Dr Jyoti Mishra, Pragati Mishra, Ravi, Dr Preeti Mishra, Dr Shobit Garg, Dr Amrit Pattojoshi

Abstract: Psychology as a profession has in recent years seen numerous changes globally, and changes in people’s lifestyles have brought fresh challenges to psychological assessment practice. The new century is characterized by increasing stress levels, economic challenges and accompanying increases in mental health diseases. Numerous challenges are facing psychological assessment practice in the21st century, and the practice will have to meet these challenges if it is to remain relevant to postmodern society.

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Introduction

A psychological assessment evaluates thinking, learning ,emotions and behavior.The assessment covers many skill areas, such as general intellectual level, language, memory and learning, problem solving, planning and organization, fine motor skills, visual spatial skills, and academic skills or specific facts about another individual. The basic goal of assessment would be to assess individual’s current and future functioning.  Anastasi (1997) defines a psychological test as, “essentially an objective and standardized measure of a sample of behaviors”.1 Psychological test is a set of items designed to measure characteristics of human beings that pertain to behavior. 2Any psychological assessment process is a test only when its procedure for administration, scoring and interpretation are standardized and has evidence for validity and reliability.3

 

Historical view of Psychological Test

The progress of psychology and psychological test started with Wilhelm Wundt (1832-1920) who established the first psychological laboratory in 1879, in Leipzig, Germany. In 1905 Binet and Simon invent the first modern intelligence test. Stern introduced the IQ, or Intelligence quotient in 1914.In 1917 Robert Woodworth develops the personal data sheet, the first personality test. These are few milestones in the field of psychological assessment. Although, psychological assessments have an extensive history within the mental health field also.  Psychological testing in its modern form originated little more than one hundred years ago in laboratory studies of sensory discrimination, motor skills and reaction time.

 

NEED FOR PSYCHOLOGICAL TESTS

History suggests that psychological tests have been used for different purposes at different times. There are thus many uses of psychological tests. Some of important uses are discussed below:  There are six major uses of psychological test; Gregory has discussed the ways in which psychological assessment has helped in treatment planning:Problem identification, Problem clarification, Identification of important patient’s characteristics, Monitoring of progress along the path of expected improvement. Other than these, psychological assessments are used to measure the attributes, abilities and many other individuals factors in vocational and community settings.4

 

TESTS OF PERSONALITY ASSESSMENTS

The personality assessment measures trait, temperament, values and many other facets of personality which determines the overall adjustment of the person. There are three most common tools or methods of personality assessment.   They are following nature:

  • Structured personality test
  • Projective personality test
  • Observational methods

 

Structured personality test:

This includes tests where individual describes his own feelings, environment and reaction of others towards himself. Thus, person reports about himself in response to some questions or items. The important one are as follows:

  1. Eysenck Personality Questionnaire (EPQ): This tool was developed by Eysenck and Eysenck in 1975 and measures three dimensions: Extroversion and Introversion (E), Neuroticism and Stability (N), Psychoticism and Super ego functioning (P). Hans Jurgen Eysenck’s theory is primarily based on genetics and physiology and he considers that personality differences are based on genetic variability, thus he focuses on what is called as temperament. 5
  2. Millon Clinical Multiaxial Inventory- III (MCMI -III): It was developed by Theodore Millon in 1977. The MCMI-III was published along publication of DSM-IV. It is designed for adult 18 year and up,reading level 8th grade level. It focuses on personality disorder along with symptoms that are frequently associated with the disorders. 6
  3. Minnesota Multiphasic Personality Inventory -II (MMPI-II): It is developed by Hathaway and McKinley in 1940. It  measures the surface traits of an individual. The validity scales of MMPI-II are VRIN, TRIN, F,FB,FP,L,K and S. Clinical scales are Hypochondriasis(H), Hysteria(Hs), Depression(D), Mania(Ma), Paranoia(P), Schizophrenia(Sc), Psychesthenia(Pt), Social introversion(Si), Psychopathic deviate(Pd), Masculinity- Feminity(Mf). Two coding type namely Hathaway and Welsh are there. It has been widely used for detection of malingering, personality disorders, aggression etc. 1
  4. Multiphasic Personality Questionnaire (MPQ): This test is adapted by H.N. Murthy in 1964, for Indian population. It consists of 100 items which are divided into 9 scales namely Hysteria, Anxiety, Depression, Mania, Psychopathic Deviate, Schizophrenia, K- scale, Repression- Sensitization, Paranoia. 7
  5. NEO-PI-R: This is the personality measure with 240 items based on Five Factor Model of personality: Extraversion, Agreeableness, Conscientiousness, Neuroticism and Openness to experience. This test is developed by Costa and McCrea to use in people with and without psychopathology and can be used on 17 years and onwards.8
  6. Raymond Cattell’s 16 Personality Factors Questionnaire: This test was first published in 1949. Fifth edition is the most current one published in 1993 and has 185 multiple choices items. The test consists of 16 personality factors and 5 global personality scales along with the three validity scales. This test is meant for age group of 16 years and older. 9
  7. Temperament and Character Inventory (TCI): It was developed by Cloninger in 1994.The TCI is based on the biosocial theory of personality. It measures four temperament scales: Harm Avoidance, Novelty seeking, Reward Dependence and Persistence. It also measures three Character scales:  Self Directedness, Cooperativeness and Self Transcendence. This scale has four validity scales: Rarity, Runs, Numtrue and like and dislike items. This scale has 240 items can be used on age group of 15 years and above. 10

