EPPP Psychological Assessment

Psychological assessment is not heavily emphasized on the EPPP, and only about five to 12 exam
questions will come from this area. The majority of the questions will ask about a theory of
intelligence or about a specific test that is used to evaluate intelligence or personality or ask you to
identify a specific disorder such as depression, ADHD, or major neurocognitive disorder. Keep in
mind that the EPPP blends the Assessment domain with the Abnormal domain, so it’s best to have
an integrative understanding of how these assessments inform diagnosis and treatment planning.

In this presentation, I'll review a few major theories of intelligence and describe several tests that
you're most likely to be asked about on the exam. I'll also present a couple of practice questions that
are similar to EPPP questions in terms of content format and difficulty level.

Our review will begin with theories of intelligence.

One of the earliest theories was proposed in 1904 by Charles Spearman, who helped develop the
statistical technique known as factor analysis. Spearman used this technique to analyze scores
obtained by subjects on several different measures of intellectual ability. Based on the results, he
concluded that intelligence consists of a general or g factor that contributes to performance on all
intellectual tasks, plus a second factor he labeled s, which contributes to performance on a variety of
more isolated, discrete tasks.

Factor analysis was also used by Horn and Cattell later in the mid-1960s. Their research led them to
conclude that intelligence can be described in terms of two primary factors: crystallized intelligence
and fluid intelligence.

Crystallized intelligence consists of a person’s acquired knowledge and skills, such as one’s
understanding of facts or general principles. Knowing the dates of significant world events or the
freezing and boiling temperatures of water are examples of crystallized intelligence. Crystallized
intelligence is highly dependent on cultural, educational, and other experiences.

In contrast, fluid intelligence is an innate ability that does not depend on prior learning or
experience and is considered to be relatively culture-free. Fluid intelligence is necessary for tasks
that require the ability to reason abstractly and quickly or to solve novel problems. The ability to
make comparisons, draw inferences, or quickly perceive relationships or patterns are examples of
fluid intelligence.

Horn and Cattell's theory was subsequently expanded to include additional intellectual abilities and
served as the foundation for other theories. One such theory presented in the mid-1990s by John
Carroll, conceptualized three levels (or strata) of intelligence. Carroll hypothesized that the top
level, stratum III, represents g or general intelligence. Beneath it, stratum II is comprised of eight
abilities including fluid intelligence, crystallized intelligence, general memory, and learning, while
the bottom level, stratum I, consists of numerous specific abilities that are related to one of the
second stratum abilities, such as spelling ability and communication.

In the late 1990s, Kevin McGrew took Carroll’s theory and Horn-Cattell’s model and consolidated
these, referring to this theory as the Cattell-Horn-Carroll theory of cognitive abilities or the CHC
model. The original CHC model was similar to Carroll's model but was subsequently expanded to
include additional broad and specific abilities, and it has been incorporated into many current
measures of intelligence, including the KABC-II and the Woodcock-Johnson IV. While McGrew
acknowledges the presence of g (general intelligence), he does not include it in his theory because
he does not consider g as useful to the practice of psychoeducational assessment.
While early theories focused on the factors that underlie intelligence, several newer theories focus
more on process. For example, Sternberg's triarchic theory focuses on the mental processes that
allow people to successfully adapt to the environment and accomplish their own goals and the goals
of society. According to Sternberg, the ability to adapt to the environment and accomplish goals
depends on three interacting aspects of intelligence: analytical, creative, and practical.

The analytical aspect is also known as component intelligence and consists of information
processing and knowledge acquisition skills that are needed to recognize and define a problem,
identify strategies for resolving the problem, and perform the mental work needed to implement and
monitor the effectiveness of that strategy. The creative aspect is also known as experiential
intelligence and is responsible for applying knowledge and skills to novel problems and unfamiliar
situations. The practical aspect is also known as contextual intelligence and is responsible for the
ability to use knowledge and skills to function effectively in everyday situations. According to
Sternberg, traditional intelligence tests focus on the analytical aspect of intelligence but neglect the
other aspects.

Let's take a look at a practice question. Here's the question.

The relationship between increasing age and intelligence was addressed by Cattell and Horn.
According to their theory, which of the following increases until middle adulthood and then
continues to increase at a slower rate or remains fairly stable until late adulthood?

A) contextual intelligence
B) experiential intelligence
C) crystallized intelligence
D) fluid intelligence

I'll repeat the question (PAUSE).

The relationship between increasing age and intelligence was addressed by Cattell and Horn.
According to their theory, which of the following increases until middle adulthood and then
continues to increase at a slower rate or remains fairly stable until late adulthood?

