Chapter 5 Classification, Assessment, and Treatment TRUE OR FALSE 1. The agreement by a group of experts that certain characteristics or symptoms occur together is the basis for clinically derived classification systems. Answer: True 2. The formal classification of children's disorders has a long history. It dates back to the inclusion of numerous categories of childhood disorders in Kraepelin's original taxonomy. Answer: False 3. The clinicians at a particular agency find a certain diagnostic system easy to use with the clients. Diagnoses are also available for all the cases they see. This suggests that the diagnostic system has good clinical utility. Answer: True 4. An indication of the validity of a diagnostic system is whether or not it provides information we did not have when we defined a category. Answer: True 5. The DSM-IV utilizes a dimensional approach to classification. Answer: False 6. A clinician using the DSM selects from among diagnoses included on two axes and evaluates the youngster on three additional axes. Answer: True 7. It is unusual for a child to have more than one DSM-IV-TR diagnosis. Answer: False 8. There is controversy regarding the categorical nature of the DSM-IV-TR. Answer: True 9. Cross cutting is used to assess areas of clinical importance that are not necessarily part of the diagnostic criteria of the client’s particular diagnosis. Answer: True 10. The empirical approach to classification uses a panel of clinical experts to determine clusters of behavior. Answer: False 11. Normative data for the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the Youth Self Report (YSR) can compare a child’s scores with a nonreferred youngster’s score. Answer: True 12. Kateri often complains of headaches and stomachaches. She is also characteristically shy and fearful in most situations. She could be described as displaying an internalizing syndrome. Answer: True 13. Kyle gets in fights and is often mean to others. He appears to lack guilt and has aggressive friends. He could be described as displaying an internalizing syndrome. Answer: False 14. Labeling can lead to stigmatization and social difficulties. Answer: True 15. On the Child Behavior Checklist, the average correlation between teacher and parent ratings on the same child is 35. Answer: True 16. Based on the case study of Alicia reported in the textbook, assessments are useful only for discovering weaknesses or problems. Answer: False 17. In the assessment of a child who is referred to a clinic, it is best to rely on information from one source so as not to get conflicting information. Answer: False 18. Clinicians rarely interview very young children because children are unable to provide valuable information. Answer: False 19. The first step in any behavioral observation system involves explicitly pinpointing and defining behaviors. Answer: True 20. The concept upon which projective tests are based derives from the social learning notion that children learn to project their impulses. Answer: False 21. A child with an IQ of 100 on a standard test of intelligence would probably be considered of average intelligence. Answer: True 22. Developmental scales like the Bayley Scales of Infant Development are insightful because they are highly correlated with later intellectual functioning. Answer: False 23. Evaluation of heart rate, muscle tension, and respiration rates are examples of psychophysiological assessments. Answer: True 24. In neuropsychological assessment no direct examination of physiological functioning is made. Rather, possible neurological deficits are inferred from performance on various tasks. Answer: True 25. Intervention includes prevention and treatment. Answer: True 26. Universal prevention strategies are targeted to high risk individuals who show minimal symptoms. Answer: False 27. Treatment often involves not only the child but also family members, peers, and school personnel. Answer: True 28. Melanie Klein’s approach is the dominant view in play therapy. Answer: False 29. Cherise has just been diagnosed with an eating disorder. It is unlikely that her family will be involved in her treatment. Answer: False 30. In working with a youngster, a therapist is likely to rely on a single mode of treatment. Answer: False 31. Psychotropic drugs produce therapeutic effects by their influence on the process of neurotransmission. Answer: True MULTIPLE CHOICE 32. By the terms classification and _________ we mean delineating major categories or dimensions of behavior disorders for either scientific or clinical purposes. A. taxonomy B. assessment C. validity D. tomography Answer: A 33. In considering systems of classification, the terms category and dimension are distinguished by A. a category is continuous whereas a dimension is a discrete grouping. B. a dimension is continuous whereas a category is a discrete grouping. C. categories are for scientific classification whereas dimensions are for clinical classification. D. dimensions are for scientific classification whereas categories are for clinical classification. Answer: B 34. After assessing Billy, three different clinicians all agree on his diagnosis. This suggests that the diagnostic system the clinicians used has good A. etiological validity. B. predictive validity. C. interrater reliability. D. test-retest reliability. Answer: C 35. A measure of the stability of a diagnosis over time is called A. concurrent validity. B. predictive validity. C. interrater reliability. D. test-retest reliability. Answer: D 36. The _________ of a classification system is judged by how complete and useful it is. A. reliability B. taxonomy C. validity D. clinical utility Answer: D 37. A categorical approach to classification assumes that the difference between normal and pathological is A. one of kind rather than degree and that distinctions are made between quantitatively different types of disorders. B. one of kind rather than degree and that distinctions are made between qualitatively different types of disorders. C. one of degree rather than kind and that distinctions are made between quantitatively different types of disorders. D. one of degree rather than kind and that distinctions are made between qualitatively different types of disorders. Answer: B 38. Which