Clinical Assessment of Child and Adolescent Personality and Behavior

Clinical Assessment

of Child and Adolescent

Personality and Behavior

Clinical Assessment

of Child and Adolescent

Personality and Behavior

Third Edition

Paul J. Frick

University of New Orleans, New Orleans, LA, USA

Christopher T. Barry

University of Southern Mississippi, Hattiesburg, MS, USA

Randy W. Kamphaus

Georgia State University, Atlanta, GA, USA

Paul J. Frick

University of New Orleans

New Orleans, LA

USA

[email protected]

Randy W. Kamphaus

Georgia State University

Atlanta, GA

USA

[email protected]

Christopher T. Barry

University of Southern Mississippi

Hattiesburg, MS

USA

[email protected]

ISBN 978-0-387-89642-7 e-ISBN 978-1-4419-0641-0

DOI 10.1007/978-1-4419-0641-0

Springer New York Dordrecht Heidelberg London

Library of Congress Control Number: 2009926176

© Springer Science+Business Media, LLC 2010

1st edition: © Allyn & Bacon, 1996

2nd edition: © Springer Science+Business Media, LLC 2005

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To my inspiration, Vicki, Josh, Jordan, and

Jacob (PJF)

To my “home team,” Tammy and Andersen (CTB)

To the memory of my parents,

Richard and Nancy Kamphaus (RWK)

vii

Preface xi

Part I

Basic Issues

Chapter 1

Historical Trends 3

Chapter Questions 3

Definitions of Terms in Personality

Assessment 4

Early History of Personality

Assessment 6

Projective Techniques 7

The Diagnostic and Statistical Manual

of Mental Disorders

Diagnostic Systems 16

IDEA and Special Education 17

Future Trends 19

Chapter Summary 19

Chapter 2

Measurement Issues 21

Chapter Questions 21

Defining Personality Tests 22

Scores, Norms, and Distributions 25

Reliability 34

Construct Validity 37

Utility 44

Conclusions 45

Chapter Summary 45

Chapter 3

Classification and

Developmental

Psychopathology 47

Chapter Questions 47

Science and Assessment 47

Classification 48

Developmental Psychopathology 58

Conclusions 64

Chapter Summary 65

Chapter 4

Standards and Fairness 67

Chapter Questions 67

APA Ethical Principles of Psychologists 68

Test Standards 69

Conclusions 79

Chapter Summary 79

Chapter 5

Planning the Evaluation

and Rapport Building 81

Chapter Questions 81

Non-specifics in Clinical Assessment 81

Clarifying the Referral Question 82

Designing the Evaluation 85

To Test or Not to Test 88

Rapport Building 89

Conclusions 96

Chapter Summary 97

C o n t e n t s

viii contents

Part II

Assessment Methods

Chapter 6

Self-Report Inventories 101

Chapter Questions 101

Omnibus Personality Inventories 101

Single Construct Personality

Inventories 138

Conclusions 138

Chapter Summary 139

Chapter 7

Parent and Teacher Rating

Scales 141

Chapter Questions 141

Evaluating Children via Parent

Ratings 141

Evaluating Children via Teacher

Ratings 143

Overview of Omnibus Parent and Teacher

Rating Scales 144

Behavior Assessment System for Children,

2nd Edition (BASC-2) 145

Achenbach System of Empirically Based

Assessment (Achenbach & Resorla,

2000, 2001) 156

Child Symptom Inventory-4

(CSI-4) 166

Conners, 3rd Edition (Conners-3) 170

Personality Inventory for Children-2

(PIC-2); Student Behavior Survey

(SBS) 174

Sample Impairment-Oriented Scales 183

Conclusions 185

Chapter Summary 187

Chapter 8

Behavioral Observations 189

Chapter Questions 189

Basics of Observational Systems 192

Examples of Observational Systems 200

Conclusions 207

Chapter Summary 208

Chapter 9

Peer-Referenced

Assessment 211

Chapter Questions 211

Ethics of Peer-Referenced

Strategies 212

Types of Peer-Referenced Techniques 214

Other Peer-Referenced Techniques 223

Conclusions 223

Chapter Summary 223

Chapter 10

Projective Techniques 225

Chapter Questions 225

The Controversy Surrounding Projective

Techniques 225

Inkblot Techniques 231

Thematic (Storytelling) Techniques 236

Sentence Completion Techniques 243

Drawing Techniques 245

Conclusions 250

Chapter Summary 250

Chapter 11

Structured Diagnostic

Interviews 253

Chapter Questions 253

History 253

Overview 254

Evaluation of Diagnostic Interviews 259

Recommendations for Use of Structured

Interviews 261

Focus on the NIMH Diagnostic

Interview Schedule for Children

(DISC-iv) 265

Conclusions 269

Chapter Summary 269

contents ix

Chapter 12

Assessing Family

Context 271

Chapter Questions 271

Introduction 271

Assessing Family Functioning:

General Issues 276

General Considerations in Assessing

Family Functioning 277

Parenting Styles and Practices 280

Parenting Stress 288

Marital Conflict 291

Parental Adjustment 293

Conclusions 296

Chapter Summary 296

Chapter 13

History Taking 299

Chapter Questions 299

Content 307

Formats 307

Conclusions 313

Chapter Summary 314

Chapter 14

Adaptive Behavior

Scales 315

Chapter Questions 315

History of the Construct 315

Characteristics of Adaptive Behavior

Scales 318

Omnibus Adaptive Behavior Scales 322

General Recommendations 327

Measuring Social Skills 332

Conclusions 334

Chapter Summary 334

Part III

Advanced Topics

Chapter 15

Integrating and Interpreting

Assessment Information 339

Chapter Questions 339

Introduction 339

Integrating Information across

Informants 342

A Multistep Strategy for Integrating

Information 347

Step1: Document all Clinically Significant

Findings Regarding the Child’s

Adjustment 349

Step2: Look for Convergent Findings

Across Sources and Methods 349

Step3: Try to Explain Discrepancies 353

Step4: Develop a Profile and Hierarchy

of Strengths and Weaknesses 353

Step5: Determine Critical Information

to Place in the Report 354

Conclusions 355

Chapter Summary 355

Chapter 16

Report Writing 357

Chapter Questions 357

Reporting Problems and Challenges 357

Report Writing as Part of Evidence-Based

Assessment 359

Pitfalls of Report Writing 360

Suggested Practices 365

Adapting Reports to Audience

and Setting 368

The Sections of the Psychological

Report 369

Communicating Results Orally 373

Conclusions 375

Chapter Summary 376

x contents

Chapter 17

Assessment of Attention

Deficit Hyperactivity

and Disruptive

Behavior Disorders 377

Chapter Questions 377

Introduction 377

Attention-Deficit Hyperactivity

Disorder 378

Conduct Problems 398

Conclusions 410

Chapter Summary 412

Chapter 18

Assessment of Depression

and Anxiety 413

Chapter Questions 413

Internalizing Disorders 413

Childhood Depression 414

An Assessment Strategy for Depression 422

Anxiety Disorders of Childhood 425

An Assessment Strategy

for Anxiety 431

Conclusions 434

Chapter Summary 434

Chapter 19

Assessment of Autism Spectrum

Disorders 437

Chapter Questions 437

Definitional Issues 437

Specialized Measures of Autism 439

An Assessment Strategy for Autism 445

A Sample Case of Autism in a Child

with Neurological Impairment 447

Conclusions 452

Chapter Summary 452

References 453

Author Index 491

Subject Index 503

xi

Psychologists offer an increasing variety

of services to the public. Among these

services, psychological assessment of per￾sonality and behavior continues to be a

central activity. One main reason is that

other mental health professionals often

do not possess a high level of competence

in this area. When one views psycholo￾gists who serve children and adolescents,

psychological, assessment seems to take on

an even greater role. It follows, then, that

comprehensive and enlightened graduate￾level instruction in assessment should be a

high priority for educators of psychologists

who are destined to work with youth.

This book is an outgrowth of our efforts

to improve our own instruction of child

and adolescent assessment skills. We found

that existing textbooks were not serving

us well. Most of them were encyclopedic,

edited volumes that were (1) uneven in

the quality across chapters and/or (2) not

geared either in format or level of presen￾tation for beginning graduate instruction.

The few single- or co-authored volumes

available tended to lack the breadth of cov￾erage we deemed necessary. Some focused

largely on theoretical issues related to psy￾chological testing, with minimal discussion

of practical applications and use of specific

tests. Others focused solely on summa￾ries of individual tests, without review￾ing the theoretical or empirical context

within which to use the tests appropriately.

Hence, this volume reflects our desire to

provide a more helpful tool for instruc￾tion - one that provides a scientific context

within which to understand psychological

testing with children and adolescents and

that translates this scientific context into

practical guidelines for using individual

tests in clinical practice.

