Ch 4: Clinical Assessment and Diagnosis

• Psychological assessment: gathering information about a person and environment to make decisions on psychological problems
• Assessment leads to diagnosis leads to treatment
• Deciding what assessment procedures and instruments to administer is tailored to the individual
• Goals of psychological assessment is diagnosis, treatment planning, consultation, forensic, research, and outcome evaluation
• Types of assessment: screening and self report, behavioral assessment, psychological assessment, diagnostic and clinical interviews, neuropsychological assessment, and personality assessment
• In screening and self-report: short assessments are done that try to identify potential problems or predict risk of future problems. Includes checklists, questionnaires, and physiological tests
• Sensitivity: screen identifies a problem that actually exists
• False positive: screen indicates a problem when it doesn't exist
• False negative: suggests no problem, but actually exists
• Specificity: screen actively identifies absence of problem
• Behavioral assessment applies principles of learning theory to assessment
• Functional assessment: clinician and patient attempt to identify causal-links between behaviors and environment (based on operant conditioning)
• Self-monitoring: client observes and records own behaviors as it happens (kids can't do this)
• Behavioral observation: observer measures clients behavior (more accurate with children)
• Psychophysiological assessment: measures brain structure and function, nervous system activity as it reflects emotions, and psychological events
• Electroencephalography (EEG): measures brain wave activity, directly assesses electrical activity in brain and measures fast responses
• Electrodermal Activity (EDA) and Galvanic skin response (GSR): measures sweat glands in order to estimate activity or peripheral nervous system, reacts to emotional states
• Structural forms are CAT and MRI that takes pictures of the brain
• Functional forms are PET and fMRI that show when/how the brain is working
• Diagnostic assessments provide more detail, take longer to give, typically done as interviews, and the goal is to determine diagnosis. You also get dimension on the severity
• Outcome evaluation is used to determine if the patient is getting better. It is a type of on going therapeutic evaluation
• The three types of clinical interviews are unstructured, semi structured, and structured
• Unstructured interviews are too soft, you get depth but no consistency
• Semi-structured interviews is a set of questions with clarification, some structure but not like a robot, is flexible and can ask follow up questions
• Structured interviews are using the same questions in the same order, it is very reliable and consistent but you often get no depth
• Neuropsychological assessment is a measure of language, memory, attention, concentration, motor skills, perception, abstract thinking, and learning abilities
• Neuropsychological assessment can be used to detect impairment in cognitive functioning, it is a task performance and can provide insight into brain function
• Personality assessment consists of projective and objective personality
• Projective personality assessment: unstructured, require individual to make interpretations of ambiguous material, there is no reliability or validity since you get different results from everyone who interprets it.
• Objective personality assessment: standardized measures that provide more objective quantification of personality, consists of questions asked in the same order compared to the same demographic. There are multiple validity scales
• All psychological assessments should be reliable, valid, and standardized (AKA psychometrics)
• Reliability: The extent to which a test yields consistent results when repeated.
• Test-retest ability: consistency over time
• Interrater reliability: agreement between two raters
• Validity: The extent to which a test measures what it is supposed to measure.
• Construct validity: accurately measure specific construct
• Predictive validity: how well does it predict future performance
• Standardization: Adds context to the results of an assessment (relative)
• Normative comparisons: compare client's score with representative sample (external)
• Self-Referent comparisons: compare clients own score with own previous performance (internal)