Digests
Psychological assessments
shown to be as valid as
medical tests
Monitor on Psychology.
Volume 32, No. 7 July/August
2001
By Jennifer Daw
Monitor staff
A recent report indicates
that psychological
assessments are just as
predictive of specific,
measurable
outcomes--sometimes even
more predictive--as many
medical tests.
Full Article
|
ADHD children show enhanced and
impaired attentional function
Psychol Med 2003;
33:
481-489
German researchers have found that
attentional function in children
with attention deficit/hyperactivity
disorder (ADHD) follows a
differential, rather than a deficit,
pattern.
The
team, led by J Koschack from the
University of Göttingen in Germany,
assessed 35 children with ADHD aged
9-12 years using a
neuropsychological test battery.
Their performance was classified
according to the data on a normative
sample of 187 healthy children of
the same age, and compared with the
performance of 35 healthy children.
Most
of the ADHD patients performed
within normal ranges on all
attentional measures. However,
compared with the healthy controls,
they reacted faster on all the
tests, with significant differences
found for the Go/No Go test and the
Divided Attention test.
Importantly, the ADHD patients
outperformed their healthy peers on
the externally-paced Divided
Attention test, whereas they made
significantly more errors on the
Go/No Go test, the Visual Scanning
test, and the Attentional Shift
test.
The
researchers note that the number of
errors on the Go/No Go test was
negatively related to the reaction
time on this test.
Thus,
the impulsivity of the ADHD
individuals led to a "more erroneous
performance in self-paced
attentional tasks, and to a better
performance in externally paced
attentional tasks," the team writes
in the journal Psychological
Medicine.
"The
impression of inattention in
everyday school or home life may
evolve because ADHD subjects are
hyperactive and often fail to
inhibit or delay responding, or to
exhibit well paced responding," they
add.
Koschack
et al also question whether
differentiated neuropsychological
tests of attention contribute to the
clinical diagnosis of ADHD.
Contrary to common belief, many
people can live well into their 90s
without becoming cognitively
impaired, study findings indicate.
Bradley Boeve (Mayo Clinic,
Rochester, Minnesota, USA) and
colleagues found that mild cognitive
impairment (MCI) exists as a
syndrome in patients aged 90 to 100
years, despite previous suggestions
that the greater degree of
functional and mental decline in the
very old may makes such a diagnosis
impossible.
Moreover, the researchers note that,
despite advancing age, the
relationship between cognitive and
functional performance and clinical
diagnosis followed patterns similar
to those described in younger
individuals.
Among
56 normal individuals, 13 with MCI,
and 42 with dementia, the ability to
carry out activities for daily
living was significantly worse among
patients with dementia, but was
similar for MCI and normal
individuals.
Similarly, performances on the
Mini-Mental State Examination and
the Dementia Rating Scale were
significantly impaired among
dementia patients, but differed only
slightly between the MCI and normal
individuals.
These
findings show that, although there
may be some decline in cognitive
performances with age, "dementia or
Alzheimer's disease are not
inevitable in all those living well
beyond 90 years of age," say the
researchers.
Indeed, memory was the only measure
of cognition among those with MCI
that showed levels of impairment
similar to patients with dementia.
Reporting in the journal
Neurology, the team concludes
that the evidence of amnesia in
nonagenarians with MCI warrants
further investigation into the
functional and clinical
characteristics of normal and
abnormal aging among the very old.
Dementia
diagnosis in developing countries
made easier
Lancet 2003; 361: 909–917
UK
researchers have developed a
culturally and educationally
sensitive instrument for diagnosing
dementia in developing countries.
Conventional tests for dementia rely
on "Western" norms such as
relatively high educational status,
Martin Prince (Institute of
Psychiatry, King's College, London)
and colleagues note.
To
overcome this problem, they
developed a "one-stage, culturally
and educationally sensitive dementia
diagnostic instrument" based on
three commonly used instruments –
the geriatric mental state, the
community screening instrument for
dementia, and the modified
Consortium to Establish a Registry
of Alzheimer's Disease 10-word
list-learning task.
The
three measures was tested in 2885
people aged 50 years or older, of
whom 760 were from India, 367 from
China and southeast Asia, 76 from
Nigeria, and 1692 from Latin America
and the Caribbean.
