How does neuropsychological assessment and screening work? - Chapter 10

Topic 10A Neurobiological Concepts and Behavior Assessment

The Human Brain

The brain is the best protected organ in the body. It is first protected by the skull. Then through meninges, three membranes that cover the brain and spinal cord. In the brain, the ventricles are filled with cerebrospinal fluid. This is a liquid that is constantly produced and refreshed and serves as protection for the brain. The brain literally floats up here and is protected against blows and dehydration. The ventricles are four hollow, connected chambers in the middle of the brain. It may be that the aqueduct leaving the 3^rd or 4^th ventricle becomes too small. This can be a problem from birth or develop throughout adulthood. This condition is known as hydrocephalus or water head. The pressure then becomes too large in the brain. In children it can cause the ventricles to grow and the brain is eventually pressed against the skull. Untreated, this can lead to mental retardation or premature death. Fortunately, it is easy to treat the excess liquid through a shunt to drain.

When the brain is surrounded by the liquid, it weighs about 1.5 kilos. The brain consists of 5 elements: gray matter, white matter, glial cells, cerebrospinal fluid, and the blood vessels that supply the brain with oxygen and nutrients.

The brain constantly needs oxygen and glucose through blood. The blood is transported through a circular network of arteries called the circle of Willis. This network ensures that the brain is constantly supplied with blood. When one gets older it can happen that one of the arteries becomes silted up by fatty plaques. Then oxygen is missing and an infarct occurs, which is a kind of stroke or cerebrovascular accident. One can also develop later multi-infarct dementia , which is the result of an accumulation of small infarcts over a number of years. It can also happen that a blood vessel breaks open and the blood immediately splashes into the brain tissue, this is called arterial rupture.

Structures and systems of the brain

We begin with the overview of the brain at the cerebrum, consisting of a left and right hemisphere. These are connected by the corpus callosum, a large bundle of neurons that transmit information from both hemispheres. This has been discovered by researchers who have investigated 'split-brain patients' whose corpus callosum has been cut. They found that the hemisphere on the one side was not aware of the visual information in the other hemisphere.

These patients have been extensively studied for hemispheric specialization studies. A lot has also become clear from research on people who have no corpus callosum since birth, this is called ACC: agenesis of the corpus callosum. Here, too, you see that verbal expression is often emotionless and / or inappropriate. The cerebrum develops from an evolutionary perspective as the last part of the brain. This is the place where thoughts, imagination, assessment and decision-making take place.

The cerebral cortex is the outer layer of the brain and is the source of the highest levels of sense, motor and cognitive processes. It consists of bulges, called gyri (singular gyrus), and of grooves called sulci (sulcus). This has the aim of surface enlargement and thus more information transfer. The cortex consists of four lobes: the frontal lobe is responsible for motor control, the parietal lobe is responsible for processing sensation and other somatosensory information, the occipital lobe is responsible for visual perception, and the temporal lobe is responsible for processing auditory information. Of course, the lobes have many other functions and they also work together a lot.

Survival systems: the rhinoceros and midbrain

The rhinoceros is the lowest part of the brain, located in the top of the spinal cord. It contains vital body functions. The lowest part is the medulla responsible for essential life functions such as breathing, swallowing and blood pressure. Damage to the medulla is usually fatal to a person. When a small stroke occurs and the person survives, the following symptoms are often visible: paralysis on the opposite side, partial loss of sensation of pain and temperature, clumsiness, dizziness, partial loss of the gag reflex, paralysis on the same side and atrophy of the tongue.

Higher up are the pons and the cerebellum. Together they are responsible for coordination of muscles, body posture, and hand and eye movements.

Above the hindbrain is the midbrain, which contains nuclei for many cranial nerves. Of these 12 nerves, some are explicit sensory, some only motoric and others both. These are mainly sensory basic functions and movements that the nerves take care of.

Attention systems

Attention is a kind of searchlight that identifies what is relevant to us and ignores what is irrelevant. It is a primitive, automatic cognitive system that is essential for survival. There are different types of attention:

• Orienting attention is related to the fight / flight reflex. All attention is directly focused on imminent danger.
• Selective attention includes the identification of a single, personally relevant stimulus in a rich environment, such as hearing your name.
• Distributed attention includes the ability to switch between multiple tasks.
• Consistent attention includes holding attention for a longer time.

There are no precise neurological systems for attention in the brain. It requires a collaboration of multiple brain sites. The reticular formation is a network of neurons from the spinal cord to the thalamus, responsible for general arousal or consciousness. Selective attention seems to be happening here. Part of the reticular formation is also known as the reticulate activating system. This system has to do with drowsiness, sedation and coma.

Motor / coordination systems

Three areas are important for motor control. The cerebellum is located under the cerebrum, at the back of the brain. It coordinates muscles, posture and eye movements. The cerebellum receives sensory information from the whole body and automatically coordinates learned movements. The cerebellum also provides the vestibuloocular reflex, keeping the eyes focused on a target while the head is moving. Damage in the cerebellum can, in addition to motor disruptions, also cause dysarthria, unclear and hesitant speech.

The basal ganglia consists of several nuclei and has connections with the cortex and thalamus. The most important parts of the basal ganglia are the caudate, the putamen and the globus pallidus. The structures of the basal ganglia are connected with the subthalamus nucleus and substantia nigra. Together with the cerebellum, the corticospinal system, and motor nuclei in the brainstem the basal ganglia participates in the control of movements. The basal ganglia has indirect motor functions because it is not in direct contact with the spinal cord. Damage to the basal ganglia can lead to Parkinson's disease: Involuntary movements, slow movements and changes in posture. In addition, Parkinson's patients also have deficiencies in cognitive functioning.

The cells in the motor cortex are for a large part contralateral: the left hemisphere controls the right side of the body and vice versa. The cells send voluntary motor movements. This part is located on the precentral gyrus on the frontal lobe.

Memory systems

There are different ways to distinguish memory:

• Episodic vs. semantic memory: memory for personal events and experiences versus general knowledge.
• Working memory vs. associative memory: the use of information that we only need temporarily for memories that come to mind because of certain stimuli.
• Declarative vs. procedural memory: the 'what' in the memory versus the 'how' in the memory.
• Explicit vs. implicit memory: directly and clearly accessible to difficult-to-access memories.
• Short term vs. long-term memory: reminders that are stored up to a maximum of a few minutes against memories that have been stored for hours to years.

Many brain areas work together in memory processes, but especially the hippocampus and amygdala are important for consolidating memories to long-term memory. Studies have shown that different areas are responsible for different memory systems. For example, the procedural memory is probably regulated by the cerebellum.

Limbic system

This is a centrally located brain network under the cortex and is involved in survival drives and emotions. It has strong connections with memory areas. In addition, pleasure centers are located here. Which parts of the brain belong to this system is not entirely clear because we actually know very little about this system. In any case, the hippocampus, amygdala, cingulate gyrus, mammilary bodies and the fornix are listed below.

Another component is the hypothalamus, which is involved in body regulation and emotional behavior. Damage to this part can cause a disrupted pituitary gland, because it has strong connections with it, so the diet can change (lots of food and drink). Damage can also cause sleep problems; excessive sleep or the inability to sleep. The hypothalamus also regulates things such as blood pressure, diet, sexual behavior and the sleep / wake rhythm.

Language functions and cerebral lateralization

Language functions are mainly found in the left hemisphere. Because many areas work together, almost every damage in the left hemisphere will bring language defects. In the left premotor area is the area of ​​Broca. People with damage here can suffer from Broca's aphasia: they can hardly understand spoken or written language. People suffering from Wernicke's aphasia, on the other hand, have difficulty with the underlying meaning of words, while they can still perceive and produce them. These patients often have damage to the left temporal lobe. However, it must always be remembered that the entire brain is active in language functions, such as speech.

Geschwind proposed a model that described in which way the areas in the left hemisphere have language functions. It shows that damage to Broca's area causes slow speech; language comprehension remains unaffected. Damage to Wernicke's area causes greatly reduced language comprehension. Damage to the angular gyrus causes serious reading problems, but not in the understanding of speech. Damage in the auditory cortex causes problems in verbal understanding, but patients can speak and read normally.

The right hemisphere is dominant for analyzing geometrical and visual spaces, understanding and expression of emotion, processing music and non-verbal sounds, production of non-verbal and spatial memories and recognition of complex forms. Damage can lead to construct dyspraxia: inability to recognize spatial relationships.

