Transcript Clinical Assessment of Children & Adolescents

You are going
to what!?!
Clinical Assessment
of
Children & Adolescents
Dale Pietrzak, Ed.D., LPCC
Counseling & Psychology in Education
University of South Dakota
Goals
• Introduce practitioners to various tools to
aid them in diagnosis, treatment planning
and understanding their child and
adolescent clients
• Evaluate the various tools according to
basic guidelines for such tools.
And I wanted to
do this because ...
Areas of Importance
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General purpose and ages for tools
Scoring
Response set detection scales
Norms
Wait until you
Reliability
hear this ….
Validity
Additional Comments
Personality Inventory for Children: Revised
• The PIC is designed for use with children and adolescents
from age 3 to age 17. It is completed by a significant other
in the child’s life (usually the mother). Published by
Western Psychological Services (800) 648-8857 the PIC
can be hand scored (using standard keys/carbon) or
computer scored (mail in or PC program). There is a
computer generated report. It has a screening
administration (130), short scale administration (240), and
full administration (420). It has response set detection
scales, clinical scales and uses a easily applied cluster
typing for configural interpretation. PIC has a long
research history.
Don’t forget us!
Norms
• Norms based on Normal Children (2,380)
– n ranges from 167 to 298 for each year
– Largely form Minnesota (Minneapolis) schools
– Educational and occupational breakdown of
parents roughly representative of current
breakdowns.
– No racial breakdown or other demographic data
Primary Scales
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Lie
Infrequency
Defensiveness
Adjustment (general)
Achievement
Intellectual Screening
Development
Somatization
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Depression
Family Relations
Delinquency
Withdrawal
Anxiety
Psychosis (also autistic)
Hyperactivity
Social Skills
• Guide to the levels of reliability:
– .70 > fair but acceptable, .80 > is good and .90 > is
excellent. Generally want .80 or higher for clinical
decisions and .90 or higher for primary placement
decisions 1
• Use the type of reliability appropriate to the
decision prediction (test-retest) and single scale
interpretations (internal consistency).
• In calculating SEM, use same procedure or worst
coefficient.
Reliability
• Clinical Test-Retest (13 to 102 days; m=51 days):
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< .70: 1 (Som .67)
.70-.79: 0
The point is?
.80-.89: 5 (IS, Dev, Dlq, Anx & Hpr)
.90 >: 7 (Adj, Ach, D, Fam, Wdl, Psy & Ssk)
• Clinical Alpha
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< .70: 3 (Ach, IS, Hyp)
.70-.79: 6 (Adj, Dev, Som, Del, Wdl & Anx)
.80-.89: 4 (D, Fam, Psy & Ssk)
.90 >: 0
Somebody slap me ...
Validity
• Scales are not normally distributed and various
scales have differing “clinical” ranges
• Content was reviewed extensively for many
scales. But, the concepts have changed some over
time.
• About 1/2 of the scales were empirically
constructed.
• Large research data base on various forms of
validity and it has held up well.
It
Stopped!
Additional Comments
• The Cluster Types provide an excellent means for
“configural” interpretation. This includes
percentage of type in various educational
placements and typical diagnoses.
• Norms could be more representative and updated,
but as pathology is not “normally” distributed the
problems are mediated to some degree.
• One of my “desert island” tools primary one for
type. I often use it with projectives with younger
children.
• The PIY is a newer self-report measure for children
ages 8 to 18 (4th to 12th grade) from WPS. It
comes with with both a tape recorded administration
or paper-pencil administration (270 items). It can
be computer scored, hand scored (“normal” keys
and carbonless) and mail-in scored. It has validity
scales, 9 major clinical scales and additional
subscales. There is a computer generated report. It
has a screening administration (80 items) and modern
norming.
No
Fair!
Norms
• The norms are from 2,327 school children
from around the country. The sample is
demographically representative of gender,
race, income, region, and guardianship.
Extensive analysis of the effects of various
demographic was investigated and handled
throughout the administration.
• Clinical comparison groups are available.
Primary Scales
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Cool!
Validity
Inconsistency
Dissimulation
Defensiveness
Cognitive Impairment
– Poor Ach. & Memory
– Inadequate Abilities
– Learning Problems
• Impulsivity & Distrac.
– Brashness
– Distract. & Overact.
– Impulsivity
• Delinquency
– Antisocial Behavior
– Dyscontrol
– Noncompliance
Primary Scales Continued
• Family Dysfunction
– Parent-Child Conflict
– Parent Maladjustment
– Marital Discord
• Reality Distortion
– Feelings of Alienation
– Halluc. & Delusions
Music to
my ears ...
