“Clinical Formulation” Section Of Final Project 2
Table of Contents
Clinical Formulation
Portion of ongoing assignment
Milestone Two Guidelines and Rubric
Overview: For your final project, you will develop a conceptualization of an individual based on background information and the results of a few select tests. To do so, you will examine research to understand the purpose of the chosen tests, why they were utilized, and how they help inform the overall understanding of an individual’s presenting problems. Throughout the course, you will complete milestone assignments that are drafts of specific sections of the final project. Because these milestone assignments are drafts, you will notice that their critical elements and rubrics are similar to those in the Final Project Guidelines and Rubric document.
In Milestone One, you focused on writing an introduction and completing critical elements A through D of the Test and Assessment Development Analysis section for each test.
In this second milestone, you will complete critical elements E through H of those sections, along with the “Clinical Formulation” section.
Prompt: You should have already chosen a vignette to focus on and research in the previous milestone. Reread the vignette thoroughly. Then, use the vignette and additional research to answer the critical elements listed below. Be sure to properly cite your resources; the final project requires you to include at least six references cited in APA format.
Guidelines and Rubric attached
PSY 550 Milestone Two Guidelines and Rubric Overview: For your final project, you will develop a conceptualization of an individual based on background information and the results of a few select tests. To do so, you will examine research to understand the purpose of the chosen tests, why they were utilized, and how they help inform the overall understanding of an individual’s presenting problems. Throughout the course, you will complete milestone assignments that are drafts of specific sections of the final project. Because these milestone assignments are drafts, you will notice that their critical elements and rubrics are similar to those in the Final Project Guidelines and Rubric document. In Milestone One, you focused on writing an introduction and completing critical elements A through D of the Test and Assessment Development Analysis section for each test. In this second milestone, you will complete critical elements E through H of those sections, along with the “Clinical Formulation” section. Prompt: You should have already chosen a vignette to focus on and research in the previous milestone. Reread the vignette thoroughly. Then, use the vignette and additional research to answer the critical elements listed below. Be sure to properly cite your resources; the final project requires you to include at least six references cited in APA format. Specifically, the following critical elements must be addressed:
II. Test and Assessment Development Analysis: Test One E. Describe the cut scores for “normal” versus “at-risk” and/or “clinically significant.” F. Assess any cultural concerns for their impact on the effectiveness of the administration of the test. G. Determine if there are any ethical issues related to administering the test. H. Assess the methods of interpreting and communicating the results (e.g., scaled scores, percentile ranks, z-scores, t-scores) for their
appropriateness. III. Test and Assessment Development Analysis: Test Two
E. Describe the cut scores for “normal” versus “at-risk” and/or “clinically significant.” F. Assess any cultural concerns for their impact on the effectiveness of the administration of the test. G. Determine if there are any ethical issues related to administering the test. H. Assess the methods of interpreting and communicating the results (e.g., scaled scores, percentile ranks, z-scores, t-scores) for their
appropriateness. IV. Clinical Formulation
A. Analyze the results of the tests using industry-standard tools. B. Determine a diagnosis based on the data provided. C. Interpret the psychometric data from the test results to address the reason for the referral.
Rubric Guidelines for Submission: Your paper should be a 1- to 2-page Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins. Use APA style for formatting and citations.
Critical Elements Proficient (100%) Needs Improvement (70%) Not Evident (0%) Value
Test and Assessment Development Analysis:
Test One: Cut Scores
Describe the cut scores of the test Describes the cut scores for the test, but response contains inaccuracies or is missing key information
Does not describe the cut scores 8
Test and Assessment Development Analysis:
Test One: Cultural Concerns
Assesses any cultural concerns for their impact on the effectiveness of the administration of the test
Assesses any cultural concerns for their impact on the effectiveness of the administration of the test, but response is cursory or illogical or lacks detail
Does not assess any cultural concerns for their impact on the effectiveness of the administration of the test
10
Test and Assessment Development Analysis: Test One: Ethical Issues
Determines if there are any ethical issues related to administering the test
Determines if there are any ethical issues related to administering the test, but response is cursory or illogical or lacks detail
Does not determine if there are any ethical issues related to administering the test
10
Test and Assessment Development Analysis:
Test One: Methods
Assesses the methods of interpreting and communicating the results for their appropriateness
Assesses the methods of interpreting and communicating the results, but response is cursory or illogical or lacks detail
Does not assess the methods of interpreting and communicating the results
6
Test and Assessment Development Analysis:
Test Two: Cut Scores
Describes the cut scores of the test Describes the cut scores for the test, but response contains inaccuracies or is missing key information
Does not describe the cut scores 8
Test and Assessment Development Analysis:
Test Two: Cultural Concerns
Assesses any cultural concerns for their impact on the effectiveness of the administration of the test
Assesses any cultural concerns for their impact on the effectiveness of the administration of the test, but response is cursory or illogical or lacks detail
Does not assess any cultural concerns for their impact on the effectiveness of the administration of the test
10
Test and Assessment Development Analysis: Test Two: Ethical Issues
Determines if there are any ethical issues related to administering the test
Determines if there are any ethical issues related to administering the test, but response is cursory or illogical or lacks detail
Does not determine if there are any ethical issues related to administering the test
10
Test and Assessment Development Analysis:
Test Two: Methods
Assesses the methods of interpreting and communicating the results for their appropriateness
Assesses the methods of interpreting and communicating the results, but response is cursory or illogical or lacks detail
Does not assess the methods of interpreting and communicating the results
6
Clinical Formulation: Results
Analyzes the results of the tests using industry-standard tools
Analyzes the results of the tests using industry-standard tools, but analysis contains inaccuracies or lacks detail
Does not analyze the results of the tests using industry-standard tools
8
Clinical Formulation: Diagnosis
Determines a diagnosis based on the data provided
Determines a diagnosis based on the data provided, but diagnosis lacks justification or detail
Does not determine the diagnosis based on the data provided
8
Clinical Formulation: Psychometric Data
Interprets the psychometric data from the test results to address the reason for the referral
Interprets the psychometric data from the test results to address the reason for the referral, but submission contains inaccuracies or is missing key details
Does not interpret the psychometric data from the test results to address the reason for the referral
8
Articulation of Response Submission has no major errors related to citations, grammar, spelling, syntax, or organization
Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas
Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas
8
Total 100%
Psretiototical.” A Journal of Consulting and Clinical Psychology I WO. Vol. 2. No. 2, 202-203
Copyright 1990 by the American Psychological Aaodatwn, Inc. 1040-3590/90/W0.75
BRIEF REPORTS
Guidelines for Interpreting W\IS-R Subtest Scores
Joel H. Kramer University of California, San Francisco Medical Center
Tables are provided that facilitate the clinical interpretation of individual Wechsler Adult Intelli- gence Scale-Revised (WAIS-R) subtest scores. Confidence intervals were computed for each possible
scaled score for each WAIS-R subtest The confidence intervals are centered around estimated true
scores and were calculated using the standard error terms for true scores. A system for converting
scores into descriptive terms is also provided.
