Lecture Preview Cognitive Testing Personality Testing Clinical Inference and Judgment Communicating Assessment Results Neuropsychological assessment examines brainbehavior relationships. Personality testing accesses both underlying intrapsychic issues and overt behavioral manifestations of each individual’s unique psyche. Cognitive Testing the assessment of a wide range of information processing or thinking skills and behaviors. They include general neuropsychological functions involving brainbehavior relationships, general intellectual functions (such as reasoning and problem solving) as well as more specific cognitive skills (such as visual and auditory memory), language skills, pattern recognition, visual perceptual skills, academic skills, and motor functions. Cognitive testing may include aptitude testing= assesses cognitive potential such as general intelligence achievement testing= assesses proficiency in specific skills such as reading or mathematics. Cognitive testing refers to many different types of tests measuring many different types of thinking and learning skills. Intelligence Testing During the beginning of the field, the goals of intellectual testing were to evaluate children in order to help them maximize their educational experience and to assist teachers for children with special needs. It was also used to screen military recruits. Now, it is used for vocational planning, assessing learning disabilities, determining eligibility for gifted and special education programs, and examining brain-behavior relationships following head injuries, strokes, or other medical conditions. We can learn about an individual’s cognitive strengths and weaknesses by INT testing. It is used not only to measure INT but to assess cognitive functioning in general. IQ testing has been frequently misused by some professionals and the public. Argument about the reliability, validity, meaning, and usefulness of IQ scores and testing continues today. What Is Intelligence? There is no agreement about definition or theory of INT. Boring (1923)defined INT as what INT tests measure. Spearman offered a two-factor theory of INT: general abilities of INT (referred to as g) and specific abilities of INT (referred to as s). Thurstone suggested that INT included nine independent skills or primary mental abilities: verbal relations, words, perceptual ability, spatial ability, induction, deduction, numerical ability, arithmetic reasoning, and memory. These distinct and separate abilities comprise INT. Cattell defined fluid abilities as the person’s genetic or inborn intellectual abilities, crystallized abilities are what a person learns through experience, culture, and various opportunities arising from interaction with the world. Fluid abilities resemble Spearman’s g and refer to general problem-solving abilities, abstract reasoning, and ability to integrate and synthesize information quickly and efficiently. Crystallized abilities resemble Spearman’s s and refer to specific skills developed by training and experience. Piaget added a developmental perspective to intellectual theory. He suggested that humans have four stages of cognitive development: sensorimotor, preoperational, concrete operational, and formal operations Piaget used the terms assimilation to refer to gathering information accommodation to refer to changing existing cognitive structures (or schemes) to allow for the newly incorporated and assimilated information. Contemporary views of INT include practical, creative, and emotional aspects in addition to more traditional abstract reasoning and academic abilities. Sternberg and Gardner accept a more biopsychosocial perspective in the description of INT. Sternberg offered a triarchic theory of INT. Three categories of INT: componential factor includes analytical thinking, experiential factor includes creative abilities. contextual factor refers to good “street smarts” and the ability to adapt to and manipulate the environment. Gardner developed a theory of multiple INTs comprising six different types of intelligence: linguistic, logical-mathematical, musical, bodily-kinesthetic, spatial, and personal. Knowing and managing one’s emotions and recognizing emotions in others are part of emotional INT(EQ) of Goleman. However, Sternberg and Gardner’s new views of INT have not resulted in the development of new tests. The traditional IQ tests have been used. How Do Clinical Psychologists Measure Intelligence? There are different tests for children, adults, ethnic minority group members, the gifted, and the disabled. Some tests are administered individually, others are administered in groups. Some are easy to administer and score, others are very difficult to use. The most popular and frequently used tests are the Wechsler Scales.The second most frequently used INT test is the Stanford-Binet (Fifth Edition). Wechsler Scales for Adults The Wechsler- Bellevue INT Scale was developed in 1939. The Wechsler Adult INT Scale (WAIS) in 1955 The Wechsler Adult INT Scale-Revised (WAIS-R)in 1981 in WAIS-III in 1997 WAIS-IV in 2008 The WAIS-IV consists of: 4 verbal subtests: Information, Similarities, Vocabulary and Comprehension, 5 perceptual reasoning subtests: Picture Completion, Block Design, Matrix Reasoning, Visual Puzzles and Figure Weights. 