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Cognitive, Physiological, and Brain-Based Assessment
Abnormal Psychology · Chapter 10: Psychological Assessment: Tools and TechniquesSection 10.3 · lesson 37 of 9711 min · free with a free account
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In this lesson
What measurement adds, and why no scan diagnoses a psychiatric condition.
- Explain norms, standard scores, and percentile rank
- Describe the major categories of psychological test
- State what physiological and imaging methods cannot establish
- Interpret a test result alongside history and observation
Transcript
Everything said in the video, section by section (1,528 words). Read along, or search it.
Psychological Assessment: Tools and Techniques
Cognitive, Physiological, and Brain-Based Assessment
Interviewing gives you depth and context that no test can supply. What it does not give you is comparability. A clinician who says someone's memory seems poor is comparing them to something. To other people that clinician happens to have seen. That standard is unstated, unexamined, and different for every clinician. So this section is about measurement, and about reading it correctly. We will cover what a score actually is, and what it is not. The categories of test, and where each one is bounded. And the physiological and brain-based methods, where one claim must be stated plainly. No brain scan currently diagnoses any psychiatric condition.
Why Measure
Interview Supplies Depth; It Does Not Supply Comparability
Standardized measurement is assessment administered and scored the same way for everyone. And compared against a defined reference group. It adds three things that interview and observation cannot. Comparability. Performance is placed against a known group rather than an unstated one. Quantification. Change can be measured rather than recalled. And reduction of judgment error. Because administration and scoring are fixed, several interview errors have less room to operate. One note before we go on. This material is educational. Psychological testing is administered and interpreted only by qualified professionals. Online and self-administered tests are not diagnostic, whatever they claim.
Reading A Score
A Raw Score Means Nothing on Its Own
A raw score means nothing on its own. Twenty-eight correct is neither good nor bad, until you know what other people scored. Standardization means the test is given and scored identically for everyone. Norms are the distribution of scores from a defined reference group. A standard score re-expresses a raw score as distance from that group's average. On a common scale, the average is set at one hundred. And fifteen points corresponds to one standard deviation. A percentile rank says the same thing differently. It is the percentage of the comparison group who scored at or below that point. So a percentile of sixteen means eighty-four percent of that group scored higher. A percentile is not a percentage correct. Those are completely different quantities.
Intelligence
The Profile Carries the Information, Not the Total
An intelligence test measures reasoning and problem-solving across several domains. Modern batteries do not produce a single number alone. They are built around an index structure. Separate scores for verbal reasoning, visual and spatial reasoning, working memory, processing speed. And here is the thing to hold onto. The index structure carries most of the information. An overall score in the average range can conceal a very uneven profile. One index far above the others, and one far below. And that pattern is usually what the referral was actually about. Now the history of misuse, which is documented and substantial. Tests of this kind were used to support immigration restriction on group score differences. And, most seriously, in programs of compulsory sterilization in several countries. It is not a statement about a person's worth, and not a fixed statement of their potential.
Attainment
Achievement, Aptitude, and a Retired Rule
An achievement test measures what a person has learned in a defined domain. An aptitude test is intended to predict future performance. The distinction is one of purpose rather than content, and it is softer than it looks. Both measure current performance. They differ mainly in what the score is used for. Now discrepancy reasoning, which you will meet in older records. It was the approach historically used to identify a specific learning difficulty. A substantial gap between general ability and attainment in one domain. The logic is intuitive, and the approach has been substantially criticized. It identifies difficulty only after a child has fallen far enough behind for a gap to open. And the size of the required gap is a convention. Approaches based on response to targeted teaching are now widely preferred.
Test Categories
Each One Bounded in a Different Way
There are several categories of psychological test, and each is bounded differently. Intelligence batteries measure reasoning across indices, summarized in an overall score. Their limitation is that the overall score conceals the profile. Achievement tests measure attainment in a defined domain. Neuropsychological batteries measure performance across cognitive domains. They are time-consuming, and performance is affected by effort, mood, fatigue, and language. Objective personality inventories measure self-reported patterns on empirically derived scales. Symptom rating scales measure severity over a stated recent period. Now read those limitations together, because they make one argument. No category's limitation is fixable by administering more of that category. Which is exactly why a test result is interpreted alongside history and observation.