In
total, 729 participants had
dementia, with the remaining
patients free of the condition. In
addition, 702 individuals had
depression, and 694 had a high- and
760 a low-level of education.
While
each measure independently predicted
a diagnosis of dementia, the
researchers found that an algorithm
derived from all three measures gave
better results than any individual
measure.
Indeed, the algorithm identified 94%
of dementia cases with false
positive rates in the depression,
high education, and low education
groups at 15%, 3%, and 6%,
respectively.
"Our
algorithm is a sound basis for
culturally and educationally
sensitive dementia diagnosis in
clinical and population-based
research, supported by translations
of its constituent measures in most
languages used in the developing
world," the team concludes in The
Lancet.
|
Mini-Mental
State Examination & Dementia
Br J Gen Practice
2002; 52: 1002–1003
MMSE for
screening elderly dementia patients
questioned
Researchers have found that using
the Mini-Mental State Examination
(MMSE) to screen elderly people for
dementia may not be as accurate as
previously thought, raising a
question mark over its potential use
in primary care.
Nia
White and colleagues from the
University of Wales in Bangor found
that using the MMSE for screening
dementia in the elderly gave a
false-positive result in 86% of
cases.
The
validity of the test was
investigated in 709 patients aged
over 75 years, and was administered
by a member of the primary care team
during annual health checks.
In
all, 286 (40%) of the participants
were considered to have dementia due
to scoring at or below the cut-off
point, which was set at 26/30 on the
MMSE test.
For
comparison, 202 of these patients
were assessed further using the
well-validated Geriatric Mental
Schedule Automated Geriatric
Examination for Computer Assisted
Taxonomy.
This
identified 173 of the patients as
not having dementia, while only 29
(14%) were diagnosed with the
condition.
These
results indicate an 86%
false-positive rate with the MMSE,
and "raise concerns regarding the
utility of the MMSE as a screening
instrument for dementia in primary
care," say the researchers in the
British Journal of General Practice.
"Simply adding the MMSE to existing
assessments of people over 75 is
unlikely to be helpful, leading to a
high rate of older people apparently
requiring further assessment and
high rate of false positives," they
add.
The
team reports that it was possible to
lower the rate of false positives to
59%, by using a lower cut-off point
of 21; however, this resulted in
over half of the true positives
being missed.
They
recommend that assessments based on
history and complaints of memory
problems from patients and carers
may be as reliable as a full MMSE.
Neuropsychological tests 'fine-tune'
dementia diagnosis
Psychol Med 2003;
119:
217-223
British researchers have discovered
that certain neuropsychological
tests are able to distinguish
between different forms of dementia,
and may be particularly useful in
the detection of mild cognitive
impairment (MCI).
Early
diagnosis of dementia is clearly
important for optimal management,
particularly since the advent of
specific anti-dementia drugs. To
assess the sensitivity and
specificity of available tests,
Celeste de Jager and colleagues at
the University of Oxford in the UK
administered a battery of tests to
individuals referred to the Oxford
Project to Investigate Memory and
Ageing (OPTIMA).
Assessment included both validated
and novel tests aimed at gauging
episodic, semantic, and working
memory, sustained and selective
attention, executive function,
speed, perception, praxis, and
visuospatial skills.
Participants comprised 51 healthy
controls, 29 subjects with MCI, 12
with cerebrovascular disease (CVD),
and 60 with "possible" or "probable"
Alzheimer's Disease (AD). All had a
score of at least 25 on the
Mini-Mental State Examination.
Patients with AD performed worse
than controls on all tests except
attention tasks, the authors report
in Psychological Medicine.
Both the Hopkins Verbal Learning
Test and The Placing Test for
episodic memory were able to
discriminate between controls and
patients.
Furthermore, attention and
processing speed tests accurately
discriminated between those with CVD
and controls. And category fluency,
episodic memory tests, and the CLOX
test for executive function
distinguished between MCI and AD.
Finally, Spearman's correlation
showed a negative association
between age and processing speed.
Years of education affected
performance on all tests except The
Placing Test.
"The
present study has shown that a
neuropsychological battery can be
used to screen for mild and later
stages of cognitive impairment as
well as help to differentiate
various subtypes of dementia," the
team concludes.