3 working memory subtests: Arithmetic, Digit Span, Letter-Numbering Sequencing 3 processing speed subtests: Symbol Search, Coding and Cancellation. Wechsler Scales The WAIS-IV generally takes about one to one-and-ahalf hours to individually administer to someone between the ages of 16 and 74. Four IQ scores are determined using the WAIS-IV: Verbal Comprehension Index Score Perceptual Reasoning Index Score Working Memory Index Score Processing Speed Index Score +++++ Full Scale IQ score Wechsler Scales The mean IQ score is 100 with a SD of 15. Scores between 90 and 110 the average range of intellectual functioning. Scores below 70 are considered to be in the mentally deficient (MR) range, Scores above 130 are considered to be in the very superior range. Wechsler Scales Kaplan have developed WAIS-R as a Neuropsychological Instrument (WAIS-R NI) with additional subtests (Sentence Arrangement, Spatial Span, Symbol Copy) as well as modifications for administration and scoring in order to measure individuals who have brain dysfunction. We can make inferences about cognitive strengths and weaknesses by examining the pattern of scores obtained on each WAIS-IV subtest. Wechsler Scales High scores on the vocabulary subtest relative to very low scores on the block design subject might suggest that the person has good use of language in solving problems and a poorer ability to solve problems using perceptual and motor integration skills. We can learn about neuropsychological problems such as brain damage. For example, low scores on performance subtests of the WAIS-IV relative to high scores on the verbal subtests has been associated with alcoholism and dementia. Wechsler Scales For Children The Wechsler INT Scale for Children (WISC) in 1949 The Wechsler INT Scale for Children- Revised (WISC-R) in 1974 The Wechsler INT Scale for Children-Third Edition (WISC-III) in 1991 The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) in 2003. The WISC-IV was developed for children aged 6 to 16. Wechsler Scales For Children four categories: Verbal Comprehension: Similarities, Vocabulary, and Comprehension Perceptual Reasoning: Block Design, Picture Concepts, and MatrixReasoning Working Memory: Digit Span,Letter-Number Sequencing Processing Speed: Coding, Symbol Search Wechsler Scales For Children The WISC-IV provides four index score IQs +++++++ a full-scale IQ score. These IQ scores all are set with a mean of 100 and a standard deviation of 15. Subtest scores have a mean of 10 and a standard deviation of 3. The Wechsler Preschool and Primary Scale of INT (WPPSI) The WPPSI in 1967 the WPPSI-R in 1989 the WPPSI-III in 2002, the current version The WPPSI-III is used for children ranging in age from 2 to 7. four IQ scores: Verbal IQ: Information, Vocabulary, and Word Reasoning Performance IQ: Block Design, Matrix Reasoning, and Picture Concept Processing Speed IQ: Symbol Search and Coding Subtest +++++ Full Scale IQ. IQ scores have a mean of 100 and a standard deviation of 15, while the subtest scores have a mean of 10 and a standard deviation of 3. Stanford-Binet Scales The first standardized INT test, developed by Alfred Binet in 1905. The test has been revised many times and most recently, in 2003. It can be used with individuals from 2 years of age through adulthood. It consists of Nonverbal (NV) and Verbal (V) domains +++++ a full-scale IQ score. The age of the subject determines which subtests are used in any evaluation. IQ scores are based on a mean of 100 and a standard deviation of 15. Stanford-Binet Scales five areas: Fluid Reasoning (FR): Object Series/Matrices, Early Reasoning, Verbal Absurdities, and Verbal Analogies Knowledge (KN): Vocabulary, Procedural Knowledge, and Picture Absurdities Visual-Spatial processing (VS): Form Board, Form Patterns, Position and Direction Working Memory (WM): Block Span, Memory for Sentences, and Last Word Quantitative Reasoning (QR): Quantitative Reasoning Other Tests of Intellectual Ability Other tests are available for specific populations such as gifted children, hearing impaired individuals, or with minority group members. Kaufman Tests (Kaufman Assessment Battery for Children [K-ABC-II] Peabody Picture Vocabulary Test- Revised, Woodcock-Johnson Psychoeducational Battery, Raven’s Progressive Matrices, General Ability Measure for Adults, System of Multicultural Pluralistic Assessment (SOMPA) Neuropsychological Testing Other tests focus on brain-behavior relationships and neuropsychological functioning. Brain impairment is due to head injury, substance abuse, stroke, or other illnesses and