Visual system

The most important sensory areas for vision are located in the occipital lobe. Here, too, there is contralateralisation, the information comes together via the splenium located in the corpus callosum. Damage in the association areas (which are more to the front) of the occipital lobe can lead to visual agnosia: the difficulty of recognizing drawings, objects or faces. This is especially the case with damage on the right side. Patients with prosopagnosia can no longer recognize faces of people they know. The association areas ensure that meaning is given to the view. Visual agnosia occurs primarily in damage to the right side of the occipital lobe, but may also be related to damage to the temporal and parietal lobes.

Executive functions

These functions provide the ability to respond to new situations in a well-adapted way. This includes:

• Volition: capacity for intentional behavior.
• Planning: recognizing and executing steps that lead to a goal.
• Purposive actions: take action and maintain it in a neat way.
• Effective performance: constantly monitoring activities on the set goals and changing strategies when necessary.

Executive functioning activity is mainly found in the frontal areas. These are essential for programming, regulation, verification and motor execution of executive functions. Implementing a plan requires a manipulation of the environment, which must be planned by the primary motor cortex, which sits in the back of the frontal lobe. The additional motor cortex involved in motor programs is the series of complex motor operations.

Damage in the motor cortex causes fine motor problems on the contralateral side of the body. Damage in the frontal cortex can cause problems in motivation, mental changes, regulation of behavior and self-awareness.

Few test instruments are sensitive to measuring executive functions. The tests often measure what a person knows, while the reactions often change because of the damage.

Because of the irregularly shaped skull the skull, the forward underside surfaces of the frontal lobes was prone to damage when someone sustained head injury. The front of the temporal lobes is also susceptible to this.

Neuropathology in adult and aging

A traumatic brain injury (TBI) can be anything from a concussion to a serious brain injury. A concussion includes a brief loss of consciousness, followed by headaches, loss of concentration, vagueness, irritability and other emotional symptoms. A 'closed head injury' is a broader term for traumatic brain damage and often involves severe limitations. The damage can also penetrate other parts of the brain. With an open head injury, the skull is also cracked. The damage to the brain is often only on the spot or near where the skull has burst.

The most common complaints are concentration and memory problems. That is also the reason why they always occur in tests.

In addition, a brain tumor in the brain can also cause various effects. It depends on the location, size and growth rate of the tumor which effects it has. Gliomas are tumors from the glial cells that grow rapidly and meningiomas are slow-growing tumors that press on the brain that originate from the membranes. Tumors are cells that mutate and thus originate from cells that our body already has.

Chronic alcohol abuse can result in neural destruction in the dendrites, especially in the areas important for memory. This can cause amnesia that is also called the disease of Korsakoff, this is mainly due to vitamin deficiency. Affected people mainly have anterograde amnesia. It was found in a study that the brain volume of alcoholics increased after 6-7 weeks without drinking. It was not much, but it did provide hopeful conclusions for interventions.

Normal Pressure Hydrocephalus is a condition in which the cerebrospinal fluid increases. This can cause symptoms such as incontinence and dementia. This often makes it mistaken for other diseases, such as Alzheimer's, while NPH is easily remedied with a catheter that removes the abundant fluid.

Alzheimer's disease is characterized by a degeneration of the brain and is the most common form of dementia. Characteristics of the brain are then a reduction of neurons, the shrinking or atrophy of the brain, reduction of acetylcholine transmitters involved in memory and an accumulation in the cerebral vasculature. Plaques and tangles arise. There are many symptoms of dementia. In addition, many normal functions such as language or motor skills are deteriorating more and more quickly. It also happens often that the personality changes.

Vascular dementia is often the result of stroke and is the second most common cause of dementia. This usually happens at once, but sometimes several small strokes can cause a multi-infarct dementia. The symptoms of a stroke are motor weakness, reduced sensation in the body and loss of consciousness. On the basis of a test called MID, a distinction can be made between Alzheimer's and this.

Parkinson's disease occurs in 2 out of 1,000 elderly people. It is primarily a motor disorder, but there are also often cognitive and emotional problems. Tremor is the most common symptom and includes vibrating and shocking movements that can not be stopped.

Behavioral assessment of neuropathology

The mental status of examinations (MSE) is a separate interview that precedes other forms of assessment. Its purpose is to provide an accurate description of the psychological functioning of the patient. The psychologist examines the important areas of personal and intellectual functioning in search of symptoms of psychopathology. It concerns: orientation, memory, thoughts, feelings and judgments.

Another way is to have behavioral scales filled in by acquaintances of the patient. The Behavioral and Psychological Assessment of Dementia (BPAD) is a measurement scale that measures dementia-related changes in behavior among the over-30s. This is done for the last four weeks and five years ago, so that a current, past and a change score can be given. The scores are scored in 7 domains divided over three clusters: psychological, behavior, and biological symptoms.

The Frontal Systems Behavior Scale (FrSBe) has been specially developed to measure symptoms of frontal brain damage. Subscales include apathy, disinhibition and executive dysfunction. This simple, short scale is a good measuring instrument for patients who have symptoms of frontal damage due to different neurodegenerative disorders.

Subject 10B Neuropsychological tests, test batteries and screening tools

Model of brain-behavior relationships

Bennett has developed a simplified model that is useful for the organization of neuropsychological tests. Each test considers one of the following categories:

1. Sensory reception
2. Attention and concentration
3. Learning and memory
4. a) Left hemisphere: language, linear thinking; b) Right hemisphere: visual space, holistic thinking
5. Executive functions
6. Motor output

Executive functions that are tested include logical analysis, concept formation, reasoning, planning, flexibility of thinking.

The order in which the categories are given is roughly the order in which incoming information is processed in the brain. It is important to remember that multiple tests are often used. One type is flexible or patient-centered testing, where an individualized test battery for the client is formed. Another type is an already formed test battery that is taken from each client.

Assessment of sensory input

The accuracy of sensory input is crucial for the competence of perception, thought, planning and action.

The Reitan-Klove Sensory-Perceptual Examination consists of simple tasks that test your sensory ability. Normal people can perform this without error. It is especially striking if the participant makes many mistakes on one side of the body. This may indicate brain damage to the contralateral hemisphere.

Possible loss of sensory power is also tested by the Finger Localization Test. Participants must indicate which of their fingers are being touched. Normal people do this almost perfectly, so errors can indicate damage to the sensory system.

Measures of attention and concentration

It is difficult in practice to distinguish between simple attention, concentration, mental shifts, mental tracking, vigilance and other variants of attention and concentration. The following test was the only one that succeeded here.

The Test of Everyday Attention (TEA) measures the subcomponents of attention, including sustained attention, divided attention and selective attention. This is done through 8 subtests.

The test has been validated in patients with TBI, stroke or Alzheimer's. In addition, the test is also well validated among the normal participants. The TEA can analyze subtests so that the strengths and weaknesses of the participants can be analyzed.

The Continuous Performance Test (CPT) is a family of tests that measure persistent attention. Although they are sensitive to various affected brain conditions, the CPT does not diagnose attention disorders such as ADHD.

Learning and memory tests

Learning and memory are two components that can hardly be investigated separately. Different memory tests therefore examine different types of memory, as was also indicated in chapter 10A. Memory tests can be categorized in different dimensions: short-term versus long-term, verbal versus pictorial, learning-curve versus non-learning curve.

The Wechsler Memory Scale-IV scores nine subtests on five index scores: Immediate Memory Index, Delayed Memory Index, Auditory Memory Index, Visual Memory Index, Visual Working Memory Index. The WMS-IV is well validated under a well-standardized standard group. It is important to remember that when a certain profile is associated with a certain disease, this does not apply the other way round. A patient with Alzheimer's with a distinctive profile does not mean that everyone with the same profile also has Alzheimer's.

The Rey Auditory Verbal Learning Test (RAVLT) includes the free recall of 15 words in any order. The participant is scored on the number of words that he has been able to retrieve in the 5 trials. Persons with a memory problem can be properly diagnosed by the RAVLT. The fact that the test has at least 7 parallel versions is both strength and weakness: a person can be tested more often, but a person learns better each time.

The Fuld Object-Memory Evaluation is a test that is mainly done in the elderly. Participants receive 10 objects that they must feel and name. After a distraction task, a selective reminder task follows in which the objects are described. The task is to retrieve the objects from the memory. The test is mainly used in the diagnosis of Alzheimer's. After all, these patients benefit little from the selective memory. The test had a sensitivity of 93% and a specificity of 90%, so that is very high.