 

Projective techniques of assessing personality:

Projective tests are considered to be the indirect way of assessing personality. Frank introduced the term “projective test” as the test to study personality with unstructured stimuli.  He stated when people attempt to understand an ambiguous or vague stimulus, they reflect their needs, feelings, experiences, prior conditioning, thought processes and so forth.

  1. The Sentence Completion Test: In this test   individuals are required to complete a number of incomplete sentence stems, presented to them.1
  2. The Draw A Person Test (DAPT): It is an expressive technique developed by Karen Machover. It requires a person to ‘draw a person’ that assess the psychodynamic aspects of personality involved with the self image and body images. The interpretation of DAPT is essentially qualitative where a particular ‘body sign’ is associated with certain personality characteristics. 4
  3. Somatic Inkblot Series (SIS): This test was developed by Dr. Wilfred A. Cassell. He started work on inkblot images in 1959 and after a rigorous field testing he proposed Somatic Inkblot Series-I (a set of 20 cards) in 1980. He proposed SIS-II version at the end of 1980 which contained 62 images. 4
  4. Thematic Apperception Test (TAT): It was developed by Henry Murray and his coworker Christiana Morgan in 1943.Murray, H.A. (1943).It consists of 31 achromatic pictures (one card is a blank card), typically showing individuals of both sexes and of different age groups involved in various activities. The test requires the subject to tell a story for each card. Responses are interpreted under categories like the hero, needs, press, outcomes, conflicts, emotions etc. It can assess a person’s cognitive style, imaginative processes, family dynamics, defensive structure, significant people, general intelligence, sexual adjustments and many more. 11
  5. Rorschach Inkblot Test: It is the most used projective test in clinical setting. It is an associative test, was developed by Swiss psychiatrist Hermann Rorschach in 1921. The test consists of 10 symmetrical, ambiguous inkblots in which card numbers I, IV, V, VI and VII are completely achromatic, card number I and III are partially chromatic and card number VIII, IX and X are completely chromatic. There are six different scoring and interpretation systems available namely Beck, Hertz, Piotrowski, Klopfer, Rapaport and Exner.12
  6. Object SortingTest: Object sorting test is used for assessing the thought processes in a person. The test gives information about the adequacy of and conceptual issues involved in thought process. TestMaterial consists of a set of commonly used objects (the number of objects can vary, but usually it is between 31 and 35). For example, knife, cigarette, match box, diary, ball etc. 4

 

Personality tests for Children:

1.     Children Personality Questionnaire (CPQ) – It is developed by Raymond B. Cattell and Rutherford B. Porter (1968) for age range 8 to12 yrs having two part A and B each of 70 items. It measures 14 Primary Factors and 4 Secondary factors. 13

2.     Children Self Report and Projective Inventory(CSRPI) -It was developed by Robert  L Ziffer and Lawrence E Shapiro(1992) in which sentence completion, projective story cards, drawing task, critical items are there to assess the conflict areas of a child. 14