"The
results of this study await
replication and extension to larger
groups of patients with MCI and
CVD."
|
Abstracts
Personnel Psychology.
2006 Spring 59(I): 189-225
Unproctored Internet Testing in
Employment Settings
Tippins NT,
Beaty J, Drasgow F, Gibson WM,
Pearlman K, Segall DO, Shepherd
W.
As the Internet has become more
accessible to individuals and
organizations, the use of
computerized testing has become
more feasible. Computerized
testing has brought with it a
demand for unproctored testing
that allows test takers to take
employment tests at times and
places convenient to them.
However despite the advantages
of costs and convenience,
unproctored Internet testing
(UIT) introduces a number of
issues, many of which have not
yet been resolved. These
problems range from hardware and
software issues to concerns
about the security of the test
content, the identity of
candidates, and cheating. This
article explores the pros and
cons of unproctored, Internet
testing. Six panelists share
their opinions and experiences
regarding issues around UIT and
offer suggestions for
appropriate use and future
research.
(Harcourt
Assessment, Inc.
Position on
Un-proctored Internet Testing
(UIT) for Cognitive Ability
Tests
Effective April 24, 2006)
Report of the
Internet Task force for the Board of
Scientific Affairs and Board of
Professional Affairs,
American Psychological Association,
2003
Psychological Testing on the
Internet: New Problems, Old
Issues
Jack A.
Naglieri, George Mason
University; Fritz Drasgow,
University of Illinois; Mark
Schmit, SHL USA, Inc; Len
Handler, University of
Tennessee; Aurelio Prifitera,
The Psychological Corporation;
Amy Margolis, Brooklyn Learning
Center; Roberto Velasquez, San
Diego State University.
The past
decade has witnessed a rapid
expansion of the Internet. This
revolutionary communication
network has significantly
changed the way people conduct
business, communicate, and live.
In this report we have focused
on how the Internet influences
the practice of psychology as it
relates to testing and
assessment. The report includes
topics such as test security,
how technical issues may
compromise test validity and
reliability, and hardware
issues. Special attention is
paid to ethical and legal
issues, with particular emphasis
on implications for people with
disabling conditions and
culturally and linguistically
diverse persons. The report also
covers issues specific to areas
of practice such as
neuropsychology,
industrial-organizational,
educational, and personality.
Illustrative examples of
Internet test use concretize the
implications of this new medium
of testing and its assessment
limitations and potential. The
most salient conclusion from
this report is that the current
psychometric standards,
particularly those regarding
test reliability and validity,
apply even though the way in
which the tests are developed
and used may be quite different.
Still, new methods made possible
by emerging technologies will
push the boundaries of existing
psychometric theory and it is up
to psychologists to test and
expand the limits of
psychometrics to keep pace with
these innovations. The Internet
provides a tremendous
opportunity for testing but with
opportunity there is a
corresponding need for the
ethical and professional use of
test results. We encourage
psychologists to think
creatively about how their
research and practice can be
improved by Internet testing.
Although there are many issues
that await resolution,
psychologists should look
forward to this new medium with
excitement and enthusiasm.
Full Report
Clin Neuropsychol.
2002 Feb;16(1):57-63.
Practice
effects on the WAIS-III across
3- and 6-month intervals.
Basso MR,
Carona FD, Lowery N, Axelrod BN.
Department of Psychology,
University of Tulsa, Tulsa, OK
74104, USA.
michael-basso@utulsa.edu
Fifty-one
participants (age M = 24.6;
education M = 14.4 years) were
administered the Wechsler Adult
Intelligence Scale - Third
Edition (WAIS-III) at baseline
and at an interval of either 3
or 6 months later. Full Scale IQ
(FSIQ), Verbal IQ (VIQ),
Performance IQ (PIQ), Verbal
Comprehension Index (VCI),
Perceptual Organization Index
(POI), and Processing Speed
Index (PSI) scores improved
significantly across time,
whereas no significant change
occurred on the Working Memory
Index. Specifically, test scores
increased approximately 3, 11,
6, 4, 8, and 7 points,
respectively on the VIQ, PIQ,
FSIQ, VCI, POI, and PSI for both
groups. Notably, the degree of
improvement was similar
regardless of whether the
inter-test interval was 3 or 6
months. These findings suggest
that prior exposure to the
WAIS-III yields considerable
increases in test scores.