Recognition of measurement error in psychological assess- ment has led to the publication of tables that convert an ob- tained score into a range of scores within which the examinee’s true score probably lies. Tables and formulas of this sort are currently available for use with the Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ scores (Brophy, 1986; Knight, 1983; Naglieri, 1982).
In addition to reporting IQs, clinicians also frequently use individual WAIS-R subtests as measures of specific cognitive abilities, such as short-term auditory memory, vocabulary, vi- suoconstruction. visual perception, and reasoning (Lezak, 1983). Responsible reporting of scores, however, requires awareness of the psychometric limitations of individual WAIS- R subtests as well as an understanding of the constructs the sub- tests purport to measure.
The purpose of this article is to provide guidelines for the interpretation of individual WAIS-R subtest scores. These guidelines rest on the premise that it is necessary to fully con- sider the effect a subtest’s reliability has on estimates of an ex- aminee’s true score and of the standard error of measurement around that score. It is known that for any given obtained score, there is a range of scores within which an examinee’s true score probably lies (Nunnally, 1980). The width of this range is in- versely related to the subtest’s reliability and directly related to the probability level the examiner wishes to use. The tables provided here are based on the view that this band of scores should be placed symmetrically around an examinee’s esti- mated true score rather than his or her obtained score (Brophy, 1986; Lord & Novik, 1968; Nunnally, 1980). The use of esti- mated true scores as the center point adjusts for measurement error by taking into consideration the reliability of the subtest.
It is also important for practitioners to have available a means for converting scores into descriptive terms. Wechsler (1981, p. 28) provided a scheme for classifying IQ scores into different
I thank Eileen Martin and Mark Zaslav for their valuable contribu-
tions.
Correspondence concerning this article should be addressed to Joel
H. Kramer, Memory Clinic and Alzheimer’s Center, University of Cali-
fornia, San Francisco Medical Center, 1350 Seventh Avenue, CSBS-228,
San Francisco, California 94143.
qualitative and diagnostic categories (e.g., high average or men- tally retarded). A second purpose of this article, therefore, is to adapt Wechsler’s (1981) system for use with subtest scores.
Table 1 provides the range of scores that fall one SEM below and above the estimated true score. Estimated true scores were calculated by the equation T = M + r(X – M), where T is the examinee’s estimated true score, X is the obtained score, M is the population mean score (10 in the case of WAIS-R subtests), and r is the subtest’s reliability coefficient (Nunnally, 1980). The appropriate formula for calculating the SEM around true scores
(SEMl) is SDJ[r(l – r)]” 2 where SDX is the subtest’s standard
deviation (Brophy, 1986;Dudek, 1979; Knight, 1983). This for- mula for SEM, referred to by Lord and Novik (1968) as the “standard error of estimation,” is the one recommended for es- tablishing confidence intervals; the more commonly used SEM term, SDJ.I – r)1/2, is a measure of error variance in a set of obtained scores and should not be used to estimate true score ranges (Knight, 1983). The estimated true scores and SEMs in Table 1 were calculated using the average reliability coefficients reported in the WAIS-R manual (Wechsler, 1981, p. 30).
The rows in Table 1 represent each possible obtained scaled score (1-19), and the columns represent individual subtests. Each coordinate contains the lower and upper ends of the band of scores contained within one SEMl of the estimated true score. Because the ranges are based on one SEMl, there is a 68.26% probability that the examinee’s true score fills within the range provided in Table 1 (Nunnally, 1980).
The classification scheme in Table 2 was adapted from the intelligence classifications presented by Wechsler (1981, p. 28) for IQ scores. The adaptation of the classification system was accomplished by converting the IQ ranges into standard scores (e.g., z = 0.67-1.27 = “High average”) and then by calculating the subtest scaled score equivalents of the standard scores. Wechsler’s terms for the lowest and highest scores have been replaced with less value-laden terms; Wechsler’s original terms are in parentheses. It must be emphasized that because the clas- sification scheme is typically used for comparing examinees to their age peers, only an examinee’s age-adjusted scaled scores should be used for interpretation.
As is evident in Table 1, the reliability of an individual subtest significantly affects the interpretation of a given obtained score. For example, an obtained score of 5 on Object Assembly indi-
