Assessment of Behaviour - Essay Example

Psychological Assessment Report Client’s Particulars S. Jones Gender: Female D.O.B 27/3/1961 Assessment: Examiner’s Sandra Smith Date of Report: Reason for Referral: The client has been seeing with the school psychologist 3 ½ weeks ago and she was referred to Dr. Smith. The reason for referral was not disclosed to the patient but assumed that she was referred to another psychologist due to her problems regarding her studies. Mrs. Jones was referred for cognitive and personality assessment. The cognitive test will be assessing her strengths and weaknesses with her thinking by the use of the WAIS IV, and strengths and weaknesses regarding her personality will be assessed as well. Informed Consent and Assessment Protocol: Dr. Smith had informed the regarding her rights as well as the limits of confidentiality. She had agreed to the policy and gave her consent by attaching her signature on the informed consent form. A copy of this assessment will be forwarded to her referring physician for the client’s benefits of treatment. Interview and assessment were done to have knowledge about the client’s current issues and provide suitable therapeutic management for the wellness of the patient. During the interview, the client’s information about her personal background, past medical history, family history, social history, educational background, employment history, and psychiatric history were gathered. History Taking Interview: This case illustrates the behavioural assessment of a client who had consulted a psychologist and was interviewed regarding her complaint which is anxiety. This is a case Mrs. Sue Jones, 50 years old, born on March 27, 1961, female, married, 3rd year BS Accountancy student but working part time as a receptionist, from Australian culture, and was referred by the campus psychologist to a professional psychologist, Dr. Sandra Smith. According to the client, she had been having problems with her studies and that her concentration and focus span had decreased. She started off with good marks of 5s but since last semester, her marks had been dropping and she barely passed. Her sleeping hours are disturbed when she awakens about 3 in the morning in which she is bothered with her thoughts of anxiousness and nervousness about her problem. She does not take any medications for this. When asked about her childhood, she stated that she was often bullied during grade 3 and 4 but that experienced had stopped before she graduated primary school. When she was 18 years old, she had drunk alcohol from 1 to 2 drinks which increased up to a bottle. The drinking had continued to increase when she met her husband who is a rum drinker. Because of this, she had been sick and was brought to hospital for gastric lavage. She decided to stop and bring her habit to a minimum since she wanted to have a family. Her financial situation is stable in that her husband is growing his own company. Her interview had revealed that she has been taking 3-4 cups of coffee daily in which this must have contributed to her waking hours during the sleep and increased anxiety level. As regards to her family, she had been proud to stay in a 30-year relationship. She described their marriage as generally being good and happy with some ups and downs. She has two little girls aged 13 and 11 years old. With her schooling, she decided to take up Accountancy since her husband has a business and she intended to help him and in addition to the fact that she does not like her work very much. With her current situation, she describes herself as a little bit of worrywart. When asked about her trust on her physician in addressing all the issues that had been bothering her, she stated that she might know what is going on with her and feeling confident that she will be able to help her with her condition. Presentation and Behavioural Observations: The client presented to the interview with appropriate grooming, of average height and built, and with good hygiene. Regarding the client’s thought process, she answers questions directly. Initially, she does not elaborate much but as the interview went on, she became at ease with the psychologist and opens herself more. Flow of thought is coherent. She did not exhibit any formal thought disorders. No neologisms, word salad or echolalia. She expresses her feelings of anxiety on her studies and worrying a lot about everything. No expressions of suicidal ideation. No delusions. She exhibits normal perception. There are no signs of any types of