3.     Children’s Apprerception Test (CAT) – It is a direct extension of the TAT, given by Leopard Bellak and Sonya Sorel Bellak in 1961. It consists of 10 pictures, suitable for children 3 to 10 years of age. The preferred version for younger children (CAT-A) depicts animals in unmistakably human social setting. A human figure version (CAT-H) is available for older children. 15

4.     Rosenzweig Picture Frustration Test (P-F Test) -This test was developed by Rosenzweig in 1942. This test has two forms: Adult form which is used on age 14 years and above and the children version and can be used on age group of 4-13 years. Both forms have cartoon like drawings depicting some conflicting situation. This test is based on frustration-aggression hypothesis, which says that frustration always lead to aggression and there can be different directions of aggression: Extra-punititive, Intro-punititive and impunitative. 4

 

Observational Methods – In Observational Method, the person whose personality traits are to be observed are put either in structured or unstructured situations and observations are made by the observers. 16

 

Observational method and rating scales for Children:

1.     Conner’s Rating Scale-Revised-An instrument devised by C. Keith Conners, which uses observer ratings and self-report ratings to assess attention deficit/hyperactivity disorder (ADHD) and evaluate problem behavior in children and adolescents. The instrument offers versions for parents, teachers, and adolescents. 17

2.     The Child Behavior Checklist (CBCL) – The Child Behavior Checklist (CBCL) given by Thomas M. Achenbach (1991) is a device by which parents or other individuals who know the child well, rate a child’s problem behaviors and competencies. 18

3.     The Childhood Autism Rating Scale (CARS) –The Childhood Autism Rating Scale (CARS) was initially developed by Schopler, Reicher and Renner in 1971. It is a 15- item behavioral rating scale developed to identify children with autism, and to distinguish them from developmentally handicapped children without the autism syndrome. 19

 

INTELLIGENCE TEST

According to Wechsler, intelligence is “the aggregate or global capacity of the individual to act purposefully, to think rationally, and to deal effectively with his environment”.

The American Association of Mental Deficiency (AAMD), defines mental retardation as a significantly sub average general intellectual functioning resulting in or associated with concurrent impairments in adaptive behavior and manifested during the developmental period, before the age of 18.

Developmental Quotient (DQ), Intelligence Quotient (IQ), Performance quotient(PQ) and assessment of adaptive functioning in terms of Social Quotient(SQ) are widely used concepts in intelligence.

Intelligent Quotient (IQ) – The term Intelligence Quotient (IQ) was devised in 1912 by William Stern. It is an expression of an individual’s ability level at a given point of time, in relation to the available age norms.1

Basal Level-A level for tests in which subtest items are ranked from easiest to hardest and below which the examinee would almost certainly answer all questions correctly. 4

Ceiling Level-A level for tests in which subtest items are ranked from easiest to hardest and above which the examinee would almost certainly fail all remaining questions. 4

Mental Level- The child’s score on the test can be expressed as mental level corresponding to the age of normal children whose performance he or she equaled. It is also called Mental Age (MA).1

Chronological Age- The age from birth to the time of testing is called chronological age. The mental age does not increase in a rapid orderly fashion after middle teens. Therefore even for adults the chronological age mostly taken to be 16 while calculating the IQ ratio.20

 

1.     Gesell Developmental Schedule (GDS): It is developed by Arnold Gesell (1880-1961) represents a standardized procedure for observing and evaluating the course of development related with child’s daily life. It assesses maturity in infants and preschool children in four major developmental areas namely (i) Motor development, (ii) Adaptive behavior, (iii) Language development and(iv). Personal social behavior. It provides an estimate of Developmental Age (DA) and Developmental Quotient (DQ) and can be used for the age range of 1-72months.4

2.     Developmental Screening Test (DST):The Developmental Screening Test developed by Bharat Raj (1977) is designed to measure mental development of children from birth to 15 years of age by a semi-structured interview with the child and a parent or a person well familiar with the child. There are 88 items distributed according to the age scales. It provides Developmental Age, DA and Developmental Quotient, DQ.21

3.     The Vineland Social Maturity Scale (VSMS):Originally developed by Edgar A. Doll in 1935, but Indian adaptation was done by A.J. Malin and can be used from birth to 15 years of age. It has eight domains with 89 items that are grouped age wise. Thus we can calculate social age as well as social quotient. 22

4.     Gesell Drawing Test: The test developed by Arnold Gesell has norms for children as young as 16 months and a ceiling of 7 yrs. There are 5 primary shapes corresponding to assigned ages, in which the individuals are instructed to copy the shapes.

