Discipline Based Literature Review
Psychological assessment has its place in almost every facet of people’s lives. It can be utilized in a variety of settings, most especially diagnostic atmospheres. Johnston and Murray (2003) point out how psychological assessment is multifaceted and a frequent process. It isn’t just one evaluation of one specific behavior utilizing only a single assessment at one particular determined point in time. Instead there are several modes of activity throughout the process, which also requires a multi-informant practice of application as well. Psychological assessment is one of the primary steps in gathering information to make a diagnosis in order to generate an effective treatment plan for patients. Psychological assessment enables specialists to get a full medical history of a patient, personal and family history, an understanding of chief symptoms and/or complaints, et cetera. In general, psychological assessment is a well-established and effective diagnostic tool that aids specialists in providing tentative and/or definitive diagnoses to patients and their families. Once a proper diagnosis has been reached, the assessment helps in devising a plan of action/treatment that is tailored to the individual patient’s needs. This literature review will discuss three general topics often associated with psychological assessment and conclude with an evaluation of the ethical and professional concerns that impact the interpretation of testing and assessment data.
To begin, we will discuss the neuropsychological assessment of adolescents. This is such a unique stage in life, where individuals are caught between still remaining “children” and being on the cusp of early adulthood. There are myriad biological and environmental shifts during this period of life, which can cause some pretty extreme behavior in some adolescents. It really is one of the most tumultuous times in a person’s life. Neuropsychological assessment can often times provide profound insight into these, sometimes, rather acute shifts in behavior. How, you might ask. Well, neuropsychological assessment is designed to offer understanding and awareness into how an adolescent solves issues, utilizes and comprehends language, processes information, remembers both short-term and long-term information, and employs cognitive proficiency malleably. Ideally, neuropsychological assessment affords parents, school officials, and medical staff information about what children and adolescents know, and how they essentially come up with and arrive at resolutions. Neuropsychological assessment involves intellectual ability along with behavioral and emotional evaluation.
A neuropsychological assessment designed to examine neurocognitive aptitudes in not only adolescents, but preschoolers and children as well, is the NEPSY-II. The instrument’s beginnings derives from the NEPS, a Finnish assessment that dates back almost 30 years. Over the years, the NEPS has undergone many revisions in an effort to include a wider range of tests, as well as to incorporate a wider age range. The Swedish devised their own version, wherein it was revised, expanded upon, and standardized in Finland and the United States. The NEPSY-II comprises 32 subtests, and these subtests are separated into six tentatively derived areas of cognitive functioning. Such realms include: “Attention and Executive Functioning; Language; Memory and Learning; Sensorimotor; Social Perception; and Visuospatial Processing” (Brooks, Sherman, and Strauss, 2010, p. 81). Psychometric properties of the NEPSY-II is quite impressive, especially when compared with additional assessments like the Wechsler Intelligence Scale for Children-Fourth Edition. Internal reliability coefficients of this measure are reported to be “adequate to very high” (Brooks, Sherman, and Strauss, 2010, p. 88). Additionally, the NEPSY-II possesses strong evidence of soundness in content, concurrent, construct, and clinical validity. When compared to another assessment like the WISC-IV, there are strong correlations in many domains/subtests. While each of these assessments have their limitations, they both harness strong reliability, validity, and overall psychometric properties, which can assist professionals in coming up with answers to why a patient may not be performing adequately in academic, personal, and social atmospheres. Once the issue has been identified, steps can be taken to accommodate the patient in ways that will ensure their overall success.
In this next section, we will discuss assessment in children with attention/deficit hyperactivity disorder (ADHD). Just within the last decade alone, ADHD diagnosis has climbed to dramatic heights. ADHD is considered a neurobehavioral/neurodevelopmental disorder, which, according to the DSM-5 criteria, impacts between five and 10 percent of school-aged children. This disorder often persists into adolescence and adulthood, with an estimated 33-66% rate (Akella, Fornari, Foley, & Kaye, 2015). It is currently among the most common of childhood conditions. This condition is frequently characterized by a “pattern of behavior, present in multiple settings (e.g. school, home, community, or work), that can result in issues related to academic and social performance (Akella, Fornari, Foley, & Kaye, 2015, p. 23). When such a condition is suspected, parents can take their children to their primary care physician and have a preliminary screen—Pediatric Checklist 17 (PSC-17—conducted to focus on specific problem areas. If the attention subscale is positive, evidence-based instruments, like the Vanderbilt rating scales, should be utilized to garner more information. Two Vanderbilt rating scales include the Vanderbilt Attention Deficit/Hyperactivity Disorder Parent Rating Scale (VADPRS) and the Vanderbilt Attention Deficit/Hyperactivity Disorder Teacher Rating Scale (VADTRS). VADTRS is an instrument that adheres to the Diagnostic and Statistical Manual of Mental Disorders criteria for ADHD. Its psychometric properties have long been established and this scale is considered to have acceptable psychometric performance and is a reliable assessment tool. The VADPRS also harness well-established validity, reliability, and psychometric properties (Wolraich, Lambert, Doffing, Bickman, Simmons, & Worley, 2003). These scales were designed to assess symptoms of ADHD in children and helps to classify the issue(s) into one of the subtypes: predominantly inattentive, predominantly hyperactive/impulsive, or a combination of both. These scales also have the ability to measure symptoms of comorbid conditions like ODD, conduct disorder, depression, so on and so forth. These scales are answered and interpreted on the severity of symptoms rated on 4 to 5-point scales. When combined, the PSC-17 and the Vanderbilt scales provide a great deal of information to come to a sound and valid diagnosis. Those children that are clinically diagnosed will then be put on a treatment plan that will not only help them thrive in their personal life, but it will also ensure that they remain successful academically and in their social interactions/relationships. Thus, we can conclude that psychological assessment in instances like these bring about understanding and awareness, as well as pathways to creating better quality of life for youth populations that suffer from this condition, but also better quality of life for patients’ caregivers as they learn how to help their child be successful.