202
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BRIEF REPORTS 203
Table 1
Confidence Intervals for WilS-R Subtest Scores
Scaled score
1
2
1
9
inlu
11
14
15
i ftlo
17
i slo
1 Q 1?
In
1.1 2.9 1.9 3.8 2.8 4.7 3.7 5.6 4.6 6.5 5.5 7.4 6.4 8.3 7.3 9.2 8.2
10.0 9.1
10.9 100 11.8 10.8 12.7 11.7 13.6 12.6 14.5 13.5 15.4 14.4 16.3 15.3 17.2 16.2 18.1 17.1 18.9
DSp
1.4 3.7 2.2 4.5 3.1 5.3 3.9 6.1 4.7 7.0 5.6 7.8 6.4 8.6 7.2 9.5 8.0
10.3 8.9
11.1 9.7
12.0 10.5 12.8 11.4 13.6 12.2 14.4 13.0 15.3 13.9 16.1 14.7 16.9 15.5 17.8 16.3 18.6
Vo
.8 1.9 1.7 2.9 2.7 3.9 3.7 4.8 4.6 5.8 5.6 6.7 6.5 7.7 7.5 8.7 8.5 9,6 9.4
10.6 10.4 11.5 11.3 12.5 12.3 13.5 13.3 14.4 14.2 15.4 15.2 16.3 16.1 17.3 17.1 18.3 18.1 19.2
Ar
1.3 3.5 2.2 4.4 3.0 5.2 3.9 6.1 4.7 6.9 5.5 7.7 6.4 8.6 7.2 9.4 8.1
10.3 8.9
11.1 9.7
11.9 10.6 12.8 11.4 13.6 12.3 14.5 13.1 15.3 13.9 16.1 14.8 17.0 15.6 17.8 16.5 18.7
Co
1.3 3.5 2.2 4.4 3.0 5.2 3.9 6.1 4.7 6.9 5.5 7.7 6.4 8.6 7.2 9.4 8.1
10.3 8.9
11.1 9.7
11.9 10.6 12.8 11.4 13.6 12.3 14.5 13.1 15.3 13.9 16.1 14.8 17.0 15.6 17.8 16.5 18.7
Si
1.3 3.5 2.2 4.4 3.0 5.2 3.9 6.1 4.7 6.9 5.5 7.7 6.4 8.6 7.2 9.4 8.1
10.3 8.9
11.1 9.7
11.9 10.6 12.8 11.4 13.6 12.3 14.5 13.1 15.3 13.9 16.1 14.8 17.0 15.6 17.8 16.5 18.7
PC
1.5 3.9 2.3 4.7 3.2 5.5 4.0 6.3 4.8 7.1 5.6 7.9 6.4 8.7 7.2 9.6 8.0
10.4 8.8
11.2 9.6
12.0 10.4 12.8 11.3 13.6 12.1 14.4 12.9 15.2 13.7 16.0 14.5 16.8 15.3 17.7 16.1 18.5
PA
2.0 4.7 2.8 5.4 3.5 6.1 4.2 6.9 5.0 7.6 5.7 8.4 6.5 9.1 7.2 9.8 7.9
10.6 8.7
11.3 9.4
12.1 10.2 12.8 10.9 13.5 11.6 14.3 12.4 15.0 13.1 15.8 13.9 16.5 14.6 17.2 15.3 18.0
BD
1.2 3.2 2.0 4.0 2.9 4.9 3.8 5.8 4.6 6.7 5.5 7.5 6.4 8.4 7.3 9.3 8.1
10.1 9.0
11.0 9.9
11.9 10.7 12.7 11.6 13.6 12.5 14.5 13.3 15.4 14.2 16.2 15.1 17.1 16.0 18.0 16.8 18.8
OA
2.5 5.3 3.2 6.0 3.8 6.6 4.5 7.3 5.2 8.0 5.9 8.7 6.6 9.4 7.2
10.0 7.9
10.7 8.6
11.4 9 3
12.1 10.0 12.8 10.6 13.4 11.3 14.1 12.0 14.8 12.7 15.5 13.4 16.2 14.0 16.8 14.7 17.5
DSy
1.5 3.8 2.3 4.6 3.1 5.4 3.9 6.2 4.7 7.1 5.6 7.9 6.4 8.7 7.2 9.5 8.0
10.3 8.8
11.2 97
12.0 10.5 12.8 11.3 13.6 12.1 14.4 12.9 15.3 13.8 16.1 14.6 16.9 15.4 17.7 16.2 18.5
Note. WMS-R = Wechsler Adult Intelligence Scale-Revised; In = Information; DSp = Digit Span; Vo = Vocabulary; Ar = Arithmetic; Co = Comprehension; Si = Similarities; PC = Picture Completion; PA = Picture Arrangement; BD = Block Design; QA = Object Assembly; DSy = Digit Symbol.
cates a true score between 5.2 and 8.0. Considerable caution
must be exercised in interpreting such a score, because the esti-
mated true score falls within a rather broad range, from border-
line to average. In contrast, the meaning of more reliable sub-
tests such as Vocabulary can be reported with greater certainty;
Table 2
Classification of Ability Levels for Individual
WAIS-R Subtest Scores
Subtest score
16 and above 14.0-15.9 12.0-13.9 8.0-11.9 6.0-7.9 4.0-5.9 3.9 and below
Classification
Significantly above average (very superior) Above average (superior) High average (high average) Average (average) Low average (low average) Below average (borderline) Significantly below average (mentally retarded)
Note. WAIS-R = Wechsler Adult Intelligence Scale-Revised. Classifi- cations in parentheses are original terms used by Wechsler.
an obtained score of 5 on Vocabulary indicates a true score be-
tween 4.6 and 5.8 and is in the borderline range.
The bands of scores in Table 1 are based on the average reli-
ability coefficients for the entire WMS-R standardization sam-
ple. These scores provide reasonably accurate and conservative
confidence intervals for most of the subtests across most age
groups. The subtests of the WAIS-R are least reliable for youn-
ger subjects, however. Eight of the 11 reliability coefficients for
the 16-17-year-old group were lower than the average reliability
coefficient by a margin of .04 or greater. Three subtests (Com-
prehension, Picture Completion, and Picture Arrangement) for
the 18-19-year-olds and four subtests (Comprehension, Simi-
larities, Picture Completion, and Picture Arrangement) for the
20-24-year-old group also have reliability coefficients that are
at least .04 less than the average. Among the older age groups,
only Object Assembly in the 70-74-year-old group falls that far
below the average. To provide more accurate confidence inter-
vals for these age groups, Tables 3 and 4 present bands of scores
based on the reliability coefficients for the less reliable subtests.
Tables 1 through 4 offer the practitioner guidelines for more
accurate clinical interpretation of individual subtest scores.