A) contextual intelligence
B) experiential intelligence
C) crystallized intelligence
D) fluid intelligence

If you are thinking, “I have no idea, I haven’t heard this information before,” you might be right.
This question asks about a topic that I haven't covered in this presentation but that is addressed in
the psychological assessment chapter of the written study materials. I've included it because it
illustrates that, when a question asks about a topic that you're not entirely familiar with, it may be
possible to narrow the answer choices in order to make an educated guess. It’s impossible to
memorize ALL the information that could be covered on the EPPP, so it’s imperative to become
comfortable using the knowledge you do have about a domain to reason through to the best possible
answer.

Before looking at the answers to this question it would be important to notice that it's asking about a
conclusion reached by Horn and Cattell about the relationship between age and intelligence. Even if
you were unable to recall anything about this relationship, you'd be able to narrow the choices to
answers C and D as long as you could distinguish between crystallized and fluid intelligence. Then
to choose between these two answers, you'd want to see if you could recall any information about
crystallized or fluid intelligence that would help you decide which one is the best choice. If you
remember that crystallized intelligence is affected by education and other experiences, that would
make answer C seem like the best answer since it makes sense that crystallized intelligence would
tend to increase over the lifespan as a person accumulates experiences and acquires more
knowledge, and, in fact, answer C is the correct answer. Research conducted by Horn and Cattell
and others has confirmed that crystallized intelligence increases until at least middle age while fluid
intelligence peaks in adolescence or early adulthood and then begins to slowly decline.

Let's take a look now at specific measures of intelligence. We will start with the Stanford-Binet,
then discuss the Weschler tests, followed by personality tests, then clinical tests.

The Stanford-Binet Intelligence Scales, Fifth Edition, or SB5, is appropriate for individuals ages
two to 85 years and older and was designed not only to measure intelligence, but also to assist in
psychoeducational, forensic, career, and neuropsychological assessment. An important advantage of
the SB5 is that it includes a large number of items that are appropriate for evaluating individuals
with very high or very low levels of intellectual ability. In other words, it has a high ceiling and a
low floor.

The development of the SB5 was based on a hierarchical model of intelligence that consists of three
levels. If you recall, this model was developed by Carroll. The first level is the full-scale IQ which
is a measure of g or general intelligence. The second level represents a verbal and non-verbal IQ
which measures the ability to reason, solve problems, and recall information of a verbal or
nonverbal nature, and the third level consists of five cognitive factors derived from the CHC model
of intellectual abilities, discussed earlier—that is, fluid reasoning, knowledge, quantitative
reasoning, visual-spatial processing, and working memory.

These five factors are assessed in both verbal and non-verbal domains with different subtests. SB5
scaled subtest scores have a mean of 10 and standard deviation of three; these are combined to
obtain standard scores in full-scale IQ, verbal and nonverbal IQ, and five factor indexes. Each
standard score has a mean of 100 and a standard deviation of 15. An abbreviated battery IQ score
can also be calculated. It is based on two routing subtests (one verbal and one nonverbal) and can be
used to obtain a quick estimate of an examinee’s intelligence. In addition, change sensitive scores
can be calculated and are useful for tracking changes in cognitive functioning over time.

Next are the Wechsler tests. The Wechsler Adult Intelligence Scale is appropriate for individuals
ages 16 through 90. The fourth edition or WAIS-IV is the most widely used measure assessing
cognitive ability. The Wechsler Adult Intelligence Scale, Fifth Edition or WAIS-V is due to be
released in 2021 and will include updated U.S.-based norms.

The Wechsler Adult Intelligence Scale provides a full scale IQ score, scores on four indexes, and
scores on 10 core and five supplemental subtests. The supplemental subtests may be substituted for
core subtests when there's clinical justification for doing so—for instance, when an examinee’s
characteristics suggest that a supplemental subtest would be more appropriate than one of the core
subtests. The full-scale IQ score and index scores have a mean of 100 and standard deviation of 15,
and subtest scores have a mean of 10 and standard deviation of 3. For the exam, you want to be
familiar with the abilities assessed by the four indexes and know which core and supplemental
subtests contribute to scores on each index.

Let's start with the verbal comprehension index, or VCI, which evaluates word knowledge,
understanding of verbal information, and the ability to use verbal skills and information to solve
novel problems. The VCI score is derived from scores on three core subtests and one supplemental
subtest. The core subtests are Vocabulary, Similarities, and Information, and the supplemental
subtest is Comprehension. The perceptual reasoning index, or PRI, evaluates visual-perceptual
organization, visual-motor coordination and non-verbal reasoning skills. The PRI score is derived
from scores on three core tests and two supplemental subtests. The core tests are Block Design,
Matrix Reasoning, and Visual Puzzles, and the supplemental subtests are Figure Weights and
Picture Completion.