The final topic we will be discussing is intellectual assessment of adults. Intellectual assessment is one of numerous ways to measure an individual’s intelligence. These tests can assist in helping specialists diagnose intellectual disabilities/discrepancies across the lifespan. However, worth noting, is the fact that IQ tests should not be solely relied on when making a diagnosis. IQ assessments are typically the first step in the diagnostic process, and additional measures and observations are crucial in ethically and professionally coming to a diagnosis and subsequent treatment plan. An intellectual assessment designed for adults is the Wechsler Adult Intelligence Scale-IV. This assessment is designed for individuals between the ages of 16 and 90 years of age. It is a version that recognizes the ever-emerging clinical and demographic trends, providing the most enhanced measures of cognitive aptitude (Hartman, 2009). This assessment tool has been quite useful in helping to identify learning disabilities in older populations. Psychometric properties of this assessment remain among the strongest when it comes to intelligence tests, as Wechsler intelligence tests “have always been the most popular scales of intelligence, arguably one of the few “golden standards” among clinical, school, and neuro-psychologists” (Hartman, 2009, p. 87). Another psychological assessment that is becoming ever-more increasingly favorable is the Neuropsychological Assessment Battery (NAB). This instrument is appropriate for individuals between the ages of 18 and 97. This is an assessment comprised of 24 individual tests in five integrated domains: “attention, language, memory, spatial, and executive functions” (Gregory, 2014, Ch. 10, section 10.21). Authors reveal that this instruments psychometric properties are quite compelling, noting that a number of recent reports support the validity of the NAB (Gregory, 2014). This assessment has been found to have great accuracy in detecting individuals with Alzheimer’s disease, which is especially noteworthy considering the increase in early-onset AD. By being able to detect conditions such as AD in the early stages, professionals may be able to come up with effective interventions to slow down the progression of adverse symptoms linked to the disorder.
Because assessments are designed to not only measure individuals, but also whole populations, demographic diversity is something rather monumental to consider. With the majority of, if not all, assessments being created by predominantly Anglo-American specialists, minority groups, or individuals from said groups, may be subject to being mislabeled, misdiagnosed, etc. Contextual characteristics are vital to interpreting and understanding assessment outcomes. The United States is the biggest mixing bowl in terms of differing demographics. Thus, when administering and interpreting assessments, specialists must consider country of origin, primary spoken language, customs, values, belief systems, ethnic identity, gender, acculturation, worldview, so on and so forth. In each of the aforementioned topics, understanding that demographic diversity will certainly play a key role in assessment results, professionals must strive to account for discrepancies in responses and work to attribute them in culturally salient ways as to avoid misdiagnosis and inadequate treatment plans.
To conclude, while testing and assessment are a large part in everyday settings, they must be conducted and interpreted ethically and professionally. To begin, psychological assessment must stay within the established guidelines set forth by the American Psychological Association’s (APA) code of ethics. The foundation of this code rests upon the principle of “Do no harm.” Though “Do no harm” can be quite ambiguous, due to people having different ideas about what “harm” means, the APA code of ethics outlines specific criteria to ensure all procedures safeguard both professionals and the patients in their care. Before any assessment takes place, professionals must obtain informed consent. Additionally, when it comes to the interpretation of assessments, professionals must base their reports, recommendations, diagnostic and/or evaluative statements on data that adequately substantiates their findings. Assessments used to garner information must be valid and reliable as established by professionals, and assessments need to adequately take into consideration things like competence, language preferences, etc. Further, professionals must take into consideration the overall purpose of the assessment and the myriad other test factors, such as abilities, cultural components, personal, and linguistic factors that may impact professionals' conclusions and/or diminish the precision of their interpretations (APA, 2010, Section 9). In the end, psychological assessment is designed to help individuals live a fulfilled and successful life.
References
Akella, S., Fornari, V., Foley, C., & Kaye, D. (2015). Diagnosing and Treating ADHD: An Innovative Model to Support New York's Family Physicians. New York Family Medicine News, 23-27.
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct including 2010 amendments: Standard 9: Assessment (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site..Retrieved from http://www.apa.org/ethics/code/index.aspx?item=12 (Links to an external site.)Links to an external site.
Brooks, B. L., Sherman, E. S., & Strauss, E. (2010). Test Review: NEPSY-II: A developmental neuropsychological assessment, Second edition. Child Neuropsychology, 16(1), 80-101. doi:10.1080/09297040903146966
Gregory, R. J. (2014). Psychological testing: History, principles, and applications (7th ed.). Boston, MA: Pearson.
Hartman, D. E. (2009). Test Review Wechsler Adult Intelligence Scale IV (WAIS IV): Return of the Gold Standard. Applied Neuropsychology, (16), 85-87. DOI: 10.1080/09084280802644466
Johnston, C., & Murray, C. (2003). Incremental validity in the psychological assessment of children and adolescents. Psychological Assessment, 15(4), 496-507.
Mark L., W., Warren, L., Melissa A., D., Leonard, B., Tonya, S., & Kim, W. (2003). Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a Referred Population. Journal Of Pediatric Psychology, (8), 559.
Comments