• Somatic Concern
– Psychosomatic Synd.
– Muscular Ten. & Anx.
– Preocc. with Disease
• Psych. Discomfort
– Fear & Worry
– Depression
– Sleep Disturbance
Primary Scales Continued
• Social Withdrawal
– Social Introversion
– Isolation
• Social Skills Deficits
– Limited Peer Status
– Conflict with Peers
Ahhh …
finally
alone!
Reliability
The
reliability
is ...
• Clinical Test-retest (7 to 10 days):
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< .70: 0
.70-.79: 3 (Som, Dis, Ssk-.79)
.80-.89: 5 (Cog, Adh, Fam, Rlt & Wdl)
.90 >: 1 (Dlq)
Note: The test-retest
Clinical Alpha
reliabilities are slightly
higher in Normals.
– < .70: 0
– .70-.79: 2 (Cog & Adh)
– .80-.89: 6 (Fam, Rlt, Som, Dis, Wdl & Ssk)
– .90 >: 1 (Dlq)
Validity
• While it is a “new” tool the criterion related,
content and other validity data were
collected as the test was developed. As a
consequence their validity data are pretty
good. A number of criteria were used; other
tools and behavioral reports.
• As always, more research will be important.
Additional Comments
• This is a very solid and useful tool. It is the
only broad band self-report pathology
measure for children under 13/14. It has the
best constructed validity scales for these
ages.
• It could use scales dealing with substance
Here is
abuse, suicide and abuse.
what we
have...
• It is a often used tool for me.
Millon Adolescent Clinical Inventory
• The MACI is a complete revision of the Millon
Adolescent Personality Inventory to parallel the
MCMI-III for adults. It has 31 scales measuring
response styles, clinical personality styles,
expressed concerns and clinical syndromes. It has
160 items and is designed for youth ages 14 to . It
is based on clinical norms and used a standard score
called a “Base Rate” (BR). The BR scores are
designed to be especially helpful in differential
diagnosis. There is a tape recorded administration
available. Available from NCS (800) NCS-7271.
MACI Continued
• It is important to remember that the philosophy
underlying the tool is NOT the identification of a
disorder but the classification of the disorder. It
assumes a clinical subject and is concerned with
which disorder is most likely. It can be hand scored
(typical keys but complex), computer scored or
scored through a mail-in service.
And so remember ...
Norms
• The clinical samples used to norm the MACI
included 900+ adolescents from the USA and
Canada. They were used to establish, and cross
validate, the base rate (BR) scores. They were
regionally, racially, educationally and treatment
setting diverse.
• Base Rate scores serve as “cutting scores.”
– 60 locates the median in the norm group
– 75 presence of style/difficulties
– 85 the prominence of the style/difficulties.
Primary Scales
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V: Validity
X: Disclosure
Y: Desirability
Z: Debasement
1: Introversive
2A: Inhibited
2B: Doleful
3: Submissive
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4: Dramatizing
WAH!
5: Egotistic
6A: Unruly
6B: Forceful
7: Conforming
I wonder
8A: Oppositional
where
8B: Self-Demeaning they are?
9: Borderline Tendency
Primary Scales Continued
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A: Identity Diffusion
B: Self-Devaluation
C: Body Disapproval
D: Sexual Discomfort
E: Peer Insecurity
F: Social Insensitivity
G: Family Discord
H: Childhood Abuse
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AA: Eating Dys.
BB: Sub. Abuse Prone.
CC: Delinquent Preds.
DD: Impuls. Propensity
EE: Anxious Feelings
FF: Depressive Affect
GG: Suicidal Tendency
Reliability
• Clinical Test-retest (3 to 7 days):
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< .70: 2 (1 & E)
.70-.79: 8 (2A, 4, 6A-.79, 8A, A, D, AA & DD)
.80-.89: 13 (2B, 3, 5, 6B, 8B, B, C, F, G, H, CC, EE & FF)
.90 >: 4 (7, 9, BB & GG)
• Clinical Alpha
– < .70:
0
– .70-.79: 9 (3,A, D, E, F, G, CC, DD & EE)
– .80-.89: 16 (1, 2A, 2B, 4, 5, 6A, 6B, 7, 8A, 9, C, H, AA,
BB, FF, GG)
– .90 >: 2 (8B & B)
Help…I need
some coffee!