5.     Seguin Form Board Test (SFB):The test given by O. Edouard Seguin is used as a quick measure of general intelligence in children between 3-11 yrs. In this test the individual is required to insert ten variously shaped blocks into the corresponding recesses as quickly as possible.4

6.     Stanford -Binet test for Intelligence-Since the development of the Stanford-Binet, it has been revised several times. Currently it is in its fifth edition assesses intelligence and cognitive abilities in children and adults aged 2 to 85 years. The items of this scale were reviewed for gender, race, ethnic, cultural, regional, and socio-economical biases. It assesses five factors: (i) fluid reasoning, (ii) knowledge, (iii) quantitative reasoning, (iv) visual-spatial processing (v) working memory. Hindi adaptation of 1960 version was done by S.P. Kulshrestha. 23

7.     Wechsler Intelligence Scale: In order to remove the difficulty and shortcomings of the Stanford Binet scale, particularly the difficulties regarding the measurement of adult intelligence. It was constructed by David Wechsler at New York University Medical Center and Bellevue Psychiatric Hospital, in 1939. This Scale was known as Wechsler-Bellevue scale. The original WAIS has gone through several revisions. 24

  • Wechsler Adult Intelligence Scale (WAIS): In 1955 Wechsler-Bellevue scale was revised and renamed the Wechsler Adult Intelligence Scale (WAIS), which consisted of 11 separate subtests, which include the Verbal scale (6 subtests) and the Performance scale (5 subtests).
  • Wechsler Intelligence Scale for Children (WISC):It measures intelligence from age 6 through 16 years 11 months and 30 days. It has 13 subtests.
  • Wechsler Preschool and Primary Scale of Intelligence (WPPSI): In 1967 wechsler developed another scale for children between 4 and 6 years of age. It covers age range of 3 years to 7 years and 3 months. Like WAIS-III and WISC-III, it has verbal subtests and performance subtests. However, only two different subtests are included in WPPSI-R: Animal pegs test and Sentence test. In the pegs test children are required to place a coloured cylinder into an appropriate hole in front of an animal within a specified time, whereas in the sentence test, they are asked to repeat to sentence told by the examiner.
  • Wechsler Adult Performance Intelligence Scale (WAPIS): It is an Indian adaptation of the performance scale of Wechsler Adult Intelligence scale (WAIS. It has five subtests namely: Picture completion, digit symbol, block design, picture arrangement and object assembly. This test can be used on individuals aged 15 – 45 years with a minimum education of 5th standard. 25

8.     Malin’s Intelligence Scale for Indian Children (MISIC):This test was given by Dr. Arthur J. Malin in 1969 for the age range 6.0-15.11 years. The scale consists of 12 subtests under the subheadings of Verbal and Performance tests. Verbal part has subtests like information, comprehension, arithmetic, similarities, vocabulary and digit span. Performance test consists of picture completion, picture arrangement, block design, object assembly, coding and mazes. This test provides us full scale intelligence quotient. 26

9.     Raven’s Progressive Matrices: it is the popular intelligence test which can be used individually as well as in a group. It covers people of age 4 onwards. The test consists of series of designs in rows and columns and one has to search for missing design. RPM is available in three forms:

  • The Standard Progressive Matrices (SPM) 1996 edition,
  • Colored Progressive Matrices (CPM) 1990 edition
  • Advanced Progressive Matrices (APM)

 

Culture Free vs. Culture Fair tests: In first part of the 20th century, psychologists began to develop psychological test for cross cultural purpose, they presumed that it would be theoretically possible to measure “hereditary intellectual potential” independent of the cultural experiences. This led to development of concept of “culture free tests”. Subsequently, this concept was found to be wrong, hereditary and environmental factors operate jointly at all stages of life thus, term culture free was replaced by term “culture fair test”. 1