The Rivermead Behavorial Memory Test consists of 12 subtests that reflect everyday memory, such as finding a route, remembering names and retrieving information. The test is popular because of the ecological validity and the different types of memory that are being tested. An online version has also been developed that correlated highly with the original test. This is therefore a promising alternative for face-to-face testing.

The Wide Range Assessment of Memory and Learning-2 (WRAML) consists of 6 subtests that contribute to three index scores: Verbal Memory, Visual Memory, and Attention / Concentration. Together they lead to a General Memory Index. The WRAML also tests for delayed memory and recognition, with differences in these memory types occurring mainly in the elderly. In addition, the subtests can be used for measuring working memory. The WMS-II and the WRAML both measure memory, but the correlation between the two is not very high. It can be concluded from this that they measure different aspects of memory and are therefore not interchangeable. The correlation between WISC and WRAML is also not very high, from which it can be concluded that the WRAML measures intelligence-related aspects.

Assessment of language functions

Aphasia includes any deviation in language functions as the result of brain damage. To test aphasia, three ways are used: non-standardized clinical examination, standardized screening or an understanding diagnostic test of aphasia.

A clinical trial has the advantages that it is simple, flexible and concise. Elements that are investigated are: spontaneous speech, repetition of sentences or phrases, comprehension of spoken language, finding words, reading, writing and copying, and calculation. Then this is scored on certain measuring scales.

Standardized screenings correspond to a clinical examination, but contain objective and precise instructions, so subtle symptoms of aphasia often do not come to light. Diagnostic tests are often performed in patients who are already known to have aphasia and are especially useful for treatment planning.

Tests for spatial and manipulatory ability

The term apraxia refers to various dysfunctions in controlling or performing complex motor actions. Tests that measure spatial and manipulation capabilities are also called construct performance tests. These tests combine perceptual activity with motor reactions and always contain a spatial component. Construct capability contains multiple complex functions and therefore limitations are quickly revealed, even when there are mild forms of dysfunction of the brain. It is only the question where the restriction comes from. This can have multiple causes: spatial confusion, perceptual limitations, attention problems, motivation problems or apraxia.

With the Bender Visual-Motor Gestalt Test (BGT), participants are asked to draw pictures. Patients are allowed to draw as slowly or quickly as they wish. Various scoring systems are available. In adults, it looks at possible brain damage, but in children the test is used to examine their mental age. The score that comes from the test is the Visual Motor Integration (VMI), and can easily be compared with IQ scores.

The Greek Cross is a drawing task in which participants have to draw a cross without having to remove their pencil from the paper. There is a scoring guide, but often the quality of the drawing is looked at. The test is sensitive to patients with brain injury. There are also block models, which participants have to recreate. This test is very sensitive to brain injury.

Assessment of executive functions

Executive functions include logical analysis, conceptualization, reasoning, planning and the flexibility of thinking. It is difficult to measure these functions, because it is difficult to properly transfer the task to the client. This problem is often solved by using clinical methods instead of formal testing. There are few tests that measure the executive functions on an acceptable level.

During the Porteus Maze Test, participants must draw a line without lifting up to come out of a series of mazes that are becoming increasingly difficult. The test is sensitive to (traumatic) brain damage. The test measures planning and insight.

The Wisconsin Card Sorting Test (WCST) is a good test for abstract thinking and the ability to switch sets. Participants receive 64 cards with 1-4 symbols in 4 colors. These have to be divided over 4 stacks in which the tactics are changed after ten good distributions. The examiner says “right” or “wrong” as the examinee lays down the cards. The test is widely used for people with recent brain trauma and to look at the recovery.

In the Tinkertoy test, participants are asked to create as extensive a structure as possible with a sort of old-fashioned K'nex. People with brain damage make only small structures and score worse than people in the control condition. With this, the researchers stated that it is a good test to investigate executive functions, but also for research into Alzheimer's.

A test battery that mainly reflects everyday situations is the Behavorial Assessment of the Dysexecutive System (BADS). It consists of 6 subtests: temporal orientation, changing rule with maps, programming action with materials, searching keys in a set, planning zoo route, completing six activities in 10 minutes. The test is scored in areas: personality / emotional, motivational, behaviour, and cognitive changes.

In addition, the ability to find an unknown place in a city is also a good test, because you need strategy and self-monitoring.

Assessment of motor output

The most widely used test is the finger-tap test. Participants must tap their index finger as much as possible in 10 seconds. Especially a big difference between the different sides (more than 10%) can indicate brain damage.

In the Purdue Pegboard Test, participants must insert pins into holes with the left hand, right hand and then with both hands. The test is good to use with a test battery, but in itself does not serve as a good screening for motor problems. A variation exists where the holes have a ridge, so the pins have to be turned to fit into the hole. This is a good tool for the assessment of (bi-)lateral brain damage.

A final way is that the client gets a sheet with figures drawn on it. It is then the intention that the client tracks the lines of the figure with a brightly colored pen. This can be done well by a 10-year-old and is therefore a good test to look at restrictions in motor regulation. It should be remembered that usable motor tests should use more refined material.

Test batteries for neuropsychological assessment

The Luria-Nebraska Neuropsychological Battery (LNNB) consists of 269 items scored on 11 clinical scales:

• C1 Motor: coordination, speed, motor skills.
• C2 Rhythm: paying attention to, distinguishing and producing rhythmic stimuli.
• C3 Tactile: identifying tangible stimuli.
• C4 Visual: identify drawings and perform visuo-spatial operations.
• C5 Receptive speech: discrimination of phonemes and understanding of words and sentences.
• C6 Expressive speech: fluently articulate sounds, words and sentences.
• C7 Writing: use of motor skills to write
• C8 Reading
• C9 Arithmetic: simple maths, and solve mathematical structures.
• C10 Memory: memorize verbal and non-verbal stimuli under certain conditions.
• C11 Intelligence: reasoning, concept formation and complex problem solving.

Hereafter, 3 summary scales are scored: pathological, left hemisphere and right hemisphere. The first scale represents the degree of recovery, the second and third must show whether the damage is mainly in the left or right hemisphere. Despite the statistical reliability and validity, there is scepticism about the heterogeneity of clinical scales and the speech scales that are not tested for aphasia.

The Neuropsychological Assessment Battery (NAB) consists of 24 tests that reflect 5 modules: attention, language, memory, spatial and executive functions. The test battery has good ecological validity, which means that the test represents the practical activities in the real world. The reliability differs per module as well as the psychometric validity.

Baseline testing with brief neuropsychological test batteries

Setting up a baseline is important because you can compare scores with it. In this way, it can be checked when someone deviates significantly. Each individual has a different level and other strengths and weaknesses. At least two areas of assessment baseline testing is often used in practice. The first application is the Automated Neuropsychological Assessment Metrics (ANAM) Traumatic Brain Injury (TBI) that is used in the military. The subtests measure reaction time, learning, memory, arithmetic processing, spatial processes, executive functions, and symptoms. The test has been developed to see if there is a traumatic brain injury. The subtests are very sensitive to the impact of injury, degenerative disease, exposure to poison, effects of medication and rehabilitation efforts. The ANAM4 TBI can be used to look at what the soldier is up to in the neurocognitive field compared to previous tests and the norm group. The norm group is carefully subdivided by age and gender and formed by very large samples. Little is known about sensitivity and specificity. The rest of psychometric characteristics are in order.

We also have another computerized test, the ImPACT. This test has been developed to investigate whether athletes can continue playing after a concussion. The test is only usable when an individual baseline is set. The test has good sensitivity (82%) and good specificity (89%). There is criticism of this test, for example there is a lot of false positives. Empirical research supports the idea that this test is suitable for making the decision whether or not an athlete can play. This requires more tests and not just these.

Screening for alcohol abuse disorders

A difference must be made between alcohol abuse and alcohol dependence. A person is diagnosed with alcohol abuse if he meets one of the four criteria:

• Drinking interferes with everyday functions.
• Drinking leads to unsafe behavior.
• Drinking causes legal violations.
• Drinking leads to conflicts with a parent or caretaker.

Someone is alcohol dependent if he meets three of the following 7 criteria:

• Increased tolerance for alcohol for the same effect.
• Withdrawal symptoms such as shaking.
• Drink more and longer for longer periods than planned.
• Desire to stop but without success.
• Spending a lot of time drinking alcohol.
• Specifying important activities to drink.
• Continue to drink despite serious health problems.

