Summary Psychological diagnostics in Health Care - Luteijn & Barelds
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Psychodiagnostics consists of three parts:
There are three types of frames of reference, each of which is based on a different idea of how (problematic) behavior is best understood and explained:
Determining the quality of frames of referenda is done on the basis of four criteria:
According to Van der Werff, the trait approach, biopsychology and orthodox social learning theories are the best frames of reference to use in diagnostics. For a diagnostician, especially the trait approach is good to use, it has also yielded many intelligence and personality tests. The biopsychological approach and the social learning theories come from the context approach. Van der Werff believes that parts of psychoanalysis such as ego psychology belong to the middle class. The underperformers are psychoanalytic, humanist and existential psychology. The ideas in these frames of reference often cannot be tested.
There are several models of test theory and statistics that are used to describe the central parts of theories and constructs. There is the classical test theory and the modern test theory (IRT). The IRT is a theory of behaviors (a latent trait such as emotional stability or math skills). This theory describes the probability that when a person has a certain value on a latent trait, a person will say yes to a question whether a task will solve well.
Factor analyzes are used for the first frame of reference. Thurstone came up with the multiple intelligence theory and eventually chose to measure it by independent factors. This was in contrast to Spearman, who used a g factor to measure intelligence. A profile of someone can be made using the factor analysis. It is also a fact that after performing a factor analysis, the five factors in the Big Five (Extraversion, Kindness, Care, Emotional Stability and Intellect) do not appear to be independent factors as the theory states.
The second frame of reference, the development, can be described with, for example, a linear, negative accelerating or exponential increase in an (un) desirable behavior. There are also stage models in which it is assumed that behaviors from different stages differ from each other.
For the third frame of reference, the context, it is mainly about the effectiveness of an intervention. This can be tested with an analysis of variance. In this, the dependent variables are understood as the result of manipulated factors, their interactions and covariates (such as sex and SES).
There are clear quality requirements for tests. The Standards for Educational and Psychological Testing was issued by the APA in 1999. In the Netherlands, a test assessment scheme has been developed based on this, which contains seven criteria. These criteria can be considered "good", "sufficient" or "insufficient". The criteria are:
The quality of the standards. In this, it is examined whether the standardization group used corresponds with the purpose of the test. There are two types of interpretations: a norm-oriented interpretation (comparison with a relevant norm group) and a criterion-oriented interpretation (comparison with an absolute value or norm). Absolute standards must be based on scientific research.
This concerns results of studies with parallel tests, internal consistency, test-retest and inter-rater reliability.
This is about how well a construct fits into a nomological network with a clear internal and external structure.
This is about how good the coherence of a test is with a criterion (the result of a treatment).
Nunnally and Bernstein have established values for decisions about when reliability coefficients can be rated as insufficient, satisfactory, or good. For important decisions, they believe that there must be a reliability of rxx> .90 for the internal consistency and stability coefficients. Based on this, criteria have been drawn up for the assessment of the coefficients:
For tests used for important decisions at the individual level (e.g. referral to special education), rxx <.80 is insufficient, .80 ≤ rxx ≤ .90 is sufficient and rxx ≥. 90 good.
For minor decisions such as a progress check, rxx <.70 is insufficient, .70 ≤ rxx ≤ .80 is sufficient and rxx ≥. 80 good.
For tests used for group level studies, rxx <.60 is insufficient, .60 ≤ rxx ≤ .70 is sufficient, and rxx ≥. 70 good.
Reliability can best be shown with the standard measurement error. In tests and questionnaires, it is expected that there will be an accidental measurement error. The mean of this accidental measurement error is called the standard measurement error. A high standard measurement error indicates low reliability.
There are no rules of thumb for determining validity. Cohen gave three rules of thumb for the desired level of a validity coefficient:
In addition to decisions about the theory, the model and the measuring instruments, the diagnostician must also decide on the method of integrating all information. This information integration of diagnosticians and assessors has often been studied. This concerns the question of whether information should be integrated by a diagnostician or by means of an empirical model. The diagnostician is often described as a moderately intuitive statistician and information processor.
A diagnostician who is clinically oriented often has conversations with his client in which he tries to learn about the specific personality and social context of this client. He makes a diagnosis and prediction through his own experiences in clinical practice and with the help of theories of behavior, cognitions and emotions.
A statistically oriented diagnostician integrates information using (linear) formulas. With this he predicts a criterion reasonably well based on a chance. However, this probability statement can never be perfect: a value of r = 1.00 is never achievable.
This has also led to studies on clinical versus mechanical prediction. Clinical is the term for the clinical orientation and mechanical for the statistical orientation. It turns out that the orientations are equally good, although the statistical orientation is slightly better.
Some limitations in a diagnostician's assessment are that they often categorize someone by one salient feature. In addition, he often does not take into account the frequencies of how often something occurs: this is called the base rate. A diagnostician also puts weight on salient information, that is, things that are clearly visible. Also, a diagnostician often disregards a sample, while results from a larger sample are much more reliable than those from a smaller sample. They also often misunderstand correlations. An example of this is: when someone becomes ill, which occurs more often, and goes to the doctor, he gets medication. He takes this and then he gets better. However, this does not mean that this is because of the drugs! It is also possible that the person heals from the disease through a natural course. This is sometimes not sufficiently taken into account in diagnostic practice.
