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Clinical Assessment INTRODUCTION -1
There are two systematic methods for evaluating behavioral, emotional, and cognitive processes1. The Mental Status Examination
(MSE)2. Psychometric evaluation
(psychological testing) Both are important in understanding a
patient’s current mental status
Clinical Assessment INTRODUCTION -2
The MSE and Psychometric evaluation are always used in conjunction with:A complete medical historyA complete physical examinationA neurologic examinationVarious laboratory and radiologic
studies
Clinical Assessment INTRODUCTION -3
In this context……The MSE is part of a broader
psychiatric examination, The psychometric evaluation part of
the broader perspective of psychological assessment
There is overlap in item content and complex interpretation may be necessary to arrive at a conclusion
The Psychometric Evaluation
• Definition: • Psychometric evaluation is a set of test
techniques by which a sample of behavior is elicited, observed, recorded, analyzed, and interpreted.
The Psychometric Evaluation
• Purposes of Psychometric Evaluation: 1. To provide descriptive information about an individual2. To enhance understanding of psychological dynamics3. To assist in establishing a diagnosis4. To assist in making decisions (eg competency,
placement)5. To assist in treatment and discharge planning6. For prognostic and predictive purposes 7. To establish baseline performance levels in
monitoring change8. To evaluate changes in brain-behavior relationship
The Psychometric Evaluation
• Principles of Psychometric Evaluation: • Three very important principles of
psychometric measurement in general, are……a. Standardization
• Collecting normative data from a representative population group, under controlled conditions
b. ReliabilityConsistency and accuracy of the test
c. ValidityWhether the test measures what it is intended to
The Psychometric Evaluation
Types of Psychological Tests: • Psychological tests differ in
1. The nature of the information obtained and focus of the test,
2. The processes of the assessment procedure
The Psychometric Evaluation
• 1. The nature of the information obtained: a. Cognitive ability tests (the most common
are tests for intellectual functioning and academic achievement)
b. Personality assessment tests (reveal information that may be descriptive of the individual or his ongoing personality dynamics)
The Psychometric Evaluation
• 1. …..nature of the information obtained: c. Vocational tests assess interests attitudes and aptitude in the context of a more general understanding of the individual, to assist in making vocational choicesd. Neuropsychological tests assess brain-behavior relationship e. Behavioral assessment refers to assessment techniques that minimize inference and have particular emphasis on observable, quantifiable measures
The Psychometric Evaluation
• 2. The process of the assessment procedure: a. Individual versus group tests. Individually administered tests yield better understanding of the individual patient. Group tests, while more time efficient, may be less informative in understanding an individual b. Potential ability versus typical performance: what an individual can do vs what he typically does
The Psychometric Evaluation• 2. …..process of the assessment procedure:
c. Objective versus Projective testsi. Objective tests are highly standardized for
administration, scoring and interpretation and are usually highly structured in format. All response possibilities are obvious and scorers can agree on the result
ii. Projective tests, in contrast, are less structured and allow greater leeway for expressing individuality and important individual dynamics. These tests are based on the projective hypothesis, revealing unconscious issues and aspects of his personality and cognitive style
The Psychometric Evaluation
• Major Psychological testsA. Tests of intellectual ability (eg,
Wechsler, and Stanford-Binet Scales)B. Achievement tests (eg, WRAT, SAT,
USMLE)C. Tests of personality functioning (eg,
MMPI, Rorschach, TAT, Sentence completion, projective drawings, etc)
D. Vocational testsE. Neuropsychological assessment
The Psychometric EvaluationMajor Psychological Tests
• A. Tests for intellectual ability -1 of 14• Intelligence is an individual’s ability to adapt
and constructively solve problems in the environment. It is a multidimensional performance construct, which includes:
• The capacity to acquire, store, access and manipulate information
• The ability to learn from experience• Insight; Abstract reasoning• The capacity to adapt to new situations, and• The ability to focus and sustain direction in
activities
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -2:• Measured intelligence tends to be quite
stable after adolescence, and test-retest reliabilities are quite high, even in young children.
• However IQ is not static and may change considerably in children over a period of years
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -3:• Basic definitions• Chronologic age (CA) is a persons actual
age in years• Mental Age (MA) is the age level of
intellectual functioning of an individual (the age at which an average person reaches the same ability)
• Intelligence quotient (IQ) is the ratio of MA to CA times 100 (ie IQ = MA/CA x 100)
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -4:• Intelligence Quotient (IQ) • Genetics play a major role in
determining IQ. • IQ is relatively stable throughout life. An
individuals IQ remains essentially the same in old age as in childhood, in the absence of brain disease
• Influences on IQ test scores may include cultural background and emotional response to testing situations
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -5:• Mental retardation-1 • Normal or average IQ in a given
population is within the range 90-109• The standard deviation in IQ scores is 15. • More than two standard deviations below
the mean (ie, an IQ of 70 or less) is considered mental retardation
IQ Ranges & Distribution
IQ Descriptor ApproximatePercentage
Percentile range
≥ 130 Very superior 2% 98-100
120-129
Superior 7% 91-98
110-119
High average 16% 75-90
90-109 Average 50% 25-95
80-89 Low average 16% 10-25
70-79 Borderline 7% 2-9
< 70 Mentally retarded 2% 0-2
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -6:• Mental Retardation-3 • The most common genetic causes of mental
retardation are Down Syndrome and Fragile X syndrome.