The CAGE questionnaire is a short screening instrument with questions about whether the person wants to stop drinking, he is annoyed by criticism about his use, he feels guilty about his use and if he has had an eye-opener. There are still doubts about the use and validity of the CAGE. Some researchers say that it works better for men than for women, so there is another screening for women, the TWEAK. This also accurately shows alcohol abuse in women.

In addition, there is also the Substance Abuse Subtle Screening Inventory. The SASSI-3 consists of 26 clear questions about substance abuse and 67 subtle questions about symptoms. The validity of the SASSI-3 is very good and it is therefore often used.

Lastly, there is the Mini-Mental State Examination (MMSE). This is an objective index for cognitive functioning and is mainly used in patients with Alzheimer's disease. It consists of 30 questions related to time orientation, direct memory, attention, calculation, language production, language comprehension and design copy. A cut-off score is used that determines whether or not a patient could have Alzheimer's disease. This is exactly 80 to 90% of the cases. The test is recommended as a rapid screening test for the elderly.

When and how are industrial, professional and career assessments done? - Chapter 11

Subject 11A Organization Assessment

Industrial and organizational psychology is concerned with behavior in work situations. I/O psychologists are used, among other things, for business, advertising and the army.

The role of tests in staff selection

Because tests provide valuable information about potential work performance, they are used by many companies and personnel selection organizations. It seems simple: the person who correlates the highest with the given work criterion will perform best. But work behavior is not simple, one-dimensional behavior. In addition, complex behavior often also partly depends on the situation. A perfect approach for selection can therefore still not be valid for everyone. Then you also have to deal with legality. Selection procedures often have such a big impact; the person is or is not accepted, that there are strict rules that must be observed. Personnel selection is therefore a vague, conditional and uncertain task. There are several ways for personnel selection which are discussed in this chapter.

Autobiographical data

The biodata are lists with data from the history of the personal and work past. It also contains demographic information. The biodata is objective and can be scored. The rational aspect of biodata is that work-related behavior can be predicted from choices and goals achieved in the past. The data is collected via questionnaires.

After collecting the biodata, psychologists must predict the work performance by devising means from the collected information. This is done by dividing the existing employees into a successful and unsuccessful group, given work performance, salary and assessments. The biodata are then compared with these two groups. By means of cross validation it is compared with a second group of successful and unsuccessful groups.

Biodata has approximately the same validity as standardized tests. Care must be taken to ensure that no conclusions are drawn from certain demographic factors (age, sex, race), even if this can predict work performance. It has been shown that people are more honest about their biodata, when they have to explain each answer specifically.

There is little doubt that pure objective data can accurately predict work performance. Employers, however, rely more on subjective information, such as the job interview, when they want to hire someone.

The job interview

Although the job interview is only part of the evaluation process, it is the decisive factor for many employees to hire someone. However, previous studies indicate that the job interview is unreliable, given inter-assessments of -.50. In addition, employees are sensitive to the halo-bias: the tendency to estimate someone high or low on all dimensions because of his general impression. Reliability turned out to be higher when interviewed by a panel or when the job interview was standardized.

This same pattern can also be seen in the validity. In earlier studies where unstructured job interviews were examined, the validity turned out to be very bad (-20). But for structured conversations, validity is already much higher (.67). It is important that job interviews are almost always used in combination with other information. Studies indicated that the validity decreases when, in addition to other information (references or objective tests), a long job interview is also used. Studies have only shown that job interviews, when unstructured, can reduce the validity of a job application process.

Interviews can therefore be valid when they are structured and standardized. The problem, however, is that the application of the conversation is often unstructured, which creates unrealistic assessments.

Despite questionable reliability and validity, job interviews are first used to meet potential future employees. Secondly, a lot of research has been done into the handshake of the applicant and the impression of it. A firm handshake gives positive effects and might even lead to the applicant being accepted. This effect applies more strongly to women. Thirdly, it appears that the impression given in the first few minutes, before the job interview, makes a difference on whether the applicant is accepted.

Cognitive ability tests

Cognitive tests can refer to general intelligence or different specific structures. Cognitive tests prove to be reasonably good for personnel selection. One concern with the use of cognitive tests is that it leads to an 'adverse impact' for minorities. That means that whites score better on them. Therefore, the tests must be used in combination with, for example, biodata. Research has shown that tests for general intelligence (the g factor) are a better predictor of work success than specific cognitive measurements.

This is because most jobs are complex and therefore require multiple cognitive skills. Specific cognitive skills are only important because different professions require different skills. A general cognitive measurement can often not bring this to the fore. The tests are fast, inexpensive and easy to interpret. They are used for personnel selection, evaluation and screening.

Wonderlic Peronnel Test-Revised (WPT-R)

This test measures general mental skills and is widely used due to its size (50 items), brevity (12 minutes) and parallel versions (about 16). The reliability is impressive, given the brevity. Internal consistency is around .90 and parallel versions correlate with .90. The validity is also positive, given the correlation of .91 with the WAIS. Disadvantages of the test, however, are that the test is less good for people with visual-spatial impairments and whose native language is not English.

Bennet Mechanical Comprehension Test (BMCT)

This test is mainly used in the understanding of mechanical constructions and principles. This is essential for many work areas. The test consists of images with questions of everyday mechanical and technical basic principles. It is a reliable (split-half from above .80) and valid (.80) test. The test proved to be a very good predictor for pilot successes in the Second World War. The only drawback is that the test and its items are dated and that the test must therefore be modernized.

Minnesota Clerical Test (MCT)

The MCT measures speed and accuracy of perception by means of two subtests: number comparison & name comparison. It can be challenging, because there are 100 equal and 100 unequal combinations that differ by 1 digit or 1 letter. The reliability is around .85, so that's pretty good. The validity is reasonable, but not very good. In addition, due to the vague norm groups, it is also not entirely clear what exactly the test measures, and how the test predicts work performance. The test is relevant for church work.

Personality tests

Before the 'Big Five' was out, empirical support was not used for the interpretation of personality tests for personnel selection. It was the subjective opinion of the psychologist. Previous studies showed that the tests were hardly valid. Only around 1990, with the emerging popularity of the Big Five, there was evidence that personality is a useful factor for personnel selection. After a study it appears that people who describe themselves as reliable, organized and hardworking (high scores on conscientiousness) deliver better work performances. Different tests that measure personality (see chapter 8 ‘on the origin of personality tests’) are valid predictors for work performance.

Integrity tests

An integrity test evaluates attitudes and experiences related to honesty, dependence, trust and pro-social behavior of an applicant. Integrity tests consist of a section that questions attitudes toward illegal behavior and a section that openly questions illegal activity. Integrity tests can easily be falsified and are therefore of lesser value.

Validity studies showed that integrity tests are no good predictors of work performance, but that they have a good correlation with counterproductive work behavior. In this way integrity is a valid factor for personnel selection. However, many critical comments remain about the use of integrity tests. Among other things because of the unqualified users, the influence of situational factors and the lack of optimal cut-off scores.

Work test and situational exercises

A work test is a miniature replica of the job that the applicant has registered for. It must contain the difficult elements of the job that separate good from bad candidates. A validity study found correlations between the .42 and .66 between work performance and assessments of the supervisor.

A situational exercise is often used in the selection of managers and other professional positions. The difference with the work trial is that the situational exercise encompasses the entire job and does not just share it. Work trials and situational exercises are based on the idea that previous performance is the best predictor for future performance in the same domain.

The in-basket test is a situational exercise that includes the work of an administrative assistant. It is scored on answer style and content. Answer style refers to the way a task is completed. Content refers to the thing that had to be done, what the task was. From the scores followed three dimensions: Preparing for action, Amount of work, and Searching for support. It appears that the in-basket test has a good predictive validity.

An assessment center is not necessarily a specific place in the company (as the name might suggest). The goal of an assessment center is to evaluate the managerial potential through all kinds of trainings, such as the in-basket technique. This ensures valid research into new managers. The only question is whether it is effective enough when you look at the high costs for such an assessment center. It has been shown that a maximum effect is achieved when an assessment center is combined with personality tests. The question is therefore whether the costs outweigh the results.

An idea would be to use interviews and cognitive ability tests to sort out the best and worst applicants and then only send those scoring in the middle range to more expensive evaluations.

Assessment of work performance

Assessments are crucial for employees, because without useful feedback, employees do not know how to improve. There are various assessment scales for this. Assessing work performance is a complex problem, often referred to as the criterion problem, the difficulties that arise are related to the description and measurement of performance structures. Work performance is often complex, vague and multidimensional.

