intelligence, etc.)


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Integrity testing

Evaluating integrity as a trait, whereas such behavior may be

situation specific (e.g., someone who would not lie in interpersonal

settings might not hesitate to cheat on their taxes). Characterological view of integrity downplays situational factors

Integrity is a very broad concept that can include diverse responses (e.g.,

passive vs. active lying, cheating vs. theft, etc.)

Early paper and pencil tests were validated with the polygraph Employed in low end entry jobs when people have to interact with

money (retail, financial services, etc.)

Today, such tests attempt to predict a wide range of behaviors

including violations of work rules, fraud, absenteeism, etc.


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Integrity testing p. 2

Overt integrity tests evaluate beliefs about the incidence of theft

and other counterproductive behaviors, punitive attitudes towards

theft, endorsement of common rationalizations for theft, and directquestions about ones own involvement in such activities.

Personality oriented measures much broader than integrity tests

and tend to have lower face validity (e.g., high conscientiousness on

the NEO) Clinical measures like the MMPI validity scales

All are difficult to validate because the behavior we are trying to

predict goes largely undetected. So if a test score does not predict it

could just mean that this is a false positive or someone who was notcaught


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The polygraph test

Measures physiological arousal that is presumed to be associatedwith lying. e.g., perspiration as indicated by galvanic skin response,brain activity suggesting arousal, etc. to the question (not answer) Is this assumption reasonable?

Confounds?

Under what circumstances can lying not be associated with arousal? Habituation effect from repeated lying?

Lack of awareness of the lying? (issue of conscious vs. unconscious)

What is the best way to quantify arousal? Should we evaluate thisnormatively or ipsatively?

Control Question Test (CQT) compares relevant questions tocontrol questions which are intended to elicit a strong physiologicalresponse from innocent subjects (e.g., Prior to 1993, did you everdo anything that was illegal or dishonest?) While innocent people know they didnt commit the crime, they are

either uncertain or lying about the CQ. Guilty persons should notrespond as much to the CQ


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The polygraph test p. 2

Criticisms of the CQT

Difficult to develop good control questions that will produce similar

responses relative to relevant questions for innocent people. This resultsin many false positives (Note: Bias for positive outcome is why most ofthese tests have artificially high success rates in forensic settings mostare guilty)

CQ are designed for each individual, so standardization is compromised

Direct Lie Control Test (DLCT) if person answers truthfully to aquestion they are asked the question again and told to lie about itwhen asked again (a known lie for comparison)

Can be standardized and the power of the DLCT is from the instruction(which is standardized) not the content of the question

Can reduce the rate of false positives and generally does better than theCQT

Initially employed absolute standards for arousal = lying and this wasnot at all effective


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The polygraph test p. 3

The guilty knowledge test (GKT) not designed to detect deception,

rather it tries to differentiate between those who have knowledge

about a particular event (crime) and those who do not (theinnocent)

The concealed information test (CIT) is similar to the above

approach and likewise tries to assess familiarity with specific

information as opposed to lying Both of these approaches have the advantage of asking the exact

same questions of all individuals and comparing responses both

within and between subjects

Minimal data on these approaches, as the bulk of the research is onthe CQT


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Does it work?

Honts (1994) reviewed the literature on the effectiveness of thepolygraph and found that it does about as well as chance in

experimental settings. Most of the reviewed research uses the DLCT In real life and experimental settings, the majority of errors are false

negatives (saying someone is innocent when they are guilty)

Most deceptive individuals (up to 95%) are misclassified

Because the cost of a false positive (saying someone is guilty whenreally they are innocent) is deemed to be higher in our legal system.Therefore, the cutoff scores (criteria) have been altered so as tomake false negatives more likely

Why does it fail?

If high arousal to control questions, then more difficult to discriminate Idiosyncratic responses to lying


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Admissibility of the polygraph (Saxe & Ben-Shakhar,

1999)

Courts have almost universally rejected the polygraph, though this

question has been and continues to be litigated extensively

Courts are increasingly being made responsible for evaluating the

merits of test data, despite lacking the expertise to do so.

Note: The literature has become increasingly discrepant in its view on

the polygraph (disagreement on its validity even in the scientific

community) What criteria should be used to evaluate this information and what

should we tell the courts?