• Other causes include factors affecting mother or fetus such as infections (eg rubella), metabolic factors affecting mother or fetus, and substance abuse,
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -7:• Mental Retardation-4 • Down syndrome: Typically, the nucleus of each
cell contains 23 pairs of chromosomes, half of which are inherited from each parent. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21.
• This additional genetic material alters the course of development and causes the characteristics (qv) associated with Down syndrome
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -8:• Mental Retardation-5 • Fragile X: Fragile X syndrome is a genetic
condition involving the X chromosome and causing a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -9:• Wechsler Intelligence Tests • In contemporary practice the most widely
used individually administered intelligence measure performance in several different areas.
• The Wechsler intelligence scales serves as a good example
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -10:• Wechsler Intelligence Tests • The currently used tests are:• Wechsler Adult Intelligence Scale – (WAIS-III)• Wechsler Intelligence Scale for Children –
(WISC-III); children 6-16½ years• Wechsler Preschool and Primary Scale of
Intelligence (WPPSI-R); children 4-6½ years The scales of Wechsler intelligence tests are
adapted for age
The Psychometric EvaluationMajor Psychological Tests
• Wechsler Intelligence Tests • The WAIS-R and the WISC-R are each divided into 2
sections, verbal and performance• Each section has its separately computed
intelligence quotient (IQ) • Each sections is further divided into 11 normalized
subtests • Verbal section: general information, comprehension,
similarities, arithmetic, digit span and vocabulary• Performance section: digit symbol, block design,
picture completion, object assembly and picture arrangement
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -13:• Vineland Social Maturity Scale • The Vineland Social Maturity Scale is a
non-projective personality measure designed to help in the assessment of social competence (ie, to evaluate skills for daily living)
The Psychometric EvaluationMajor Psychological Tests
• A. Tests of Intellectual Ability -14:• The Stanford-Binet Scale is used with
individuals ages 2 thru 18 (best in the under 6): • To test general intellectual ability, • To assess giftedness, and • to address educational placement issues
• Comprises 142 brief tests, sampling a variety of skills
• Content arranged in age-appropriate levels• Best used with very young, very impaired or very
bright
The Psychometric EvaluationMajor Psychological Tests
• B. Achievement tests -1 of 2:• Measurement of achievement is the
evaluation of mastered information and skills that have been part of specific instruction.
• These tests:• Are widely used in the education system but
may be useful also in counseling and industry and may be included as part of neuropsychological batteries
• does not assess aptitude or future performance
The Psychometric EvaluationMajor Psychological Tests
• B. Achievement tests -2:• Examples of Achievement tests:• Wide-Range Achievement Test (WRAT)• Stanford Achievement test• Iowa Test of Educational Development• California Achievement test• Peabody Individual Achievement Test
The Psychometric EvaluationMajor Psychological Tests
• C. Tests of Personality functioning -1 of 3:• MMPI: An objective self-report test for obtaining
diagnostic, clinical information on psychiatric and medical patients and in research. (the most [ab]used)• Often utilized in forensic evaluations, in assessment of
treatment outcomes, substantive issues of malingering and in evaluating psychological determinants of chronic pain
• Rorschach Inkblot Test: is the major projective test of personality assessment• The Rorschach is used to assess personality dynamics
and organization as well as cognitive style
The Psychometric EvaluationMajor Psychological Tests
• C. Tests of Personality functioning -2:• TAT: Used in assessment of personality
functioning A way of evaluating drives, emotions, sentiments and conflicts of which an individual may be unaware
• Sentence completion test: An economical way of surveying a patient’s thoughts, feelings, motivations, and behavior along a number of psychological dimensions
The Psychometric EvaluationMajor Psychological Tests
• C. Tests of Personality functioning -3:• Projective drawings: These types of
procedures are used more to assess personality adjustment than aspects of intelligence
• Other tests of personality functioning:• Beck Depression Inventory• The Sixteen Personality Factors Inventory• The Symptom Checklist-90 • Milton Clinical Multiaxial Inventory
The Psychometric EvaluationMajor Psychological Tests
• D. Vocational Tests:• Infrequently used in medical settings• Tests of aptitude and ability; used in
career counseling• Information may be yielded on general
interest areas and on interest areas that are analogous to various occupations
The Psychometric EvaluationMajor Psychological Tests
• E. Neuropsychological assessment:• The evaluation of brain injury and
dysfunction in humans through the use of psychological tests has become a specialty of psychology
• The major approaches to assessment have been through the use of standardized batteries eg, Halstead-Reitan Neuropsychological Test Battery (HRB)
The Psychometric EvaluationMajor Psychological Tests
• E. Neuropsychological assessment -2:• The Halstead-Reitan
Neuropsychological Test Battery (HRB) addresses questions of the presence, absence, and localization of brain dysfunction.
• Prognostic and rehabilitative statements are often made on the basis of HRB and other supplementary neuropsychological tests