Different approaches

A first way to assess work performance is to measure performance. This involves, for example, the amount that an employee has produced or how many sales he has made. There are several problems for this objective and valid method.

• The quantity of production can be beyond the control of the employee.
• For most jobs it is not possible to count an amount.
• Such a quantitative assessment can degrade the quality of production.
• Production counts are unreliable, especially for short time periods.
• The amount of production can only be a small part of the required skills.

As a second way of assessing work performance, the employee's absence is monitored. However, it is a useless measure of work performance, with the exception of the extreme exceptions. The first problem is the definition of absence; the criteria are vague. The second problem is that absence measurements are very unreliable. Finally, the absence rates are generally quite low.

Thirdly, reports from colleagues and self-reporting are used. However, this is not entirely reliable either, because people value themselves higher than colleagues and supervisors have different ideas about what is important in a job than employees.

The rating scales used by the supervisor are the most commonly used method. Despite their mild reliability, these are used for about ¾ of the assessments.

A graphical rating scale consists of characteristics, definitions and a continuum on which a score is scored. It is simple, but the dimension of work performance is vague.

A critical incident scale is based on desirable and undesirable behavior during work. This forms a long list where certain behaviors can then be ticked off. A behavioral anchored rating scale (BARS) is based on behaviors related to the personality and attitudes of the employee. It is a complex, time-consuming and expensive job to develop such a criterium scale.

A behavioral observation scale (BOS) is a variation on the BARS that is scored from 'almost never' to 'almost always' for the specific behaviors. A forced choice scale has been developed to combat bias and subjectivity. Of four items, two are positive and two are negative. Of the positive and negative items there is one that describes the job well. The manager must choose one of the items as 'best descriptive' and one as 'merely descriptive' for the employee.

Sources of bias

A first bias that is made a lot is the halo effect. Employees are rated high or low on all dimensions because of a general impression. Most often, a positive halo effect occurs, so that employees are highly rated because of a good general impression. Halo effects can be countered by special training sessions, reviewing the supervisor as they assess, doing exercises in advance, keeping track of what information is relevant to the assessment, and using managers who are less susceptible to halo effects.

There are various assessor biases. Mildness or strictness provides too mild or too strict assessments. Context errors are made when the employee is judged on the basis of the performance of his colleagues. It is striking that the affect towards the employee does not have much effect on the assessment.

Criterion contamination exists when a criterion measure is subject to factors that do not belong to the job. Opportunity bias arises when different colleagues have different chances of success. Group characteristics bias occurs when group characteristics affect individual performance. Knowledge of predictor bias occurs when the supervisor allows personal knowledge of the employee to play a role in the assessment. With these forms of bias, it is therefore important that the manager makes a clear distinction between what is and is not relevant to the job.

Assessment of work performance is difficult. The method must be psychometrically valid (validity), but must also be consistent with the organizational goals (feasibility). In addition, it is not allowed to discriminate against race, sex and other factors (legality). These three factors often collide with each other. Especially training with assessors can help. Two types of training are mentioned here: rater error training whereby the assessor is trained in finding specific errors. And frame of reference training in which the assessor is trained to become familiar with the content of each performance dimension. Finally, a study was done on cultural differences in assessments of work performance.

They found that agreement between social norms and personal assessment methods resulted in less outflow and absence. Especially the 360 ​​evaluation works well. An employee is assessed by all levels with whom he interacts during his work.

Topic 11B Career assessment in global economy

Career development

Career identity is a concept that has not been around for a long time, but is now indispensable. The career has become a part of who someone is. A job says a lot about someone, something about his personality, economic class and social point of view. Flexibility in career development is needed more than ever by the globalization of the world economy. People also change jobs more often. It is therefore not easy for psychologists to offer guidance in this development. They can therefore not give a simple answer that shows which career someone has to follow.

Functions of work

For many people, work is more than a means of paying for food and housing. However, many disadvantaged people do not have the opportunity to fulfill a career flow. Blustein et al. (2008) provide a meta-analysis for three sets of needs that work can fulfill:

• Survival and power: the most fundamental reasons to work, namely for basic needs and access to economic and social power.
• Social connection: work is the place where our social ties originate. This can again ensure better work performance.
• Self-development: work can be a fulfillment of self-actualization and personal fulfillment.

Origin of theories of career development

In 1909, on the basis of a clear understanding of 1. yourself and your possibilities, 2. The requirements and conditions for success, and 3. reasoning about the relationship between these two, the first questionnaire was drawn up for career choice by Parsons. This consisted of 116 items that had questions about the goals, interests and abilities of the client. The goal was to match personal characteristics with factors of the job, in order to choose the right job.

Theory of the person-environment fit

According to Holland, there are personality types consisting of clusters of personality traits and interests. With this he created the RIASEC model of six personality types with associated work themes:

1. Realistic: taking action.
2. Investigative: thinking, generating ideas.
3. Artistic: aesthetics, creations.
4. Social: connecting and helping.
5. Enterprising: leading people.
6. Conventional: routine and structures.

With the first letters of each type the Holland code be drawn up, since each individual does not have only one type of personality. This model has been very influential.

Theory of person-environment correspondence

Also shortened to PEC, this theory resembles that of Holland in the fact that both theories determine suitable careers based on the person's skills and the qualities required for professions. This leads to 6 crucial values ​​that are important for the assessment of career development:

1. Achievement: the use of one's skills and a sense of success.
2. Altruism: harmony with and serving others.
3. Autonomy: being independent and having a sense of control.
4. Comfort: feeling comfortable and not being stressful.
5. Safety: stability, order and predictability.
6. Status: recognize and fulfill a dominant position.

If these values ​​are met, an employee will soon be satisfied with his job. In addition, there are also environmental styles on a continuum that play a role in completing a profession:

• Celerity: the speed required to respond to requirements.
• Pace: the level of effort that must be delivered to the environment.
• Rhythm: the pattern of response to the environment: stable, cyclic or unstable.
• Endurance: whether the duration of the response to the environment is short or long-term.

The theory corresponds to the model of Holland as both are about matching personality traits to the factors of a job. The only difference is that this theory places more emphasis on the personal abilities necessary for certain professions and not so much on the skills.

Skills can finally be taught, it is important what level the person can achieve with the right training. From this theory a hypothesis has been used that is often used in research: the satisfaction of a person about a job is a function of the match between the available environmental factors with the values ​​of the individual, under the condition that the competence of the person corresponds with what is needed for the job.

Phase theories of career development

Donald Super had a more flexible, holistic, life-course perspective on career development. The individual self-concept changes with time and experience. Thus he identified five professional life stages, also known as the career ladder:

1. Growth phase: observing adult behavior and exploring fantasies and interests in adolescence.
2. Exploration phase: divided into fantasy, experimental, and realistic phases, in which the young adult tries out different training / education.
3. Establishment phase: divided into a trial and stabilization phase, in which the adult enters a company and establishes relationships and promotions.
4. Enforcement phase: the individual may need innovation, must update his skills and see his career stagnate.
5. Decline: the individual is already old and needs specialization, decoupling or retirement.

This theory shows that a career development is lifelong, but it is based on white middle or higher class citizens.

Social cognitive approaches

Social cognitive approaches assume that people learn and develop attitudes about work within a social context through observation and modeling behavior.

Krumboltz developed the 'Happenstance Learning Theory' (HLT). He states that "human behavior is a product of different learning experiences that are available through (un) planned situations in which people find themselves.

The learning outcomes are skills, interests, knowledge, attitudes, preferences, sensitivities, emotions, and future actions. According to him social injustice must be avoided. The theory is based on four premises:

1. Career counseling aims to help clients to learn actions so that their career and personal life is more satisfying, not to give a single career choice.
2. Assessments must be used to stimulate learning, not to match personal characteristics with professional characteristics. He therefore criticizes many tests.
3. Clients learn to use investigative actions so that they can successfully deal with unscheduled events, not to plan all their actions for improvement.
4. Guidance success is evaluated by what the client achieves in the real world, not what happens during the counseling sessions.

The theory is an activity-based theory in which the client and counselor work together to find out what the client can do to learn new things and to seize new opportunities.

O * NET in career development

The Occupational Information Network (O * NET) is a database website, sponsored by the US government, that contains information about thousands of jobs, such as the knowledge, skills and capabilities that are required. In addition, various assessment tools are available, which can also be filled in by yourself.