Validity
• The tool is relatively new (1993) but was
constructed with criterion related validity as
it’s driving concept. It has been compared
to other tools, clinician’s ratings and is
being researched.
• Additional research is always needed.
Now let me see…
What about this ...
Yak Yak Yak
Additional Comments
• The MACI is the only tool of it’s type for
this age group (aside from he MCMI-III any
age group). It is an ideal tool for anyone
working in outpatient, inpatient, private
practice or correctional settings.
• Caution is needed not to over diagnose
pathology with the tool (assumes client has
a disorder it is a mater of type).
• My “desert island” tool with adolescents.
MMPI-A
• The MMPI-A is a 478 item self-report measure
intended for adolescents age 14 to 18. It has 36
typically scored scales (13 “clinical” scales which
parallel the MMPI-2). It can be hand scored,
computer scored or scored through a mail-in
service. It is a downward extension of the MMPI2/MMPI. There is a tape recorded administration
available. Available from NCS.
Norms
• 805 male adolescents and 815 female
adolescents were obtained from schools in 7
states in the USA. 13 year olds were found
to have difficulty completing the material
and were eliminated. The norms are
approximately representative of the USA in
ethnic and several socioeconomic variables.
And so, this looks
pretty good ...
Primary Scales
Cool names!
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L: Lie
F: Infrequency (3)
K: Defensiveness
1: Hypochondriasis
2: Depression
3: Hysteria
4: Psych. Deviate
5: Masculin./Faminin.
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6: Paranoia
7: Psychasthenia
8: Schizophrenia
9: Hypomaina
0: Social Introversion
A-anx: Anxiety
A-obs: Obsessiveness
A-hea: Health Con.
Looks good...
Primary Scales Continued
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A-biz: Bizarre Ment.
A-ang: Anger
A-cyn: Cynicism
A-aln: Alienation
A-con: Conduct Probs.
A-lse: Low Self-Esteem
A-las: Low Aspirations
A-sod: Social Discom.
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A-fam: Family Probs.
A-sch: School Probs.
A-trt: Neg. Treat. Inds.
A: Anxiety
R: Repression
Mac-R
PRO: Alc./Drg Prone.
ACK: Alc/Drg Ack.
IMM: Immaturity
Reliability: Clinical & Content
• Normal Pop. Test-retest (1 week):
– < .70:
7 (Pa, A-biz, A-aln, A-con, A-las, A-sch, A-trt)
– .70-.79: 10 (Hs, D, Hy, Ma, A-obs, A-hea, A-ang, A-cyn,
A-lse & A-sod)
– .80-.89: 8 (Pd, Mf, Pt, Sc, Si, A-anx, A-dep & A-fam)
– .90 >: 0
Note: Clinical alphas were
• Normal Pop. Alpha
slightly higher (1 below .70)
– < .70:
9 (D, Hy, Pd, Mf, Pa, Ma, A-ang, A-las & A-sch)
– .70-.79: 8 (Hs, A-obs, A-biz, A-aln, A-con, A-lse, A-sod,
& A-trt)
– .80-.89: (Pt, Sc, Si, A-anx, A-dep, A-hea & A-fam)
– .90 >: 0
Hum ...This isn’t adding up.
Validity
• The MMPI-A has little research completed on it at
this time. There is a great deal of research under
way. The use of code type data from previous
research with MMPI are being applied, but this
practice is currently not very supported. The
applicability of previous research to it is unknown.
Psychometrically it is the weakest tool covered
here. If used reliance on the content and validity
scales seems the most justified practice.
Additional Comments
• The reading level of over a quarter of the
items is at the 8th grade or higher.
• This is not one of the tools I use very often
for a number of reasons.
They won’t
– Psychometric weaknesses
– Length
MYTHS
– Myths
like this.
Other Scales & Thoughts
• There are currently no good “teacher’s”
checklist available.
• The Achenbach CBCL is widely used, but
has no validity indicators (to my
knowledge).
• The Basic Personality Inventory (BPI) is
another sound choice (if computer scored)
for adolescents age 12 or older (WPS).
References
1
Cicchetti, D. (1994). Guidelines, criteria, and rules of
thumb for evaluating normed and standardized
instruments in psychology. Psychological Assessment, 6,
284-290.
Heilbrun, K. (1992). The role of psychological testing
in forensic assessment. Law and Human Behavior, 16,
257-272.
Walsh, W. & Betz, N. (1995). Tests and assessment
(3rd ed.) Englewood Cliffs, NJ: Prentice Hall.