Tests in Clinical Settings

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Tests in Clinical Settings
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MMPI Minnesota Multiphasic Personality Inventory

• Usually takes 1 to 1.5 hours to complete
• Who can take the MMPI-II
• Anyone 18 years or older
• MMPI-A used with 18 years younger
• At age 18 clinician chooses II or A depending
  on school or work
• Establish rapport before administration

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MMPI Minnesota Multiphasic Personality Inventory

• L(ie) scale
• I gossip a little at times
• F(requency) scale
• it would be better if almost all laws were
  thrown out
• Elevated score interpreted as not taking test
  seriously or malingering, eccentric?
• K(correction) scale
• Corrects for over/under willingness to admit
  deviancy
• Cannot Say Scale

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MMPI Clinical Scales

• Hs (1)
• Hypochondriasis
• D (2)
• Depression
• Hy (3)
• Hysteria
• Pd (4)
• Psychopathic Deviate
• Mf (5)
• Masculinity / Femininity

• Pa (6)
• Paranoia
• Pt (7)
• Psychasthenia
• Sc (8)
• Schizophrenia
• Ma (9)
• Hypomania
• Si (0)
• Social Introversion

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MMPI-II Clinical ScalesHs (1) Hypochondrisis

• Assesses somatic concerns and delusions

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MMPI-II Clinical ScalesD (2) Depression

• An index of discomfort
• Dissatisfaction with life
• Scores associated with age
• Elderly Individuals score 5-10 points higher
• Adolescents score 5-10 points lower

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MMPI-II Clinical ScalesHy (3) Hysteria

• Identify individuals who have developed a
  psychogenic based sensory or motor disorder
• Females and persons who are more intelligent,
  better educated, higher Socioeconomic status
  score higher.

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MMPI-II Clinical ScalesPd (4) Psychopathic
Deviate

• Assess level of social adjustment
• Asocial / antisocial behavior
• Adolescents score higher than adults
• Elevated scores are seen in the following
• Graduate students in the humanities social
  sciences

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MMPI-II Clinical ScalesMf (5) Masculinity /
Femininity

• Originally developed to ID homosexuality gender
  identity
• Relates to the degree of traditional gender roles

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MMPI-II Clinical ScalesPa (6) Paranoia

• Designed to detect paranoid symptoms
• Measures degree of interpersonal sensitivity,
  self-righteousness, suspiciousness

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MMPI-II Clinical ScalesPt (7) Psychasthenia

• An index of psychological turmoil discomfort.
• Usually diagnosed with Anxiety
• Obsessive thinking, compulsive ritualistic
  behavior

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MMPI-II Clinical ScalesSc (8) Schizophrenia

• Designed to ID Schizophrenia
• Identifies individuals with disturbances of
• Thinking
• Mood
• Behavior

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MMPI-II Clinical ScalesMa (9) Hypomania

• Designed to ID individuals experiencing hypomanic
  symptoms (manic episodes)
• Adolescents college age students score higher
  than elderly individuals.

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MMPI-II Clinical ScalesSi (0) Social
Introversion

• Designed to assess tendencies to withdraw from
  social contacts responsibilities
• Not typically included in a clinical assessment

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MMPI Content Scales

• ANX
• Anxiety
• FRS
• Fears
• OBS
• Obsessiveness
• DEP
• Depression
• HEA
• Health Concerns
• BIZ
• Bizarre Mentation
• ANG
• Anger
• CYN
• Cynicism

• ASP
• Antisocial Practices
• TPA
• Type A Behavior
• LSE
• Low Self-Esteem
• SOD
• Social Discomfort
• FAM
• Family Problems
• WRK
• Work Interference
• TRT
• Negative Treatment Indicators

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Clinical versus Actuarial Prediction

• Actuarial Prediction
• Based on how groups of individuals with similar
  characteristics have acted in the past
• Clinical prediction
• Based on experience working with a certain kind
  of clientele
• Courts assume clinicians are accurate.
• However, research consistently reveals accuracy
  of actuarial prediction is higher than clinical
  prediction (e.g., Dawes, Faust, Meehl, 1989).