Next is the working memory index, or WMI, which provides information on auditory attention and
discrimination, mental processing speed, ability to manipulate information in short-term memory,
and numerical reasoning. The WMI score is derived from scores on two core subtests and one
supplemental subtest. The core subtests are Digit Span and Arithmetic, and the supplemental subtest
is Letter-Number Sequencing.

Finally, the processing speed index, or PSI, evaluates perceptual and processing speed, visual-motor
coordination, and short-term visual memory. Its scores derive from two core subtests, Symbol
Search and Coding, and one supplemental subtest, Cancellation.

Two downward extensions of the test for are available for younger examinees. The Wechsler
Intelligence Scale for Children, Fifth Edition, or WISC-V, is available in traditional paper-and-
pencil and digital formats and is appropriate for examinees six through 16 years of age. It provides a
full-scale IQ score, five primary index scales, several complimentary and ancillary index scales and
subtest scores. The five primary index scores correspond to five cognitive domains which are verbal
comprehension, visual-spatial, fluid reasoning, working memory, and processing speed. The
primary and complimentary indexes provide information on complex cognitive processes, while the
ancillary indexes provide information on cognitive processes that are known to be related to
learning difficulties.

Finally, the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, or WPPSI-IV, is
appropriate for examinees two through seven years of age. It provides a full-scale IQ score, scores
on primary and ancillary indexes, and subtest scores.

The next topic is personality tests. For the exam, you want to be familiar with some common
objective personality tests like the MMPI and the NEO-PI, as well as some basic projective
personality tests like the Rorschach and TAT. One of the most important objective personality tests
is the Minnesota Multiphasic Personality Inventory or MMPI. On the EPPP, you may be asked to
interpret a particular MMPI profile by scale numbers only, to determine if an MMPI profile is valid
based only on provided validity and reliability scores, or to decide when it would be appropriate to
give an MMPI based on a clinical level vignette.

The MMPI-2 is appropriate for individuals 18 years of age and older, and the MMPI-A is designed
for individuals 14 to 18 years of age. An updated release of the MMPI, the MMPI-3, is scheduled
for release in late 2020 and will include norms aligned with the latest census projections. The
MMPI is used to identify personal, social, and behavioral problems in order to assist in the
diagnosis of psychopathology and selection of treatment strategies, as well asin non-clinical settings
to screen applicants for police officer, firefighter, air traffic controller, and other high-risk public
safety jobs.

The MMPI-2 provides scores on the 10 clinical scales and four validity scales that were included in
the original version of the test, as well as scores on nine restructured clinical scales, numerous
content and supplementary scales, and additional validity scales. Raw scores for each scale are
converted to T-scores that have a mean of 50 and standard deviation of 10. A score of 65 or higher
is considered to be clinically significant, and the greater the number of elevated scores and the
higher the elevations, the more likely that the examinee experiences personal and social distress and
has difficulty carrying out normal activities of daily life. Scores on the MMPI-2’s clinical scales are
often interpreted in terms of profile analysis, which involves considering the examinee’s two
highest scores. For example, a two-score code of 1, 2 or 2, 1 indicates that the examinee’s highest
scores are on scales one and two which are hypochondriasis and depression. This profile is
associated with depression, worry, pessimism, and chronic pain.

In contrast, to score a code of 4, 9 or 9, 4 indicates that the examinee’s highest scores are on scales
four and nine, which are the psychopathic deviant and hypomania scales. This profile is associated
with feelings of alienation and antisocial behavior and is characteristic of people with a history of
family, work, and legal problems, alcohol or drug abuse, delinquency, or sex offenses.

One of the most notable aspects of the MMPI’s structure is its thorough validity scales. The MMPI-
2's validity scales include the F-, L-, and K-scales. The F- or frequency scale measures the extent to
which the examinee has answered items in an atypical or deviant way. A high score on the scale
suggests deliberate malingering, delusional thinking, eccentricity, or random responding. In
contrast, a low score may indicate a tendency towards social conformity and absence of significant
psychopathology or in the presence of known psychopathology, an attempt to “fake good.” The L-
or lie scale measures the extent to which the examinee has attempted to describe him or herself in
an unrealistically positive way. A high scale score suggests a deliberate attempt to present oneself in
a favorable light or a lack of insight into one's own motivations, while a low score suggests
frankness in responding, exaggeration of negative characteristics, independence, and self-reliance or
cynicism.