Reliable change indices
indicated that large confidence
intervals might be expected. As
such, users of the WAIS-III
should interpret reevaluations
across these intervals
cautiously.
PMID: 11992227
[PubMed - indexed for MEDLINE]
Assessment. 2000
Sep;7(3):227-35.
Psychological test usage with
adolescent clients: survey
update.
Archer RP,
Newsom CR.
Department of Psychiatry and
Behavioral Sciences, Eastern
Virginia Medical School, Norfolk
23507, USA.
In 1991,
Archer, Maruish, Imhof, and
Piotrowski presented survey
findings based on the responses
of a national sample of
psychologists who performed
psychological assessment with
adolescent clients. The current
survey was designed to update
their results by examining the
test use practices reported by
346 psychologists who work with
adolescents in a variety of
clinical and academic settings.
These respondents represented an
adjusted survey return rate of
36% and predominantly consisted
of doctoral prepared
psychologists (95%) in private
practice settings (51%). The
survey respondents had a mean of
13.6 years of post-degree
clinical experience, and spent
an average of 45% of their
clinical time working with
adolescents. Survey results
reveal a substantial similarity
in test usage between the 1991
survey and the current
investigation. For example, the
Wechsler Intelligence Scales,
Rorschach, Thematic Apperception
Test (TAT), and Minnesota
Multiphasic Personality
Inventory (MMPI) remain among
the widely used tests with
adolescents. However, several
changes were also noted
including a reduction in the use
of the Bender-Gestalt and
increases in the use of parent
and teacher rating instruments.
The current findings are used to
estimate the relative popularity
of an extensive list of test
instruments, compare current
findings to 1991 survey results,
and to examine several issues
related to general effects of
managed care procedures and
policies on test usage with
adolescents.
PMID: 11037390
[PubMed - indexed for MEDLINE]
J Pers Assess.
1998 Jun;70(3):441-7.
The impact of "managed care" on the
practice of psychological testing:
preliminary findings.
Piotrowski C,
Belter RW, Keller JW.
Department of Psychology,
University of West Florida, USA.
Although the
impact of managed care
constraints on assessment
practices has received recent
attention, a review of the
literature found no data-based
articles that address this
issue. We report survey data on
137 members of the National
Register of Health Service
Providers in Psychology (Council
for the National Register of
Health Service Providers in
Psychology, 1996) on current
testing practices. The majority
(72%) reported that their use of
tests has changed in the last 5
years due to managed care
directives. These clinicians are
doing less testing overall and
restrict their pool of
assessment instruments. The
Rorschach inkblot technique
(Rorschach, 1942), the Thematic
Apperception Test (Murray,
1943), and the Wechsler
Intelligence scales (Matarazzo,
1972) were the instruments most
noted for disuse. Apparently,
practitioners are relying more
on short, brief self-report
measures that tap targeted
symptoms or problem areas, and
less on tests that demand
considerable clinicians' time.
Implications and limitations of
the findings are discussed.
PMID: 9760737
[PubMed - indexed for MEDLINE]
J Pers Assess.
1994 Oct;63(2):239-49.
Time requirements of psychological
testing: a survey of practitioners.
Ball JD,
Archer RP, Imhof EA.
Department of Psychiatry,
Eastern Virginia Medical School,
Virginia Beach 23462.
Surveys
regarding practitioner
perceptions of time requirements
for psychological testing were
mailed to a national sample of
clinical psychologists. There
were 228 (36%) returns from 630
mailings actually received. On
the basis of 151 usable returns
from respondents who conduct
psychological testing services,
data are presented separately
for time requirements associated
with administering, scoring, and
interpreting the 24 most
commonly used tests. Data are
also presented regarding the
composition of typical test
batteries and practitioner usage
of technician and/or computer
assistance in psychological
testing. The implications of
these data for research and
practice are discussed.
PMID: 7965569
[PubMed - indexed for MEDLINE]
J Clin Psychol. 1992
Sep;48(5):666-72.
Neuropsychological battery
choice and theoretical
orientation: a multivariate
analysis.
Retzlaff P,
Butler M, Vanderploeg RD.
University of Northern Colorado.
In order to
investigate the tests selected
by neuropsychologists to make up
clinical batteries, a large
survey of neuropsychological
test usage was cluster analyzed.