There are a number of heuristics (prejudices) that can influence the assessment process. There are four types of heuristics for each step in an information processing process:
Because diagnosticians make quite a few mistakes in their assessment, it is important to train them on this. With the help of training, you can learn to take the base rate into account, to deal with the availability bias and to prevent foreclose. This is accepting a statement too quickly without looking further.
Another way to avoid errors is by following prescriptions such as the diagnostic cycle (the hypothesis-testing model) and the use of empirically established rules to weigh up and integrate information properly.
Also, feedback on the correctness of the diagnoses they make could help, but this happens very little in practice.
It should be taken into account that tests are often in Dutch. There are also sections in intelligence tests where people are judged on their understanding of the Dutch language (proverbs), such as in intelligence tests. For this reason, tests in the diagnosis of persons who do not have a good command of the Dutch language, such as refugees, are limited.
A diagnostician must also take into account his colleagues, the institution where he works and the legislation. Psychologists and educationalists come under the Individual Health Care Professions Act (BIG Act).
There are rules for the professional association that members must adhere to. These are:
There is a committee that deals with complaints. In the Netherlands there are very few complaints.
Test fairness means that there is no bias (bias) in the use of tests. Keep in mind that an intelligence test cannot be used well for refugees who do not have an optimal command of the language and they will therefore score lower. Or, for example, a question about cars that men can answer more easily than women and therefore score higher in a test about technical insight. With the help of modern test theory (IRT) the items can be assessed on this. This is called Differential Item Functioning (dif). So, the goal is that people with the same skill do not score differently on a test.
Second, it is important for test fairness that there is equal treatment of people in the testing process. The third point is equal opportunity to learn: this is about education. Not every group in society has access to this. Finally, it could be that the tested self is dishonest and masquerades differently. This can occur in personality tests, in which faking bad (pretending to be worse) and faking good (pretending to be better) can occur.
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.......read moreA psychodiagnostic examination can start in two ways: the client can be referred to the diagnostician or the client can go to the diagnostician himself. Once at the diagnostician, he analyzes the client's request for help as well as the referrer's request. These are not the same type of questions. The client's request for help could be about how to overcome his compulsive behavior, while the referrer's request might be about obsessive-compulsive disorder.
Based on these questions, the diagnostician asks three types of questions:
A diagnostic scenario is drawn up based on these questions. This contains a preliminary theory about the client's behavior. Subsequently, this theory is tested using five steps:
On the basis of this assessment, they will come to a diagnostic conclusion.
It is useful to build up the psychodiagnostic process according to De Groot's empirical (scientific) cycle. This empirical cycle consists of observation, induction, deduction, testing and evaluation. Yet this is not standard applied by diagnosticians.
There are five types of questions that often arise in psychodiagnostics. With each of these questions it is important to have a certain knowledge of psychology (knowledge base). It is best if the diagnosis answers the five basic questions in sequence and goes through the steps in the diagnostic cycle. These are the five basic questions:
The question that can be asked here is: what is the problem, what succeeds and what goes wrong? The recognition phase includes an inventory, description, ordering, categorization and an estimate of the seriousness of the problem behavior. The difference between and a diagnostic formulation should be considered. Classification is about categorizing someone's behavior based on the DSM. A disadvantage of a categoric classification is that it is quite limited and leads to "labeling". An advantage is that it improves the communication between information. A diagnostic formulation, on the other hand, contains more detailed information about a client's behavior and takes more into account the context in which this behavior is in place. The authors of the book advocate a diagnostic formulation.
The question that can be asked is 'why are the problems there?' The statement contains 3 parts:
Psychodiagnostics consists of three parts:
There are three types of frames of reference, each of which is based on a different idea of how (problematic) behavior is best understood and explained:
Determining the quality of frames of referenda is done on the basis of four criteria:
According to Van der Werff, the trait approach, biopsychology and orthodox social learning theories are the best frames of reference to use in diagnostics. For a diagnostician, especially the trait approach is good to use, it has also yielded many intelligence and personality tests. The biopsychological approach and the social learning theories come from the context approach. Van der Werff believes that parts of psychoanalysis such as ego psychology belong to the middle class. The underperformers are psychoanalytic, humanist and existential psychology. The ideas in these frames of reference often cannot be tested.
There are several models of test theory and statistics that are used to describe the central parts of theories and constructs. There is the classical test theory and the modern test theory (IRT). The IRT is a theory of behaviors (a latent trait such as emotional stability or math skills). This theory describes the probability that when a person has a certain value on a latent trait, a person will say yes to a question whether a task will solve well.
Factor analyzes are used for the first frame of reference. Thurstone came up with the multiple intelligence theory and eventually chose to measure it by independent factors. This was in contrast to Spearman, who used a g factor to measure intelligence. A profile
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