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Assessment and Diagnosis
Chapter 3
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Chapter Outline
Clinical Assessment
Assessment Instruments
Diagnosis and Classification
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Clinical Assessment
Process of gathering information about a
person and his/her environment to make
decisions about the nature, status, and
treatment of psychological problems
-Begins with a set of referral questions
-Questions determine goals of assessment
-Selection of appropriate psychological tests and
measurements
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Goals of Assessment
Deciding what
assessment
procedures and
instruments to
administer
Tailoring an
assessment to types
of symptoms, age,
and medical status
Differential diagnosis is
a process in which a
clinician weighs how
likely it is that a person
has one diagnosis
instead of another.
Screening (identify psychological
problems or predict the risk for future
problems)
Diagnosis (identification of illness)
Treatment plan (individual’s plan
of care to meet mental health needs)
Outcome evaluation
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The major reason one is
misdiagnosed is because
of insufficient assessment
and inaccurate diagnosis
which leads to
inappropriate treatment.
Real People, Real Disorders…
Cases of Misdiagnosis
Brain tumor vs.
Deafness vs. Mental Anorexia Nervosa
Retardation
What is the difference
between misdiagnosis
and comorbidity?
Epilepsy vs.
Schizophrenia
Impact of clinical
Medication Reaction significance
How might misdiagnosis affect not only the
vs. Depression
patients in the future, but the clinician as well?
What precautions should one take to make
sure this does not happen?
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And the Usual Properties of
Assessment Instruments Are…
Standardization
Normative comparisons
Self-referent comparisons
Reliability
These are important in
reviewing the
psychometric properties
of instruments to ensure
a clinician’s confidence
in the testing results.
-Test-retest reliability
-Interrater agreement
Validity
-Construct, criterion, concurrent, predictive
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Assessing
Abnormality Using
the Normal Curve…
Figure 3.2 The Normal Curve
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Stop and Think!
Do you personally think the following
two measures – Scholastic Aptitude Test
(SAT) and the American College Testing
Program (ACT) – can predict future
college performance or even performance
in graduate school?
Key Points: It is important to remember that one form of criterion validity, predictive validity,
refers to the ability of an instrument to predict future performance or potential success, where
the SAT is to predict scores on graduate school admissions tests.
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Developmental and Cultural
Considerations
Age
Developmental
status
People involved in
testing
Nature of test chosen
Testing environment
Cultural factors
Administrating assessment tools to
individuals from diverse backgrounds may
produce bias results. What factors do you
believe contribute to this? How can
practitioners account for this in making sure a
patient receives the correct diagnosis?
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Assessment Instruments
Self-report measures (ask patients to evaluate their
own symptoms)
Clinician-rated measures (clinician rates symptoms)
Subjective responses vs. objective responses
Types of assessments
-Clinical interviews
-Psychological tests
-Behavioral Assessments
-Psychophysiological Assessments
Remember a patient’s
“perception is their reality” when
they report information related to
the assessment.
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Clinical Interviews
Conversation
between an
interviewer and a
patient, the purpose
of which is to gather
information and
make judgments
related to
assessment goals
Purpose of
interviews (screening,
diagnosis, treatment
planning, or outcome
evaluation)
Types of interviews
-Unstructured
-Structured
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Psychological Tests
Personality tests (psychological test that
measures personality characteristics)
Minnesota Multiphasic Personality Inventory
(MMPI; Hathaway & McKinley, 1943)
Nine clinical subscales: hypochondriasis, depression,
hysteria, psychopathic deviance, masculinity-femininity,
paranoia, psychasthenia, schizophrenia, & hypomania
The Million Clinical Multiaxial Inventory
(MCMI)
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Figure 3.3 Sample MMPI Profile
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I object or accept! What are your
thoughts?
Does your personality type really indicate which
career path you should take?
1. According to Reinhold (2009), understanding your
personality type can help you in the following ways
regarding your career:
(a) select a good fit career, (b) increase awareness of learning
style, (c) better manage job challenges, and (d) will add in
job searching.
Is anyone familiar with the
What other factors do you believe
contribute to one selecting a career?
Myers-Briggs Type Indicator, or
taken a personality test?
Reinhold, R. (2009). Retrieved on August 5th, 2009, from http://www.personalitypathways.com/article/career-plan.html.
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Neuropsychological Testing
Used to detect
impairment in
cognitive
functioning
Measures: memory,
attention and attention,
motor skills, perception,
abstraction, and learning
abilities
 Halstead-Reitan
Neuropsychological Battery
(Reitan & Davidson, 1974)
 Wisconsin Card Sorting Test
(WCST)
 Bender Visual Motor Gestalt
Test
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Figure 3.5 The Wisconsin
Card Sorting Test
This instrument
measures set
shifting or the
ability to display
flexibility in
thinking as the goal
of the task changes.
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From Nevid/Rathus/Greene, Abnormal Psychology in
a Changing World, 5e, p. 91 . Copyright © 2008
Pearson/Prentice Hall. Reprinted by permission.
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 3.6 The Bender Visual
Motor Gestalt Test
The average IQ is 100 (mean) and the
standard deviation is 15. So if someone
has an IQ of 130 that means their IQ is
two standard deviations above the
mean.