axis is used to note psychosocial and environmental problems when diagnosing using the DSM system? A. Axis I B. Axis II C. Axis III D. Axis IV Answer: D 39. Which of the following diagnoses would be placed on Axis II? A. Intellectual disability B. Depression C. Autism D. Attention deficit hyperactivity disorder Answer: A 40. In the case study of Kevin in the textbook, where was Attention Deficit Hyperactivity Disorder listed ? A. Axis I B. Axis II C. Axis III D. Axis IV Answer: A 41. If an individual is given a global assessment of functioning score of 30, which of the following is likely true? A. The individual is exhibiting superior functioning. B. The individual has some impairment in almost all areas. C. The individual has generally good functioning with difficulty in only a couple of areas. D. The individual is uncooperative and functioning cannot be determined. Answer: B 42. The term comorbidity refers to A. a child meeting the criteria for more than one disorder. B. two children in a family having the same disorder. C. a child and parent having the same disorder. D. two disorders having some of the same cause. Answer: A 43. Comorbidity or co-occurrence of disorders in children and adolescents is A. quite common. B. very rare. C. not possible using the DSM system. D. common for females but not for males. Answer: A 44. Which of the following has been expressed as a concern regarding the DSM classification system? A. There are not enough diagnoses to adequately assess children. B. The emphasis on validity and reliability has been detrimental. C. The cultural context has been overemphasized. D. The classification system used by the DSM can be misleading. Answer: D 45. _________ refers to groups of disorders that are thought to share certain psychological and biological qualities. A. Dimension B. Classification C. Spectrum D. Syndrome Answer: C 46. A _________ describes behaviors that tend to occur together. A. diagnosis B. syndrome C. dimension D. spectrum Answer: B 47. Two broad syndromes of childhood disorders (referred to as X and Y) have been identified by empirical approaches. Which pairs of terms have been employed to label these two broad syndromes? A. X: internalizing or overcontrolled versus Y: externalizing or conduct disorder B. X: internalizing or undercontrolled versus Y: externalizing or conduct disorder C. X: undercontrolled or anxiety-withdrawal versus Y: overcontrolled or internalizing D. X: internalizing or anxiety-withdrawal versus Y: overcontrolled or conduct disorder Answer: A 48. Which of the following is one of the narrowband syndromes identified for the Child Behavior Checklist (CBCL)? A. Assertive B. Thought problems C. Phobias D. Suicidal Answer: B 49. Which of the following statements is accurate regarding empirical approaches to classification? A. Norms do not exist for different age and gender groups. B. Agreement between different kinds of raters (e.g., teachers and parents) on a child's scores is very high. C. The validity of the broad-band distinctions is questionable since different broad-band syndromes emerge when different types of people complete the instruments. D. The finding that scores from clinic samples differ from nonclinic samples supports the validity of this approach. Answer: D 50. Which of the following statements regarding diagnostic labels is part of the concern with the impact of such labeling? A. Diagnostic labels have a social impact as well as a clinical and scientific purpose. B. Diagnostic labels do not influence observer expectations regarding the child who is labeled. C. Diagnostic labels do not help to provide adults with an explanation or understanding of the child’s behavior. D. Diagnostic labels do not lead to generalizations about the characteristics of all children receiving a particular label. Answer: A 51. According to the textbook, stigmatization has three components. These include: A. branding, dismissing, and rejecting B. suspending, suspicion, and social isolation C. deducing, compiling, and illusion D. stereotyping, devaluing, and discriminating Answer: D 52. _________ relies on empirical evidence and theory to guide an evaluation and selected instruments. A. Classification approach assessment B. Multidimensional assessment C. Evidence based assessment D. Judgment based assessment Answer: C 53. The most common form of assessment is A. the projective test. B. the general clinical interview. C. the structured interview. D. structured observations. Answer: B 54. Structured interviews have been developed to A. create more open-ended interviews. B. create more reliable interviews. C. avoid diagnoses such as DSM-IV. D. be useful for individuals rather than for large populations. Answer: B 55. The Diagnostic Interview for Children and the Schedule for Affective Disorders and Schizophrenia for School-Aged Children are examples of A. schedules of how to time assessments for children. B. schedules of when in the therapeutic process the young child should be seen. C. general clinical interviews. D. structured interviews. Answer: D 56. The greatest impediment to the utility of direct observational assessment is probably A. reactivity. B. test-retest reliability. C. observer bias. D. interrater reliability. Answer: A 57. Which of the following is an example of a projective test? A. Rorschach B. Stanford Binet C. Child Behavior Checklist D. Bayley Scales Answer: A 58. In projective tests the term "projective" refers to the fact that A. the test is trying to project into the future. B. the test is looking for positive attributes in the child. C. the test is derived from ideas related to a particular psychoanalytic defense mechanism. D. the test makes use of visual aids (e.g., slides) that the child is asked to respond to. Answer: C 59. The Stanford-Binet, the Wechsler tests, and the Kaufman Assessment Battery for Children are all examples of A. group administered intelligence tests. B. individually administered intelligence tests. C. achievement tests. D. neuropsychological tests. Answer: B 60. Developmental scales emphasize A. language and communication. B. sensorimotor and simple social skills. C. abstract reasoning abilities. D. number and relational concepts. Answer: B 61. Which of the following is an example of an