Psychological Testing


The Clinical & Forensic Psychology Practice of Dr. Glen Skoler

DrGlenSkoler@Gmail.com • (240) 605-2988

 
 


  





The Psychological, Therapeutic & Economic Value of Psychological Testing Before Beginning Psychotherapy or Medication


    A theme throughout this website is that psychological testing can yield significant diagnostic and therapeutic information, in a limited amount of time, and at a limited cost. Given the emotional, financial and time investments made in counseling and psychiatric medications, obtaining this immediate, cost-effective “data on the self” makes a great deal of sense.


    For about the cost of a single therapy session, a client can take a psychodiagnostic test or clinical inventory in 30-45 minutes, by marking hundreds of true/false questions which are then generated by a computer into about 50-100 scales and sub-scales (depending on the test). These tests are designed for pre-adolescents (ages 9-12), adolescents and adults.


    Psychoeducational testing to assess IQ, learning disabilities and attention deficit disorders takes somewhat longer, and costs somewhat more. This is because each item must be administered, recorded, scored, often timed, and then interpreted by the psychologist. Similarly, neuropsychological testing is also time-intensive for the psychologist since, again, each item must be administered to the evaluation subject directly.


Types of Psychological Testing for Adults, Teens & Children


  1. Psychodiagnostic tests, sometimes referred to as personality inventories or clinical inventories, involve the subject marking hundreds of true false questions in less than an hour. A computer scoring program then generates about a 100 or more scales and sub-scales across a range of psychological symptoms and personality traits. The Minnesota Multiphasic Personality Inventory (MMPI-II), and the Millon Clinical Inventories (MCMI-III, MACI and M-PACI) are among the most well-known and respected of such tests.


  1. Psychoeducational tests assess IQ, learning disabilities (LD), attention deficit disorders (ADD, ADHD) and giftedness (GT). A typical psycho-educational test battery might consist of an IQ test, a test of achievement measuring traditional academic skills and progress, and a test of memory and learning to assess information processing, concentration, and the ability to learn, store and remember newly presented information.


  1. The gold standard Wechsler IQ tests for adults and children (WAIS-IV & WISC-IV) are also neuropsychological screening batteries that yield far more than an overall IQ number. Each test is composed of about 12 scales or subtests, divided between verbal and non-verbal skills. In addition to an overall IQ, the tests yield significant information about verbal comprehension, perceptual reasoning, information processing, processing speed and vulnerability to distractibility. A full scale IQ administration is the first step in any assessment for learning disabilities and neuropsychological impairment, and is, of course, central to assessing giftedness and intellectual impairment.


  1. IQ test batteries have sister test batteries called “memory scales,” or “memory and learning scales,” such as the WMS, CMS & WRAML (see psychological tests list below). These tests are actually batteries containing classic neuropsychological tests to measure memory, learning and information processing. A teenager may be very bright, but what if he can’t smoothly process all the information involved in note-taking: simultaneously listening to the teacher, remembering what he is hearing, recording the information in notes, and learning the information, all while he continues to listen and begins to record the next piece of information. Of course, these memory and learning batteries are often central in assessing more serious neuropsychological impairment, such as memory problems associated with dementia. Remember, for the layperson, the term “memory” is somewhat misleading. If you think about it, everything we know has to be “remembered” and “learned.” That is, it has to be instantly recorded in short term memory and “entered” onto the “hard drive” of our brain, so that it can be recognized and called up later.


  1. Neuropsychological testing assesses serious learning disabilities, brain damage, disorders of executive functioning, neuropsychological impairment, memory and dementia.


  1. There are actually hundreds of brief psychological tests and instruments for assessing many conditions and capacities. For example, in my clinical and forensic psychology practice, I use specialized tests to assess post-traumatic stress disorders, neuropsychological disorders, dissociative disorders, sexual disorders, substance abuse disorders, competency to stand trial and risk of dangerousness.


  1. For a list of the psychological, psychoeducational, neuropsychological and forensic tests and instruments I administer, please select the link below:


* Psychological Tests Administered *


The Questionable Ethics of Instant Diagnoses


     It is literally scary how quickly some mental health diagnoses are made in this country. I recently learned at a presentation by an Air Force psychiatrist, sponsored by the American Psychological Association, that most psychiatric diagnoses and medication prescriptions are made in this country, not by psychiatrists, but by family doctors and general practitioners. He also noted that in this age of “managed care” health services, by the time one waits in a doctor’s examining room and has vital signs taken by a nurse, the actual contact time with the doctor himself or herself is often 10 minutes, or less. (He claimed the national average was 8 minutes.) That is, millions of people on psychiatric medications are often initially psychiatrically assessed in 10 minutes or less.


    A “luxury” in the psychiatric community is a whole 50 minutes to conclude that someone has a lifelong mental disorder or “biochemical” imbalance, but without a single “biochemical test” to confirm the “biochemical diagnosis,” without a single empirically validated psychological test to confirm the diagnosis, and often without a thorough psychosocial history.


    Psychiatrists (M.D.’s) and social workers (M.S.W.’s) are neither trained nor licensed to administer psychological tests. They therefore often do not place importance on psychological testing or feel they need to “refer out” to establish complex mental health diagnoses. And managed care health insurance companies place severe limits on such tests to hold costs down.


    Another factor discouraging psychological testing is the controversial but influential Diagnostic and Statistical Manual of Mental Disorders (the DSM-IV), which lists brief, numbered behavioral criteria for different mental disorders in a pocket manual. This creates the impression that a serious mental health diagnosis such as a personality disorder can quickly be established during brief interviews by professionals with limited mental health training, such as a resident.


    The DSM-IV is published by the medical profession, the American Psychiatric Association, not the American Psychological Associations. Using such criteria, millions of people could conceivably look like they “fit” certain diagnoses. For example, anxiety and agitation could occur in a post-traumatic stress disorder, an agitated depression, a bipolar disorder, an onsetting psychotic disorder––or in a victim of abuse. Therefore, the concept of “differential diagnosis” is important. The DSM-IV itself, in its full length manual, not just in its simple diagnostic criteria quoted on mental health websites and Wikipedia, emphasizes the importance of differential diagnosis: how not to confuse one mental health disorder with another. Therefore, it is often useful to compare psychological test results with DSM-IV diagnostic criteria.