Intelligence Tests
Used to measure
intelligence
quotient (IQ)
Intelligence
Quotient (a source of
 Stanford-Binet Intelligence
Scale
 Wechsler Adult Intelligence
Scale (WAIS-IV; Wechsler,
2008)
 Wechsler Intelligence Scale for
Children (WISC-IV, 7-16
cognitive functioning
years)
that compares a
person’s performance to  Wechsler Preschool and
his or her age-matched
Primary Scale of Intelligence
peers)
(WPPS-III, 2½-7 years)
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Projective Tests
Tests derived from psychoanalytic theory in
which people are asked to respond to
ambiguous stimuli
Rorschach Inkblot Test (Rorschach, 1921)
-The patient is exposed to ambiguous stimuli and then
projects a unique interpretation onto them that reflects
his/her underlying unconscious processes and conflicts.
Thematic Apperception Test (TAT; 1935)
-Consists of 31 black-and-white pictorial cards and the
patient is asked to make up a story about the image
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Thematic Apperception Test
Copyright (c) Pearson Education 2010
Figure 3.7 An
inkblot similar
to those in the
Rorschach
Inkblot.
What do you
see?
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The Rorschach Inkblot Test
Let’s examine the
evidence
Examine the Evidence: It’s important to
remember 25% of the CS scores are
Fact: 75% of the Exner’s not considered reliable, “the norms”
Comprehensive System published by Exner is extremely
outdated (from the 1970s and 1980s),
(CS) scores warrant
and adequate validity only exists for 20
internal validity which
of the 180 CS scores.
is based on sums of
individual scores.
Some previous studies found that
validity increases when clinicians use
their clinical judgment to incorporate
the Rorschach results with information
gathered from other sources.
Conclusion: There continues to be critics
and advocates for the utility of the
Rorschach; however no sound
empirical data exists.
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The goal of behavioral
assessments is to understand
behavior within the context
of learning, “learned
behavior.”
Behavioral Assessment
Functional analysis – where a clinician identifies
causal links between behavior and environment
Self-monitoring – a patient records and observes his
or her own behavior
Behavioral observation – measurement of
behavior by a trained observer.
Behavioral avoidance tests – strategies used to
assess avoidance behavior
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What do you see as the potential benefits of
self-monitoring? Do you foresee any
downfalls of this technique?
Figure 3.8 Awareness Practice Form
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Psychophysiological Assessment
Assessment strategies that measure brain and
nervous system activity
Electroencephalography (EEG, a noninvasive
procedure that measures and records brainwaves)
Electrodermal activity (EDA, measures changes in
electrical conductance produced by increased or decreased
sweat gland activity)
Biofeedback (trains patients to recognize and modify
physiological signals)
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Why is it important to assess
these biochemical changes in
the brain?
Research HOT Topic: Oxytocin and
“Mind Reading”
 Oxytocin is a naturally
occurring substance in our
bodies involved in labor
contractions and lactation.
 Associated with complex
social behaviors
 After taking oxytocin
people were more likely to
trust another person with
their money
 Ability to sense emotions
Is the ability to “read” other’s
emotions a skill worth
having? Why or why not?
 How can society use
these findings?
 What are the negative
implications, if any?
 How might this be used
with people with social
impairment or even
autism?
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The Historical Roots of Diagnosis…
American Psychiatric Association (APA,
1952)
Diagnostic and Statistical Manual of
Mental Disorders (DSM, current edition
DSM-IV-TR)
Multiaxial system of diagnosis and
classification
International Classification of Diseases
(ICD)
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Axis I = Major mental
illnesses
Axis II =
Personality
disorders and
mental
retardation
(MR)
Axis III =
Other
general
medical
conditions
Axis IV =
Social,
occupational,
and
educational
stressors
Axis V =
Global
Assessment
of
Functioning
(GAF)
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Comorbidity
The presence of
With each new
more than one
edition of the DSM
disorder
new diagnostic
categories arise
50% of people who
meet diagnostic
The DSM has
criteria for one
tripled in size since
mental disorder meet the 1st edition
Why do you think so many individuals meet
criteria for at least
diagnostic criteria for more than one mental
disorder? How do you feel about the increasing
one other disorder
number of disorders with each new DSM?
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Developmental and Cultural
Considerations
Diagnostic criteria may need to vary across the
life span
Differences in prevalence (men vs. women)
-Women and depression vs. men and substance abuse
disorders
Differences in symptoms and disorders (based
on ethnicity and race)
Culture-bound syndrome (sets of symptoms that
occur together uniquely in certain ethnic or racial groups)
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When is a diagnostic system harmful?
Stereotypes &
labels
Premature or
inaccurate
assumptions by
clinicians
Self-fulfilling
prophecies
Prevention of a
thorough evaluation
or comprehensive
treatment plan
Stigma
DSM (limited knowledge
of an era and too many
disorders)
Over-medicalization
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Dimensional Systems vs. Categorical
Systems
Dimensional (suggests that people with disorder are not
qualitatively distinct from people without disorders)
-Psychiatric illness conceptualized as dimensions of
functioning versus discrete clinical conditioning
Features that support the value of dimensional
approaches
-High frequency of comorbidity and within category
variability
-“Common language” of classification
Cons of dimensional system
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