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204 BRIEF REPORTS
Table 3
Confidence Intervals for the Least Reliable WAIS-R Subtests: 16-17- Year-Olds
Scaled score
ii
6
7
10
DSp
2.3 5.1 3.0 5.8 3.7 6.5 4.4 7.2 5.1 7.9 5.8 8.6 6.5 9.3 7.2
10.0 7.9
10.7 8.6
11.4
Ar
2.1 4.8 2.8 5.5 3.6 6.2 4.3 7.0 5.0 7.7 5.7 8.4 6.5 9.1 7.2 9.9 7.9
10.6 8.7
11.3
Co
1.7 4.2 2.5 5.0 3.3 5.8 4.1 6.6 4.9 7.3 5.6 8.1 6.4 8.9 7.2 9.7 8.0
10.5 8.8
11.2
Si
1.6 4.0 2.4 4.8 3.2 5.6 4.0 6.4 4.8 7.2 5.6 8.0 6.4 8.8 7.2 9.6 8.0
10.4 8.8
11.2
PC
2.2 5.0 3.0 5.7 3.7 6.4 4.4 7.1 5.1 7.8 5.8 8.5 6.5 9.2 7.2 9.9 7.9
10.7 8.6
11.4
PA
2.6 5.5 3.3 6.1 4.0 6.8 4.6 7.5 5.3 8.1 5.9 8.8 6.6 9.4 7.3
10.1 7.9
10.8 8.6
11.4
OA
3.8 6.8 4.3 7.3 4.9 7.9 5.4 8.4 5.9 8.9 6.4 9.4 6.9 9.9 7.5
10.5 8.0
11.0 8.5
11.5
DSy
2.1 4.8 2.8 5.5 3.6 6.2 4.3 7.0 5.0 7.7 5.7 8.4 6.5 9.1 7.2 9.9 7.9
10.6 8.7
11.3
Scaled score
11
12
13
14
15
16
17
18
19
DSp
9.3 12.1 10.0 12.8 10.7 13.5 11.4 14.2 12.1 14.9 12.8 15.6 13.5 16.3 14.2 17.0 14.9 17.7
Ar
9.4 12.1 10.1 12.8 10.9 13.5 11.6 14.3 12.3 15.0 13.0 15.7 13.8 16.4 14.5 17.2 15.2 17.9
Co
9.5 12.0 10.3 12.8 11.1 13.6 11.9 14.4 12.7 15.1 13.4 15.9 14.2 16.7 15.0 17.5 15.8 18.3
Si
9.6 12.0 10.4 12.8 11.2 13.6 12.0 14.4 12.8 15.2 13.6 16.0 14.4 16.8 15.2 17.6 16.0 18.4
PC
9.3 12.1 10.1 12.8 10.8 13.5 11.5 14.2 12.2 14.9 12.9 15.6 13.6 16.3 14.3 17.0 15.0 17.8
PA
9.2 12.1 9.9
12.7 10.6 13.4 11.2 14.1 11.9 14.7 12.5 15.4 13.2 16.0 13.9 16.7 14.5 17.4
OA
9.0 12.0 9.5
12.5 10.1 13.1 10.6 13.6 11.1 14.1 11.6 14.6 12.1 15.1 12.7 15.7 13.2 16.2
DSy
9.4 12.1 10.1 12.8 10.9 13.5 11.6 14.3 12.3 15.0 13.0 15.7 13.8 16.4 14.5 17.2 15.2 17.9
Note. WUS-R = Wechsler Adult Intelligence Scale-Revised; DSp = Digit Span; Ar = Arithmetic; Co = Comprehension; Si = Similarities; PC = Picture Completion; PA = Picture Arrangement; OA = Object Assembly; DSy = Digit Symbol.
Table 4
Confidence Intervals for the Least Reliable WIIS-R Subtests: 18-74-Year-Olds
Scaled score
ii
2
3
5
7
10
1 1
12
13
14
15
16
17
18
19
18-19-year-olds
Co
1.6 4.0 2.4 4.8 3.2 5.6 4.0 6.4 4.8 7.2 5.6 8.0 6.4 8.8 7.2 9.6 8.0
10.4 8.8
11.2 9.6
12.0 10.4 12.8 11.2 13.6 12.0 14.4 12.8 15.2 13.6 16.0 14.4 16.8 15.2 17.6 16.0 18.4
PC
2.0 4.7 2.8 5.4 3.5 6.1 4.2 6.9 5.0 7.6 5.7 8.4 6.5 9.1 7.2 9.8 7.9
10.6 8.7
11.3 9.4
12.1 10.2 12.8 10.9 13.5 11.6 14.3 12.4 15.0 13.1 15.8 13.9 16.5 14.6 17.2 15.3 18.0
PA
2.3 5.1 3.0 5.8 3.7 6.5 4.4 7.2 5.1 7.9 5.8 8.6 6.5 9.3 7.2
10.0 7.9
10.7 8.6
11.4 9.3
12.1 10.0 12.8 10.7 13.5 11.4 14.2 12.1 14.9 12.8 15.6 13.5 16.3 14.2 17.0 14.9 17.7
Co
1.8 4.3 2.6 5.1 3.3 5.9 4.1 6.6 4.9 7.4 5.7 8.2 6.4 9.0 7.2 9.7 8.0
10.5 8.7
11.3 9.5
12.0 10.3 12.8 11.0 13.6 11.8 14.3 12.6 15.1 13.4 15.9 14.1 16.7 14.9 17.4 15.7 18.2
20-24-year-olds
Si
1.7 4.2 2.5 5.0 3.3 5.8 4.1 6.6 4.9 7.3 5.6 8.1 6.4 8.9 7.2 9.7 8.0
10.5 8.8
11.2 9.5
12.0 10.3 12.8 11.1 13.6 11.9 14.4 12.7 15.1 13.4 15.9 14.2 16.7 15.0 17.5 15.8 18.3
PC
1.9 4.4 2.6 5.2 3.4 6.0 4.2 6.7 4.9 7.5 5.7 8.2 6.4 9.0 7.2 9.8 8.0
10.5 8.7
11.3 9.5
12.0 10.2 12.8 11.0 13.6 11.8 14.3 12.5 15.1 13.3 15.8 14.0 16.6 14.8 17.4 15.6 18.1
PA
2.5 5.3 3.2 6.0 3.8 6.6 4.5 7.3 5.2 8.0 5.9 8.7 6.6 9.4 7.2
10.0 7.9
10.7 8.6
11.4 9.3
12.1 10.0 12.8 10.6 13.4 11.3 14.1 12.0 14.8 12.7 15.5 13.4 16.2 14.0 16.8 14.7 17.5
70-74-year-olds
OA
3.0 5.9 3.6 6.5 4.2 7.1 4.8 7.7 5.4 8.4 6.1 9.0 6.7 9.6 7.3 10.2 7.9
10.8 8.5
11.5 9.2
12.1 9.8
12.7 10.4 13.3 11.0 13.9 11.6 14.6 12.3 15.2 12.9 15.8 13.5 16.4 14.1 17.0
Note. WAIS-R = Wechsler Adult Intelligence Scale-Revised; Co = Comprehension; PC = Picture Comple- tion; PA = Picture Arrangement; Si = Similarities; OA = Object Assembly.
