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Psychological Assessment

Intelligence Tests

Intelligence is a hard construct to define and therefore it is also difficult to measure. Wechsler wrote that "intelligence, as a hypothetical construct, is the aggregate or global capacity of the individual to act purposefully, to think rationally, and to deal effectively with the environment". The Wechsler series of IQ tests cover the majority of the human age range. Wechsler Preschool and Primary Scale of Intelligence (ages 4 to 6), Wechsler Intelligence Scale for 

All the Wechsler scales provide three major IQ tests scores: the Full Scale IQ, Verbal IQ and Performance IQ. All three IQ scores have a mean of 100 and SD of 15. This statistical features means that a 15 point differences between a subject's Verbal and Performance IQ can be considered both statistically significant and

It is important to realize that IQ scores represent a patients ordinal position, their percentile ranking as it were, on the test relative to the normative sample. These scores do not represent a patient's innate intelligence and there is no good evidence that they measure a genetically determined intelligence. They do reflect some degree of the patient's current adaptive functioning.

The Wechsler IQ tests are composed of 10 or 11 subtests tapping two primarily intellectual domains, verbal intelligence (Vocabulary, Similarities, Arithmetic, Digit Span, Information and Comprehension) and non-verbal visual spatial intelligence (Picture Completion, Digit Symbol, Block Design, Matrix Reasoning, and Picture Arrangement).

All the Wechsler subtests are constructed to have a mean score of 10 and standard deviation of 3. Given this statistical feature we know that if two subtests differ by 3 or more scaled score points that the difference is significant. All IQ scores and subtest scaled scores are

Tests of Personality, Psychopathology and Psychological Functioning

The objective tests of personality and psychopathology. Objective psychological tests, also called self-report tests, are designed to clarify and quantify a patients personality functioning and their psychopathology. Objective tests use a patient's response to a series of tree/false (or multiple choice) questions to broadly assess their psychological functioning. Objective tests provide excellent insight into how the patient sees him or herself and how they want others to see and react to 

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2). The MMPI-2, (Butcher, Dahlstrom, Graham, Tellegen & Kaemmer, 1989) is a 567 item true/false, self-report test of psychological functioning. It was designed to provide an objective measure of abnormal behavior, basically to separate subjects into two groups, normals and abnormals, and than to further sub-categorize the abnormal group into

The MMPI-2 contains 10 Clinical Scales that assess major categories of psychopathology and three Validity Scales designed to assess test taking attitudes. MMPI-2 validity scales are; (L) Lie, (F) Infrequency, and (K) correction. The MMPI-2 Clinical Scales include: (1) Hs-Hypochondriasis; (2) D-Depression; O) Hy-Conversion Hysteria; (4) Pd-Psychopathic Deviate; (5) Mr-Masculinity-Femininity; (6) Pa-Paranoia; (7) Pt-Psychasthenia; (8) So-Schizophrenia; (9) Ma-Hypomania; and 

MMPI raw scores are transformed into T-score and a T-score >65 indicates clinical psychopathology. The MMPI-2 is interpreted by determining the highest two or three scales, called a code type. For example, a 2-4-7 code type indicates the presence of depression (scale 2), anxiety (scale 7) and impulsivity (scale 4) and the likelihood of a personality disorder (Greene, 1991). Computer scoring and interpretive reports for the MMPI-2 are 

The Millon Clinical Multiaxial Inventory-III (MCMI-III) The MCMI-III is a 175 item true/false, self-report questionnaire designed to identify both symptom disorders (Axis I conditions) and personality disorders (PDs) (Millon, 1994). The MCMI-III is composed of 

One of the unique features of the MCMI-III is that it attempts to assess both Axis I and Axis II psychopathology simultaneously. The PD scales resemble but are not identical to the DSM-IV PDs. Computer scoring and interpretive reports are also available from NCS (see above). Its relatively short length (175 items) can have advantages in the assessment patients who are agitated, whose stamina is significantly impaired or who are just sub-optimally motivated.

The Personality Assessment Inventory (PAI) (Morey, 1991). The PAI is one of the newest objective psychological tests available. The PAI was developed using a construct validation framework with equal emphasis placed upon theory guided item selection and the empirical functioning of the scales. The PAl uses 344 items and a four point response format (False, Slightly True, Mainly True, and Very True) to make 22 nonoverlapping scales. These 22 scales (4 validity scales, 11 clinical scales, 5 treatment scales, and 2 interpersonal scales) cover a range of clinically important Axis I and Axis II psychopathology and other variables relevant to interpersonal functioning and treatment planning. The PAI is marketed by Psychological Assessment Resources (PAR) P.O. Box 998, Odessa, FLA., 33556 (1-880-331-TEST).