History

Marston (1917) used a blood pressure cuff to determine truthfulness(arousal) in a defendant (Frye), based on the assumption that while truth

required little or no energy, lies do rejected by the courts


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History of the Polygraph

Note the courts use of the term experimental as not wellestablished evidence

The Frye ruling adequately reflects the courts treatment of thepolygraph even today, though now based on the Federal Rules ofEvidence (FRE) which require that the evidence (polygraph orotherwise) be relevant and that it aid the jury (i.e., be valid).

Daubert (1993) was based on the FRE and highlights 4considerations when ruling on evidence:

Testability or falsifiability (see Popper and the method of science)

Error rate

Peer review and publication

General acceptance This basically requires juries & judges to evaluate scientific issues


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History of the Polygraph p. 2

In trials like Daubert, scientists with opposing views on thepolygraph present their views and the jury must decide on the

merits of their arguments Generally there has been no legal distinction between the concepts

of reliability and validity (you can see where this is go, since, from ascientific standpoint, reliability limits validity)

An additional problem with these concepts is that the data iscollected as a series of discrepancy scores and these are thensummed to reflect a qualitative assessment of truthful, deceptive,and inconclusive. Thus, very different discrepancy readings mightstill result in similar qualitative assessments.

Two accepted approaches for reliability are: Test the same person twice on the same issue using the same polygraph

technique with 2 different testers

Test the person once, but have the chart scored by two different people


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The latter approach deals on with the error involved in chart scoringand ignores (or equates) administration error

The real issue is whether the procedure as a whole is reliable (e.g.,the creation and administration of control questions), therebygetting at internal reliability (do different parts of the test agree),test retest reliability (different administrations of the test agree),inter-rater reliability (different test administrators agree as to the

outcome) Note: There are practical limitations to how often the same test could

be given to the same individual

What little data exists on reliability focuses only on the betweenexaminers approach (inter-rater reliability), though this reliability isreasonable (not high). Thus, this remains an unevaluatedcomponent of the polygraph (major limitation)


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Because the courts do not distinguish between reliability andvalidity, the minimal reliability that does exist carries far more

weight than it should. Modern views of validity highlight the integrative component of

validity (recall Messick, 1995), though to evaluate it, it is necessaryto consider different aspects separately

Different types of validity are more relevant depending on the

question at hand

e.g., predictive validity for integrity testing in job placement/hiring, vs.criterion validity being more relevant for determining truth/lying

Construct validity gets at the theoretical issue of what is a lie. Is it a

situational phenomenon or a trait? Can it be represented byphysiological responding? Etc.

No theory to explain why a stronger response should occur for lies vs.truth


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Similar physiological responses to lying appear to occur forexperiences such as surprise/novelty

Note: For the CQT, questions about the crime are expected to be wellrehearsed for the criminal

Thus, they have questionable construct validity (not necessarilymeasuring what they propose to measure)

Under-represents the construct of interest and over-represents

irrelevant constructs (surprise, stress, etc.)

What criterion can be used?

Outcome of a trial? If the case is dismissed?

Do either of these assure that we know the clients status re: lying?

Note also that a true evaluation of the polygraph would mean thatthe examiner only has access to the polygraph data (that s never thecase).


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The criterion and predictor are rarely independent.

e.g., if the polygraph is used to get a confession and the confession helps

get a conviction, then by definition, the polygraph is part of the criterion(polygraphs are frequently used to get confessions)

Experimental criteria for the polygraph generally lack externalvalidity (is lying in an experiment = to lying in a crime involvingyourself? That is, are all types of deception equal?), while real life

evaluations of the polygraph lack experimental rigor and control(e.g., only a subset of them will ultimately have a clear outcomeregarding deception and this may not be representative of allrespondents).

The CQT assumes that you can create similar control questions.

Do deceptions involving different types of crime result in the samephysiological response?


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Issues in assessing alcohol/substance abuse

Recognition of dual diagnosis (vs. assuming all other problems are merelysecondary to the addiction) How can we address this?

Timing of assessment remains an important concern as this can dramaticallyalter the outcome- When is the optimal time to assess?