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BRIEF REPORTS 205
Two cautionary notes concerning the use of these tables must
be emphasized, however. First, the ranges in Table 1 represent
a band of only one SEMi. This indicates that the probability of
the examinee’s true score falling within that band is 68%.
Greater degrees of confidence require broader ranges. Inter-
ested readers should use the formula T ± SEMl(z) to compute
broader ranges; z values of 1.15, 1.44, 1.64, 1.96, and 2.58 will
yield confidence intervals of 75%, 85%, 90%, 95%, and 99%,
respectively. For some of the less reliable subtests, however, use
of broader ranges will make meaningful interpretation of an in-
dividual score more difficult.
Second, even if an examinee’s estimated true score falls
within a sufficiently narrow range, interpretation is limited by
our understanding of what that particular subtest is measuring
in that particular person. Interpretation of any individual sulv
test is difficult when the specific variance of the subtest is less
than the variance shared by all of the subtests (Silverstein,
1976). Furthermore, most of the tasks represented on the
WAIS-R are heterogeneous; performance successes and failures
can be attributed to a number of different possible underlying
cognitive skills. Observation and quantification of such vari-
ables as the types of errors made and the problem-solving strate-
gies used often provide more clues about the status of an exam-
inee’s intellectual operations than does the final achievement
score (Kaplan, 1988).
The less-than-perfect reliability of Wechsler scale subtests
also has bearing on clinical assessment research. Many investi-
gators have examined the usefulness of subtest pattern analysis
for diagnosing organicity (Wechsler, 1958), Alzheimer’s disease
(Brinkman & Braun, 1984; Fuld, 1982), learning disabilities
(Hale & Saxe, 1983), emotional disturbance (Dean, 1977), and
other disorders. These efforts have met with minimal success,
however (Filley, Kobayashi, & Heaton, 1987; Matarazzo, 1972).
Considering the caution one must exercise in interpreting a sin-
gle subtest score, it is not surprising that the reliability, and
hence validity, of formulas based on multiple subtest scores will
be limited.
References
Brinkman, S. D., & Braun, P. (1984). Classification of dementia pa- tients by a WAIS profile related to central cholinergic deficiencies. Journal of Clinical Neuropsychdogy, 6, 393-400.
Bropny, A. L. (1986). Confidence intervals for true scores and retest
scores on clinical tests. Journal of Clinical Psychology, 42.989-991.
Dean, R. S. (1977). Patterns of emotional disturbance on the WISC-R.
Journal of Clinical Psychology, 33,4186-490.
Dudek, F. J. (1979). The continuing misinterpretation of the standard error of measurement. Psychological Bulletin, 86, 335-337.
Filley, C. M, Kobayashi, J., & Heaton, R. K. (1987). Wechsler intelli- gence scale profiles, the cholinergic system, and Alzheimer’s disease.
Journal of Clinical and Experimental Newopsychology, 9,180-186.
Fuld, P. A. (1982). Behavioral signs of cholinergic deficiency in Alzhei-
mer dementia. In S. Corkin, K. L. Davis, J. H. Growdon, E. Usdin,
& R. J. Wurtman (Eds.), Alzheimer’s disease: A report of progress in research (pp. 193-196). New \brk: Raven Press.
Hale, R. L., & Saxe, J. E. (1983). Profile analysis of the Wechsler Intelli- gence Scale for Children-Revised. Journal of Psychoeducalional As-
sessment, 1. 155-161.
Kaplan, E. (1988). A process approach to neuropsychological assess- ment. In T. Boll & B. K. Bryant (Eds.), Clinical neuropsyckotogy and
brainfunction: Research, measurement, and practice (pp. 129-167). Washington, DC: American Psychological Association.
Knight, R. G. (1983). On interpreting the several standard errors of
the WAIS-R: Some further tables. Journal of Consulting and Clinical Psychology, SI, 671-673.
Lezak, M. D. (1983). Neuropsychological assessment. New \ork: Ox- ford University Press.
Lord, F. M., & Novik, M. R. (1968). Statistical theories of mental test scores. Reading, MA: Addison-Wesley.
Matarazzo, J. D. (1972). Wechsler’s Measurement and Appraisal of
Adult Intelligence (5th ed.). New York: Oxford University Press.
Naglieri, J. A. (1982). TV«> types of tables for use with the WAIS-R.
Journal of Consulting and Clinical Psychology, SO. 319-321.
Nurmally. J. C. (1980). Introduction to psychological measurement. New -York: McGraw-Hill.
Silverstein, A. B. (1976). \feriance components in the subtests of the WISC-R. Psychological Reports, 39, 1109-1110.
Wechsler, D. (1958). The measurement and appraisal of adult intelli-
gence (4th ed.). Baltimore, MD: Williams & Wilkins.
Wechsler, D. (1981). WAIS-R manual. Cleveland, OH: The Psychologi- cal Corporation.
