Psychometric Assessment

• • • Standardization Reliability Validity

Standardization

• Procedures are completely specified for: Administration Scoring Interpretation • Provides normative group

Reliability Consistency or Accuracy X = T + E X = score obtained by individual T = “true” or actual amount of attribute that individual possesses E = amount of random error present at time of testing The less reliable the test the more it reflects error (error: ambiguous items, inconsistent instructions, etc)

Reliability

• • • •

Equivalent Forms Test-Retest Split-Half Internal Consistency -------

•

Reliability: 0 to 1.00

Validity

• • •

Content Validity Is the test an adequate sample of the knowledge that it purports to measure?

Criterion-Referenced Validity How well does the test predict performance?

Construct Validity Provides information about the trait or attribute possessed by the individual

.

Psychological Testing

• • • • • Large Scale Selection military, industrial, educational Classification Placement Vocational/Educational Planning Diagnosis and determination of particular problem

Psychometric Assessment

• Personality character traits/psychodynamics • Cognitive Abilities intellectual fxing/achievement • Neuropsychology brain/behavior relationships

Tests of Personal Adjustment

• Projective Tests inkblots (Rorschach) ill-defined scenes (TAT) draw persons • Objective Tests self-report (MMPI/MMPI-2)

Projective Tests

stimuli/instructions:

•

ambiguous • • evocative unstructured

MMPI/MMPI-2

• • • Validity Scales L (Lie) F (Faking Good/Bad) K • • • • • • • • •

•

Clinical Scales Hs (Hypochon) D (Depression) Hy (Hysteria) Pd (Psych Dev) Mf (Masc/Fem) Pa (Paranoia) Pt (Psychasthenia) Sc (Schizophrenia) Ma (Hypomania) Si (Social Introver)

MMPI Profiles (2)

Intellectual Functioning

•

Binet Scales - 1905 Mental Age (MA): individual’s MA corresponded to age of children whose performance he equalled

•

Stanford-Binet Scales - 1916 IQ = MA/CA x 100

Wechsler Intelligence Scales

•

Wechsler Adult Intelligence Scale 16-89 years (WAIS-III) • Wechsler Intelligence Scale 6-15 years for Children (WISC-III) • Wechsler Preschool and Primary 4-6 1/2 y ears Scale of Intelligence (WPPSI)

Wechsler Adult Intelligence Scale-III WAIS-III • • • • • • • Verbal Scale Vocabulary Similarities Arithmetic Digit Span Information Letter/# Seq. (O) Comprehension • • • • • • Performance Scale Picture Completion Digit Symbol Block Design Matrix Reasoning Symbol Search (O) Picture Arrangement

Wechsler Adult Intelligence Scale-III WAIS-III • Verbal Comprehension Vocabulary Similarities Information • Perceptual Organization Picture Completion Block Design Matrix Reasoning • Working Memory Digit Span Letter/Number Seq. Arithmetic • Processing Speed Digit Symbol Symbol Search

Neuropsychological Examination

•

A method of examining the brain; abnormal behavior is linked to the fxing of specific areas of the brain through the use of the psychological test

•

neurological dysfunction is reflected in test performance

Behavioral Neuroanatomy

• • • •

Temporal lobes: language comprehension, memory Parietal lobes: visuospatial ability, praxis, sensory function Occipital lobes: visual processes Frontal lobes: language expression, executive function, motor function

Behavioral Neuroanatomy Hemispheres

Left

•

Analysis

•

Sequential

•

Codified Fxs Right

•

Synthesis

•

Simultaneous

•

Spatially Oriented

Behavioral Neuroanatomy

•

Posterior Input

–

reception

–

storage

–

integration

•

Anterior Output

–

activity

Neuropsychological Assessment

•

refinement and extension of mental status component of neurological examination

Neurological Examination

• • • •

sensory and motor systems cranial nerves reflexes mental status examination

Neurological Exam • projection areas/all-or-none or coarse gradations Neuropsychological Exam • association areas/graded scales

NEUROPSYCHOLOGICAL EXAMINATION

• • •

Attention/Concentration Information Processing Learning and Memory -----

• • • •

Language Skills Visuospatial/Constructional Skills Executive Functions/Problem Solving Emotional Status

Attention

• • • • •

focussed sustained selective divided alternating

Memory

• • • •

Registration Encoding Storage Retrieval

–

recall

–

recognition

Approaches to Assessment

• • •

Fixed Battery Flexible Battery Individualized

Neuropsychological Assessment Test Batteries

• • • Wechsler Adult Intelligence Scale-III (WAIS-III) Wechsler Memory Scale-III (WMS-III) Halsted-Reitan Neuropsychological Battery (HRNB)

Wechsler Memory Scale-III

• •

Auditory/Verbal Immediate Logical Memory Verb Paired Assoc Delayed Logical Mem Recall Verb PA Recall

• •

Visual

Immediate

Face Recognition Family Pictures Delayed Face Recognition Family Pict Recall

Halstead-Reitan Battery

• • • • • •

Category Test Abstract Reasoning Tactual Performance Test Psychomotor Functions Finger Tapping Test Psychomotor Functions Trail Making Test Mental Flexibility/tracking Seashore Rhythm Test Attention/Concentration Speech Sounds Perception Test Attention/Concentration

The neuropsychological evaluation in adult Psychiatric patients

• •

to assist in differential diagnosis To document a specific neuro-cognitive disorder

•

to evaluate the effects of psychopharmacological intervention on neurocognitive function

The neuropsychological evaluation Common referral issue in inpatient and outpatient settings:

•

Differential diagnosis of early dementia vs. depression

The neuropsychological evaluation dementia vs depression

• • •

Intensive evaluation of: attentional processes encoding, storage, and retrieval of new information review of linguistic, constructional and executive processes

The neuropsychological evaluation Mild Head Injury

• • •

information processing speed attention and memory executive function

Left Hemishpere Stroke (MCA) 52-year old male

• • • General Cognitive Abilities: Language: Memory: – Verbal (acquisition) – Visual • • Visuo-Constr Abilities: Complex Att Processes: high average intact

impaired

average hi average

impaired

TBI with SAH and SDH 29-year old male

• • • •

General Cognitive Abilities: average Memory:

–

Verbal

–

Visual hi average superior Visuo-Constr Abilities: Complex Att Processes: hi average

impaired

Approaches to Assessment

• • •

Fixed Battery Flexible Battery Individualized

Methods of Inference

• • • •

Level of Performance Pattern of Performance Right-Left Differences Pathognomic Signs

Why Assess?

• • • • •

Differential Diagnosis Delineate Competencies

–

cognitive/behavioral/emotional Counsel patient and Family Evaluate Rehabilitation Potential Establish Baseline

–

disease progression

–

surgical intervention

–

pharmacologic intervention