Chapter V

Testing in Clinical Psychology

What is a test?It is a systematic procedure for observing and

describing a person’s behaviour in a standard situation

Tests present a set of planned stimuli (inkblots or true-false questions) and ask the client to respond them in dome way

The client’s reactions become the test results or scores, to be used as samples, signs, or correlates in the clinician’s assessment strategy

Test data may lead to conservative, situation specific statements or to sweeping, high-level inference

In some ways tests are different than any other assessment devices:A test can be administered in private settingClient’s test response can be quantitatively

compared to statistical norms established by the responses of others

Tests can be distributed in groups as well as individually

What do tests measure?Tests provide measures of everything from A to

Z Some of the tests ask direct, specific questions

(do you ever feel discouraged?), while others ask for general directions to less distinct stimuli (tell me what you see in this drawing?)

Some have correct answers (what is a chicken?) while others probe for opinions or preferences (I enjoy looking at flowers- T or F?)

Some are presented in paper and pencil form, some are given orally

Some require verbal skills (what does analogy mean?) some ask the client to perform various tasks (please trace the correct path through this puzzle maze) and others combine verbal, numerical, and performance items

Many tests can be grouped into three categories:Intellectual or cognitive abilitiesPersonality characteristicsAttitudes, interests, preferences, and values

Test construction proceduresAnalytic Approach: Begin by asking “What are the qualities I want

to measure?”, “How do I define these qualities?”, and “What kind of tests and test items would make sense for assessing these qualities

This is a deductive approach to test construction

Empirical Approach:Instead of deciding ahead of time what test

content should be used to measure a particular target, the tester lets the content “choose itself”

Empirically driven testers are usually willing to employ items that reliably discriminate among the target groups even though the conceptual relevance of those items cannot always be explained clearly

Sequential System Approach:Combines aspects of the analytical and

empirical techniquesFor example, testers who choose initial test

items analytically may then examine results statistically to determine which item responses are, and are not, correlated with one another, which items are too easy or too difficult, which items do and do not discriminate. Groups of correlated items are then identified as scales which are thought to be relatively pure measures of certain dimensions of personality, mental ability, or the like

Standardization and score interpretationStandardization refers to consistency in

administration and scoring of a testThe numbers that come from the

standardization sample – means, variances, percentages, and so on – are called norms

Tests scores can also be interpreted based on a criterion established by the tester rather than on a normative sample

Tests scores can be interpreted by comparing only to himself or herself. This is called ipsative measurement

Avoiding distortion in test scoresCircumstances under which a test is given –

temprature, noise, presence of a stranger, etc. – can affect the results

Some clients tend to respond in particular ways, which is called response set, response style, and response bias (such as social desirability)

Minimizing the extraneous sources of variability:Developing clear, simple instructionsPilot testingEnlisting experts on test biasBuilding indicators of response bias

Ethical Standards for Psychologists’ Use of Tests:

Table 5.2, p. 170CompetenceProfessional/scientific responsibilityIntegrityRespect for rights and dignityConcern for others’ welfareSocial responsibilityAccess to test materials

Criteria for Judging the Psychometric Quality of a Testing

Table 5.4, p. 172NormsInternal consistencyTest-retest reliabilityInter-rater reliabilityContent validityConstruct validityGeneralization validityClinical utility

Theories of IntelligenceGeneral intelligence model (g)

Psychometric approachIntelligence as a global, general ability

Multiple Specific Intelligences Models:Intelligence as a collection of relatively separate

abilitiesStenberg’s triarchic theory (three kinds of intelligence:

analytical, creative, practical)Gardner (8 frames of mind: verbal, mathematical,

spatial, bodily-kinaesthetic, musical, intrapersonal, interpersonal, and naturalistic

Hierarchical and Factor Analytic ModelsCombination of the two

Test of Intellectual FunctioningThe Binet Scale:1905-1st version. 30 questions and tasks,

including things like wrapping a piece of candy, repeating numbers or sentences from memory, etc.

1908 revision, Binet tests were age graded, so younger children were expected to pass earlier questions, and older children were expected to pass the later ones

1926 Stanford-Binet. Intelligence Quotient (Mental Age / Chronological Test x 100)

These categories are used: very superior, superior, high average, average, low average, borderline, and mentally retarded ( mildly, moderately, severely, and profoundly retarded)

1960 edition. They changed the way IQ was derived. IQ tables in which the formula’s results were corrected in light of mean and variance IQs at each age level

1986 edition. Within each subtest, the items are arranged in increasing order of difficulty and their results are organised to assess four major areas of intellectual functioning: verbal reasoning, abstract/visual reasoning, quantitative reasoning, and short-term memory

Standard Age Score (SAS) is determined for each subtest by using tables that convert raw scores to normalised standard scores with a mean of 50 and a standard deviation of 8 for each age group