Received May 4,1989
Revision received August 31, 1989
Accepted October 2,1989
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PAR Psychological Assessment Resources, Inc./16204 N. Florida Ave. Lutz, FL 33549/1.800.331.8378 Copyright ©1994, 2006 by Psychological Assessment Resources, Inc. All rights reserved. May not be reproduced in whole or in part in any form or by any means without written permission of Psychological Assessment Resources, Inc.
Version: 2.00.010
Millon Clinical Multiaxial Inventory II/III
Narrative Report by
Robert J. Craig, PhD and
PAR Staff
Client Information
Client Name: Sample
Client ID:
Date of Evaluation: 03/13/2006
Age: 43
Gender: Male
Education: 12
Marital Status: Single
Setting: Inpatient
The MCMI (as revised) was normed on individuals being evaluated or treated in mental health settings. Thus, the test should only be used with individuals who are in similar clinical settings for problems that are defined as psychological/psychiatric. Administering this test to people without clinical symptoms is inappropriate and will result in inaccurate descriptions of their functioning. Because this test is focused on personality disorders and clinical symptoms, the report is necessarily focused on these problematic behaviors, and cannot describe a person’s strengths and competencies.
The interpretive information contained in this report should be viewed as only one source of hypotheses about the individual being evaluated. No decisions should be based solely on the information contained in this report. This material should be integrated with all other sources of information in reaching professional decisions about this individual. This report is confidential and intended for use by qualified professionals only. It should not be released to the individual being evaluated.
Client: Sample Test Date: 03/13/2006 ID#: Page 2
MCMI – II/III Profile Modifying Indices
Disclosure – 65 (X)
Desirability – 70 (Y)
Debasement – 60 (Z)
Clinical Personality Patterns Schizoid – 60 (1)
Avoidant – 87 (2A)
Depressive – 68 (2B)
Dependent – 71 (3)
Histrionic – 66 (4)
Narcissistic – 69 (5)
Antisocial – 65 (6A)
Aggressive/Sadistic – 67 (6B)
Compulsive – 42 (7)
Passive-Aggressive – 91 (8A)
Self-Defeating – 65 (8B)
Severe Personality Pathology Schizotypal – 62 (S)
Borderline – 65 (C)
Paranoid – 67 (P)
Clinical Syndromes Anxiety – 82 (A)
Somatoform Disorder – 66 (H)
Bipolar: Manic Disorder – 64 (N)
Dysthymic Disorder – 78 (D)
Alcohol Dependence – 80 (B)
Drug Dependence – 92 (T)
Post-Traumatic Stress Disorder – 61 (R)
Severe Clinical Syndromes Thought Disorder – 55 (SS)
Major Depression – 69 (CC)
Delusional Disorder – 43 (PP)
60 75 85 115
Client: Sample Test Date: 03/13/2006 ID#: Page 3
Modifier Indices Configurations This patient’s response style in taking this test appeared to be open and honest and no response distortions appear evident. The results of this test are likely to be valid.
Disclosure Level (X)
This patient responded to the MCMI items by using an appropriate amount of self-disclosure, and no defensive test-taking attitudes appear evident. This suggests that the patient was cooperative with the testing process.
Desirability Gauge (Y)
This patient showed no tendency to respond to the MCMI items in a socially desirable manner. This suggests the patient may have cooperated with the testing process.
Debasement (Z)
This patient is reporting an appropriate level of behavioral, emotional, or interpersonal problems and shows no tendency to underreport or exaggerate those difficulties.
Personality Style 8A2A’
These patients display a mixture of passive compliance and obedience at one time and then oppositional and negativistic behavior the next time. They are moody, irritable, and hostile; they manifest a grumbling and pessimistic demeanor; and they are erratically and explosively angry and stubborn at one moment and feel guilty and contrite at the next moment. Disillusionment seems to permeate their lives. They feel misunderstood, so they vacillate between passive dependency and stubborn contrariness that provokes discomfort and exasperation in those around them. They expect disappointment and maintain an unstable and conflictual role in relations with others. They sulk, feel unappreciated and/or feel they are being treated unfairly, constantly complain, and are persistently petulant and discontented. They often have problems with authority and, if employed, have job difficulties.
This patient presents as socially awkward, withdrawn, introverted, and self-conscious. Because people such as this patient are hypersensitive to rejection and fear negative evaluations, they either try to maintain a good social appearance despite their underlying fear or they withdraw from social contacts. Tension, anxiety, and anger also may be present but all stemming from the same issue–a desire for social acceptance and a fear of rejection. Most often, they maintain a social distance in order to avoid any further experience of being rejected. They are devastated by perceived signs of disapproval and tend to withdraw, thus reducing the chance to enhance relationships. This circumstance results in social isolation despite a very strong need for social relatedness. These patients can put on a pleasant appearance to mask their underlying social anxiety, but they have a pervasive belief that others will be disparaging of them. Their essential conflict is a strong desire to relate but an equally strong expectation of disapproval, depreciation,
Client: Sample Test Date: 03/13/2006 ID#: Page 4
and rejection. This conflict results in keeping others at a distance but also in loneliness, isolation, and continued shyness and timidity. These people are at risk for social phobias.
Commentary: Elevations in Scale 8A are a good indicator of problems with authority and with criminal behaviors or potential for criminal behavior. Also, clinical elevations on this scale appear in a number of profile codes involving psychiatric patients. Patients with elevations on Scale 8A warrant close clinical evaluation.
Possible Diagnosis: Personality Disorder Not Otherwise Specified, Passive-Aggressive (negativistic) and Avoidant Personality Disorder.
Additional Personality Disorder Scales This section provides narrative statements covering scales that were not considered primary in the profile code. However, this section may contain important information on additional personality traits. In some cases, information in these scales may appear inconsistent or contradictory to statements made in the main report. The clinician needs to determine which statements are applicable to the individual patient.