academic achievement test? A. Stanford Binet B. The Wechsler scales C. Roberts Apperception Test for Children D. Iowa Test of Basic Skills Answer: D 62. _________ examine the rate of activity of different parts of the brain by assessing the use of oxygen and glucose. A. MRI methods B. Electroencephalographs C. PET scans D. CAT scans Answer: C 63. Which of the following is likely to be employed as part of a neuropsychological assessment? A. the Halstead-Reitan B. the Rorschach C. Bellak's CAT D. PET scan Answer: A 64. Which of the following statements regarding direct neurological assessment and neuropsychological assessment is correct? A. Neurological assessment indirectly evaluates neurological functioning, whereas neuropsychological assessment directly evaluates it. B. Neurological assessment directly evaluates neurological functioning, whereas neuropsychological assessment indirectly evaluates it. C. Neuropsychological assessment would not be used to differentiate learning disabled youngsters from normal learners. D. The use of neurological assessment with children has decreased with the development of the computer. Answer: B 65. _________ refers to interventions targeting individuals who are not yet experiencing symptoms of a disorder. A. Indirect assessment B. Prevention C. Treatment D. Evaluation Answer: B 66. Which of the following is described as a “nipping in the bud” strategy in the textbook? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Universal prevention Answer: B 67. Play therapy A. is most likely to be used with children in the upper elementary school grades or older who are able to play the role of another person. B. often uses play as a way to adapt more verbal psychotherapeutic approaches to children in order to facilitate communication. C. is used primarily with children who experience play difficulties with their peers. D. is used to allow treatment to approximate the mother-child relationship. Answer: B 68. Which of the following used play as the basis for psychoanalytic interpretation (e.g., a child opening a purse during play represents a desire to explore the womb)? A. Melanie Klein B. Anna Freud C. Grace Fernald D. Virginia Axline Answer: A 69. The term psychopharmacological treatment refers to A. medications used to treat psychosis. B. treatments used to treat drug-induced psychosis. C. medications that are thought to affect mood, thought, or behavior. D. treatment of psychologically based substance abuse. Answer: C 70. Which of the following is true regarding the pharmacological treatment of children? A. Research indicates a higher usage of medications for African American and Latino children. B. The rate of medication usage in children and adolescents has decreased. C. Medications are rarely prescribed for children until they are proven to be safe and useful. D. High income and private insurance are associated with a greater likelihood of medication use. Answer: D 71. The term empirically supported treatments refers to A. treatments that are paid for by research funds. B. treatments for which there is adequate research support regarding effectiveness. C. treatments that are used to collect research data. D. treatments based on a particular theoretical position. Answer: B BRIEF ESSAY QUESTIONS 72. Define these terms: classification, taxonomy, diagnosis, and assessment. How are these concepts related? Answer: Define each of these terms and then discuss their relationships: 1. Classification: Classification refers to the process of categorizing entities into groups or classes based on shared characteristics. In various fields such as biology, psychology, and sociology, classification helps in organizing information systematically for easier understanding and analysis. 2. Taxonomy: Taxonomy specifically refers to the science of classification. It involves the principles and methods of classifying organisms or other entities into hierarchical categories based on similarities and differences. In biology, for example, taxonomy classifies organisms into domains, kingdoms, phyla, classes, etc., based on their evolutionary relationships. 3. Diagnosis: Diagnosis involves identifying and determining the nature or cause of a problem or condition. It is commonly used in medicine and psychology to identify diseases or disorders based on symptoms, signs, and test results. Diagnosis helps in understanding what is happening and guides appropriate treatment or management. 4. Assessment: Assessment involves gathering information and making judgments about an individual's characteristics, abilities, or qualities. It can be used to evaluate performance, diagnose conditions, predict outcomes, or measure progress. Assessment methods vary depending on the context, such as tests, observations, interviews, or self-reports. Relationships between these concepts: • Classification and Taxonomy: Taxonomy is a specific type of classification that is highly structured and often hierarchical. Taxonomy provides a systematic way to classify entities (such as organisms) based on shared characteristics, while classification in a broader sense can refer to organizing any kind of information into categories. • Diagnosis and Assessment: Diagnosis is a specific form of assessment focused on identifying a particular condition or problem. Assessment is a broader concept that encompasses diagnosis but also includes other purposes such as evaluation, prediction, or measurement. Diagnosis is typically a part of assessment processes, especially in fields like medicine and psychology. • Assessment and Classification/Taxonomy: Assessment often involves categorizing individuals or situations based on certain criteria, which can be seen as a form of classification. For example, in educational assessment, students may be classified into different performance levels based on test scores (classification aspect), and then further assessed to diagnose specific learning needs (diagnostic aspect). In summary, while these terms have distinct meanings and applications, they are related through the common theme of organizing, understanding, and making judgments about entities or conditions based on systematic analysis and classification. 