hallucinations, pseudohallucinations, or illusions. She is aware and alert of what is happening. She is oriented to time, place and person. Concentration on her studies as described by the client is decreased but all throughout the interview, she seems to be attentive to the physician. Memory is good for immediate, recent, and remote recall. She was at first anxious on her meeting with the psychologist but as the interview proceeded, she felt more relaxed and opened herself up. Signs of anxiety exhibited by the client include constant moving of her hands, touching or playing with hair, and looking somewhat stiff in sitting. She also started to talk in low volume and does not elaborate much on her answers. With a friendly approach from the psychologist, the client had felt relaxed and slowly opened about herself. Client has recognized that there is something wrong since her marks had been tapering down. She is cooperative with the requests of the psychologist such as gaining access on her previous psychological check up regarding information about what she was being treated for, strategies utilized which might have helped her to alleviate her condition and some other things which could be of help to her current situation. She is feeling confident that the current management on her condition will be able to address the issues that she is facing with her anxiety. She is positive that the physicians will be able to help her with her condition. Assessment Results: Cognitive Ability The Wechsler scales have been very useful with regard to neuropsychological assessment and evaluation and to cognitive neuroscience including its role in clinical, counseling, school, and forensic psychologists. The basic composition of WAIS IV comprises 15 subtests formed into 4 index scales pertaining to various cognitive domains: verbal comprehension, perceptual reasoning, working memory, and processing speed. Each domain has core subtests which are utilized to deduce the composite scores. Furthermore, supplemental subtests are given aside from the core subtests in order to allow further clinical data, or given in replacement of core subtests if they become invalid. The core subtests under Verbal Comprehension Scale are Similarities, Vocabulary, and Information. Supplemental subtest includes Comprehension. Perceptual Reasoning Scale has core subtests of Block Design, Matrix Reasoning, and Visual Puzzles and the supplemental subtests are Figure Weights and Picture Completion. Furthermore, Working Memory Scale Core subtests comprise of Digit Span and Arithmetic with supplemental subtest of Letter-Number Sequencing. Lastly, the Processing Speed Scale contains core subtests of Symbol Search and Coding with supplemental subtests of Cancellation. Under the verbal comprehension scale, the Similarities subtest assesses development of verbal concept, abstract verbal reasoning, categorical thinking, and the ability to recognize difference of essential and non-essential characteristics. The Vocabulary subtest which basically consists of verbal and picture items assesses verbal concept formation, language development, word knowledge, and long-term memory recall. Information subtests measures stored knowledge, long-term memory and recall, verbal comprehension, and crystallized intelligence. Comprehension supplemental subtest evaluates verbal conceptualization, verbal expression, practical knowledge, social judgment, crystallized intelligence, and common sense. Next, with regard to Perceptual Reasoning subtests, Block Design assesses non-verbal reasoning, analysis and synthesis, visual perception and organization, and visual-motor coordination. Matrix Reasoning on the other hand, evaluates fluid intelligence, visuospatial ability, simultaneous processing, and perceptual organization. The Visual Puzzle was designed as non-motor task which measures perceptual reasoning, visuospatial ability, analysis and synthesis, and simultaneous processing. Supplemental subtests such as the Figure Weights assesses fluid reasoning i.e. quantitative and analogical reasoning. Picture Completion measures visual perception, perceptual organization, and attention to visual detail. The next scale is the Working Memory. Digit Span measures working memory, attention, auditory processing, and mental manipulation. The Arithmetic subtest evaluates working memory, mental manipulation, attention, concentration, sequential processing, and numerical reasoning. The supplemental subtest for Letter– Number Sequencing measures working memory, mental manipulation, attention, concentration, and