injuries. Brain impairment impacts the cognitive ability to use language, think and make appropriate judgments, perceive and respond to stimuli, and remember old or new information. Neuropsychological testing assesses intellectual, abstract reasoning, memory, visual-perceptual, attention, concentration, gross and fine motor, and language functioning. Neuropsychological Testing Neuropsychological test batteries: The Halstead-Reitan Battery and the Luria- Nebraska Battery are the most commonly used. The HalsteadReitan Battery can be administered to persons aged 15 through adulthood and consists of 12 separate tests, the MMPI-2 and the WAIS-III. It takes 6 to 8 hours to administer. The Luria-Nebraska Battery consists of 11 subtests which assess reading, writing, speech, memory, arithmetic, and other skills. It takes about 2.5 hours to administer. Bilnot Battery, Prof. Dr. Sirel Karakaş Neuropsychological Testing Another neuropsychological testing approach, the Boston Process uses a subset of a wide variety of tests in order to answer specific neuropsychological questions. Performance on one test determines which tests or subtests will be used next. The testing process could be short or long involving few or many tests. Individual neuropsychological tests: the Wechsler Memory Scale-III , the Benton Visual Retention Test, the WAIS-R as a Neuropsychological Instrument and Wisconsin Card Sorting Test. Neuropsychological Testing Physiological tests such as evoked potentials, electroencephalography (EEG), and reaction time measures may be useful in the assessment of INT and cognitive abilities. Evoked potentials assess the brain’s ability to process the perception of a stimulus. EEG measures electrical activity of the brain. We are currently not licensed to administer neuroimaging techniques such as computerized axial tomography (CAT), magnetic resonance imaging (MRI), and positron emission tomography (PET), these techniques investigate brain structure and function. In the SCH, AD, anorexia nervosa, alcoholism, and mood disorders, cortical atrophy or actual loss of brain tissue has occured. Neuropsychological tests are used with clinical interviews, behavioral observations, and other cognitive, personality, and physiological assessment tools. Neuropsychological testing is not isolated from other evaluation techniques. Neuropsychologists must have a high level of information about brain structure and functioning. Questions on IQ and Cognitive Testing ARE WE BORN WITH A CERTAIN IQ? For some people, we are born with an innately determined level of IQ that is not influenced by social, emotional, and environmental factors. For some, there are some IQ differences among different racial groups. The book, The Bell Curve (Herrnstein & Murray, 1994) suggested African Americans <Caucasians <Asians less intelligent. Heritability of INT is between .40 and .80. biological (e.g., prenatal care, genetics, nutrition), psychological (e.g., anxiety, motivation, self-esteem), and social (e.g., culture, SES) factors are associated with INT. Questions on IQ and Cognitive Testing ARE IQ SCORES STABLE OVER TIME? Many factors influence the stability of IQ scores. 1. Scores obtained when a child is very young are likely to be less stable than scores obtained when a child is older. Early childhood tests focus on perceptual and motor skills, tests for older children and adults focus more on verbal skills. 2. The longer the time between testing administrations, the more unstable the IQ score will appear. 3. Environmental factors such as stress, nutrition, educational opportunities, exposure to toxins such as lead, and illness play a role in the IQ scores. Questions on IQ and Cognitive Testing ARE IQ SCORES BIASED? Do children from high SES perform better on IQ tests than those from lower SES? IQ tests may not be appropriate for ethnic minority groups. Most standardized IQ tests such as the Wechsler and Stanford-Binet scales are not biased. But, tests can be misused by both unqualified and well-meaning people. Questions on IQ and Cognitive Testing Flynn effect IQ scores have increased over generations, by about 3 points every 10 years. This is due to influences such as better education, improved nutrition, technological advances, and nuclear family. Questions on IQ and Cognitive Testing SHOULD THE TERMS INTELLIGENCE QUOTIENT OR IQ CONTINUE TO BE USED? Some experts suggest that general IQ scores must be left out. Some new tests such as the newest version of the Stanford-Binet have not used the terms intelligence quotient or IQ. Conclusion Cognitive testing is used to identify overall intellectual skills, to identify cognitive strengths and weaknesses, to assess the presence of learning disabilities, to predict academic success, to examine brain dysfunction, and to assess personality. We must be cautious in the use of cognitive testing. We must be aware of the limitations of the testing situation and the test. We