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This chapter offers considerations and recommendations for conducting a comprehensive evaluation of neurodevelopmental disorders, with a particular focus on autism spectrum disorder due to its frequency and symptom overlap with other conditions. Commonly used measures for neurodevelopmental assessment are also reviewed. Components of evaluation discussed include developmental and medical history as well as assessments across multiple domains: diagnostic symptoms (social skills, communication skills, repetitive behaviors), cognitive skills (intellectual, language, attention, executive functioning), adaptive behavior, and psychiatric comorbidities. In conducting the evaluation, the examiner must carefully consider which developmental areas to assess and which measures to administer to best answer the referral question, provide accurate diagnosis, and inform treatment recommendations. Considerations and strategies are presented for cases in which specific needs or behaviors may necessitate changes to typical assessment choices and administration.
This chapter provides a discussion of multicultural issues in clinical psychological assessment. The first two sections discuss best practice–related issues in assessment in relation to (1) clinical diagnosis and (2) psychological testing and assessment. For example, in terms of clinical diagnosis, the Cultural Formulation approach in DSM-5 represents the current major framework for conducting diagnosis with culturally diverse patients. At the same time, we also highlight the importance of cultural threats to validity. In the third and final section, we discuss the remaining challenges and the future directions related to multicultural issues in clinical psychological assessment. These challenges include the evaluation of cultural validity and measurement invariance of our psychological tests and measures. Future directions for the field involve achieving greater representation and generalizability in light of the WEIRD sample bias, that is, most of the psychological research has been conducted in Western Industrialized Rich Democracies.
Many clinical psychologists either work with children who may be eligible for educational accommodations and special education or else work with adults who have received such services. This chapter provides an overview of assessment issues in educational settings, with a focus on K-12 schooling. We review the legal framework for special education assessment, before considering two controversial issues that interact with that framework: multitiered systems of support that delay comprehensive assessments and the question of whether students with ethnic minority backgrounds are overidentified as having disabilities. We then turn to the assessment of learning disabilities, the largest special education category; we review and evaluate major approaches to learning disability identification. Our next topic is the use of assessment data to determine which students need accommodations on classroom and high-stakes tests. Finally, we discuss an emerging issue: the measurement of effort and motivation that students exhibit during testing in educational settings.
Psychological assessment and report writing are arguably two of the more important tasks of clinical psychologists. The overall purpose of this chapter is to provide some recommendations and guidelines on how to write a psychological report using evidence-based assessment methods. Principles on psychological report writing derived from seminal papers in the field of psychological assessment were adapted and used as an organizing tool to create a template on how to write all varieties of psychological reports that incorporate evidence-based assessment methods. Report writers who share similar approaches to evidence-based assessment methods may find this template helpful when formatting their psychological reports.
Most behavioral health care occurs within primary care settings. Increasingly, behavioral health providers are integrating into these settings to enhance the ability of medical providers to assess and treat behavioral health concerns. Compared to specialty care, primary care is optimized, in part through brief appointments, to provide care to a larger proportion of the population. Behavioral health integration models, such as the Primary Care Behavioral Health model, require behavioral health providers to adapt to the environmental demands of primary care and focus on providing targeted brief screenings and assessments to quickly identify presenting concerns. In this chapter, we discuss the special considerations for conducting screenings and assessments in primary care and describe brief and targeted measures appropriate for this environment.
The Personality Assessment Inventory (PAI; Morey, 1991) is a 344-item self-administered questionnaire that assesses a variety of psychopathology and personality domains. The PAI consists of twenty-two non-overlapping scales, including four validity scales, eleven clinical scales, five treatment scales, and two interpersonal scales. Ten of the scales are further organized into subscales intended to assure breadth of coverage within diagnostic constructs. PAI scale and subscale raw scores are linearly transformed to T-scores (mean of 50, standard deviation of 10) to provide interpretation relative to a community standardization sample. Each item on the PAI is rated using a four-alternative scale, ranging from False, Not at all True (F), to Very True (VT). The PAI has practical applications across a variety of assessment specialties, including diagnostic decision-making, treatment planning, forensic evaluation, and personnel selection.