short-term auditory memory. Lastly, the Processing Speed subtests include Symbol Search which assesses visual-motor processing speed, short-term visual memory, visual discrimination, attention, and concentration; and Coding which evaluates visual-motor processing speed, short-term visual memory, learning ability, cognitive flexibility, attention, concentration, and motivation . The supplemental subtest of Cancellation assesses visual-motor processing speed, visual selective attention, and visual neglect. From each subtest, the examiner can derive a score which is scaled to a metric with a mean of 10 and a standard deviation of 3. The totality of scaled scores for the subtests within a domain is employed to deduce the representing index score. For instance, the total of scaled scores for Similarities, Vocabulary, and Information is used in most situations to derive the VCI. Index scores are categorized according to Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). Furthermore, when each score in each core subtests in all of the four domains, the Full Scale IQ (FSIQ) is derived. All of the composite scores, including the index scores and the FSIQ are scaled to a metric with a mean of 100 and a standard deviation of 15. Aside from these primary scores, there are other possible scores to be deduced. Scores at subtest level gives additional information on an individual’s performance based on each specific subtest such as the Block Design and Digit Span. At index level, the General Ability Index (GAI) is considered as an optional index score which comes from the total of scaled scores for the core Verbal Comprehension and Perceptual Reasoning subtests, and as a consequence, a composite which is not so much affected by the demands of working memory and processing speed as compared with FSIQ. A lower result on WM and PS tasks lowers the FSIQ as given by many learning-disabled students, which lessens the size of difference between ability and achievement in which the GAI may be used to determine and analyse the discrepancy in order to establish qualification to special education. Next, is the Cognitive Proficiency Index (CPI) which sums up functioning on the Working Memory and Processing Speed Indexes. WAIS-IV CPI does not include the performance results from verbal comprehension and perceptual reasoning. Therefore, CPI and GAI provide distinct perspectives of an individual’s intellectual abilities if there is significant variance with the relevant index scores. Generally, scores from both perspectives is needed to establish a complete image regarding the individual’s strengths and weaknesses. For the overall sample, 15 point differences may be an adequate rule of thumb for interpretable findings. Prior to interpretation of GAI, CPI, or their difference it must be ensured that there are no big differences between VCI and PRI or WMI and PSI. If such occurs, each of the four index scores is analyzed separately. For the client’s assessment of her cognitive functioning, the Wechsler Adult Intelligence Scale was used. Scores measured and interpreted include composite scores composed of scaled subtests, and indexes of the four scales including the Full ScaleIQ and their corresponding qualitative descriptions; index score discrepancies; and ipsative discrepancy scores. Table 1 below shows the subtest raw and scaled scores which was interpreted using table A.1 of WAIS-IV Administration and Scoring Manual. Using the scores for each subtest administered which are similarities, vocabulary, and information under which are under verbal comprehension scale; block design, matrix reasoning, and visual puzzles under the domain of perceptual reasoning scale; design span and arithmetic to test the client’s working memory; and symbol search and coding for processing speed scale, her cognitive functioning can be assessed. Table 1. Scaled Scores of Subtests Subtest Subtest Raw Score Subtest Scaled Score Verbal Comprehension Scale Similarities (SI) 26 10 Vocabulary (VC) 46 12 Information (IN) 15 10 Comprehension (CO) Not administered NA Perceptual Reasoning Scale Block Design (BD) 41 10 Matrix Reasoning (MR) 16 10 Visual Puzzles (VP) 13 9 Figure Weights (16-69) (FW) Not administered NA Picture Completion (PCm) Not administered NA Working Memory Scale Digit Span (DS) 24 8 Arithmetic (AR) 13 9 Letter-Number Sequencing (LNS) Not administered NA Processing Speed Scale Symbol Search (SS) 22 7 Coding (CD) 46 6 Cancellation (CA) Not administered NA As summarized in Table 2, Mrs. Jones obtained a total FSIQ scaled score