This provided groupings of tests
that are endorsed in common.
Theoretical orientation within
neuropsychology also was
included in the analysis to
determine which tests and
clusters of tests are more and
less associated with the
reported orientation of the
neuropsychologist. Fifteen
clusters of tests were found.
Strong and appropriate
associations with the eclectic,
hypothesis testing, process
approach, Halstead-Reitan,
Luria, and Benton orientations
were seen.
PMID: 1401153
[PubMed - indexed for MEDLINE]
Special Topics
Obesity
Obesity Surgery.
In press.
Psychological Evaluation of
Bariatric Surgery
Applicants: Procedures and
Reasons for Delay or Denial
of Surgery
Steven
Walfish
Independent Practice,
Atlanta, Georgia
Dana Vance
Georgia State University
Anthony N. Fabricatore
University of Pennsylvania
School of Medicine
Background: Psychologists
play an important role as
members of the bariatric
surgery team. The current
investigation examined the
frequency with which
psychologists recommend
delay or denial of surgery
for psychological reasons,
the procedures they use in
making their clinical
decisions, and the reasons
for such conclusions.
Method: A sample of 103
psychologists with
experience in conducting
presurgical psychological
evaluations responded to a
brief survey.
Results: There was
significant variability in
the number of evaluations
psychologists complete and
the instruments they use to
make their clinical
decisions. For most
candidates, the evaluation
results in psychological
clearance for surgery.
However, approximately 15%,
on average, are delayed or
denied for psychological
reasons. The most common
reasons for delaying or
denying surgery were
significant psychopathology
(including psychosis or
bipolar disorder), untreated
or undertreated depression,
and lack of understanding
about the risks and
postoperative requirements
of surgery, which were
reported by 51%, 39%, and
30% of respondents,
respectively. Several other
reasons were reported less
frequently and many appeared
to be idiosyncratic.
Conclusion: Psychologists
differ in their preoperative
evaluation practices.
Further research is needed
to determine the reasons for
the variability in clinical
decision-making and the
long-term medical and
psychosocial outcomes
associated with the
recommendation to delay or
deny surgery for
psychosocial reasons. When
patients receive such a
recommendation, they can be
encouraged to seek a second
opinion from a mental health
professional with bariatric
expertise.
Reprints available from:
Steven Walfish, Ph.D.
2004 Cliff Valley Way, Suite
101
Atlanta, Georgia 30329
e-mail: psychpubs@aol.com
Obesity Surgery.
Springerlink New York, May 10,
2008
Limitations of the Millon
Behavioral Medicine
Diagnostic (MBMD) with
Bariatric Surgical
Candidates
Steven Walfish (1,4),
Edward A. Wise (2) and
David L. Streiner (3)
(1) Independent Practice,
Atlanta, GA, USA
(2) Mental Health Resources,
Memphis, TN, USA
(3) Baycrest Centre,
University of Toronto,
Toronto, Canada
(4) Present address: 2004
Cliff Valley Way, Suite 101,
Atlanta, GA 30329, USA
Received:
17 March 2008 Accepted:
15 April 2008 Published
online: 10 May 2008
Background In this paper,
we critique the Millon
Behavioral Medicine
Diagnostic’s (MBMD)
psychometric characteristics
for use with bariatric
surgery patients.
Methods The reliability
data presented by the test
authors in their manual were
examined.
Results The results found
16 of 32 scales of have
internal consistency
reliability coefficients
that do not meet minimal
standards for use with
bariatric populations. Of
the remaining 16 scales, 13
do not have any compelling
evidence that they are
reliable. We suggest that if
a test is not
psychometrically reliable
then its validity is called
into question. Based on
these data, 16 of the MBMD’s
32 scales have inadequate
reliability and 13 are
lacking evidence of
reliability. We urge
clinicians to carefully
consider these findings and
the implications for their
work with bariatric surgery
patients.
|
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Commentary
HIPPA
and releasing test data
Martin H. Williams, Ph.D.
Forensic and Clinical Psychologist
Reprinted by permission of the
Division of Independent Practice,
American Psychological Association.
The
2002 APA Ethics Code, which takes
effect on June 1, 2003, differs
substantially from the current 1992
Code regarding release of test data.