Patterns of use/abuse and general categories (e.g., stimulants, sedatives, etc.) ofuse may be important to assessment and intervention

Also some drugs may be used to offset the deleterious effects of other drugs

Context in which use typically occurs may help in identifying triggers and highrisk settings for potential relapse Examples of assess & tx?

Motivation for seeking treatment is likewise a critical component to evaluatingthe patient Why? How would you assess and tx differently?

e.g., legal motivation, social/family pressure, work requirement, etc.

May require different test features to identify those still using as opposed tothose who have used before but are not now using

The outcome of research in this area varies greatly as a function of how use isdefined (any use, quantity/freq, problem behaviors, combos., etc.)

May identify different pops (e.g., those with liver damage vs. those losing jobs)


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Specific measures to assess alcohol and drug abuse

The MMPI-2 has 2 items (264 I have used alcohol excessively &489 I have a drug or alcohol problem) that directly assess use, but

the small number of items limits their psychometric properties. These items each appear to identify very different groups

Sensitivity (how well the test identifies those who abuse alcohol) ofapprox. 80% for males and 75% for women

Specificity (how well the test identifies those who do not abuse alcohol)

ranges from 53% to 95% for men and from 76% to 97% for women(varying on the item and race of the respondent)

Because the lifetime prevalence base rates for use in the populationare 8% for women and 16% for men, it is difficult to improve on thebase rate of non-use (84% or more)

Other measures include the MAST and the CAGE what do youknow about these?

Both have problems identifying female substance abusers (they weredeveloped for and validated on, men)


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Specific measures to assess alcohol and drug abuse:

MMPI-2 scales p. 2

MacAndrew Alcoholism scale (from the MMPI-2) is best for identifyingwhite males who have a propensity for polydrug abuse. It has a sensitivity of

approx. 70-75% and 20% false negatives. Very high false positive rate for black males, little data on females and

adolescents, and lower hit rates for psychiatric patients

Addiction Admission scale (also from the MMPI-2) acknowledgment ordenial of substance abuse problems

Low reliability Addiction Potential scale (also from the MMPI-2) personality features

associated with use

Low reliability

MMPI-2 profiles associated with use: 2/4, 4/2, 2/7, 7/2, 9/4, 4/9,

Just males: 1/2, 2/1

Just females: 3/4, 4/3, 6/4, 4/6, 8/4, 4/8

Code types account for 25-35% of alcoholics & they dont differ on tx success


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Issues in alcohol/drug assessment

Is there any utility in identify substance abusers who are doing so

covertly or who dont believe they have a problem? Drawbacks: Treatment generally requires the clients willing consent, so why

bother identifying anyone other than those who acknowledge use? This isconsistent with the most widely used model, AA.

Some benefits: Accuracy of other diagnoses, as use can alter presentation of

other symptoms, it can make some medication treatments undesirable dueto interaction effects, it could bring a problem to a higher level of awarenessfor the client, etc.

Utility in administering a measure for some clients as it can serve as astandard (vs. an opinion) to the lay person, that allows for a normative

evaluation * Research suggests that exposure to norms can not only help with

assessment, but also recognition of problem drinking

Use, in and of itself is considered problem use for an alcoholic from an

AA perspective. What factors are relevant from a CD perspective?


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Legal/ethical issues in assessing children

Three components of consent for testing

Knowledge what will be done, why, and how

Voluntariness absence of coercion; a child alone cant do this, but theyare usually asked for assent

Competence parents must be legally competent and guardians to giveconsent for child

Also you are ethically (though not legally) bound to tell the parents

ofpotential risks from testing (e.g., what test scores can be used for such as being grounds to deny entry to a special educationprogram)

Child is not likely to be the one who asked for testing. So are theythe client? If not, who is?

Legal issues abound for intelligence testing, but there have been fewprecedents for personality assessment. Why?


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Demers (1986) on testing

Although there are few legal challenges of personality tests, these

measures do tend to have more problems with reliability and

validity Little to no evidence for gender or racial bias in personality testing

Also, most personality tests are administered in a voluntary context

Test validation issues:

Tests must be validated for the purpose for which they are being

used

Tests must be reliable for the pop being used, and appropriate

norms must exist for that pop.

The tests must be capable of generating appropriate decisions for

that pop (i.e., validity)


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Providing feedback to clients

APA requires that feedback be provided after testing, but it must bein a form that they can understand (varies depending on the client)

This can be best accomplished through an overview of the findings andthen a Q & A session.