73. Explain the concepts of interrater reliability, test retest reliability, and validity in regard to classification. Answer: Let's explore these concepts of reliability and validity in the context of classification: 1. Interrater Reliability: • Definition: Interrater reliability refers to the consistency or agreement between two or more raters or observers who are evaluating or classifying the same set of entities or behaviors. • Importance: It is crucial in ensuring that different raters or observers are interpreting and applying classification criteria consistently. For example, in psychology or medicine, if different clinicians are classifying patients into diagnostic categories, high interrater reliability means they are likely to reach similar conclusions. • Measurement: Interrater reliability is often quantified using statistical measures such as Cohen's kappa coefficient or intraclass correlation coefficient (ICC). These measures assess the degree of agreement between raters beyond what would be expected by chance. 2. Test-Retest Reliability: • Definition: Test-retest reliability assesses the consistency of classification or measurement when the same test or measurement procedure is repeated over time with the same subjects or entities. • Importance: It ensures that the classification or measurement is stable and not influenced by random variability or measurement error. For example, if a psychological test is used to classify individuals into personality types, high test-retest reliability indicates that individuals would receive similar classifications if tested at different times. • Measurement: Test-retest reliability is typically assessed by administering the same test or measurement to a group of subjects on two separate occasions and then correlating the results between the two administrations. High correlation indicates high test-retest reliability. 3. Validity: • Definition: Validity refers to the extent to which a classification or measurement accurately reflects the concept it is intended to measure or classify. • Types of Validity: • Content Validity: The degree to which a classification system or measurement instrument covers the full range of meanings or behaviors within a concept. • Criterion Validity: The extent to which the classification or measurement correlates with a known criterion or standard. • Construct Validity: The degree to which the classification or measurement corresponds to theoretical concepts or constructs. • Importance: Validity is essential because it ensures that the classifications or measurements are meaningful and useful for their intended purposes. For example, a diagnostic classification system in medicine should accurately identify individuals with a specific disease (high validity). Relationship to Classification: • Interrater reliability, test-retest reliability, and validity are all critical considerations when developing and using classification systems. These concepts ensure that classifications are consistent (interrater reliability), stable over time (test-retest reliability), and accurately reflect the intended constructs or categories (validity). Together, they help establish the trustworthiness and utility of classification systems across various fields such as psychology, medicine, education, and sociology. 74. Briefly define what is meant by the term comorbidity and describe two different reasons that this phenomenon might occur. Answer: Comorbidity refers to the presence of two or more coexisting medical conditions or disorders in an individual. These conditions can occur simultaneously or sequentially and are not necessarily directly related to each other. Here are two different reasons why comorbidity might occur: 1. Shared Risk Factors: Some conditions may share common risk factors that increase the likelihood of developing both conditions. For example: • Obesity is a risk factor for both type 2 diabetes and cardiovascular diseases. Individuals who are obese are at higher risk of developing both conditions concurrently. • Smoking is a shared risk factor for various respiratory conditions (like chronic obstructive pulmonary disease - COPD) and cardiovascular diseases. In these cases, the presence of one condition (e.g., obesity or smoking) increases the chances of developing other conditions that share similar underlying causes or pathways. 2. Pathophysiological Links: Sometimes, the presence of one condition can predispose an individual to develop another condition due to shared underlying mechanisms or pathophysiological processes: • Diabetes mellitus increases the risk of developing diabetic nephropathy (kidney disease) and diabetic retinopathy (eye disease) due to the damaging effects of high blood sugar levels on these organs. • Rheumatoid arthritis is an autoimmune disorder that can lead to inflammation and damage in multiple joints, but it can also be associated with other autoimmune conditions like lupus or Sjögren's syndrome due to shared immune dysregulation. Here, the presence of one condition (e.g., diabetes or rheumatoid arthritis) can contribute to the development of other conditions through interconnected biological pathways or immune responses. Overall, comorbidity is a common phenomenon influenced by a complex interplay of genetic, environmental, and behavioral factors. Understanding comorbidity is crucial for effective medical management, as it affects treatment strategies, outcomes, and overall health care planning for individuals with multiple coexisting conditions. 75. Describe the concerns that exist regarding DSM classification systems. Answer: The DSM (Diagnostic and Statistical Manual of Mental Disorders) classification systems, published by the American Psychiatric Association, are widely used to classify and diagnose mental disorders. While the DSM has evolved over the years and serves as a valuable tool in clinical practice and research, several concerns have been raised regarding its classification systems: 1. Reliability Issues: • Interrater Reliability: Despite efforts to improve reliability, there can still be variability in how different clinicians interpret and apply DSM criteria, leading to inconsistent diagnoses. • Changes Across Revisions: Each new edition of the DSM introduces changes to diagnostic criteria and classification, which can affect the reliability of diagnoses over time. This inconsistency can impact treatment decisions and research outcomes. 