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Clinical versus Actuarial Prediction

• Measuring Judgment Accuracy
• Compare judgment to criterion
• Examine agreement across judges
• Determine if bad cues are used
• Determine if good cues are missed

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Clinical versus Actuarial Prediction

• Why clinical predictions often miss the mark
• Use far less data, have difficulty weighting data
  and identifying relevant from irrelevant
  information, rely too heavily on intuition and
  the unusual case
• Tend to attribute causality to personality rather
  than environment (fundamental attribution error)
• Lean toward expectations of referral source
• Rarely receive feedback

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Behavioral Profiling

• How do we know whether behavioral evidence is
  probative (i.e., providing useful, diagnostic
  information) of the likelihood of future
  behavior?
• Intuitive profiling logic If most As are Bs,
  then most Bs are As.
• If persons who commit embezzlement are likely to
  be in debt, then persons who are in debt are
  likely to be embezzlers.
• If most men who murder their wives are having an
  extramarital affair, then men who have affairs
  are likely to murder their wives.

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Behavioral Profiling

• The predictive value of a test varies in relation
  to the base rate
• Base Rate
• Prior probabilities not conditioned on featural
  evidence
• Sensitivity
• How well a test predicts a condition
• Positive Predictive Value- proportion of subjects
  with positive test result who are correctly
  diagnosed
• Specificity
• How well a test predicts the absence of a
  condition
• Negative Predictive Value- proportion of subjects
  with negative test result who are correctly
  classified
• In the next examples, well see that the
  predictive value of CAP (Child Abuse Potential
  Inventory) scores varies with base rate of child
  abuse.

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Base Rates and Predictive Validity

• 50 Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 91 19 110
• NonAbuser 13 97 110
• Total 104 116 220

Base rate of abuse is 110/220 or 50
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Base Rates and Predictive Validity

• 50 Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 91 19 110
• NonAbuser 13 97 110
• Total 104 116 220

Sensitivity 91/110 (83) Abusers correctly
Classified
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Base Rates and Predictive Validity

• 50 Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 91 19 110
• NonAbuser 13 97 110
• Total 104 116 220

Positive Predictive Value 91/104 (88) are
abusers given a positive CAP test result
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Base Rates and Predictive Validity

• 50 Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 91 19 110
• NonAbuser 13 97 110
• Total 104 116 220

Specificity 97/110 (88) Non-Abusers correctly
classified
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Base Rates and Predictive Validity

• 50 Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 91 19 110
• NonAbuser 13 97 110
• Total 104 116 220

Negative Predictive Value 97/116 or 84 of those
who test negative on CAP are really negative
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Base Rates and Predictive Validity

• Low Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 41 9 50
• NonAbuser 112 838 950
• Total 153 847 1000

Base rate of abuse is 50/1000 or 5
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Base Rates and Predictive Validity

• Low Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 41 9 50
• NonAbuser 112 838 950
• Total 153 847 1000

Sensitivity 41/50 (82) Abusers correctly
classified
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Base Rates and Predictive Validity

• Low Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 41 9 50
• NonAbuser 112 838 950
• Total 153 847 1000

Positive Predictive Value 41/153 or only 27 of
those positive on CAP are actually positive!
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Base Rates and Predictive Validity

• Low Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 41 9 50
• NonAbuser 112 838 950
• Total 153 847 1000

Specificity 838/950 (88) Non-Abusers correctly
classified
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Base Rates and Predictive Validity

• Low Base Rate of Child Abuse
• CAP Test Results
• Abuser Nonabuser Total
• Abuser 41 9 50
• NonAbuser 112 838 950
• Total 153 847 1000

Negative Predictive Value 838/847 or 99 of
Non-Abusers correctly classified
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Predictor Faithful Unfaithful To
tal Kill Wife 0 240 240 Do not Kill
Wife 740,000 259,760 999,760 Total 740,000 260,0
00 1,000,000 Probability of Murder if
Unfaithful Set at ceiling, so 240/260,000
.000923 Probability of Murder if Faithful Set
at floor, so 0. Maximum Probative Value of
Infidelity .000923 (Probability of Murder if
Unfaithful - Probability of Murder if Faithful
.000923-0) Number of times conclusion incorrect
for every time correct 259,760/240 1082
incorrect to every 1 correct!
Criterion
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When baserate of the criterion (murder in this
example) is low and the baserate of the
predictor (battering in this example) is high,
the maximum utility of a given behavioral
predictor is the smallest. In these two
examples, base rate of predictor (battering) is
held constant (50/100) but the base rate of the
criterion in Case 1 is low (10), and in Case 2
is high (40). Case 1 Predictor Does not
Batter Batters Total Kill 0 10 10 Do not
Kill 50 40 90 Total 50 50 100 Probability
kill given batters 10/50 or .20 Case
2 Predictor Does not Batter Batters
Total Kill 0 40 40 Do not
Kill 50 10 60 Total 50 50 100 Probability
kill given batters 40/50 or .80
Criterion
Criterion