of 91 with an age-corrected score of 94 and a corresponding description of average, while she was evaluated to belong to low average in processing speed index. Her verbal comprehension score is highest at 103 and lowest at processing speed with 81. Except for processing speed, her general criteria fall on average. Her low score on processing speed index is consistent to the interview with the client in which she stated that her attention and concentration spans have been shortened as what is measured by this domain. Table 2. Composite Score Summary (FSIQ and all four factor indices) Sum of scaled score Age-corrected score %ile Rank 95% Confidence Interval Qualitative descriptor Verbal Comprehension (VCI) 32 103 58 97-109 Average Perceptual Reasoning (PRI) 29 98 45 92-104 Average Working Memory (WMI) 17 92 30 86-99 Average Processing Speed (PSI) 13 81 10 75-91 Low Average Full Scale IQ (FSIQ) 91 94 34 90-98 Average Table 3 below shows the discrepancy analysis measures the differences among the client’s abilities. A score from the difference of paired factors are used to determine if the difference is significant or otherwise. From the corresponding critical values at 0.5 level on Table B.1, it can be deduced that paired factors including VCI-WMI, VCI-PSI, and PRI-PSI are significant since the difference scores between them falls above their critical values. Meanwhile, difference of paired factors such as VCI-PRI, PRI-WMI, and WMI-PSI are considered not significant. Scores that are significant are compared with the frequency of occurrence in the population. VCI-PSI has a difference score of 22 which is significant with a base rate of 8.4% which occurs rarely in less than or equal to 10% of the population. Likewise, PRI-PSI has a difference score of 17 with a normative sample of 12.1 and VCI-WMI has difference score of 11 with normative sample of 19.7. Both of which can be concluded that difference scores are significant but are not unusual to have such difference since it may occur in greater than 10% of the population. Table 3. Index Score Discrepancy Summary for FSIQ between 90-109 Comparison Index Score #1 Index Score #2 Difference Score Critical Value at .05 Significant Difference Yes/No Base Rate (Normative Sample) VCI-PRI 103 98 5 7.78 No - VCI-WMI 103 92 11 8.31 Yes 19.7 VCI-PSI 103 81 22 11.76 Yes 8.4 PRI-WMI 98 92 6 8.81 No - PRI-PSI 98 81 17 12.12 Yes 12.1 WMI-PSI 92 81 11 12.47 No - Table 4. Ipsative Discrepancy Score Summary Subtest Subtest Scaled Sore Mean Scaled Score Difference Critical Value at .05 level Significant Difference Strength/ Weakness Base Rate (Normative sample) Similarities 10 9.1 0.9 2.82 - - Vocabulary 12 9.1 2.9 2.03 Strength 5% Information 10 9.1 0.9 2.19 - Block Design 10 9.1 0.9 2.85 - - Matrix Reasoning 10 9.1 0.9 2.54 - - Visual Puzzles 9 9.1 -0.1 2.71 - - Digit Span 8 9.1 -1.1 2.22 - - Arithmetic 9 9.1 -0.1 2.73 - - Symbol Search 7 9.1 -2.1 3.42 - - Coding 6 9.1 -3.1 2.97 Weakness 7.5%-10% The Ipsative Discrepancy Score which is shown on Table 4 measures what particular subtests the client exhibits to be her strength or weakness. At 0.5 level of significance, the critical value for vocabulary is 2.03 which can be considered as Mrs. Jones` strength. Meanwhile, at 0.5 level of significance, the critical value for coding is 2.97 which can be concluded as her weakness. Personality Evaluation The 16 Personality Factor (16 PF) Questionnaire is a comprehensive assessment of normal personality which is used in any context which requires a thorough and integrated picture of an individual. The 16 PF was structured with 16 primary traits constituting the five global factors or Big Five which can be used to assess the broadest level of personality. The test has been subjected to various empirical researches which had been currently providing a well-established theory regarding individual differences and with its ability to give signs and predict an extensive diversity of important behavioural characteristics. At present, the 16PF has been utilized to anticipate signs of leadership, creativity, conscientiousness, social skills, empathy, self esteem, power dynamics, and coping patterns. The 16 PF Fifth Edition is composed of 185 multiple-choice items that are written at a fifth grade reading level. The examination is taken for approximately 35 to 50 minutes for an individual to complete the test in paper-and-pencil format or 25 to 30 minutes by administration through a computer. The test assesses scores from 16 primary factor scales, five global scales, and three validity