Research roundup: Assessment

This month's roundup features recent publications about psychological assessment and practical considerations for application

by Practice Research and Policy Staff

November 18, 2010 — Assessment has traditionally been a core domain of practice for psychologists, one that distinguishes psychological practice from other mental and behavioral health fields. Psychological assessment can help determine diagnoses, evaluate functioning or disability, help select treatment types, review treatment outcomes or help decide cases in court such as competency or child custody.

The practice of assessment continues to evolve, and the importance of assessment as a tool for psychology continues to grow. The articles below highlight some of the literature published in the past 12 months and practical considerations for application.

Poston, J. M., & Hanson, W. E. (2010). Meta-analysis of psychological assessment as a therapeutic intervention. Psychological Assessment, 22(2), 203-212.

Summary

Models for the use of assessment as a therapeutic intervention have been developed in recent years that serve as both a conceptual guide and a strategy for evaluating this practice. Typically, this approach involves working with the client to identify the questions to be addressed through testing and then providing that feedback to the client in a collaborative fashion. Poston and Hanson used meta-analytic techniques to analyze effect sizes across seventeen published studies of psychological assessment as a therapeutic intervention. In this sample of studies, which involves 1,496 participants, a significant overall Cohen's d effect size was found, whereby 66 percent of participants who had psychological assessment as an intervention fell above the control and comparison group means. When categorical variables were taken into account, significant treatment group effects were found for therapy process variables (within session interactions), therapy outcomes (effects of treatment), and combined process/outcome variables. Taken together, they suggest that psychological assessment procedures--when combined with personalized, collaborative, and highly involving test feedback--have positive, clinically meaningful effects on treatment, especially regarding treatment processes.

Practical considerations

Since 2002, psychologists have had an ethical obligation to provide test feedback to clients. This meta-analysis shows that when such feedback is offered in a sensitive, clinically meaningful manner, it can have significant therapeutic impact. Psychologists who are not routinely providing such feedback should determine how best to begin doing so within their practices  to provide greater benefits for the clients being assessed. 

Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychological Assessment, 21(3), 256-271.  

Summary

A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM-IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked overlap of the DSM-IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specificity of panic attacks in panic disorder and specific phobia). Brown and Barlow propose an approach that emphasizes empirically supported common dimensions of emotional disorders over disorder-specific criteria sets. Selection and assessment of these dimensions are discussed along with how these methods could be implemented to promote more reliable and valid diagnosis, prognosis, and treatment planning. For instance, the advantages of this system are discussed in context of transdiagnostic treatment protocols that are efficaciously applied to a variety of disorders by targeting their shared features.

Practical considerations

This article argues that the often difficult differential diagnosis between depressive disorders and anxiety disorders is rooted in common higher order personality dimensions that are common to both. Focusing on underlying common dimensions of emotional disorders may lead to better targeted treatments and more accurate prognostic predictions. Psychologists may wish to target their assessments to parsing out the underlying common dimensions to better guide diagnosis and treatment planning. 

Stern, B. L., Caligor, E., Clarkin, J. F., Critchfield, K. L., Horz, S., MacCornack, V., . . . Kernberg, O. F. (2010). Structured Interview of Personality Organization (STIPO): Preliminary psychometrics in a clinical sample. Journal of Personality Assessment, 92(1), 35-44.

Summary

The Structured Interview of Personality Organization (STIPO) is a semi-structured interview designed for the dimensional assessment of identity, primitive defenses, and reality testing, the three primary content domains in the model of personality health and disorder elaborated by Kernberg (1984; Kernberg & Caligor, 2005). The STIPO was evaluated with a clinical sample representing a broad range of personality pathology. Results suggest that identity and primitive defenses as operationalized in the STIPO are internally consistent and that interrater reliability for all 3 content domains is adequate. Validity findings suggest that the assessment of one's sense of self and significant others (Identity) is predictive of measures of positive and negative affect, whereas the maladaptive ways in which the person uses his or her objects for purposes of regulating one's self experience (Primitive Defenses) is predictive of measures of aggression and personality disorder traits associated with cluster B personality disorders.

Practical considerations

The theories of psychoanalyst Otto Kernberg have influenced many psychologists with their conceptual understanding of personality. The STIPO is a useful development that takes the concepts and operationalizes them for use in research and practice. The preliminary evaluation of the tool supports its relevance and use of the tool may provide a mechanism for clinicians to systematically capture elements of personality that will help to inform diagnosis and treatment planning.  

Sollman, M. J., Ranseen, J. D., & Berry, D. T. (2010). Detection of feigned ADHD in college students. Psychological Assessment, 22(2), 325-335.

Summary

Young-adult students may have incentives to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD) in order to gain academic benefits (lengthened test periods, increased academic support). With ADHD information readily accessible on the Internet, those motivated to obtain an ADHD diagnosis may be able to feign symptoms at evaluation. The authors compared the performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated students motivated and coached to present with ADHD symptoms were readily able to produce ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test--II findings appeared more related to motivation than condition. Cognitive symptom validity tests (SVTs) such as the Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test, demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.

Practical considerations

In today’s high-pressure academic world, some students may be motivated to seek a competitive edge by seeking special accommodations for feigned disabilities. This study shows that motivated students can feign ADHD symptoms and provides strategies for evaluators to detect “real” ADHD from potentially feigned ADHD. 

Vachon, D. D., & Bagby, R. (2009). Pathological gambling subtypes. Psychological Assessment, 21(4), 608-615.

Summary

Although pathological gambling (PG) is regarded in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) as a unitary diagnostic construct, it is likely composed of distinct subtypes. This study used cluster analyses of personality traits with a non-treatment-seeking community sample of gamblers and identified 3 PG subtypes. Gamblers partitioned into a simple PG cluster, characterized by low rates of comorbid psychopathology and trait scores near the normative mean; a hedonic PG cluster, characterized by moderate rates of comorbid psychopathology and a proclivity for excitement seeking and positive affect; and a demoralized PG cluster, characterized by high rates of comorbid psychopathology and a propensity toward negative affect, low positive emotionality, and disinhibition. The findings provide preliminary support for an empirically based typology of gamblers, distinguishable in terms of personality structure, which may reflect different etiologies.

Comment

This study provides preliminary support for the conclusion that pathological gamblers are not all alike. Recognizing how the same problem behavior may reflect different personality subtypes in different individuals may lead to improved treatment planning and a new appreciation of differential effects of positive and negative mood states on gambling among the different subtypes. 

 

Special thanks to Robert Erard, PhD, of APA and the Society for Personality Assessment who assisted on this article.