 

Measures of deterioration and premorbid IQ: the deterioration in cognitive functioning with age can be accessed through the overall scatter between the scores of the Wechsler subtests. Wechsler (1958)proposed that the relation of verbal to performance IQ, and Hold to Don’t Hold test can measure the deterioration.24

Don’t Hold- Digit Span, Similarities, Digit Symbol, and Black Design are those which normally decline with age. Hold test-Vocabulary, Information, Object Assembly, and Picture Completion tend to remain stable through age. 27

 

Deterioration Index (DI) = Hold-Don’t Hold /    2

Premorbid IQ provides the information with which it is possible to compare the current performance level of an individual to the premorbid level of functioning. For estimating premorbid ability, the performance on hold test is considered as the found to be more resistant to neurological impairment. It can also assessed by demographic variables based regression equation developed National Adult Reading Test(NART) developed by Hazel and Nelson in the 1980s and published in 1982 or Wechsler Test of Adult Reading(WTAR) developed by Wechsler, 2001. 16

 

NEUROPSYCHOLOGICAL ASSESSMENT TEST

Neuropsychological assessment is a relatively a new term that has replaced older terms like “testing for brain damage” or “testing for organicity”. Neuropsychological assessment as began in the 1950s is a well defined discipline with the work of Halstead, Reitan, and Goldstein in the United States, Ray in France, and Luria of the Soviet Union. According to Lezak,  these procedures are used for three purposes: diagnosis, provision of information that is important for the patient and research. One more important component is rehabilitation planning and monitoring. 28

 

1. Bender Visual Motor Gestalt Test (BVMGT) –It is developed by Lauretta Bender in 1938. It cannot be used with the children below age 3 years. There are total nine cards in which card A is the orientation card. It assesses visual acuity and motor functioning. There are several scoring methods available in which Pascal and Hain’s are most commonly used, in which the protocol must be scored on the basis of 15 signs.  In this the maximum score is 34. The score of 9 and above shows severe dysfunction. 28

1.     Wisconsin Card Sorting Test (WCST)

WCST was originally developed to assess abstract reasoning ability and set shifting ability. Thus it is a measure of executive functions, and has been employed as a clinical neuropsychological instrument. WCST is very popular tool among clinicians because of its sensitivity to brain dysfunction affecting frontal lobe. It is also effective in the early brain insults in children. WCST was developed by Grant and Berg, in the year 1948. It consists of 4 stimulus cards and 128 response cards. The test can be used in age group 6 ½ to 89. 28

2.     The Stroop Color and Word Test

This test was originally developed by Stroop in 1935. Then it was again developed by Charles Golden in 1978 and this was more standardized version. It has been revised in 2002. It can be administered on age range of 15 years and onwards. Test consists of three pages: word page in which person has to read out words, second page is Color page in which subject has to recognize colors and last page is Color-Word page in this page subject has to read out the color name by which words are written. Stroop is considered to be the test of executive functions, selective attention, cognitive flexibility and processing speed. Stroop has child version that can be applied on age group of 5-14 years. 28

3.     PGI Battery of Brain Dysfunction (PGI-BBD)

PGI-BBD developed by Dwarka Pershad and Verma in 1989 and published in the “Department of Psychiatry of the Postgraduate Institute of Medical Education and Research, Chandigarh.” It is standardize on the adult Neuro-psychiatric patients in the age range of 20-45 years but can be used up to 50 years of age irrespective of their educational level and sex. PGI- Memory scale which consists of 10 subtests, Revised Bhatia’s Short Battery of Performance Tests of Intelligence. Verbal Adult Intelligence Scale, Nehor-Benson test and Bender Visual Motor Gestalt Test.  It can be used to rule out or confirm the diagnosis of Organic Brain Pathology, any memory deficit, intelligence, and can also be used in rehabilitation planning.29

4.     Wechsler Memory Scale-III (WMS-III)

This battery of tests is used assess the domains like learning, memory and working memory. The battery consists of total 11 tests in which 6 are primary tests and 5 are optional tests.  The test can be applied on the age range of 16- 89 years. 30

5.     NIMHANS Neuropsychology Battery

This test is developed by Shobini Rao, Subbakrishna and K. Gopukumar in 2004. It can be used to assess the deficits in the brain. It consists of 19 subtests which assess domains like Speed, Attention, Executive functions, Comprehension (verbal Learning and memory), Visuo-spatial Construction and Learning and Memory (Visual). 31

6.     Luria-Nebraska Neuropsychological Battery (LNNB)

It is a multidimensional battery used to screen and diagnose any neurological deficits and gives us the account of lateralization and localization of focal brain impairments and also helps us in planning and rehabilitation.