scales. One unique feature of the 16 PF Questionnaire is that test questions tend to represent a wide scope of normal behaviour by asking the testing individual regarding concrete circumstances or behaviours. The global level of personality gives a general summary of the most basic level of functioning. However, the global factors can still be categorized into their corresponding and more specific primary factors in order to provide a more refined and deeper picture of the individual thus providing a basis for stronger predictors of actual behaviour (Hersen, 2004). With its functionality however, there are some disadvantages that can be ascribed to this type of personality examination. Several of its weakness includes a brief cognitive ability scale (Reasoning B), self report assessment figures can be falsified since some of the scales (L, M, N, Q1) do not correspond well with the old scales which had much smaller internal consistency, and as a consequence of homogeneity, scale interpretations will be limited than in previous forms such that further validation reports with the use of bigger samples are necessitated. All of the 16PF personality scales are bipolar meaning behaviours on each end of each scales are extremes. Scores on the 16PF personality scales are provided in “standard-ten” or sten scores, which are rated from 1 to 10, with an average of 5.5 and standard deviation of 2. A large score on a scale is not expressed as good, which is similar with a low score not regarded as bad. Instead, a score toward either end of the scale increases the possibility that the trait defined by the pole will be evident and typical in the client’s behaviour. The positive and negative effects of such behaviour are beyond the scope of the test since it depends on a particular setting. High score on a primary scale is indicated by a positive (+) sign while a low score is indicated with a negative (-) sign. In addition, sine global scales were formed via factor analysis of the primary scales, the primary scales may provide to global scales in a positive or a negative direction. The global scale Extraversion is composed of the primary scales Warmth (A+), Liveliness (F+), Social Boldness (H+), Privateness (N-), and Self-Reliance (Q2-). A consistently high pattern on Extraversion indicates a person who is warm (A+), animated (F+), boldly outgoing (H+), self-disclosing (N-), and group oriented (Q2-). The global scale Anxiety is composed of the primary scales of Emotional Stability (C-), Vigilance (L+), Apprehension (O+), and Tension (Q4+). This scale broadly determines an individual`s internal level of emotional comfort or discomfort. The global scale Tough-Mindedness is composed of the primary scales of Warmth (A-), Sensitivity (I-), Abstractedness (M-), and Openness to Change (Q1-). Independence or Accommodation consist of the primary scales of Dominance (E+), Social Boldness (H+), Vigilance (L+) and Openness to Change (Q1+). Lastly, Self-Control global scale is composed of the primary scales of Rule-Consciousness (G+) and Perfectionism (Q3+), Liveliness (F-) and Abstractedness (M-). Figure 1 shows the personality assessment of Mrs. Jones. As a result of the personality test taken by the client, she obtained high scores with the following personality: (C+) emotional stability, (E+) dominance, (G+) rule consciousness, (H+) social boldness, (Q1+) openness to change, (Q2+) self reliance, and (Q3+) perfectionism. Meanwhile, she tends to be on the left side with these behaviours: (A-) warmth, (B-) reasoning, (F-) liveliness, (I-) sensitivity, (L-) vigilance, (M-) abstracteness, (N-) privateness, (O-) apprehension, and (Q4-) tension. Scores from the global factors indicate a broader picture of the characteristic that an individual may be more inclined to. The five elements of the global factors are extraversion, anxiety, tough-mindedness, and independence and accommodation. The client is leaning more towards introverted and socially inhibited as exemplified by the results of her primary factors (A-), (F-), (H+), (N-), and (Q2+) which can be interpreted as reserved rather than outgoing, serious, forthright, solitary and individualistic but is socially bold . Also, with regard to her anxiety level, she is classified as having low anxiety level and unperturbed which is reflected on her primary scores of (C+), (L-), (O-), and (Q4-). Her primary behaviours can be interpreted as emotionally stable and mature, accepting and self assured, and relaxed. With results for Tough-Mindedness, she is inclined more to be on the