The advancement and spread of technology have improved options for clinical assessment. Specifically, ambulatory assessment (AA) methods have improved the ability to assess constructs with a particular focus on intra-individual and dynamic time processes, which are highly relevant to the assessment of mood and behavior. This chapter reviews current technologies, including applications of online platforms and devices, often utilized to collect data in an AA framework, and discusses their applications within research and clinical settings (e.g., assessment of mood instability). AA has a number of benefits, including limited or no reliance on retrospective recall as well as the ability to assess context and construct of interest in the “real world,” and allows for the ability to gather rich information regarding mood, behavior, and psychophysiology as part of the clinical assessment process. Much of the clinical application of AA is in the early stages. A number of important considerations and recommendations, including data security, accessibility, and future directions, are also reviewed within the context of AA methods.
The MMPI has been a mainstay of psychological assessment for nearly eight decades, a testament to the richness and clinical utility of the test. We begin this chapter by tracing the history and evolution of the MMPI instruments, including the rationale for and development of the MMPI-2-RF. First, we provide an overview of the test scales and the documents available to guide its administration, scoring, and interpretation. Next, we give an overview of the psychometric features of the MMPI-2-RF scales and a review of the literature on its use in a broad of applied settings. We then review the literature on multicultural considerations when using the MMPI-2-RF. A brief description of the adolescent version of the inventory, the MMPI-A-RF, is followed by a concluding section that illustrates MMPI-2-RF interpretation with a case study.
This introductory chapter provides an overview of the structure and content of The Cambridge Handbook of Clinical Assessment and Diagnosis. Cross-cutting themes from the chapters are considered within the context of elements of a good clinical psychological assessment. More specifically, the various parts of clinical assessment, including referral, sources of information, differential diagnosis, clinical formulation, and report writing, along with considerations for noncredible reporting and cultural considerations, are discussed. For each component of a clinical assessment, reference to more detailed information in specific chapters is provided. This chapter ends with a call for future developments in clinical psychological assessment, with an emphasis on various technological advances to further bring assessment practices into the twenty-first century.
Studies in many societies have shown low to moderate agreement between reports of psychopathology by different informants, including self-reports by the people being assessed. Research has also shown that psychiatric diagnoses based only on self-reports are often wrong when compared with diagnoses based on multiple sources of data. Furthermore, reports from different informants predict different aspects of outcomes. Because different informants can contribute valuable information about an assessed person’s functioning, comprehensive clinical assessment should include data from multiple informants. Practical methods were presented for obtaining, comparing, and using data from multiple informants scored in relation to norms for the age and gender of the assessed person, the type of informant, and appropriate multicultural norms. When deemed appropriate, clinicians can show clients bar graph comparisons of scale scores from multiple informants to foster therapeutic alliances and to evaluate progress and outcomes. Although more research on multi-informant data is warranted, applications of existing knowledge and instruments can advance clinical services now.
In this chapter, we describe the field of clinical neuropsychology and approaches to neuropsychological assessment. We critically review tests commonly used in neuropsychological assessment. Our critical review includes coverage of concurrent and criterion validity as well as other important aspects to construct validity for neuropsychological tests (i.e., relationship to functional and structural imaging, ecological validity of test scores). Throughout our review, we also address the use of neuropsychological tests with diverse individuals. Throughout the chapter, we emphasize the need for assessment of the credibility of neuropsychological test performance in order to interpret test results. We also discuss unique assessment issues that arise in neuropsychological assessment, with a focus on neuropsychological test selection issues, interpretation of scores from neuropsychological tests, and integration of test scores with other data. We also briefly discuss relatively unique ethical/professional issues that arise in the neuropsychological assessment context.
Vocational assessment includes tests designed to measure work-related characteristics, such as interests, values, personality, skills, abilities, and self-efficacy. Vocational assessment is typically conducted to provide information for the client in the context of individual career counseling or other career intervention, but also may be used in other settings within professional psychology. The primary goals typically are to increase individuals’ self-exploration and self-understanding, and to improve outcomes such as career choice fit or job satisfaction. This chapter describes commonly used measures of interests (Strong Interest Inventory, Self-Directed Search, and O*NET Interest Profiler), work values (Minnesota Importance Questionnaire and O*NET Work Importance Profiler), self-efficacy (Skills Confidence Inventory), and career adaptability (Career Adapt-Abilities Scale), as well as using traditional measures of personality. Future directions include integrated assessment platforms, connection of results to databases of occupational information, and attention to intersecting gender and cultural identities.