Tests for career assessment

A first test that is used is the 'Career Beliefs Inventory' (CBI), by Krumboltz. This measures and identifies the attitudes and beliefs that can hold back a career development. Often these are self-limiting beliefs. The CBI must give it awareness and the potential influence it has. The CBI consists of 96 items divided over 25 scales under the following five factors:

1. Your current career situation (4): work status, career plans, acceptance of uncertainty, openness.
2. What is necessary for your happiness (5): achievement / success, education, intrinsic satisfaction, equality to peers, structured work environment.
3. Factors that influence your choices (6): control, responsibility, approval of others, self-others comparison, vocational training variation, career path flexibility.
4. Changes you are willing to make (3): post-training transition, job experimentation, relocation.
5. Effort you are willing to initiate (7): self-improvement, continuing with uncertainty, taking risks, learning job skills, negotiating / searching, overcoming obstacles, working hard.

Standardization was done at 7500 people. Reliabilities were mixed: test-retests between .30 and .70. and internal consistency between .40 and .80. The CBI had an average construct validity.

Tests for interest assessment

Interest assessment is done because of two goals: life satisfaction and professional productivity. A good fit between interests and the chosen profession provides more satisfaction, which in turn leads to higher productivity. But the skills are also important. In other words: productivity = skill x interest.

Strong Interest Inventory-Revised (SII-R)

The SII-R is a revised version of the 'Strong Vocational Interest Blank' (SVIB). The assumptions of this test were:

1. Every profession has a desired pattern of interests and personality traits represented by the successful employees.
2. Every individual has stable interests and personality traits. So when these match those of the profession, the individual has a great opportunity to practice that profession and to be successful.
3. It is possible to distinguish individuals in a particular profession from other people on the basis of the desired pattern of interests and traits of that profession.

The SII-R is also based on these assumptions. But the test has been revised on the points that it is shorter; the current professions have been added; the level of business, technology and teamwork measurements are increased; work and leisure activities have been broadened; and the diversity of the US workforce has been reflected. The 291 items are based on the 6 professional types of Holland. The SII-R also gives five scales including the personal styles that reflect the lifestyle and work style:

1. Work style: high scores show interests in working with people; low scores with ideas, data and things.
2. Learning environment: high scores give preference to academic learning environments; low scores for applied learning activities.
3. Leadership style: high scores provide comfort in taking the lead; low scores indicate discomfort.
4. Risk taking / adventure: high scores give preference to risky and adventurous activities; low scores for safe and predictable activities.
5. Team orientation: high scores give preference for collaboration and teamwork; low scores for working alone and independently.

Reliability of the SII-R is good: test-re-tests of .90, but is lower in adolescents and when there is longer time between them. The validity is also reasonably good: two out of three people choose a 'right job'.

Vocational Preference Inventory (VPI)

The VPI measures a total of 11 dimensions. In addition to the 6 personality-environment dimensions of Holland, it also measures Self-control, Masculinity / femininity, Status, Infrequency, and Acquiescence. It is a short test of 160 items with yes / no questions.

The test-retest reliability is .89-.97. The properties of the standardization sample are not well defined and therefore the standards are somewhat difficult to interpret. The validity is very good, the test is very similar to the model of Holland.

By means of the VPI Holland's theory could be applied to many professions, so that for many professions a three-letter Holland code was created, such as a landscape architect RIA and a real estate trader ECS. This can also be applied to university masters.

Self-Directed Search (SDS)

The SDS measures the 6 RIASEC themes on 4 scales with dichotomous items: Activities, Competences, Occupation and Self-estimates. When the SDS is scored, the three highest themes are transformed into a Holland code. The SDS is mainly digital, which has the advantage that it is fast and simple and that no one is required to score, interpret or give feedback. Both the construct and the predictive validity are supported by different studies.

Campbell Interest and Skill Survey

The CISS consists of 200 interest items and 120 skill items given by a person on a 6-point scale. Interest items include professions, school subjects and work activities and the skill items include activities that are assessed on 'expert in this area' to 'no experience'.

The CISS is scored on various scales, including an Orientation scale that compiles the profile using 7 orientations: Influence, Organization, Helping, Creating, Analyzing, Producing, and Adventuring. The other scales are: Basic interests and skills Scale, Professional scales, Special scales, and Procedural checks.

The reliability is very strong; most scales have a test-retest of .80. The validity of the CISS is also confirmed by various correlation studies. So it is a useful tool, especially because it is digital and you can interpret it yourself. The book contains examples of the results of the CISS. The CISS will be a rival for the SII-R.

Where lies the future of psychological testing? - Chapter 12

Topic 12B Computer assessment and the future of testing

Computers are currently used in almost every aspect of assessment, including the administration, scoring and interpretation of many tests. The psychologist can even put the client behind a computer with the only instruction: 'follow the instructions'. Minutes later, a detailed report with a summary of the results and interpretation is rolled out.

Use of computers during testing

During the entire process of the assessment, a person does not have to interact, when computer assimilation is used. The term here is computer assisted psychological assessment (CAPA). Computers are used for designing tests, interpreting results, writing reports, and presenting test stimuli.

Current status of computer-based test interpretation

Computer-based test interpretation (CBTI) refers to the test interpretation and report writing by a computer. CBTI is available in four ways: scoring reports, descriptive reports, actuarial / statistical report, and a clinical report. Every major test provider offers computer-based interpretations.

A scoring report consists of the achieved scores or profiles on a test. It also contains statistical significance tests and confidence intervals, but never a narrative text or explanation of scores.

A descriptive report goes a step further and gives a short interpretation of the test results per scale. It provides valuable information in less than half a page. It is especially useful for people in healthcare who do not understand the test. In this way they can still use the results.

Statistical report: clinical vs. actuarial prediction

The statistical report is based on empirical relationships between test results and the determined criteria. It gives predictions about the person being tested. There is an important difference in computer predictions between clinical and actuarial / statistical judgment. In the clinical judgment, the decision-maker processes the information in his / her head to subsequently give a diagnosis, classification or prediction of behavior. Use is made of experience, intuition, or knowledge.

In the actuarial judgment, an empirically derived formula is used to give a diagnosis, classification, or prediction of behavior. A comparison is made between scale scores and a research-based formula.

An actuarial judgment is not the same as a computer judgment, although computers use the statistical judgment. Meehl first made the difference between the two: "when do we use our head instead of the formula?" In order to make a fair comparison between the two approaches, two conditions are needed. First, both methods must be based on the same data. Secondly, conditions must be avoided that artificially increase the accuracy of the statistical method. This shows that the statistical method often has a better predictive validity than the clinical method, although this is not significant. Both methods are good and support the idea that "the best predictor of behavior in the future is the behavior of the past."

Actuarial interpretation: sample approach

Actuarial interpretation uses empirical correlations between individual scales and important non-test criteria. For example, it can be used with the PIC-2. In the first phase, the child's descriptions are correlated with the 20 scales of the PIC-2 to recognize significant scales. In the second phase, the significant correlations are further analyzed to compare with T scores. Then it becomes clear where the significant problems are.

Computer-assisted clinical reports

The interpretation of the test results is based on the judgment of one or more clinical experts. Their clinical thoughts are transformed into a computer code. The advantage of the clinical method is that all test profiles can be interpreted, while in the statistical method some profiles cannot be interpreted when they are used in a new setting / population, for example. Then it can happen that many test profiles are missed, because they do not fit the formula, while they actually do meet a certain profile.

Interactive video, virtual reality and smartphones

Interactive videos can now be used for assessment. It is especially useful in career assessment, because you better see how someone reacts to complex, realistic events than with a pen-and-paper test. An example of such a test is the Conflict Resolution Skills Assessment (CRSA), consisting of 9 scenes that reflect conflicts. The client must at some point choose from a number of options what he would do in that situation. Then the scene continues.

However, it is difficult and expensive to develop such tests because they also have to be realistic. In addition, the theory is also unclear: when do you have good conflict solving skills? Nevertheless, such tests explain more variance and show that social skills are independent of intelligence, which has always been demonstrated in traditional tests. This is due to the shared method variance.

Virtual reality (VR) is a human-computer interaction, through which a person can navigate and manipulate a virtual 3D environment (VE). This type of research is still in its infancy, but is promising. It has good ecological validity, given the realistic issues. An example of such a test is the 'VE Grocery Store test'. It is a good test for executive functions. One has to navigate through a virtual green store, then search for the right products, and select and price them. A memory task is also done. The pen-and-paper tests that measure executive functions are often not everyday actions and shopping is. The researcher can adjust the packaging, environment and background noise in the test. This ensures a higher ecological validity.

