Chapter 3 – Clinical Assessment and Diagnosis

I. Assessment: What is it, and why do it?

A. Assessment: uses a variety of measures and methods

1. For screening

2. To yield a diagnosis

3. For treatment planning

4. For outcome evaluation

a. statistical vs clinical significance

II. Measurement Issues

A. Standardization

1. How measure is administered

2. Against whom one is compared

a. normative comparisons

b. self-referent comparisons

B. Reliability – consistency of measurement

1. inter-rater reliability

2. test-retest reliability

3. other forms (e.g., alternate forms, internal consistency)

C. Validity – does it measure what it’s supposed to measure

1. construct validity

2. criterion validity (concurrent and predictive)

3. statistical vs clinical prediction

D. Selection of appropriate measures

1. Good psychometric properties

2. Appropriate for purpose of evaluation

3. Appropriate for person being evaluated

III. Assessment Instruments

A. Clinical Interviews

1. Structured

2. Unstructured

B. Testing

1. Projective personality (e.g., Rorschach)

2. Objective personality (e.g., MMPI)

3. Cognitive/Intelligence (e.g., WAIS)

4. Neuropsychological (e.g., Bender-Gestalt)

5. Others for specific reasons (e.g., Beck Depression Inventory)

C. Behavioral Assessment/Observation (e.g., event recording, BAT)

1. info is often used for a functional analysis

D. Psychophysiological Assessment (e.g., brain scans, skin conductance)

E. Collateral Information (e.g., teacher reports, other reports)

IV. The DSM System

A. DSM = Diagnostic and Statistical Manual of Mental Disorders

B. Currently using DSM-IV-TR, DSM-V is in the works (amidst much drama)

C. Uses a multiaxial system

1. Axis I: Most psych disorders

2. Axis II: Pervasive chronic disorders

3. Axis III: Medical conditions

4. Axis IV: Psychosocial stressors

5. Axis V: GAF – Global Assessment of Functioning

6. Can have multiple (comorbid) disorders/problems on axes 1-4

a. some disorders include hierarchical rules, preventing some comorbid disorders

D. Has appendices for:

1. Potential disorders and axes, in need of further study

2. Culture-bound syndromes

V. Issues in Classification and Diagnosis

A. Political aspects behind inclusion/exclusion of diagnoses

B. Too many diagnoses? “Frivolous” diagnoses? Too much comorbidity?

C. Are diagnoses really reliable and valid?

D. Consequences of labeling

1. Both negative and positive

E. Potential Conclusions?

1. categorical vs. dimensional approach (see also pg 10 in chapter 1)

2. increased recognition of potentially harmful consequences

3. increased attention to external pressures

4. increased attention to cultural issues