The Wechsler Scale:Wechsler-Bellevue aimed at adults (aged 17

and older)It is a point scale (client receives credit for

each correct answerItems were arranged in subtests based on

similarity. Each subtest contained increasingly difficult items

The WB contained six verbal subtests (information, comprehension, arithmetic, similarities, digit span, and vocabulary) and five performance subtests (digit symbol, picture completion, block design, picture arrangement, and object assembly)

WAIS (Wechsler Adult Intelligence Scale):6 verbal and 5 performance subtestsMeasure Verbal IQ, Performance IQ, and Full-

Scale IQ

The WAIS III:Extended age range (through age 89)Four new Index Scores (verbal comprehension,

working memory, perceptual organisation, and processing speed)

Clinicians can obtain a multifaceted description of a person’s cognitive strengths and weaknesses

WISC (Wechsler Intelligence Scale for Children):

12 subtests (6 verbal and 6 performance) of which only 10 were usually administered

Not useful for very young kids (5 to 15)WPPSI (the Wechsler Preschool and Primary

Scale of Intelligence) reached to 4 years oldWPPSI-R reached to 3 years old

WISC-R12 subtests (6 verbal and 6 performance) of

which only 10 were usually administeredMore representative content than WISC

WISC IIINew items were added to replace outdated,

culturally unfair, to easy or too difficult Symbol Search subscale was added as a

supplementary for the Coding subtest

Other Intelligence Tests:Kaufman Assessment Battery for Children

(K-ABC):Children 2 ½ to 12 ½ years of ageIt defines the intelligence as the ability to solve

new problems (fluid intelligence) rather than knowledge of facts (crystallized intelligence)

Woodcock-Johnson Psycho-Educational Battery

Both children and adults27 subtest cover cognitive ability, academic

achievement, and individual interests

The Peabody Picture Vocabulary Test – RevisedThe Porteus Maze TestThe Raven’s Progressive Matrices

Aptitude and Achievement TestsThe Scholastic Aptitude Tests (SAT)Woodcock-Johnson Cognitive Battery IIIWoodcock-Johnson Achievement Battery IIIKaufman Test Educational Achievement (K-

TEA)Wechsler Individual Assessment (WIAT)

Tests of Attitudes, Interests, Preferences and Values The Strong-Campbell Interest Survey The Kuder Occupational Interest Survey Career Assessment Inventory These paper and pencil tests designed to assess

client’s preferences for various pursuits, occupations, academic subjects, recreational activities, and people

Allport-Vernon-Lindzey Study of Values: generalised life orientations (theoretical, economic, aesthetic, social, political, and religious)

Purpose-in-Life Test: humanistic value assessment scale

Reinforcement Survey Schedule: a list of situations and activities that the client rates in terms of desirability

Personality Tests Personality can be defined as the pattern of behavioural

and psychological characteristics by which a person can be compared and contrast with other people

Clinicians seek way to describe and understand consistencies and inconsistencies in a given person, and also how people in general tend to resemble and differ from one another

Theoretical approaches to personality varies Objective Tests: present relatively clear, specific stimuli

such as questions, statements, or concepts to which the client responds with direct answers, choices or ratings

Projective Tests: each individual’s personality will determine the way she interprets things. Clients are asked to respond to ambiguous or unstructured stimuli (inkblots, drawings, etc) and their responses are interpreted as a reflection of both conscious and unconscious aspects of their personality structure and dynamics

Objective Personality Tests

Personal Data Sheet: is a first objective tests The MMPI (the Minnesota Multiphasic

Personality Inventory): True-false-cannot say response style When compared to “normals” members of various

diagnostic groups showed statistically different responses to many items

There are 10 clinical scales (Hypochondriasis, Depression, Conversion Hysteria, Psychopathic Deviance, Masculinity-femininity, Paranoia, Psychasthenia, Schizophrenia, Hypomania, Social Introversion), 4 validity scales (?, L, F, K)

Clinicians conduct profile analyses by comparing a client’s MMPI scores with those of other clients:

a.Clinically: by recalling previous clients’ patternsb.Statistically: by reference to books containing

sample profiles and the characteristics of the people who produced them

The original MMPI was criticised for its outdated and unrepresentative standardisation sample, for deficiencies in its covarage of some aspects of mental disorders, for its old-fashioned items, and for the unreliability of some of its scales

MMPI-2

The CPI (The California Psychological Inventory): Broad-range, empirically constructed, objective

personality test Developed to measure personality in the normal

population Items are grouped into more diverse and positively

oriented scales (sociability, self-acceptance, responsibility, dominance, self-control, etc.) and three validity scales

Representative of standardisation sample

Other Objective Personality Inventories: Personality Research Form (PRF), The Milton Clinical

Multiaxial Inventory (MCM-II), and the Meyers-Briggs Type Indicator (MBTI)

Objective Tests Based on Factor Analysis:Aim is to determine the minimum number of traits

or characteristicsOne approach is to examine how much different

traits overlap with one anotherFA is a mathematical procedure that helps to

reduce the complexity of many different traits by grouping them into clusters or factors based on the pattern of correlations between the different traits