2. Validity Concerns: • Overlapping and Vague Categories: Some critics argue that DSM categories often overlap or lack clear boundaries, leading to difficulties in distinguishing between different disorders. This can contribute to misdiagnosis or underdiagnosis. • Diagnostic Heterogeneity: Within some diagnostic categories, there can be significant heterogeneity in symptom presentation and underlying mechanisms. This may complicate accurate diagnosis and treatment planning. 3. Cultural and Societal Influence: • Western Bias: The DSM has been criticized for its Western-centric perspective, potentially leading to underdiagnosis or misinterpretation of disorders that manifest differently in non-Western cultures. • Social and Cultural Changes: The DSM's categorizations may not adequately reflect evolving societal understandings of mental health, gender diversity, or other social factors that influence mental disorders. 4. Medicalization and Normalization: • Expanding Definitions: Some argue that the DSM's expansion of diagnostic criteria may lead to the medicalization of normal human experiences or behaviors, potentially pathologizing variations that do not necessarily require clinical intervention. • Influence of Pharmaceutical Industry: Concerns have been raised about the influence of pharmaceutical companies on the DSM revisions, potentially expanding diagnostic criteria to increase the market for psychiatric medications. 5. Stigma and Labeling: • Stigmatization: The use of diagnostic labels from the DSM can contribute to stigma against individuals with mental health conditions. Labels may oversimplify complex experiences and perpetuate stereotypes. • Impact on Self-Identity: Being labeled with a mental disorder based on DSM criteria can affect an individual's self-concept and how they are perceived by others, potentially influencing their life trajectory and opportunities. 6. Critiques of Diagnostic Categories: • Dimensional vs. Categorical Approaches: There is ongoing debate about whether DSM should adopt more dimensional approaches to capture the spectrum of symptom severity and functioning, rather than relying solely on categorical diagnoses. In summary, while the DSM classification systems have made significant contributions to clinical practice and research in psychiatry, they are not without their limitations and criticisms. Addressing these concerns involves ongoing dialogue, research, and consideration of diverse perspectives to improve the reliability, validity, and cultural sensitivity of diagnostic classifications in mental health. 76. What are the two broad-band syndromes identified by empirical approaches to classification? Briefly describe the kinds of behaviors characteristic of each. Answer: Empirical approaches to classification in psychology have identified two broad-band syndromes based on patterns of behavior and symptoms. These syndromes are: 1. Internalizing Syndrome: • Characteristics: This syndrome includes behaviors and symptoms characterized by internalizing emotions and distress. • Examples: • Anxiety Disorders: Excessive worry, fear, and avoidance behaviors (e.g., generalized anxiety disorder, social anxiety disorder). • Depressive Disorders: Persistent sadness, loss of interest in activities, changes in appetite or sleep patterns (e.g., major depressive disorder, dysthymia). • Somatic Symptoms: Physical complaints without a clear medical cause (e.g., somatic symptom disorder). • Withdrawal: Social withdrawal, isolation, and avoidance of interpersonal interactions. Individuals with internalizing syndromes often experience emotional turmoil, rumination, and may exhibit behaviors aimed at reducing distress or avoiding triggers of anxiety or depression. 2. Externalizing Syndrome: • Characteristics: This syndrome encompasses behaviors that are directed outwardly and often involve disinhibition and impulsivity. • Examples: • Disruptive Behavior Disorders: Aggression, defiance, rule-breaking behaviors (e.g., conduct disorder, oppositional defiant disorder). • Substance Use Disorders: Problematic use of substances such as alcohol or drugs despite negative consequences. • Attention-Deficit/Hyperactivity Disorder (ADHD): Impulsivity, hyperactivity, and difficulty maintaining attention and focus. Individuals with externalizing syndromes may struggle with self-regulation, have difficulty controlling impulses, and engage in behaviors that disrupt their own lives or the lives of others. Note: These broad-band syndromes are not mutually exclusive, and individuals may exhibit symptoms from both categories to varying degrees. They provide a framework for understanding common patterns of behavior and guiding treatment approaches in clinical psychology and psychiatry. 77. The correlations of Achenbach scores obtained from different informants (regarding the same youngster) can be calculated. Describe two things, beyond issues of the reliability of the instruments, that may impact interrater reliability. Answer: Interrater reliability refers to the degree of agreement among raters or informants when assessing the same phenomenon. When considering the Achenbach scores obtained from different informants (such as parents, teachers, or the youth themselves) regarding the same youngster, several factors beyond the reliability of the instruments themselves can impact interrater reliability: 1. Differences in Perspectives and Contexts: Different informants observe the youngster in varied settings and situations, which can significantly influence their ratings. For example, a teacher may observe a child's behavior in a structured classroom environment, while a parent sees the child in more informal and diverse home settings. These different contexts can lead to variations in behavior and, consequently, different ratings. Additionally, each informant may have unique perspectives based on their relationship with the child, their expectations, and their sensitivity to certain behaviors. 