The feedback should provide a clear path to treatment goals

Consider anything that is assessed as representing a continuum,such that any characteristic will be shared by some portion of the

population

Terminology such as unique and different can be substituted forabnormal, deviant, or pathological

Client need not agree with your feedback. Objections can be used to

clarify findings and as a starting point for the intervention Have client summarize info. Back to you


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Providing feedback to clients - p.2

Feedback should also include information on the tests themselves

(validity and reliability) in language that can be understood by the

client General psychometrics can be used to enhance the credibility of the test

e.g., The MMPI has been used for over 50 years by clinicians and it is

one of the most widely used tests. Many research studies have been

done to show that it is pretty consistent in the scores it produces and

that it works pretty well at predicting behaviors.

This issue may be further complicated when giving feedback to

those with limited cognitive abilities, but a more detailed account

can be provided to those who have legal guardianship


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Providing MMPI-2 feedback to clients

Empirical evaluation of getting MMPI-2 feedback

Compared MMPI-2 feedback of college students relative to attention

with no feedback The former showed increased self-esteem, immediately & after 2

weeks

Decreased symptomatic distress, immediately and after 2 weeks

Why would this occur? Nature of the client population? (higher functioning, therefore feedback

is likely to be generally positive?)

Selective sampling? (Those seeking out personality evaluations arewanting feedback and are more likely to construe it positively?)

When initially meeting with clients and discussing the testing andthe eventual feedback you will be able to differentiate those whowill be most/least receptive to the feedback

Highlights the importance of having the client arrive at the decision totest


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Legal precedents

Griggs v Duke Power Company (1971) job testing

Hobson v Hansen (1967) racial disparity (problems with standardization &

norms; assessed present skills rather than innate ability) Larry P. V Riles (1972) culturally biased IQ tests for EMR determination

PASE v. Hannon (1980) reversed the Larry P. decision based on the fact thatEMR determinations were based on more than just IQ testing (any thoughts onthe item by item review by the judge?)

Lora v Board of Education City of New York use of TAT, Rorschach, & Bender-Gestalt to label minority children as emotionally disturbed (vague def. for latter)

Note: Most personality tests are administered voluntarily. Test validation issues:

Tests must be validated for the purpose for which they are being used

Tests must be reliable for the pop being used, and appropriate norms mustexist for that pop.

The tests must be capable of generating appropriate decisions for that pop(i.e., validity)

Note: many personality tests were developed for adults and co-opted forchildren. Which of the above issues is most affected?


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Example DSM-IV codes: Review

The parenthetical term (provisional) may follow a diagnosis to indicatea significant degree of diagnostic uncertainty

The phrase rule out is used to denote other diagnoses that should beconsidered and that are still to be ruled out.

The numeric code should follow the AXIS number and then the formalname of the disorder should be listed.

e.g., AXIS I: 295.40 Schizophreniform disorder (Provisional, rule out

Organic Delusional Disorder), with(out) goodprognostic features.

Numeric codes from the DSM are matched to the ICD (InternationalClassification of Diseases) codes to allow for international compatibility.

Recording procedures: e.g., Major Depressive Disorder

AXIS I: 296.34 - 4th digit is either 2 (single episode) or 3 (multiple)-5th digit is severity: 1 = mild, 2= moderate, 3 = severe withoutpsychotic features, 4= severe with psychotic features, 5= partialremission, 6= full remission.

4th and 5th digits typically apply to most recent or current episode.


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DSM-IV codes - continued

Recording procedures: e.g., Bipolar I disorder

AXIS I: 296.34 - 4th digit is 0 (single episode). For recurrent episodes,its 4 if current or most recent episode is hypomanic or

manic, 5 if depressive, 6 if mixed, 7 if unspecified.

-5th digit is severity: 1 = mild, 2= moderate, 3 = severe

without psychotic features, 4= severe with psychotic

features, 5= partial remission, 6= full remission, 0 =

unspecified (except for hypomanic where 5th digit is

always a 0, and unspecified, where there is no 5th digit).

For Bipolar II, the 4th digit coding is the same, but do not use the 5th digit

code as is already specified as 9.

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