Neuropsychology
Which Functions Work, Not How Able the Person Is
Neuropsychological assessment measures cognitive functioning across defined domains. It is distinguished from intelligence testing by its purpose. The question is not how able the person is in general. It is which specific functions are working as expected, and which are not. A screening measure is brief, covers several domains shallowly, and answers one question. A full battery takes several hours and characterizes each domain in detail. The domains are attention, memory, language, visuospatial ability. Notice that each one is anchored to something the person actually does. Executive difficulty looks like being unable to organize a multi-step task. It is what the score explains about what they can and cannot manage. And a low score identifies a difficulty on that task. Not its cause.
Personality Methods
Validity Scales, and a Genuinely Contested Method
An objective personality inventory is a self-report questionnaire with fixed response options. Meaning the scales were built by finding which items actually distinguish groups. Rather than by assuming from an item's wording what it measures. Note what objective refers to. The scoring, which is fixed. Their distinctive feature is the inclusion of validity scales. These detect how the person approached the task, rather than what they reported. A validity scale finding is a finding about the testing situation. Someone assessed where consequences attach has a comprehensible reason to present a certain way. Projective techniques are a different matter, and their standing is contested. Reliability across scorers has been poor for many scoring approaches. And that no conclusion should rest on a projective finding alone.
Body Measures
Arousal Is Real; What It Is About Is Not in the Reading
Symptom rating scales are brief instruments measuring severity over a recent period. Administered before treatment and repeated during it, they produce a trajectory. The essential point is that such a score is a measure of change, not a diagnosis. Exceeding a cut-off indicates that further assessment is warranted. Nothing more. Psychophysiological measurement records bodily indices of arousal. Heart rate and its variability, skin conductance, respiration, muscle tension, cortisol. What it adds is a measure that does not depend on report at all. Now the limitation, and it is decisive for diagnosis. Poor specificity. Elevated arousal accompanies fear, anger, excitement, exertion, caffeine, and pain. A raised heart rate is consistent with almost every state a person can be in. So the reading identifies arousal, and not what the arousal is about.
Brain-Based
No Brain Scan Currently Diagnoses Any Psychiatric Condition
Electroencephalography records electrical activity through sensors on the scalp. Its established clinical uses are specific and real. Identifying seizure activity, which is a genuine diagnostic application. And characterizing sleep architecture in the investigation of sleep disorders. It is not a diagnostic instrument for psychiatric conditions. Now the central accuracy requirement of this section, and it is not hedged. No brain scan currently diagnoses any psychiatric condition. Structural imaging shows physical anatomy. Whether tissue is present, damaged, or displaced. In this field it is used to exclude neurological disease. Functional imaging gives indirect indices of activity, and its psychiatric use is research. Group-level differences have been found between people with and without a condition. But those differences do not transfer to classifying an individual. The same reasoning applies to biomarkers, and none has reached clinical use as a test.
Interpretation
Four Principles, Each Answering a Common Error
Four principles govern interpretation, and each answers a common error. First, convergence across methods. A finding supported by test data, history and observation is on much stronger ground. Second, an isolated discrepant finding is a question, not a conclusion. Testing conditions, effort, an unsuitable norm group, or ordinary measurement error. Third, effort and motivation shape performance. A test measures what the person did on that occasion, and nothing more. Poor performance can reflect impairment. It can equally reflect fatigue, pain, or low mood. Fourth, test data are interpreted alongside history, never in isolation. A score describes performance relative to a group. Whether that is a change, a difficulty, or a lifelong pattern comes only from history.
Two Composites
One Low Score That Is Not Impairment, One Profile That Converges
Tomasz is forty-five, referred after his employer raised performance concerns. He moved to the country six years ago and speaks the assessment language as a second language. His verbal reasoning index comes out at seventy-eight. The seventh percentile. But his visual and spatial reasoning is one hundred and four. The sixty-first percentile. Reported without further reasoning, this would support a conclusion of general impairment. Several things say otherwise, and they all point the same way. Conversational fluency develops years before the vocabulary depth verbal tasks require. The norms come from a population tested in its first language. And the history contradicts the conclusion. He held the same skilled job for six years. Now Margaret, seventy-one, referred after her daughter raised concerns about memory. Her memory for newly learned material comes out at the third percentile. While attention, language, and visuospatial ability are all broadly intact. Her daughter, with consent, describes the same difficulties beginning about eighteen months ago. Three sources with different limitations agree on a specific pattern. Note also what the imaging did here. It excluded neurological disease.
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