2. Biases and Subjectivity: Each informant may have inherent biases and subjective views that affect their assessments. For instance, a parent who is particularly anxious about their child's well-being may overreport behavioral issues, while another parent might underreport problems due to denial or a desire to present their child in a more favorable light. Similarly, teachers might have biases based on their experiences with other students, their teaching style, or their expectations for behavior in the classroom. These biases can lead to discrepancies in ratings between different informants. Addressing these factors involves recognizing the potential for differing contexts and subjective biases and attempting to account for them in analyses and interpretations of interrater reliability. 78. Discuss the pros and cons of labeling. Answer: Labeling has both advantages and disadvantages: Pros: 1. Clarity and Communication: Labels help in succinctly communicating complex conditions, aiding in understanding and discussions. 2. Access to Resources: Labels can provide access to targeted treatments, programs, and accommodations. 3. Validation: Receiving a label can bring relief and connect individuals to supportive communities. Cons: 1. Stigmatization: Labels can lead to negative perceptions, discrimination, and stereotypes. 2. Self-Fulfilling Prophecy: Individuals may internalize labels, affecting their self-esteem and behavior, and shaping others' biased expectations. 3. Overgeneralization: Labels can ignore individual differences and oversimplify complex conditions, leading to ineffective one-size-fits-all approaches. 79. What are the differences between structured and unstructured clinical interviews? Answer: Structured and unstructured clinical interviews are two different approaches used in the assessment and diagnosis of mental health conditions. Here are the key differences between them: Structured Clinical Interviews: 1. Format: • Pre-Determined Questions: Structured interviews follow a specific set of questions and a standardized format. • Consistency: All interviewees are asked the same questions in the same order, ensuring uniformity. 2. Advantages: • Reliability: High reliability and reproducibility as the standardized format minimizes interviewer bias. • Comparability: Easier to compare results across different individuals and settings. • Diagnostic Accuracy: Often used for diagnostic purposes due to their structured nature. 3. Examples: • Structured Clinical Interview for DSM (SCID) • Mini International Neuropsychiatric Interview (MINI) Unstructured Clinical Interviews: 1. Format: • Flexible Approach: Unstructured interviews do not follow a set format, allowing the interviewer to explore topics as they arise. • Open-Ended Questions: Questions are open-ended, and the interviewer can probe deeper based on the interviewee’s responses. 2. Advantages: • Flexibility: Greater flexibility to explore unique issues and follow the interviewee’s lead. • Rapport Building: Easier to build rapport and trust with the interviewee, potentially leading to more in-depth information. • Individualized Assessment: Can be tailored to the specific needs and context of the individual being assessed. 3. Examples: • General clinical assessments without a fixed format, often used in initial therapy sessions. Key Differences: • Structure: Structured interviews have a rigid, pre-determined format, while unstructured interviews are flexible and guided by the flow of conversation. • Consistency: Structured interviews ensure consistency and comparability across different interviewees, whereas unstructured interviews allow for more personalized and in-depth exploration. • Use Case: Structured interviews are often used for diagnostic purposes due to their reliability, while unstructured interviews are commonly used in therapeutic settings to build rapport and gain comprehensive insights. Both structured and unstructured clinical interviews have their unique advantages and are chosen based on the goals of the assessment, the context, and the needs of the individual being interviewed. 80. Describe the issue of reactivity with respect to behavioral observation. Briefly report on two procedures that might be employed to reduce reactivity. Answer: Reactivity in Behavioral Observation: Reactivity refers to the phenomenon where individuals alter their behavior because they are aware that they are being observed. This can lead to distorted data that does not accurately represent typical behavior, thus affecting the validity of the observations. Procedures to Reduce Reactivity: 1. Unobtrusive Observation: • Method: Observers remain hidden or use indirect methods to observe behavior, such as through one-way mirrors, video recordings, or naturalistic settings where the presence of the observer is minimized. • Effectiveness: By reducing the visibility of the observer, individuals are less likely to be aware they are being watched, leading to more natural and typical behavior. 2. Habituation: • Method: Observers spend extended periods in the observation setting without collecting data initially, allowing individuals to become accustomed to their presence. Once the subjects are habituated and behave normally despite the observer's presence, actual data collection begins. • Effectiveness: Over time, the subjects' initial reactivity decreases as they habituate to the observer, resulting in more accurate and representative behavior being observed. Both methods aim to reduce the impact of reactivity, ensuring that the observed behaviors are as close to natural as possible. 81. Review the pros and cons of including tests of intellectual functioning in clinical assessments. Answer: Pros of Including Tests of Intellectual Functioning in Clinical Assessments: 1. Comprehensive Evaluation: • Provides a broad view of cognitive abilities. • Identifies strengths and weaknesses for tailored interventions. 2. Diagnostic Clarity: • Aids in accurate diagnosis of cognitive impairments and learning disorders. • Helps differentiate between cognitive and psychological issues. 3. Educational and Occupational Planning: • Informs individualized educational plans and career guidance. • Provides valuable insights for appropriate educational and occupational strategies. 