The MCMI-IV is frequently deployed in personality diagnosis to foster incremental validity, as its constructs correspond closely to established DSM-5 constructs. However, its use is constrained to this basic function with clinicians who are not sufficiently trained in the underlying theory of the test, the nuances of the constructs, or both. This chapter seeks to provide a primer for Millon’s Evolutionary Theory, specifically as it relates to a more thorough application in assessment and treatment with the MCMI-IV. This includes a contextual view of the MCMI-IV as it differs from other objective measures, as well as an overview of interpretive procedures from basic administration to more advanced theory integration. It also informs the clinician of potential for therapeutic enhancement using the instrument’s findings. Advantages and disadvantages of the MCMI-IV’s deductive approach in test construction and empirical grounding are discussed, as are strengths and limitations.
Psychotic and bipolar affective disorders are considered severe mental illnesses with a long-term course and fluctuating presentation. Psychotic disorders are particularly characterized by significant changes to beliefs, cognition, and perception, and bipolar affective disorders are characterized by episodes of elevated mood (mania) and depression, as well as interepisode mood fluctuation. The symptoms and impacts of these disorders can be wide-ranging and complex and their presentations highly varied. Assessors need to be clear about the rationale, aims, and scope of their assessment in order to select appropriate assessment instruments. Generally, valid and meaningful assessments take a holistic approach and are built on thoughtful and sensitive engagement with interviewees. This chapter reviews pertinent issues and common assessment instruments for categorizing, quantifying, and formulating psychotic and bipolar affective disorders.
This chapter addresses the essential ethical and professional considerations when conducting psychological assessments. Testing impacts the life of examinees in a variety of ways from licensing examinations and screening for certain professions to custody evaluations and competency to be executed. Ethical practice in the area of assessment reflects good clinical practice. Topics include informed consent, confidentiality, the involvement of third parties in assessment, external consequences, test construction, test revisions, obsolete tests and outdated test results, cultural competence, test data and test security, assessment in the digital age, as well as the less frequently addressed topic of report writing and providing assessment feedback. A good ethical decision-making framework as well as the APA Ethical Principles of Psychologists and Code of Conduct (APA 2017a) and the Standards for Educational and Psychological Testing (AERA et. al. 2014) provide guidance on preventing ethical issues from becoming ethical challenges both currently and as new ethical issues in assessment continue to emerge.
This chapter reviews the performance-based techniques most commonly used by clinical psychologists. These include the Rorschach inkblot task, two picture story tasks (the Thematic Apperception Test and Adult Attachment Projective), two sentence stem tasks (the Rotter Incomplete Sentences Blank and Washington University Sentence Completion Test), and two types of prompted drawing tasks (variations of human figure drawings and the Wartegg Drawing Completion Test). We review how each measure is used as well as evidence for their reliability, validity, and normative standards. In order to facilitate optimal use of these measures in multimethod clinical assessment, we also contextualize them as typical performance methods that help illustrate what a person is prone to do in standardized contexts when given wide latitude to perform and differentiate them from maximum performance methods of ability that illustrate what a person can do when performing their best at a task with clear guidelines for success, or self- and informant-reported methods that indicate what a person is like based on linguistically mediated introspective recall.
In this chapter, we review the current state of personality disorder (PD) assessment practices. The review includes both traditional measures that are rooted in categorical conceptualizations of PD and dimensional measures that have emerged in response to mounting evidence that has called into question the validity of traditional PD classification approaches. The scope of this chapter includes prominent and promising models and measures of PD. Moreover, our review is focused on omnibus measures that present a relatively “complete” picture of personality pathology rather than measures that focus on the features of only one or a limited set of PDs. Finally, we address two important topics relevant to PD assessment. First, we discuss the cross-cultural PD assessment literature, which is characterized by a relative lack of strong cross-cultural research on the manifestation and measurement of PD. Second, we address the disconnect between research and applied practice of PD assessment.
The practice of neuropsychology offers a unique yet multidimensional approach to clinical assessment, with its emphasis on the Bio-Psycho-Social Model. This chapter addresses a variety of issues that are relevant in our field, beginning with a discussion of the recommended model of training in neuropsychology and purposes of neuropsychological assessment. To give the reader a sense of the current context of neuropsychological assessment, we also describe the most typical work settings and specific issues in each, as well as populations seen and instruments used in our field. We then discuss some aspects of the assessment process that neuropsychologists consider, in addition to common challenges of our clinical and research practice, such as the assessment of practice effects, effort, individuals from diverse cultural and linguistic backgrounds, and general validity issues. We end this chapter with a brief discussion of the future of neuropsychological assessment and how technology may play a key role in shaping the activities and settings of our practice.