must be careful to use tests for the purpose for which the test was developed. We must understand the biopsychosocial influences that might affect the scores. Stress level and coping abilities are associated with cognitive abilities. Personality testing strives to observe and describe the structure and content of personality. Personality can be defined as the characteristic ways in which an individual thinks, feels, and behaves. Personality testing is useful in clarifying diagnosis, problematic patterns and symptoms, intrapsychic and interpersonal dynamics, and treatment implications. What Are Personality and Psychological Functioning? Each individual has a unique manner of interacting with the world. Personality is the enduring styles of thinking and behaving when interacting with the world. Personality is influenced by biological, psychological, and social factors. Between 20% and 60% of the variance in personality traits are influenced by genetic factors, remaining is influenced by psychosocial factors (e.g., relationships with parents, siblings, and friends, as well as life events). Psychological functioning is a more general term. It refers to the individual’s cognitive, personality, and emotional worlds. Psychological functioning includes personality as well as other aspects of emotional, behavioral, cognitive, and interpersonal functioning. But, we mean to psychological functioning as noncognitive areas of functioning such as mood and interpersonal relationships. While anxiety, depr, and anger may be persistent personality traits, they can also be temporary mood states. Someone facing stressful life events, such as the death of a loved one, may experience severe anxiety, depr, or anger. The individual may feel and behave in an anxious or depressed manner as a reaction to the stressful event(s) but does not tend to be anxious or depressed most of the time. Is Personality Really Persistent? Many people believe that behavior is consistent across situations, many argue that behavior is generally situation specific. Behavior is predictable but is not rigidly consistent. People have personality styles that are generally consistent but interact with situational factors; personality and behavior differs from situation to situation. How to Measure Personality and Psychological Functioning? Interviews, observations, checklists, inventories, and even biological assessments ++++++ tests for personality and psychological functioning. These tests can be classified as either objective or projective. Objective testing presents specific questions (e.g., Do you feel sad more days than not?) or statements (e.g., I feel rested) and the person responds by using specific answers (e.g., yes/no, true/false, multiple choice) or a rating scale (e.g., 1 = strongly disagree, 10 = strongly agree).Then scores are compared with those of reference groups, using norms. Projective testing uses ambiguous or unstructured stimuli such as inkblots, incomplete sentences, or pictures of people engaged in various activities. Subjects are asked to respond freely to the stimuli, rather than answering specific questions using specific structured responses (e.g., yes/no, true/false, agree/disagree). tell stories about pictures, describe what you see in an inkblot, or say the first thing that comes to your mind when hearing a word Objective Testing There are hundreds of objective tests. The most commonly used one is the Minnesota Multiphasic Personality Inventory (MMPI), now in its second edition (MMPI-2). Adolescent version is called the MMPI-Adolescents (MMPI-A). Other objective tests such as the Millon Clinical Multiaxial Inventory-III (MCMI-III), the 16 Personality ±Factors Questionnaire, Fifth Edition (16PF), and the NEOPersonality Inventory-Revised (NEO-PI-R). THE MINNESOTA MULTIPHASIC PERSONALITY INVENTORY The MMPI was published in 1943 by psychologist S. Hathaway and psychiatrist J. C. McKinley. The MMPI was revised and became available as the MMPI2 in 1989. The original MMPI consisted of 550 true/false items. The items were selected from other personality tests and from the developers’ clinical experience. The MMPI is used with individuals ages 16 through adulthood. The MMPI takes about one to one-and-a-half hours to complete. MMPI The MMPI gives us four validity scores and ten clinical scores. The validity measures include the ? (Cannot Say), L (Lie), F (Validity), and K (Correction) scales. MMPI Admitting to many problems or “faking bad” is reflected in an reverse V configuration with low scores on the L and K scales and a high score on the F scale. L F K MMPI Presenting oneself in a favorable light or “faking good” is reflected in a V configuration with high scores on the L and K scales and a low score on the F scale. L F K The clinical scales: Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Psychopathic deviation (Pd), Masculinity-femininity (Mf), Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), Hypomania (Ma), and Social Introversion (Si). Scores are normed using standardized T-scores. T scores means that each scale has a mean of 50 and a SD of 10. MMPI Since the MMPI was published, a number of additional subscales have been developed. It has been estimated that there are over 400 subtests of the MMPI. Although the original MMPI was the most widely used test, a revision was needed. 