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
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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.
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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."
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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
Journal. 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
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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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