Schizoid (1)
This patient is likely to be viewed as a wallflower. Interpersonal relationships are generally absent but, if present, they do not seem central to the patient’s personal happiness. Traits that describe scores at this level include introverted, quiet, dependent, self-sacrificing, passive, timid, and uncommunicative. Such people appear emotionally bland and even indifferent to events in their lives. These patients may lack affective expression with deficiencies in social communication. They prefer a simple life and defer to someone else in the management of their day-to-day life. They have little drive or ambition and prefer isolated activities to group involvement. If this patient is in a committed relationship, the spouse may complain about this person’s lack of affection and, perhaps, reduced interest in sex.
Depressive (2B)
This patient has reported some traits associated with a depressive personality style but not in sufficient quantity to be diagnostically significant.
Dependent (3)
This patient has mild dependency needs that seem to drive many aspects of behavior. Timidity, some withdrawal tendencies, passivity, and perhaps demureness may be part of the personality constellation. Personal needs are sometimes sacrificed in order for the patient to please others. The patient does not take a dominant role in relationships and may take on too many tasks in order to please significant others. The patient is unlikely to erupt in emotional outbursts. These traits are not at sufficient intensity to warrant a personality disorder diagnosis and are more stylistic in nature than pathological.
Client: Sample Test Date: 03/13/2006 ID#: Page 5
Histrionic (4)
This patient has high needs for attention, recognition, and praise, and has a gregarious and extroverted personality style. Rather than acting seductively, dramatically, or in a manipulative manner, which characterizes patients who score at higher levels on this scale, the patient uses a natural charm and wit to have these needs met. When the patient becomes overly demanding, it usually is with close family relationships or within a work setting. Rarely is this style a cause of interpersonal disruption.
Narcissistic (5)
This patient shows some evidence of narcissistic-like traits. It is not possible to determine exactly which ones are manifest, and a clinical interview would be needed for more exact characterization. This patient probably does have high self-esteem.
Antisocial (6A)
This patient shows some evidence of antisocial-like traits. It is not possible to determine exactly which ones are manifest, and a clinical interview would be needed for more exact characterization.
Aggressive/Sadistic (6B)
This patient shows some evidence of aggressive traits. It is not possible to determine exactly which ones are manifest, and a clinical interview would be needed for more exact characterization.
Compulsive (7)
Millon does not provide information on nor does he interpret low scale scores. However, a low score on Compulsive might suggest a lack of conformity and low impulse control.
Self-Defeating (8B)
This patient shows some evidence of self-defeating traits. It is not possible to determine exactly which ones are manifest and a clinical interview would be needed for more exact characterization.
Schizotypal (S)
This patient shows few, if any, symptoms, behaviors, or traits associated with a schizotypal personality disorder.
Borderline (C)
This patient shows some evidence of borderline traits. It is not possible to determine exactly which ones are manifest and a clinical interview would be needed for more exact characterization.
Paranoid (P)
This patient shows few, if any, symptoms, behaviors, or traits associated with a paranoid personality disorder.
Client: Sample Test Date: 03/13/2006 ID#: Page 6
Clinical Syndromes
Anxiety (A)
This patient has reported many symptoms associated with anxiety. High scores on this scale are often seen in patients who are restless, anxious, apprehensive, edgy, and jittery. These patients tend to have a variety of somatic complaints associated with physiological overarousal. These complaints could include insomnia, headaches, nausea, cold sweats, undue perspiration, clammy hands, and palpitations. These symptoms appear to be experienced by the patient at a moderate degree of intensity.
Somatoform Disorder (H)
This patient shows only mild tendencies toward somatization.
Bipolar: Manic Disorder (N)
This patient reports some manic-like symptoms. The cause may be related to substance abuse, or the patient may have a recently developed Bipolar Affective Disorder and is self-medicated with substance abuse. A closer clinical evaluation is suggested.
Dysthymic Disorder (D)
This patient is reporting many problems and symptoms associated with depression. These problems and symptoms may include apathy, social withdrawal, guilt, pessimism, low self- esteem, feelings of inadequacy and worthlessness, self-doubts, and a diminished sense of pleasure. Generally, such patients can meet their day-to-day responsibilities but continue to experience a chronic dysphoria. A diagnosis associated with depression is usually associated with scores at this level, with Dysthymic Disorder being the most prevalent diagnosis. However, this depression may be secondary to substance abuse, particularly alcoholism or alcohol abuse. A more thorough clinical evaluation is recommended to determine if there are vegetative signs of depression and to determine which disorder, depression or substance abuse, is primary.
Possible Diagnosis: Rule out Dysthymic Disorder; Rule out Alcohol Abuse or Dependence; Rule out Drug Abuse or Dependence.
Alcohol Dependence (B)
This patient has reported symptoms and traits commonly associated with alcohol abuse and/or alcohol dependence. It also is possible that the patient has endorsed personality traits often seen in patients who subsequently develop problematic drinking. It also is possible that the patient has had problems with alcohol and is in recovery. A more thorough evaluation of the patient’s drinking history, pattern and problems is recommended.
Drug Dependence (T)
This patient has reported symptoms and traits commonly associated with drug abuse and/or drug dependence. It also is possible that the patient has endorsed personality traits often seen in patients who subsequently develop problems associated with drug abuse. It also is possible that
Client: Sample Test Date: 03/13/2006 ID#: Page 7
the patient has had problems with drugs and is in recovery. A more thorough clinical evaluation should be conducted to determine the presence of any specific problems that may be associated with this condition (e.g., medical, social, legal, psychological, psychiatric, vocational, spiritual). Scores at this level almost always reflect a diagnosis associated with drug abuse.
Possible Diagnosis: Drug Abuse/Dependence.
Post-Traumatic Stress Disorder (R)
This patient reports no symptoms associated with post-traumatic stress disorder.
Thought Disorder (SS)
This patient reports no abnormalities consistent with a thought disorder.
Major Depression (CC)
This patient is reporting some mild signs of depression, but not of sufficient severity to impair daily functioning.
Delusional Disorder (PP)
This patient reports no symptoms associated with a delusional disorder.