1.The original sample included Caucasians living near University of Minnesota hospitals. For this reason, MMPI did not use a representative sample. 2. More complicated methods of test construction and analysis of today were not available in the 1930s. MMPI-2 During the late 1980s, MMPI was restandardized and many of the items were rewritten. Many new items were added, and outdated items were excluded. The MMPI-2 (Butcher, et all. 1989) consists of 567 items and can be used with individuals aged 18 through adulthood. The MMPI-2 uses the same validity and clinical scale names as the MMPI. The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) was developed for use with teens between the ages of 14 and 18 by Butcher, et al. in 1992. The MMPI-A has 478 true/false items and includes a number of validity measures in addition to those available in the MMPI. THE MILLON CLINICAL MULTIAXIAL INVENTORIES include several tests that assess personality functioning using the DSM-IV and the Theodore Millon theory of personality. The Millon was designed to assess personality disorders in the DSM such as histrionic, borderline, paranoid, and obsessive compulsive personalities. The first Millon test was published in 1982; additional tests and revisions developed during the 1980s and 1990s. The current version is the MCM-IIII developed by Millon, Millon, & Davis in 1994. It is a 175 true/false item for persons ages 18 through adulthood and takes a 30 minutes to complete. It includes 14 personality pattern scales and 10 clinical syndrome scales. THE SIXTEEN PERSONALITY FACTORS (16PF) was developed by Raymond Cattell in 1993. It is currently in its fifth edition. It is a 185-item multiple-choice questionnaire that takes approximately 45 minutes to complete. The 16PF is administered to individuals ages 16 years through adulthood. Scoring the 16PF results in 16 primary personality traits (e.g., warmth, reasoning , dominance, sensitivity, openness to change, self seliance, perfectionism and tension) and five global factors (e.g., anxiety, extraversion). THE NEO-PERSONALITY INVENTORY REVISED (NEO-PI-R): was developed by Costa & McCrae in 1985. It is a 240item questionnaire that uses a 5-point rating system. The NEO-PI-R measures the big five personality dimensions: neuroticism, extroversion, openness, agreeableness, and conscientiousness. Other Objective Tests Eysenck Personality Questionnaire (Eysenck & Eysenck, 1975) measures three basic personality characteristics: psychoticism, introversion-extroversion, and emotionality- stability. Projective Testing The theory behind projective testing is that unconscious or conscious needs, interests, dynamics, and motivations are projected onto the ambiguous stimuli, thereby revealing the internal dynamics or personality. There are many projective instruments. the Rorschach, the Thematic Apperception Test (TAT), Projective Drawings, and Incomplete Sentences. THE RORSCHACH is the famous inkblot test developed by Hermann Rorschach in 1921. The idea of seeing objects in inkblots came from a common game in the 1800s called Blotto. Someone would put a drop of ink on a piece of paper and fold the paper in half, creating a unique inkblot. Others would take turns identifying objects in the inkblots. Alfred Binet used this technique with children. Swiss psychiatrist Rorschach noticed that mental patients respond very differently to this game relative to others. The Rorschach consists of 10 inkblots that are symmetrical. THE RORSCHACH Half of the cards are black, white, and gray, and half are colorful. There are several different ways to administer and score, the majority of psychologists use the Exner’s method. During the free-association phase, the question, “What might this be?” The psychologist writes down everything the patient says and does not question the patient. After all 10 cards are administered, the psychologist shows the patient each card a second time and asks questions. Inquiry phase, the psychologist might say: “I want you to help me see what you saw. I’m going to read what you said, and then I want you to show me where on the blot you saw it and what there is there that makes it look like that, so that I can see it too. I’d like to see it just like you did, so help me now.” THE RORSCHACH We ask a question: “What about the card made it look like a____to you?” several categories to score: location (i.e., the area of the blot being used), content (i.e., the nature of the object being described), determinants (i.e., form, color, shading, and movement), and