Validity scales. Certain response styles or sets negatively impact the accuracy of the patient's self-report. Validity scales assess the degree to which a patient's response style may have distorted the findings of the self-report test.

The three most typical response styles are: careless or random responding, attempting to "look good", and attempting to "look bad".

Objective tests and the DSM-IV. The computer generated reports available from objective tests frequently provide suggested DSM diagnoses. At best these diagnoses are informed suggestions and at worse marketing gimmicks.

The Projective Psychological Tests.

Projective tests of psychological functioning are less structured, providing the patient with freedom to demonstrate his or her own unique personality characteristics and psychological organizing processes.

While the objective test provides a view of the patient "conscious" self presentation, the projective tests provide insights into the patient's typical style of perceiving, organizing and responding to ambiguous external and internal stimuli. When combined together, data from objective and projective tests can provide a fairly complete picture or description of a patient's range of functioning.

The Rorschach Inkblot Test. The inkblot test, developed by Hermann Rorschach, is a test of whole personality functioning (Rorschach, 1942/1921). The Rorschach test consists of 10 Cards which contain inkblots on them to which the patient is required to say, what the inkblot might be. The test is administered in two phases. First the patient is presented with the 10 inkblots one at a time and asked "what might this be." The responses are recorded verbatim and the examiner tries to get two response to each of the first two cards. In the second phase the examiner reviews the patient's responses and inquires where on the card the response was seen (known as location in Rorschach language) and what made it look that way (known as the determinants) to the patient.

For example, if a patient responded to Card V with "A flying bat." (Inquiry "Can you show me where you say that?") "Here I used the whole card", (What made it look like a bat?") "The color the black made it look like a bat to me." This response would be coded: WO FMa. FC'o A P 1.0.

In the past Rorschach "scoring" has been criticized for being too subjective. However, over the last 20 years John Exner Jr. (Exner, 1986) and his colleagues have developed a Rorschach system (called the Comprehensive System) which has demonstrated acceptable levels of reliability. Rorschach data are particularly useful for quantifying a patient's reality contact and the quality of their thinking.

Thematic Apperception Test (TAT). The TAT is useful in revealing a patient's dominant motivations, emotions, and core personality conflicts (Murray, 1938). The TAT consists of a series of 20 cards depicting people in various interpersonal interactions. The cards were intentionally drawn to be ambiguous. The TAT is administered by presenting eight to 10 of these cards, one at a time, with the instructions to "Make up a story around this picture. Like all good stories it should have a beginning, middle and an ending. Tell me how the people feel and what they are thinking."

No one accepted standard scoring method exists for the TAT (making it more of a clinical technique than psychological test proper), psychologists typically assess TAT stories for 1) emotional themes, 2) level of emotional and cognitive integration, 3) interpersonal relational style, and 4) view of the world (is it seen as a helpful or hurtful place).

Projective Drawings. Psychologists sometimes employ projective drawings (free hand drawings of human figures or of house-tree-person) as a supplemental assessment procedure. The represent clinical techniques more than tests as there are no formal scoring methods.

The Assessment Consultation Process and Report

Obtaining the assessment consultation. Referring a patient for an assessment consultation should be like referring to any professional colleague. Testing cannot be done "blind". The psychologist will want to hear relevant case information and explore with you what question(s) you want answered (referral question).

It is helpful if you prepare your patient for the testing by reviewing with him or her why the consultation is desired and that it will likely take a few, about 3, hours to complete.

The psychologist to evaluate your patient in a timely manner and provide you with verbal feedback, a "wet read" within a few days after the testing. The written report should be available within two weeks.

You should review the relevant findings from the consultation with your patient. If either you or your patient have any questions about the findings you should contact the psychologist for clarification.

If necessary the psychologist should be willing to meet with you or with the patient to explain the test results.

The assessment report. The report is the written statement of the psychologist's findings. It should be understandable and it should plainly state and answer the referral question(s).

The report should contain the following information: 1) relevant background information, 2) a list of the procedures used in the consultation, 3) a statement about the validity of the test results and the confidence the psychologist has in the findings, 4) a detailed description of the patient based upon test data and 4) recommendations drawn from the test findings.

The test findings should be presented in a logical manner providing a rich integrated description of the patient (not a description of the individual test results). It should contain some raw data (i.e. IQ scores) to facilitate follow-up testing. It should close with a list of useful recommendations.

To a considerable degree the quality of a report (and a consultation) can be judged from the recommendations provided. A good assessment report should contain a number of useful recommendations.

You should never read just the summary of a test report; this results in the loss of important information, as the whole report is already a summary of a