Among our specific objectives for this

volume are the following:

• To focus on measures specifically

designed to assess the emotional, behav￾ioral, and social functioning of children

and adolescents

• To provide current research findings

that enable students to draw heavily

on science as the basis for their clinical

practice

• To help in the translation of research

into practice by providing specific and

practical guidelines for clinical practice

• To include a broad coverage of assess￾ment methods from a variety of

theoretical, practical, and empirical tra￾ditions

• To systematically compare tests and

assessment methods using research

findings, reviews, and our own synthe￾sis of positions

• To provide a readable volume that would

enhance the interest and retention of

students through the use of numerous

P r e f a c e

xii

case examples, tables, research notes, and

other “boxes” containing practical advice

In writing a readable text that goes beyond

a cursory survey of available instruments,

we were faced with the difficult task of

determining what specific instruments to

include in the book. As we struggled with

this decision, we eventually chose several

selection criteria. Our main criterion for

inclusion was a test’s ability to serve as an

exemplar of some specific type of assess￾ment instrument or theoretical approach

to assessment. In many cases we looked

for “prototypes” that we thought would

highlight some key points to the reader

that could then be used in evaluating

other assessment instruments not cov￾ered specifically in the text. Other criteria

included a test’s popularity or our estimate

of a new test’s potential impact on the field.

Granted, this decision- making was highly

subjective, but we strove to be analytic and

to limit to the extent possible our personal

feelings and biases. Fortunately, several

external anonymous reviewers of earlier

drafts of the text helped us to be more

objective.

A final point that should be clearly out￾lined is our basic orientation to psycho￾logical assessment. We feel that the goal

of psychological assessment is the mea￾surement of psychological constructs and,

for clinical practice, measurement of psy￾chological constructs that have important

clinical implications, such as documenting

the need for treatment or the type of inter￾vention that is most appropriate. For an

individual child the constructs that need to

be assessed will vary from case to case and

depend on the referral question. But what

is important from this conceptualization is

that our view of psychological assessment

is not test-driven but construct-driven.

Without exception, assessment tech￾niques will measure some constructs well

and other psychological dimensions less

well. Another important implication from

this view of testing is that it is critical that

assessors become familiar with and main￾tain familiarity with research on the con￾structs they are trying to assess. In short,

the most critical component in choosing a

method of assessment and in interpreting

assessment data is understanding what one

is trying to measure.

In this volume, we have focused on the

measurement of psychological constructs

that emphasize a child’s emotional, behav￾ioral, and social functioning. There is still

a great debate over definitional issues in

this arena of psychological functioning in

terms of what should be called “personal￾ity,” “temperament,” “behavior,” or “emo￾tions,” with distinctions usually determined

by the level of analysis (e.g., overt behavior

vs. unconscious motivational processes),

assumed etiology (e.g., biologically deter￾mined vs. learned), or proven stability

(e.g., transient problems vs. a stable pat￾tern of functioning) (see Frick, 2004; Mar￾tin, 1988). Unfortunately, people often use

the same terms with very different con￾notations. In writing this text, we tried to

avoid this debate by maintaining a broad

focus on “psychological constructs,” which

often vary on the most appropriate level of

analysis, assumed etiology, or stability. This

definitional variability adds a level of com￾plexity to the assessment process because

assessors must always consider what they

are attempting to measure in a particular

case and what research suggests about

the best way of conceptualizing this con￾struct before they can select the best way

of measuring it. It would be much easier if

one could develop expertise with a single

favorite instrument or a single assessment

modality that could be used in all evalu￾ations to measure all constructs. Because

this is not the case, psychologists must

develop broad-based assessment expertise.

Hence, our overriding objective in writ￾ing this volume is to provide the breadth

of coverage that we feel is needed by the

psychologist in training.

preface

xiii

We have organized the text into three

sections consistent with our approach to

teaching. Part I provides students with an

introduction to the psychological knowl￾edge base necessary for modern assessment

practice including historical perspectives;

measurement science; research in develop￾mental psychopathology; ethical, legal, and

cultural issues; and the basics of beginning

the assessment process (e.g., planning the

evaluation, rapport building). Part II gives

students a broad review of the specific

assessment methods used by psychologists,

accompanied by specific advice regarding

the use and the strengths and weaknesses of

each method. In Part III we help students

perform some of the most sophisticated of

assessment practices: integrating and com￾municating assessment results and infus￾ing assessment practice with knowledge of

child development and psychopathology.