LNNB consists of two forms, form I, consists of 269 items was introduced in 1980 and form II, consists of 279 items and  was introduced in 1984. LNNB scales are grouped into major 4 categories:  Clinical scales, Summery scales, Localization and Factor scales.32

7.     Cambridge Neuropsychological Test Automated Battery (CANTAB)

This test was first developed at university of Cambridge in 1980’s and has many versions. It consists of neuropsychological tests to assess various domains like assessing general memory and learning, working memory and executive functions, visual memory, attention and reaction time, semantic memory, decision making and response control. 33

 

ASSESSING SPECIAL POPULATION

To assess the special population, who cannot be properly or adequately, examined with traditional instruments the performance, non language and non verbal tests are widely used. Mentally Retarded Persons, Person with Physical Disabilities comes under this group (Anastasi, 1997).Following tests have been developed for these populations:

1.        Assessment of Disability in Persons Suffering from Mental Retardation (ADPMR): Individual tests for intelligence and measure for adaptive behavior in everyday life are widely used to assess the strengths and deficit areas of mentally retarded persons.It comprised of five areas, namely Perceptual-Motor, Self- Care, Communication and Social, Academic and Occupational. Rating can be done by direct observation and informant’s information.34

2.        Indian Disability Evaluation and Assessment Scale (IDEAS) : It is a scale for measuring and quantifying disability in mental disorders. It is best  suited  for  the  purpose  of  measuring  and  certifying  disability  for  the  mentally  ill  population  in  India. Patients  with  the  following  diagnosis are  eligible  for  the  disability  benefits-Schizophrenia, Bipolar  disorder, Dementia, Obsessive  Compulsive  disorder. The duration  of  illness  at least  2  years – the  number  of  months  the  patient  was  symptomatic  in  last  2  years should  be  determined. 35

3.        Behavioural Assessment Scale for Indian Children with Mental Retardation (BASIC-MR) –This scale, developed by Peshawaria and Venkatesan (1992), is divided into two parts. Part A which has seven domains with 280 items, deals with skill behaviours, and Part B which deals with problem behaviours, consisting of 10 domains with 75 items .The information on the scale is collected through direct observation of the child and by interviewing parents.36

4.        Grade Level Assessment Device (GLAD): this is again used to assess Learning Disabilities in children and can be used from grade level 1 to grade 4. This was formed by Jayanthi Narayan in 1999. Different question need to be answered by child as per the grade applicable. This test consists of questions from English, Hindi and Mathematics.  37

 

COMPUTERIZATION OF PSYCHOLOGICAL TESTS

With the advent of computer technology, many researchers felt that psychological tests can also be computerized. Computerization also helps to reduce errors that can have occurred while calculating the results. Many tests have been computerized which ranges from administration to scoring and interpretation. Strong Vocational Interest Blank (SVIB) in 1970’s was probably the first revolution in the computerization of the psychological tests. By 1980’s the concept of Computer Assisted Psychological Assessment (CAPA) was so prevalent that virtually all available tests could be assisted by computers at different stages of psychological assessment i.e., administration, scoring and interpretation. Many tests like MMPI, WAIS-R, WISC-R, Rorschach, CANTAB and many more psychological tools has computer versions.  But computerization of tests has its benefits as well as some negative effects but a critical cost-benefit ratio assessment will always lead to positive results. 38, 33

 

Conclusion : Psychological assessment is an interesting area which provides an overview of person’s behavior. Psychological testing can give valid information about a person only if it is applied after proper knowledge of its use and interpretation. The evidence of growing popularity  of psychological tests are  its use in schools, colleges, hospitals, industry, business, the government, and so forth and new applications and creative uses continue to emerge in response to them

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