Another test is the Virtual Reality Lateralized Attention Test (VRLAT). The participants must walk over a number of virtual paths and indicate which objects they see. This test measures and classifies symptoms of 'hemispatial neglect', a right hemisphere abnormality in which the spatial skills are greatly reduced. Research shows that VRLAT has a strong sensitivity and specificity, requires little exercise and has strong validity. To measure the collision, the clients had to walk through a maze with several turns to the left and to the right. The number of collisions is then measured.

Evaluation of computer-based test interpretation

The first advantage of computer-based test interpretation is that the time between testing and the report is virtually zero. It saves a lot of time for both the client and the test taker. The total cost is the second advantage. These are less high than when the whole process is done with the effort of a clinician. The third advantage is reliability and objectivity. They are not subject to human biases.

A disadvantage is that the whole process is dominated by the computer. The human contribution of the psychologist only has a serving function. In addition, it is possible that the original and the computer version of a test is almost no longer equivalent. Then the computer version is much more difficult, which is not good for the validity.

Computerized adaptive testing

Computerized adaptive testing (CAT) are procedures that accurately and efficiently measure skills. Most methods contain the following characteristics:

1. The item response characteristics are precisely valued (% strokes vs. skill).
2. These item response characteristics and the item selection are programmed in the computer.
3. The history of the responses is used in selecting the next item.
4. The computer recalculates the estimated skill after each response.
5. The computer estimates the precision of measurement after each response.
6. Testing continues until a predetermined level of measuring precision has been achieved.
7. The participant's skill score is based on the level of difficulty and other measurement characteristics, not on the correct number.

The advantages of CAT are precision and efficiency. CAT guarantees that every participant is measured with the same amount of precision. Second, the CAT method requires far fewer items than traditional testing. In addition, CAT is better because of the test safety, direct scoring and feedback, the same challenge, presenting new items and many different question types (multiple-choice, open, video questions). However, for personality tests, CAT is not good to use because context effects can occur due to different questions.

Future of testing

In the future, biological measurement methods, such as EEG, MRI or PET scans, will increasingly be used for assessment in the normal population. This will also cause fear, because biological factors cannot be influenced and are permanent. The fear is then a fear of a biological caste system.

A first use that is more likely to occur is for the the measurement of people with brain surgery. Another prediction is that fewer broad-spectrum tests will be developed because of the too high costs and because people are often only interested in certain specific functions.

A third prediction is that less and less wide-spectrum tests and more tests aimed at special areas of functioning or special target groups are being spent purely for economic reasons.

A fourth prediction is that more use will be made of evidence-based assessment, where the validity of a test is determined not only by reliability and validation, but also by the clinical utility. In addition to the treatment utility (good outcomes of treatment), the clinical benefit also refers to the financial costs. There must be a balance between costs for the assessment and costs for the treatment.

Third, it refers to psychological costs, when someone is misdiagnosed, for example. Finally, it refers to the client's acceptability.

As a final prediction, positive psychological assessment is becoming more and more common. This stems from the field positive psychology, which examines what is right with people. It is a spin-off of the positive psychology movement that was focused on the optimal functioning of humans.

Smartphone revolution

Smartphones have the potential to be useful for psychological testing because they have such a fast processing speed. All kinds of behavior can be determined through apps. Short questionnaires can also be made. Problems, however, are that there is no true 'informed consent', because everyone always accepts the conditions without reading. In addition, confidentiality is difficult to guarantee because of hackers. At last, the technology grows so fast that updates are always needed. For older researchers, the use of a smartphone will be trickier, because they are less familiar with it.

As the last vision of the future, the big questions in psychology are changing. Psychological testing can play a greater role with these developments in issues such as the nature / nurture debate. Other issues are how evolution has played a role in developments of a personality. The final issue raises the idea of ​​whether we can improve our physical health by changing our social networks. You see this through correlational (not causal!) Research in which certain networks have more positive health outcomes. All in all: what will be the role of psychological testing in the future for answering the big questions?

How can behavioral problems be diagnosed? - Chapter 11

What is behavioral and personality diagnosis?

The attribution of behavior to other people is an informal evaluation that happens automatically. Through this evaluation, someone knows who he or she does not want to deal with. With behavioral diagnosis, the typical response of a person in a given situation is examined. Behavior diagnosis assumes that observable behavior represents the feelings and thoughts of a person. These observations are then generalized to the everyday life of a person. On the basis of this, it can be seen whether someone has a problem with, for example, fears, aggression or hyperactivity. The difference between behavioral and personality diagnosis is that personality diagnosis looks at what a person has (attributes or characteristics such as anxiety); behavioral diagnosis looks at what a person does. However, self-reporting is not seen as an objective way of measuring. Behavior diagnosis is found to be more objective because behavioral assessment scales generally do not ask for subjective interpretation. Behavioral and personality diagnoses, however, also have overlaps and are often used both - it is important to know how people typically behave and how they think and feel about themselves.

What are response sets in behavioral diagnosis?

Chapter 10 already revealed that a response set is an (unconscious) positive or negative answer to an item. As a result, the true characteristics of a person can be misinterpreted. Response sets also occur in behavioral diagnosis and can lead to a reduction in validity. If the participant answered in this way, the results on a test do not represent the construct that the test actually measures. To prevent a reduction in validity, behavioral tests include validity scales that can detect the presence of response sets. Later in this chapter and in chapter 17 we will go deeper into response sets.

What behavioral diagnosis is there in schools?

According to the law, schools are obliged to provide special services to students with emotional disorders. To identify students with such disorders, behavior and personality in schools is measured using various instruments. Of the top 10 tools that school psychologists use, there are 5 behavioral assessment scales, 4 projective techniques and 1 instrument based on self-reporting. This distribution is representative of the tools that school psychologists use in a child who is thought to have an emotional or behavioral disorder. Behavior diagnosis in schools is often done by an expert in collaboration with teachers. Teachers have insight into the (in) consistency of a child's behavior. Teachers also see the behavior of the child in different circumstances.

What is a behavioral interview?

A traditional clinical interview starts with a broad question such as 'How can I help you?' or 'Why are you here?' After this, the clinician tries to understand the psychodynamic characteristics of the interviewee. A Conversely behavioral interview focuses on the antecedents (precursors) and consequences of specific (problem-)behaviors and on the attempts already made to change behavior. We also look at the relevant ratification (what encouraged behavior?). The behavioral interview consists of six steps:

• The problem is described and defined in terms of behavior.
• Possible events that confirm the relevant behavior will be evaluated. We also look at which steps have already been taken to change.
• A plan is being developed to change these possible events and reinforcers. The behavior can be adjusted on the basis of this.
• The interviewee carries out the plan.
• The outcomes of the treatment are evaluated.
• The treatment is adjusted if the behavior has not changed. Then the outcomes of these changes are evaluated.

Which behavioral assessment scales are there?

Behavioral rating scales have become increasingly popular in the last twenty years. On a behavioral assessment scale, a person is assessed in different domains. In a child or adolescent, it is usually the parents or a teacher who assesses the child. An adult is usually assessed by a partner or adult child. The assessor must indicate how well certain sentences fit the person being assessed. An example is that a mother must indicate whether her son is 0 - rarely or never, 1 - sometimes, 2 - often, or 3 - almost always tells lies.

An advantage of behavioral assessment scales in children is that parents know the behavior of their child in different circumstances. If a clinician wants to gather information from different perspectives, he will have the behavioral assessment scale filled out by both parents and teachers. In this way the behavior of a child is highlighted from different perspectives. The presence of rare behavior, such as arson and animal abuse, can also be identified through behavioral assessment scales. The presence of this behavior can be overlooked in a clinical interview. Furthermore, children can find it difficult to accurately tell their own feelings and behaviors, for example due to insufficient insight into their own behaviour or reduced verbal skills.

A disadvantage of behavioral rating scales is that they are sensitive to response sets. For example, a teacher may exaggerate a student's problematic behavior to ensure that the student receives special education. Furthermore, behavioral assessment scales cannot measure internalizing problems such as depression and anxiety, because they are not directly observable. The assessment of behavior is impressionistic: based on the impressions of the person filling in the scale. In other words: the items on behavior rating scales are interpretable in several ways. Options that an assessor can choose from an item such as rarely, sometimes, often or almost always, can be interpreted in different ways by different people. However, research into the reliability of behavioral assessment scales shows that they are a good predictor of future behavior and learning problems. Changes in behavior can also be well investigated and the best intervention can be determined to change behavior. Below are the most popular behavioral assessment scales for children and adolescents.