Cattel-16 PF (16 Personality Factors Questionnaire)Eysenck Personality Questionnaire (3 Basic

Personality Factors – Psychoticism, Introversion-Extraversion, and Emotional Stability)

Many studies resulted in 5-factor solutions

Big-Five factors includes:1. Neuroticism: a tendency to feel anxious,

angry, and depressed in many situations2. Extraversion: a tendency to be assertive,

active, and prefer to be with other people3. Openness: a quality indicating active

imagination, curiosity, and receptiveness to many experiences

4. Agreeableness: orientation toward positive, sympathetic, helpful interactions with others

5. Conscientiousness: a tendency to be reliable and persistent in pursuing goals

Behavioural Tests: Fear Survey Schedule: list of objects,

persons, situations that the client rates in terms of fearsomeness

State-Trait Anxiety InventoryThe Social Phobia and Anxiety InventoryPTSD Symptom ScaleBeck depression InventoryThe Multiple Affect Adjective ChecklistThe Bulimia Test-Revised

Projective Personality TestsThe Rorschach Inkblot Test:A set of 10 coloured and black-and-white inkblotsThe client is shown 10 cards, one at a time and

client asked what she sees or what the blot could beThe tester records all responses verbatim and takes

about response times, how the card was held as responses occurred, noticeable emotional reactions, and other behaviours

When she is done, tester goes back through the set of cards and conducts an inquiry or systematic questioning of the client about the characteristics of each blot

Initial reactions and comments during the inquiry are coded

Example

The Thematic Apperception Test (TAT):Consist of 30 drawings of people, objects, and

landscapesGenerally 10 of these cards (one of them blank) are

administeredDetermined by the client’s age, sex, and by the

clinician’s interestTester shows each picture and ask the client to make

up a story about it, including what led up to the scene, what is now happening, and what is going to happen

Client is encouraged to say what the people in the drawings are thinking and feeling

For the blank card the respondents are asked to imagine a drawing, describe it, and then construct a story about it

Example

Analysis of the TAT can focus upon both the content and the structure of TAT stories

Content: what client describe, the people, the feelings, the events, the outcomes.

Structure: how client tells her story: logic, organisation, use of language, the appearance of speech dysfluency, the misunderstanding of instructions or stimuli in the drawing, and obvious emotional arousal

Some clinicians prefer TAT scoring systems that are relatively unstructured. They develop an idiosyncratic combination of principles derived from psychodynamic theory and their clinical experience

Incomplete Sentence Test:Ask clients to complete incomplete sentencesHow the client finishes the sentences reflect

important personality characteristics“I like…”, “My father,…”, “I secretly…” (Rotter

Incomplete Sentence Blank)

Example Rotter Incomplete Sentence Blank 1. I feel . . .hopeful about most things.

2. I regret . . .not being able to communicate with my ex-wife3. Other people . . .are usually fair and honest.4. I am best when . . .I'm at home with my family.5. What bothers me is . . .the thought of losing contact with my children.6. The happiest time . . .is when I'm spending time with my children.7. I am afraid of . . .being separated from my children.8. My father . . .is someone I can always talk to about things.9. I dislike to . . .argue with my wife.10. I failed . . .to understand my wife's needs.11. At home . . .is one of the places I like best.12. Boys . . .can be a challenge to keep up with!13. My mother . . .always took care of her family.14. I suffer . . .from trying too hard sometimes.15. The future . . .seems uncertain right now.16. Other kids . . .were my best friends when I was young.17. My nerves are . . .somewhat unsettled lately.18. Girls . . .were a mystery to me in High School.19. My greatest worry is . . .not being able to see my kids.

Projective Drawings: The client’s drawing serve as the basis for the

clinician’s inference about various aspects of client’s personality

House-tree-person (HTP)Draw a Person Test (DAP)Bender-Gestalt (sometimes)

Example: Draw a Person (C. 7 years old)

The Psychometric Properties of TestsReliability:In general reliability of psychological tests

tend to be adequate but not uniformly soDetermining reliability of projective tests is

problematic because split-half, parallel form, and test-retest coefficients often do not make sense with such instruments

The scoring of projective tests has traditionally been far more subjective than for objective tests

Interrater reliabilities have tended to be lowMore objective scoring systems for some of

the projective tests (such as Rorschach)

Validity:Overall the validity of psychological tests

has been less impressive than their reliability

For most tests the size of the discrepancy between the reliability and validity is too great

In general, the closer a test content or task are to the content or task being assessed (i.e. the criterion) the higher the validity will be

Distortion of Test Scores: Non-standard data collection procedures Client’s motivation Structure of the items and response alternatives The testing circumstances Client’s tendency to respond in particular ways (i.e.

response style, social desirability bias, and response bias):

- Social desirability (responding in most socially acceptable way)

- Acquiescent response style (tendency to be agree with any self-descriptive items)

Other Client variables (culture, education, etc.)