right side as characterized by tough minded, resolute, and unempathic. The client has marks which pertains to behaviours of reserved (A-), unsentimental (I-), and practical (M-) but is open to change (Q1+).With regard to independence and accommodation, she tends to have a high score which leans towards being independent and persuasive with her primary marks of dominant (E+), socially bold (H+), open to change (Q1+), but trusting (L-). Her scores for self control most probably predisposes her to being concerned regarding following accepted rules (G+), evinces self discipline and organizational skills (Q3+), cautious rather than fun-loving (F-), and can remain focused on practical issues (M-). There are no low global scores (sten 1-3) but a high sten score of 8 is marked for independence. Below average sten scores includes anxiety with a mark of 4 and above average sten scores are extraversion, tough mindedness, and self control of 6, 7, and 7 respectively. With the use of Rapid Reference 4.5, it can be shown that the client`s profile show only one extreme which is considered to be within the average range since 86% of the normative sample provided an a total number or extreme score from 0 to 2. Her high score on independence suggests that she is a person who is self directed and independent rather than being accommodating, agreeable, and selfless. With regard to his primary factors, the client has two high sten scores which are dominance and perfectionism. The corresponding percentage of sample with her number of extreme score as referred to Rapid Reference 4.6 is 12.1% which means that her behaviour may not be extreme in either direction which is interpreted as average or the individual may have an unclear picture of herself with regard to her behaviours. The primary scores that fall extremely to the left are sensitivity and privateness and scores on extreme right are dominance and perfectionism. This is essential in such a way that these behaviours are more likely to affect the client in dealing with her everyday life and are most probably the behaviours that define her. Summary and Recommendations With the information at hand, such as the data from the interview with the client and the cognitive and personality assessment, it can be concluded that she is subjectively dealing with anxiety and concentration. She provided an overview of her background which is relevant in making appropriate decision for her treatment. As what is evaluated in her cognitive assessment, her strength is in vocabulary while her weakness falls with coding. Her weakness can be reflected in her shorter concentrations span. Overall, the client belongs to the average and is within normal limits. Her personality assessment reveals that she has the tendency to be independent rather than accommodating. Also, her primary scores show behaviours that show dominance and perfectionism. As a conclusion, the client’s overall cognitive and personality functioning falls within normal range. Appendix Rapid Reference 4.5 Number of Extreme Global Factor Scores on 16 PF Profiles Number of Extreme Scores Percent of Sample Cumulative Percent 0 26.4 26.4 1 35.5 61.9 2 24.4 86.3 3 10.3 96.6 4 3.1 99.6 5 0.4 100.0 Note: N=10 261. Based on updated norm sample released in 2002. Adapted with permission from Russell, M., and Karol, D. (2002). 16PF Fifith Edition Administrator`s Manual with Updates Norms. Champaign, IL:Institute for Personality and Ability Testing. Rapid Reference 4.6 Number of Extreme Primary Factor Scores on 16 PF Profiles Number of Extreme Scores Percent of Sample Cumulative Percent 0 1.8 1.8 1 6.6 8.3 2 12.1 20.5 3-6 61.6 82.1 7 8.6 90.7 8 4. 4 95.1 9-15 4.9 100.0 Note: N=10 261. Based on updated norm sample released in 2002. Adapted with permission from Russell, M., and Karol, D. (2002). 16PF Fifith Edition Administrator`s Manual with Updates Norms. Champaign, IL:Institute for Personality and Ability Testing. Reference Cattell, Heather E. P., Schuerger, James M. 2003. Essentials of 16PF Assessment. Hoboken, NJ, USA: Wiley. Available at http://site.ebrary.com/lib/oculyork/Doc?id=10304901&ppg=42 Hersen ,M. 2004. Comprehensive Handbook of Psychological Assessment Volume 2 Personality Assessment. John and Wiley Sons, Inc. Weiss, L., Saklofske, D., Coalson, D. 2010. WAIS-IV Clinical Use and Interpretation: Scientist-Practitioner Perspectives. Burlington, MA, USA: Elsevier Science & Technology. Elsevier Science & Technology. Retrieved on March 14, 2011. Available at http://site.ebrary.com/lib/oculyork/Doc?id=10399281&ppg=36 Read More