Behavior Assessment System for Children - Second Edition

The Behavior Assessment System for Children - Second Edition (BASC-2) is an instrument that can be used for children between 2 and 21 years of age. The BASC-2 consists of a Teacher Rating Scale (TRS), a Parent Rating Scale (PRS), self-reporting, a class observation system, a Parenting Relationship Questionnaire and a structured history of the development of the child. The BASC-2 consists of 16 subscales that measure, among other things, aggression, fear, depression, leadership, social skills and study skills. When interpreting the scores, the testmakers advise to use a "top-down" approach, where the clinician starts at the most global level (the behavioral symptoms index BSI) and works down to the more specific levels, (starting with internalizing problems, externalizing problems, school problems and finally adaptive skills).

Today, the TRS and PRS are the most common behavioral assessment scales in schools. The TRS provides a clear representation of the school-related behavior of the child, while the PRS reflects the behavior of the child at home and in society. The TRS and PRS contain characteristics that make them unique in use. For example, they contain validity scales with which the presence of response sets can be noticed. A second characteristic is that the TRS and PRS measure a broad spectrum of negative as well as positive and adaptive behavior. Before the BASC was developed, behavioral assessment scales were often criticized for the fact that they mainly measured negative behavior and pathology. A final unique characteristic is that the TRS and PRS offer three standard comparisons, which can be chosen depending on the clinical focus: a national sample, a gender-specific national sample, or a national sample with children who already have a diagnosis and receive treatment

Achenbach System or Empirically Based Assessment

The Achenbach System of Empirically Based Assessment (ASEBA) consists of the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), self-reporting and a direct observation system.

There are two forms of the CBCL, one for children from 2 to 3 years and one for children from 4 to 18 years old. The TRF is suitable for children from 5 to 18 years old. The CBCL and TRF are among the most commonly used psychological tests in schools and consist of two basic components. The first part deals with activities and competences of the child in the areas of recreation, social functioning and school. The second part consists of items about problem behavior to which an assessor must give his / her opinion. The subscales of the CBCL and TRF measure, among other things, social problems, attention problems, delinquent behavior and somatic complaints. The CBCL and TRF offer three composite scores: total behavioral problems, externalizing problems (delinquent behavior, aggressive behavior) and internalizing problems (withdrawal, somatic complaints, anxiety and mood complaints). Advantages of the CBCL and TRF are that they are easy to use and easy to score with the aid of computer software. They are also useful in both clinical and research areas.

Omnibus and single-domain assessment scales

The TRS, PRS, CBCL and TRF are called omnibus assessment scales. This means that they measure a wide range of symptoms and behaviors associated with different emotional and behavioral disorders. The most ideal omnibus rating scale measures both internalization (anxiety, depression) and externalization (hyperactivity, aggression). Measuring both internalization and externalization is especially important in children and adolescents because there is a lot of comorbidity in this population. Comorbidity means that a person has at least two disorders at the same time. If a scale only measures internalizing behavior, externalizing behavior is not noticed and the diagnosis is not complete. An incomplete diagnosis then leads to inaccurate treatment.

Single-domain (syndrome-specific) rating scales are focused on a specific disorder or behavioral dimension. Single-domain assessment scales provide a more in-depth diagnosis of a particular domain than omnibus scales, and can be well used in the diagnosis of, among other things, ADHD and depression. A few single-domain assessment scales are briefly discussed below:

• The Childhood Autism Rating Scale (CARS) is suitable for diagnosing autism in children from 2 years of age. The scale consists of 15 items and the results on the items also indicate the severity of autism.
• The BASC Monitor for ADHD has been developed for children and adolescents between the ages of 4 and 18 with ADHD. The BASC Monitor is intended to make the treatment of ADHD easier. The test consists of two parts with 45 items each. One part is filled in by the teacher, the other part by the parents. The subscales that come from the BASC Monitor are Attention Problems, Hyperactivity, Internalizing Problems and Adaptive Skills.
• The Pediatric Behavior Rating Scale (PBRS) is intended to identify the first symptoms of bipolar disorder and to exclude disorders with similar aspects. The PBRS consists of a scale for teachers (95 items) and a scale for parents (102 items) and is suitable for children between 3 and 18 years old. The PBRS results in subscales such as Affect, Impulsiveness, Aggression and Grandeur.
• Assessment scales of adaptive behavior. A special type of syndrome-specific scale has been developed to measure adaptive behavior. Adaptive behavior is a collection of conceptual, practical and social skills. Conceptual skills include literacy, being able to read the clock and being able to use money. Practical skills include self-care and cleaning the house. Interpersonal relationships and the ability to comply with rules and laws are covered by social skills. Such are rated by the Vineland Adaptive Behavior Scales - Second Edition (Vineland-II). The Vineland-II exists in three forms: an interview, a rating scale for the parents, and a rating scale for the teacher.

For the initial diagnosis (screening and assessment), omnibus scales such as the BASC-2 and CBCL should always be used first before a syndrome-specific rating scale is used.

Adult Behavior Assessment Scales

So far, only behavioral rating scales for children and adolescents have been discussed because they are more prevalent in schools and clinical areas than adult behavioral scales. However, it is expected that these scales for adults will increase. The Clinical Assessment Scales for the Eldery (CASE) is an example of such a scale. It is an omnibus rating scale for people between 55 and 90 years old. The assessor is an adult child or partner of the assessed person.

There are many differences between assessment scales for adults and rating scales for children and adolescents. One difference is that the CASE contains, among other things, a Fear or Aging scale that measures depressive symptoms in adults. The CASE also contains a Cognitive Competency scale that evaluates intelligence and related neuropsychological skills. Another scale that is usually not measured in children and adolescents is the Substance Abuse scale. The Substance Abuse scale measures the abuse of drugs and prescribed drugs, as this is relatively common in the adult population. But why do not most rating scales for children and adolescents have a scale with regard to substance abuse? Adolescents between the ages of 13 and 18 abuse many psychoactive substances, but often do so in secret. An assessor often does not know anything about the abuse, so the outcome of the scale indicates that the assessed adolescent is not abusing funds. Clinicians can therefore draw the wrong conclusion that there is no substance abuse.

What does direct observation mean?

Direct observation of behavior is the oldest method of behavioral diagnosis and is still used worldwide. In direct observation, an individual is observed in his natural environment, such as at school or at home. Usually the individual does not know that he or she is being observed. Yet it is difficult to get an accurate sample of typical behavior, because observing always ensures a degree of change in behavior. With direct observation it is important that the observer is objective and the behavior counts and scores accurately.

The most used and popular system for direct observation is the Student Observation System (SOS). The SOS is part of the BASC-2 and measures 14 standardized dimensions of behavior. The SOS measures both negative and positive behavior and can be used in any structured learning environment. The 14 dimensions of behavior have a high interrater reliability. The SOS uses momentarily time sampling (MTS) to ensure that the entire spectrum of behaviors (both adaptive and unadapted behavior) is noticed. In the case of an MTS, a child is observed for a fixed period in the classroom, and the assessor on the assessment form will address the behaviors he / she has seen. This is done again after a certain time (for the same time period).

What are continuous performance tests?

Continuous Performance tests (CPT) are specific behavioural tests that were originally developed to measure alertness, sustained and selective attention and executive control. A CPT is conducted with a computer. The individual is instructed to respond to certain stimuli that appear on the image and ignore certain stimuli. The tasks are usually simple so that factors such as general intelligence do not affect the results, but can be made more complex. CPTs are very sensitive for identifying disorders in self-regulation where attention, concentration and response-inhibiting systems are affected (as in the case of ADHD). CPTs provide unique performance-based information on executive control systems. CPTs do not correlate highly with behavioral assessment scales (where behavior is observed).

What is psychophysiological diagnostics?

Psychophysiological diagnostics is a way of behavioural assessment in which physical changes in the body are measured during a certain event. A lie detector is an example of a psychophysiological test. A lie detector measures heart rate, respiration and perspiration. Many psychophysiological tests are not accurately standardized and therefore not suitable for clinical use. The EEG, on the other hand, is a widely used and valid form of psychophysiological testing. It is expected that psychophysiological diagnostics have a lot to offer in the future.