populars (i.e., the responses typically seen by others). Scoring of Rorschach can be very complicated and may take a long time to complete. Many experienced psychologists do not score the test in fine detail. Rorschach responses are associated with psychological functioning. The use of human movement are associated with adaptive psychological functioning. Numerous responses of minor details reflect obsessive-compulsive traits. Frequent use of the white space is associated with negativizm and/or avoidance. Rorschach Interpretation Human movement – generally positive Color – emotion Texture – dependency needs Many have argued: «the Rorschach is not a reliable and valid instrument». In fact many graduate programs have stopped using it. Exner has developed a method with scoring criteria and has used this method to demonstrate its’ reliability and validity. In a review of Rorschach research, revealed reliability coefficients were found to be in the .80s and the average validity coefficient to be about .42. THE THEMATIC APPERCEPTION TEST (TAT) was developed during the late 1930s by Henry Murray and Christiana Morgan at Harvard University. The TAT was designed to measure personality factors in research settings. The TAT consists of 31 pictures (one of which is blank). Some of the pictures are designed to be administered to males, some to females, and others to both genders. «I will give you a series of pictures and request to tell a story about each.» They should reflect what the people in the picture are thinking, feeling, and doing at that moment, what happened in the past and what will happen in the future. After each card is presented to the patient, the psychologist writes down everything that is said. For scoring, most clinicians use their clinical experience and judgment. The Children’s Apperception Test (CAT) was developed by Bellak in 1986, for very young children and describes animals interacting in various ways. PROJECTIVE DRAWINGS Many clinicians ask both children and adults to draw pictures to assess their psychological functioning. People are asked to draw a house, a tree, a person, and their family doing something together. the Draw-a-Person test, the House-Tree-Person Technique, and the Kinetic Family Drawing Technique. PROJECTIVE DRAWINGS on the Draw-a- Person test instructs the patient to draw persons of the same and opposite sex. PROJECTIVE DRAWINGS Many clinicians feel that these techniques are quick and easy methods to establish rapport with children or with those who have great difficulty expressing their feelings verbally. But, some clinicians overinterpret projective drawings without adequate research support to justify their interpretations. SENTENCE COMPLETION TECHNIQUES There are many different versions: Beier Sentence Completion Test Rotter Sentence Completion Test Items are such as, “Most mothers are _______.” The patient is asked to give the first response what comes to mind. Several scoring systems have been developed. However, most clinicians prefer to use their own experience and clinical judgment to interpret the themes that emerge from the completed sentences. Questions on Personality and Psychological Testing ARE PERSONALITY RESULTS ASSESSED THROUGH TESTING STABLE? Many psychologists have assumed that personality is a stable phenomenon—that each individual’s personality traits and style are consistent over time and various situations. But, several researchers have demonstrated that personality is not stable, depends on specific environmental and situational circumstances. Rather than thinking of someone as an anxious person, it is useful to evaluate and understand in which circumstances he or she is likely to show anxiety (e.g., testing situations, speaking public, asking someone for a date). Questions on Personality and Psychological Testing ARE PROJECTIVE TECHNIQUES RELIABLE AND VALID? Many reviews have concluded: projective techniques haven’t adequate reliability and validity. Some defender stated that projective tests are similar to structured interviews, whose purpose is to better know, understand, and describe a person. Most of the debate has centered around the Rorschach. However, more recent studies have been much more favorable of the Rorschach if “properly used by trained clinicians». TAT and projective drawing techniques have generally failed to provide research support for their reliability and validity. Many clinicians report that these instruments are useful for a better understanding of the patient. However, the percentage of clinical psychologists who use projective testing had decreased from about 72% in 1986 to 39% in 2003. Questions on Personality and Psychological Testing ARE PERSONALITY AND PSYCHOLOGICAL TESTS APPROPRIATE FOR USE WITH MINORITY GROUP MEMBERS? We must be aware of the limitations of the tests that we use and be sensitive to diversity issues when making judgments based on psychological tests used with