4. Tracking Progress: • Establishes a baseline for monitoring changes over time. • Evaluates the effectiveness of interventions. Cons of Including Tests of Intellectual Functioning in Clinical Assessments: 1. Cultural and Socioeconomic Bias: • Potential for biased results towards certain groups. • Risk of misinterpretation without considering cultural and contextual factors. 2. Stress and Anxiety: • Can cause test anxiety, affecting performance. • Poor results may lead to negative labeling and self-esteem issues. 3. Resource Intensive: • Time-consuming and costly to administer and interpret. • Limited accessibility in some areas. 4. Overemphasis on Intelligence: • May overlook other important factors like emotional intelligence and creativity. • Risks reducing a person’s capabilities to a single score. 82. Describe the domains and assessment methods used in neurological assessment. Answer: Domains of Neurological Assessment: 1. Cognitive Functioning: • Memory, attention, executive functioning, language, visuospatial skills. 2. Motor Functioning: • Muscle strength, coordination, balance. 3. Sensory Functioning: • Tactile sensation, proprioception, visual and auditory perception. 4. Emotional and Behavioral Functioning: • Mood, affect, behavioral regulation. Assessment Methods: 1. Clinical Interview: • Detailed history and symptom description. 2. Standardized Tests: • Neuropsychological tests (e.g., WAIS, MMSE, MoCA), language tests, memory tests. 3. Physical Examination: • Neurological exam, gait, and balance tests. 4. Imaging Techniques: • MRI, CT scans, EEG. 5. Laboratory Tests: • Blood tests, cerebrospinal fluid analysis. 6. Behavioral Observation: • Observing behavior in various settings. 7. Functional Assessments: • Activities of daily living (ADLs) evaluation. 83. Describe the Weisz, Sandler, Durlak & Anton (2005) model of intervention. Answer: The Weisz, Sandler, Durlak, & Anton (2005) model of intervention, also known as the "Mental Health Services for Children and Adolescents" framework, focuses on translating research into effective practice for child and adolescent mental health interventions. Here are the key components of their model: Key Components of the Weisz et al. (2005) Model: 1. Empirical Evidence: • Evidence-Based Practices (EBPs): The model emphasizes the use of interventions that have been rigorously tested and proven effective through empirical research. • Research-to-Practice Gap: It addresses the challenge of bridging the gap between research findings and practical application in real-world settings. 2. Contextual Fit: • Adaptation to Settings: Interventions should be adaptable to various settings, such as schools, clinics, and community centers, ensuring they fit the specific context in which they are implemented. • Cultural Sensitivity: The model advocates for culturally sensitive interventions that consider the diverse backgrounds and needs of children and adolescents. 3. Implementation Quality: • Training and Support: Effective implementation requires adequate training and ongoing support for practitioners to ensure they deliver interventions with fidelity. • Monitoring and Evaluation: Regular monitoring and evaluation of the intervention process and outcomes are essential to ensure effectiveness and identify areas for improvement. 4. Outcome Measurement: • Multiple Outcomes: The model stresses the importance of measuring various outcomes, including symptom reduction, functional improvement, and overall well-being. • Longitudinal Assessment: Long-term follow-up is recommended to assess the sustained impact of interventions over time. 5. Collaboration: • Stakeholder Involvement: Collaboration among researchers, practitioners, families, and community stakeholders is crucial for successful intervention development and implementation. • Interdisciplinary Approach: The model supports an interdisciplinary approach, combining insights from psychology, education, social work, and other relevant fields. Summary: The Weisz et al. (2005) model of intervention provides a comprehensive framework for developing, implementing, and evaluating mental health services for children and adolescents. It emphasizes the importance of evidence-based practices, contextual fit, quality implementation, outcome measurement, and collaboration to ensure effective and sustainable interventions. 84. Discuss the concerns and benefits regarding prevention. Answer: Concerns Regarding Prevention: • Cost and Resource Allocation: Initial investment and long-term sustainability. • Effectiveness and Impact: Measurement challenges and unintended consequences. • Ethical Considerations: Equity, access, autonomy, and privacy concerns. • Complexity and Interconnectedness: Understanding and addressing complex factors and interconnected issues. Benefits of Prevention: • Cost Savings: Long-term cost-effectiveness and reduced burden on resources. • Improved Health and Well-being: Enhanced quality of life and reduced suffering. • Social and Economic Benefits: Improved social cohesion and economic growth. • Empowerment and Resilience: Empowerment of individuals and communities, building resilience. Prevention efforts, despite their challenges, offer significant benefits in terms of cost savings, improved well-being, and social development. 85. Describe the Institute of Medicine’s tripartite model of prevention. Create an example of each strategy. Answer: Institute of Medicine's Tripartite Model of Prevention: 1. Primary Prevention: • Aim: Preventing the onset of disease. • Example: Vaccination campaigns to prevent infectious diseases. 2. Secondary Prevention: • Aim: Early detection and intervention. • Example: Regular screenings for breast cancer. 3. Tertiary Prevention: • Aim: Managing and treating existing diseases. • Example: Cardiac rehabilitation programs for heart attack survivors. Each level targets different stages of disease development, highlighting the importance of prevention at multiple levels for overall health and well-being. 86. Briefly describe three reasons why one might employ a group rather than individual mode of treatment. Answer: Reasons for Employing Group Treatment over Individual Treatment: 1. Social Support and Interaction: • Mutual Support: Group members can provide each other with empathy, understanding, and encouragement, which can be particularly beneficial for individuals feeling isolated or stigmatized. • Normalization: Sharing experiences with others facing similar challenges can help normalize individual experiences and reduce feelings of loneliness or alienation. 