We think that, on completion of this vol￾ume, and a similar one covering aspects of

cognitive assessment (Kamphaus, 2001 and

in press), that the student psychologist has

the background necessary for supervised

practicum experiences in the assessment of

children and adolescents.

preface

Paul J. Frick

Christopher T. Barry

Randy W. Kamphaus

P a r t I

Basic Issues

3

P.J. Frick et al., Clinical Assessment of Child and Adolescent Personality and Behavior,

DOI 10.1007/978-1-4419-0641-0_1, © Springer Science+Business Media, LLC 2010

C h a p t e r 1

Historical Trends

Chapter Questions

l Who were the major innovators in the

field of personality assessment?

l How were these innovations extended to

the assessment of children and adolescents?

l What is meant by the terms personality

and behavior?

l What is meant by the terms objective

and projective personality assessment?

l Who conducted the seminal research

and coined the terms internalizing and

externalizing behavior problems?

Personality assessment is a process that

most individuals engage in throughout

their lives (Martin, 1988). Mothers label

their children as happy, cranky, or simi￾larly shortly after birth, and often in utero

(e.g., active). The musings of Alfred Binet

about the personality of his two daughters

are typical of observations made by parents.

He described Madeleine as silent, cool, and

concentrated, while Alice was gay, thought￾less, giddy, and turbulent (Wolf, 1966).

Adolescents are keenly aware of person￾ality evaluation as they carefully consider

feedback from their peers to perform their

own self-assessments. Personality assess￾ment is also prized by the business commu￾nity, in which human resources personnel

consult with managers and others to gauge

the effects of their personality on coworkers

and productivity.

Early personality assessment emphasized

the assessment of enduring traits that were

thought to underlie behavior or, in modern

terminology, latent traits. Kleinmuntz (1967)

described personality as a unique organiza￾tion of factors (i.e., traits) that characterizes

an individual and determines his or her pat￾tern of interaction with the environment.

Thus, personality structure is commonly

thought to be a result of multiple individual

traits interacting with one another, and with

the person’s environment.

4 CHAPTER 1 HISTORICAL TRENDS

Definitions of Terms

in Personality Assessment

Traits

A trait is often conceptualized as a relatively

stable disposition to engage in particular acts

or ways of thinking (Kamphaus, 2001 and in

press). A child, for example, may be described

by her parents as either shy or extroverted.

The shy (introverted in psychological terms)

child may tend to cope with stressful situa￾tions by withdrawing from social contact,

whereas the extrovert readily approaches

social situations. For parents and psycholo￾gists alike, these traits are often thought to

have value for predicting human behavior,

because of the presumption of trait stability

across time and, in many cases, environments.

In fact, because of trait stability, parents may

take special precautions to ensure that the

shy child adapts well to the social aspects

of attending a new school by asking one of

their child’s friends who attends the same

school to accompany the child on the first

day. Similarly, a stable tendency to be shy or

introverted should manifest itself in numer￾ous social situations such as interactions in

the neighborhood, at church, and in ballet

class. Personality traits, then, are character￾ized by longitudinal and situational stability,

not unlike other enduring characteristics of

a person such as intelligence, height, and

activity level.

The Big Five Personality

Traits (Factors)

In 1961, Tupes and Christal discovered

five factors of personality that appeared in

the reanalysis of numerous data sets from

scales of bipolar personality descriptors.

These central personality traits have sub￾sequently become the focus of an extensive

research effort, including the development

of tests designed to assess the constructs.

One of the well known scales used to iden￾tify the “big five” in adults is the NEO

Personality Inventory (NEO-PI; Costa &

McCrae, 1985).

Although commonly referred to as “fac￾tors” because of their origins in factor analy￾sis, they are prototypical examples of traits

with the requisite characteristic of presumed

stability. The big five factors are typically

identified by bipolar comparisons that are

summarized in Table 1.1. These factors are

often assessed using forced-choice item for￾mats in which adjectives are used as person￾ality descriptors. This item format is in direct

contrast to the more commonplace true/false

item format that is typical of many psycho￾logical tests.

Table 1.1 Early Descriptions of the Big

Five Personality Dimensions (Goldberg,

1992)

Factor I – Surgency (or introversion–extro￾version)

Unenergetic vs. energetic

Silent vs. talkative

Timid vs. bold

Factor II – Agreeableness (or pleasant￾ness)

Cold vs. warm

Unkind vs. kind

Uncooperative vs. cooperative

Factor III – Conscientiousness (or depend￾ability)

Disorganized vs. organized

Irresponsible vs. responsible

Negligent vs. conscientious

Factor IV – Emotional stability (vs. neu￾roticism)

Tense vs. relaxed

Nervous vs. at ease

Factor V – Culture, intellect, openness,

or sophistication

Unintelligent vs. intelligent

Unanalytical vs. analytical

Unreflective vs. reflective