Client: Sample Test Date: 03/13/2006 ID#: Page 8
Research The following studies have found this codetype among the populations indicated below:
8A2A’
(1) 25 Vietnam veterans with PTSD (Robert, J. A., Ryan, J. J., McEntyre, W. L., McFarland, R. S., Lips, O. J., & Rosenberg, S. J. [1985]. MCMI characteristics of DSM-III: Posttraumatic stress disorder in Vietnam veterans. Journal of Personality Assessment, 49, 226-230.)
(2) 144 depressed alcoholics (McMahon, R. C., & Davidson, R. S. [1986]. An examination of depressed vs. nondepressed alcoholics in inpatient treatment. Journal of Clinical Psychology, 42, 177-184.)
(3) 189 Vietnam veterans with PTSD (Sherwood, R. J., Funari, D. J., & Piekarski, A. M. [1990]. Adapted character styles of Vietnam veterans with posttraumatic stress disorder. Psychological Reports, 66, 623-631.)
(4) 100 Vietnam veterans with PTSD (Hyer, L. A., Albrecht, J. W., Boudewyns, P. A., Woods, M. G., & Brandsma, J. [1993]. Dissociative experiences of Vietnam veterans with chronic posttraumatic stress disorder. Psychological Reports, 73, 519-530.)
(5) 34 angry, nonpsychotic, black, psychiatric inpatients (Greenblatt, R. L., & Davis, W. E. [1992]. Accuracy of MCMI classification of angry and psychotic Black and White patients. Journal of Clinical Psychology, 48, 59-63.)
(6) Cluster analysis Type I Vietnam veterans with PTSD (sample size not indicated) (Hyer, L., Davis, H., Albrecht, W., Boudewyns, P. A., & Woods, G. [1994]. Cluster analysis of MCMI and MCMI-II of chronic PTSD victims. Journal of Clinical Psychology, 50, 502-515.) (MCMI-II)
(7) 69 patients treated in a military mental hygiene clinic (Rudd, M. D., & Orman, D. T. [1996]. Millon Clinical Multiaxial Inventory profiles and maladjustment in the military: Preliminary findings. Military Medicine, 161, 349-351.)
(8) 182 male and 73 female substance abusers (Nadeau, L., Landry, M., & Racine, S. [1999]. Prevalence of personality disorders among clients in treatment for addiction. Canadian Journal of Psychiatry, 44, 592-596.)
References Additional interpretive material and test information is available in the following resources. The reader is encouraged to consult these sources for more specific test information.
Choca, J. P. (2003). Interpretive guide to the Millon Clinical Multiaxial Inventory (3rd ed.). Washington, DC: American Psychological Association.
Craig, R. J. (1993). Psychological assessment with the Millon Clinical Multiaxial Inventory (II): An interpretive guide. Odessa, FL: Psychological Assessment Resources.
Client: Sample Test Date: 03/13/2006 ID#: Page 9
Craig, R. J. (Ed.) (1993). The Millon Clinical Multiaxial Inventory: A clinical research information synthesis. Hillsdale, NJ: Erlbaum.
Craig, R. J. (Ed.). (2005). New directions in interpreting the Millon Clinical Multiaxial Inventory-III (MCMI-III). New York: Wiley.
Millon, T., Davis, R., & Millon, C. (1997). Millon Clinical Multiaxial Inventory-III (MCMI-III) manual. Bloomington, MN: Pearson Assessments.
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PSY 550 Final Project Vignette One Ms. G is a 33-year-old single, Caucasian female who was referred for an evaluation to clarify diagnostic issues and establish educational and vocational goals. Ms. G was born with spina bifida, but otherwise had no notable developmental concerns. She requires a manual wheelchair for ambulation due to her spina bifida. Ms. G never received special education or had an individualized education program (IEP). She completed two years of college but then took a leave of absence. She would like some guidance as to whether she should continue to pursue her bachelor’s degree, as the first two years of college were extremely challenging for her. She reports struggling academically and just “not fitting in” with her peers. From a mental health perspective, she has a history of being in and out of counseling. She is currently prescribed Zoloft and Xanax for depression and anxiety, respectively. She reported a fear of vomiting, and also reported generally being anxious and depressed at times. She estimated that she has been severely depressed on at least three occasions. The client reports concerns related to her inability to secure a job and not “knowing what to do.” She has noticed that she has been losing friends and is not sure why. She is hoping to gain further input around her psychological status as it relates to her anxiety, depression, and social concerns. Below are her scores from the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) and Millon Clinical Multiaxial Inventory – III (MCMI-III).
WAIS-IV
FSIQ 94
VCI 107
PRI 82
WMI 108
PSI 81
GAI 95
MCMI-III
Disclosure 71
Desirability 75
Debasement 42
Schizoid 81
Avoidant 66
Depressive 75
Dependent 81
Histrionic 63
Narcissistic 54
Antisocial 62
Sadistic 36
Compulsive 69
Negativistic 64
Masochistic 80
Schizotypal 65
Borderline 34
Paranoid 60
Anxiety 85
Somatoform 15
Bipolar: Manic 60
Dysthymia 24
Alcohol Dependence 40
Drug Dependence 60
PTSD 60
Thought Disorder 15
Major Depressive 79
Delusional Disorder 62
You can use these resources to help you review the data from Ms. G’s WAIS-IV and MCMI-III scores: WAIS-IV
1. Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) a) Scroll down and find the “Training” tab.
MCMI-III
1. C512 MCMI a) Bacon, S. F. Millon Clinical Multiaxial Inventory III (MCMI-III) [PPT document]. Retrieved
from California State University’s website: http://www.csub.edu/~sbacon/C512_MCMI.ppt
b) The Millon Personality Group Website c) Millon Clinical Multiaxial Inventory-III (MCMI-III)
o Scroll down and find the “Scoring and Reporting” tab.
o There are sample interpretive and annotated interpretative reports, as well as a
sample profile report in PDF format.
http://www.csub.edu/~sbacon/C512_MCMI.ppt
http://www.csub.edu/~sbacon/C512_MCMI.ppt