2. Diverse Perspectives and Feedback: • Multiple Perspectives: Group members offer diverse viewpoints and insights, providing a broader range of feedback and suggestions for problem-solving. • Behavioral Modeling: Observing others in the group can provide behavioral models for coping strategies and skill development. 3. Economical and Efficient Use of Resources: • Cost-Effectiveness: Group treatment can be more cost-effective than individual therapy, as one therapist can work with several clients simultaneously. • Time Efficiency: Groups allow therapists to address common issues with multiple clients at once, maximizing the use of limited time and resources. Conclusion: Group treatment can offer unique benefits that may not be as easily achievable in individual therapy, including social support, diverse perspectives, and efficient use of resources. It can be particularly effective for individuals who can benefit from interactions with others facing similar challenges and for therapists looking to maximize the impact of their interventions. 87. Briefly describe three different modes of treatment employed to address the behavior disorders of children and/or adolescents. Answer: Modes of Treatment for Behavior Disorders in Children and Adolescents: 1. Behavioral Therapy: • Focuses on specific behaviors. • Uses techniques like reinforcement and behavior modification. 2. Cognitive-Behavioral Therapy (CBT): • Addresses behavior and underlying thought patterns. • Involves identifying and changing negative thought patterns. 3. Family Therapy: • Involves the family in treatment. • Focuses on improving family dynamics and interactions. These modes can be used alone or together to address behavior disorders in children and adolescents, focusing on behavior change and improving overall functioning. 88. Briefly describe three ways in which pharmacological treatments might affect neurotransmission. Answer: Ways Pharmacological Treatments Affect Neurotransmission: 1. Enhancing Neurotransmitter Activity: • Some medications increase the release of neurotransmitters into the synapse or prevent their reuptake, leading to increased neurotransmitter activity. • Example: Selective serotonin reuptake inhibitors (SSRIs) increase serotonin levels by blocking its reuptake, enhancing its effects in the brain. 2. Inhibiting Neurotransmitter Activity: • Other medications may decrease neurotransmitter release or block receptors, reducing neurotransmitter activity. • Example: Antipsychotic medications block dopamine receptors, reducing dopamine activity and helping to alleviate symptoms of psychosis. 3. Modulating Neurotransmitter Function: • Some drugs alter the functioning of neurotransmitter receptors, changing the response of neurons to neurotransmitters. • Example: Benzodiazepines enhance the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, by binding to GABA receptors and increasing their activity. Conclusion: Pharmacological treatments can impact neurotransmission in various ways, including enhancing, inhibiting, or modulating neurotransmitter activity. These effects can help to restore balance in neurotransmitter systems and alleviate symptoms of neurological and psychiatric disorders. 89. List and describe the types of interventions typically involved in parent training. Answer: Types of Parent Training Interventions: 1. Behavior Management: Teaching parents to manage behavior through reinforcement and consequences. 2. Communication Skills: Improving interactions with active listening and assertiveness. 3. Problem-Solving: Developing skills to address challenging behaviors or situations. 4. Stress Management: Strategies to cope with stress and maintain a positive approach. 5. Self-Care: Emphasizing the importance of parental well-being. 6. Setting Expectations: Educating parents about age-appropriate behavior. 7. Positive Parenting: Promoting practices like praise and quality time. These interventions aim to enhance parent-child interactions, reduce behavior problems, and support positive child development. 90. List 4 of the 8 alternative strategies for providing treatment content to youth and families reported by Weisz & Kazdin (2010). Answer: Alternative Strategies for Providing Treatment Content to Youth and Families: 1. Computer-Based Programs: • Using interactive computer programs to deliver treatment content. • Example: Online cognitive-behavioral therapy (CBT) programs for youth with anxiety or depression. 2. Self-Help Books or Manuals: • Providing families with written materials to guide them through treatment. • Example: A self-help book outlining strategies for managing ADHD symptoms in children. 3. Web-Based Resources: • Offering online resources such as videos, articles, or forums for support and information. • Example: A website providing parenting tips and strategies for managing behavior problems in children. 4. Peer-Led Support Groups: • Facilitating support groups where peers can share experiences and provide mutual support. • Example: A support group for teens with eating disorders led by young adults in recovery. These alternative strategies aim to provide accessible and flexible treatment options for youth and families, supplementing traditional in-person therapy. 91. According to the Society of Clinical Psychology, what are the criteria for considering a treatment to be evidence based? Answer: Criteria for Considering a Treatment Evidence-Based: 1. Empirical Support: Supported by rigorous research. 2. Specificity: Clear and replicable techniques. 3. Comparison to Control: Compared to control conditions. 4. Clinical Significance: Produces clinically significant changes. 5. Real-world Effectiveness: Effective in real-world settings. 6. Maintenance of Gains: Effects maintained over time. 7. Drop-out Rates: Reasonable drop-out rates. 8. Cost-effectiveness: Cost-effective relative to alternatives. 9. Effectiveness Across Populations: Effective across diverse populations. Test Bank for Abnormal Child and Adolescent Psychology Rita Wicks-Nelson, Allen C. Israel 9781317351344, 9780205036066, 9780205901128
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