Most of the changes in sections 9.04
and 9.11 of the new Code were
implemented to comply with HIPAA.
Psychologists, under the new Code
and HIPAA, must release patients’
test data pursuant to a signed
patient request to do so. This
represents a major change from the
old Code.
The old Code held, in section 2.02b,
that psychologists had a duty not
to release test data to
untrained individuals who might
misuse it. This was stated in the
Code as follows:
“This
includes refraining from releasing
raw test results or raw data to
persons, other than to patients or
clients as appropriate, who are not
qualified to use such information.”
A specific example of those “not
qualified to use such information”
might be attorneys. Psychologists
who carried out psychological
assessments in the context of
litigation would customarily refuse
to release their test data to
attorneys, who might misunderstand
and misuse the findings in court.
Instead, psychologists would insist
on releasing the test data only to
another psychologist who would be
designated by the attorney seeking
the data. Often, though,
psychologists would be compelled by
court order to release the data
anyway.
The new Code recognizes that HIPAA
gives patients a great degree of
control over their medical
information. Psychologists
can no longer refuse to
release test data and must release
it to anyone the patient designates,
regardless of the psychologist’s
opinion regarding the qualifications
of the individual who would receive
the data. The new Code states, in
Section 9.04, the following:
“Pursuant to a client/patient
release, psychologists provide test
data to the client/patient or other
persons identified in the release.”
Test data is defined as follows:
"The
term test data refers to raw and
scaled scores, client/patient
responses to test questions or
stimuli, and psychologists’ notes
and recordings concerning
client/patient statements and
behavior during examination."
The Code goes on to state that
psychologists can hold back release
of test data if they believe it will
lead to harm or misuse or
misrepresentation. This is stated as
follows:
“Psychologists may refrain from
releasing test data to protect a
client/patient or others from
substantial harm or misuse or
misrepresentation of the data or the
test, recognizing that in many
instances release of confidential
information under these
circumstances is regulated by law.”
However, for those psychologists who
come under HIPAA, concerns about
misuse or misrepresentation do not
apply, and are not sufficient
reason to refuse to release test
data. This is explained by Celia
Fisher, Ph.D., director of the
Fordham University Center for Ethics
Education, Vice-Chair of the Board
of Trustees for the APA Insurance
Trust, and Chair of APA's Ethics
Code Task Force. Dr. Fisher is the
architect of the latest Code
revision and was referenced in a
recent article on the new Ethics
Code that appeared in the APA
Monitor.
“The
2002 code does permit psychologists
to withhold test data to protect the
client from ‘substantial harm or
misuse or misinterpretation of the
data or the test.’ However, Fisher
cautions that HIPAA does not
recognize the misuse or
misinterpretation of tests as a
legitimate reason to withhold health
records, so psychologists should
take caution in such situations.”
(APA Monitor, January, 2003, p.
62).”
The new Code also distinguishes
between “test materials,” which
psychologists are required to
protect from release, and “test
data” which must be released under
certain circumstances. Test
materials and test security are
covered in section 9.11 as follows:
“The
term test materials refers to
manuals, instruments, protocols, and
test questions or stimuli and does
not include test data as
defined in Standard 9.04, Release of
Test Data. Psychologists make
reasonable efforts to maintain the
integrity and security of test
materials and other assessment
techniques consistent with law and
contractual obligations, and in a
manner that permits adherence to
this Ethics Code.”
Although psychologists are required
to guard the integrity and security
of test materials, they should note
that any test materials that
contain patient/client responses
become redefined as test data and,
hence, become releasable. This
is stated in section 9.04 as
follows:
“Those portions of test materials
that include client/patient
responses are included in the
definition of test data.”
As an example, the Rorschach scoring
sheets contain small representations
of the actual Rorschach plates. A
blank scoring sheet would be
considered “test materials” and
would be subject to security. In
contrast, once the same scoring
sheet contains “notes and recordings
concerning client/patient statements
and behavior during examination,” it
would become “test data” and would
be releasable.
Finally, since ethical and legal
decision-making sometimes involves
very complex circumstances, always
consult with colleagues or
appropriate authorities whenever the
ethical or legal course of action
seems unclear.
The
new Code was published in the
December, 2002, American
Psychologist and is online at
www.apa.org/ethics
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