minority groups. SHOULD PERSONALITY AND PSYCHOLOGICAL TESTS BE USED FOR EMPLOYMENT DECISIONS? Many people use personality tests such as MMPI to screen job applicants for psychiatric disorders or personality problems. A shy and withdrawn person may not succeed as a salesperson; someone who is not detail-oriented may not succeed as an accountant. Some have argued that personality tests were not designed and validated for use in employment settings and should not be used for employment decisions. Some claim that personality measures can be used in employment settings. There are specialized tests for personnel selection. Clinical Conclusion and Judgment When we complete an interview, conduct a behavioral observation, and administer intellectual and personality testing, we must pull all the information together and make decisions regarding diagnosis and treatment. Integrating similar and different information from different sources requires skill, training, and experience. We use our own judgment, impressions, and experience along with objective data to make decisions.The quality of our clinical judgment can be enhanced by the use of multiple assessment sources (e.g., interview, case history, tests, observations). If a patient reports feeling depressed, if the results of tests point to depr, we will accurately conclude that the patient is indeed depressed. Sometimes, clinical decisions are not so clear. A patient may report feeling depressed, but scores on tests measuring depr are not elevated. Or, a patient may deny feeling depressed during the interview, while testing scores indicate depr. Depression may be associated with numerous factors: to have medical conditions (cardiac problems, diabetes) to have personality disorders (antisocial, borderline) to have ADHD, learning disabilities, and other syndromes to get medical attention (Munchausen’s syndrome) to obtain secondary gain (obtain sympathy and attention from loved ones, staying home from work) to express their feelings through somatic complaints and do not recognize their depr. factors in the environment may lead to depr (loss of job or a loved one). We must examine all the pieces of the puzzle. Our theoretical framework, prior experience and clinical training become part of clinical judgment. Assessment is on a regular basis rather than in a single snapshot at the beginning of treatment. Initial formulations are constantly being checked and changed due to the new information. Psychologists will likely be required to make clinical judgments that are based on training, experience, and intuition. Efforts to increase their skills and achieve reliable, valid, and useful conclusions are worthy attempts. Communicating Assessment Results After testing is completed, analyzed, and interpreted, the results are communicated to patients and other interested parties. Results are communicated to others only with the permission of the person. If the patient is seriously disabled, permission isn’t necessary. After a psychological evaluation, the psychologist will organize a feedback session to show the results to the patient, explain the findings in understandable language, and answer all questions. We must explain the assessment results to other interested parties such as parents, teachers, attorneys, and physicians. In addition to oral feedback, we prepare a written report. A testing report includes the reason for the referral of the referring party, the list of assessment instruments used, test scores, the psychologist’s interpretation of the findings, a diagnostic impression, and recommendations. The language of report may be very different from one to a school teacher or a parent or another mental health professional. We avoid professional jargon, so our reports will be understandable. Confidentiality is another important issue when sending them only to interested part. Who is competent to administer tests? Many people administer tests. Learning specialists, social workers, doctors, marriage and family therapists, and speech and language therapists may use psychological tests. There are thousands of tests available for use. It is unrealistic to expect that psychologists will be competent in all of tests. Many tests are regularly updated, it is unlikely to expect that psychologists can keep on top of the latest revisions. Someone who specializes in the test to adults may be untrained and unqualified to administer tests to children. How can we determine who is qualified to use these tests? The APA states that testers should have coursework and competence that cover classical test theory, descriptive statistics, reliability and measurement error, validity and the meaning of test scores, normative interpretation of test scores, selection for appropriate tests, test administration procedures, issues related to ethnic, racial, cultural, gender, age, linguistic, and disability variables. They should have adequate supervision and experience.