Finally, the K- or correction scale also assesses the extent to which examinees have described
themselves in an overly positive way, and a high score on this scale suggests a high degree of
defensiveness or a desire to “fake good,” or indicates that the examinee has answered false to all
items. In contrast, a low score suggests excessive frankness, self-criticism, or a desire to “fake bad.”

The K-scale is considered to be a suppressor variable, since scores correlate with defensiveness,
education level, and socio-economic status, which are unrelated to what is measured by the test’s
clinical scales. An examinee’s K-scale score can be used to correct his or her scores on some of the
clinical scales.

In memorizing these validity scales, think F for frequency, items that are very infrequently marked;
L for lying, meaning a high score suggests they are faking good; and K as in correction (reader:
emphasize the K sound in correction), as in, “I don’t believe you’re either faking good or bad.”

Let’s take a look at a practice question about this assessment measure. Here's the question.

An elevated score on the MMPI-2 K-scale suggests that the examinee

A) has responded randomly to most or all items.
B) is described by others as being cynical and sarcastic.
C) has attempted to present him or herself in a very unfavorable light.
D) is unwilling to admit psychological problems.

I'll repeat the question (PAUSE).

An elevated score on the MMPI-2 K scale suggests that the examinee

A) has responded randomly to most or all items.
B) is described by others as being cynical and sarcastic.
C) has attempted to present him or herself in a very unfavorable light.
 D) is unwilling to admit psychological problems.

Recall that the K-scale assesses the extent to which examinees have described themselves in an
overly favorable way. Let's look at the answers. Answer A is has responded randomly to most or all
items. Let's assume that you recall that random responding produces an elevated score on the MMPI
as an F-scale, not the K-scale, so you'd eliminate this answer. Answer B says the examinee is
described by others as being cynical and sarcastic. If you remembered that a low score on the
MMPI’s L-scale may be due to cynicism, you'd eliminate this answer or, if not, you'd reconsider it
if no other answer seems correct. Answer C is has attempted to present him or herself in a very
unfavorable light. If you know that a low, not a high, K-scale score suggests that the examinee has
attempted to fake bad, you'd also eliminate this answer. And that leaves answer D, which says the
examinee is unwilling to admit psychological problems. Hopefully, you recall that a high score on
the K-scale suggests that the examinee has described him or herself in an overly favorable way,
which could be due to a lack of insight into his or her own behavior or to an unwillingness to admit
psychological problems. So, answer D is the correct response. It's the only answer that accurately
describes a possible explanation for an elevated score on the K-scale.

The MMPI was originally developed using the empirical criterion keying strategy, meaning that
proposed test items were administered to clinical groups and a control group. Items that served to
discriminate between the two groups were included in the test’s clinical scale. Newer content scales
such as anxiety, obsessiveness, and cynicism were developed using content analysis, where
developers selected items based on their content and included those that correlated highly with the
total scale score.

A second objective personality test, the NEO Personality Inventory-3 or NEO-PI-3, was developed
using a different approach, known as the atheoretical lexical approach. The items were not derived
from a theory of personality, but rather from languages around the world. Assuming that all
personality characteristics are reflected in human language, developers determined through factor
analysis which traits are relevant across cultures. The emerging top five traits became known as the
Big Five personality traits; they are extraversion, agreeableness, conscientiousness, neuroticism,
and openness to experience. The mnemonic often used to remember these is either the word
OCEAN or CANOE. Research has largely confirmed that this model of personality is replicable
across cultures, though a number of recent studies have failed to replicate openness to experience in
some non-Western countries, and there are cultural differences in the strength of some traits
worldwide. Still, the NEO-PI-3 and the Big Five personality traits are among the most recognized
and empirically based approaches to personality measurement.

I’ll move on to some of the projective personality tests you may encounter on the exam. The
projective hypothesis assumes that ambiguous or unstructured stimuli can elicit useful information
about an examinee’s personality. These tests are generally less susceptible than structured tests to
“faking,” but have come under scrutiny related to reliability and validity. You are not likely to get
many questions on projective personality tests on the EPPP, but it’s best to be prepared in case.

Perhaps the best known is the Rorschach Inkblot Test, which involves presenting 10 cards to the
examinee in a prescribed order. There are two phases to administration. The first involves eliciting
freely associated responses the administrator records verbatim. A subsequent inquiry phase involves
asking the examinee about the features of the inkblot that prompted his or her initial responses.
Employing Exner’s Comprehensive System of scoring is associated with higher levels of inter-rater
reliability and validity.

The Thematic Apperception Test or TAT involves presenting the examinee with a subset of eight to
12 out of a total of 20 cards picturing black-and-white images of one or more human figures. This
test is appropriate for children or adults. The examinee is instructed to make up a story about each
picture. The technique emerged out of Henry Murray’s theory of needs and involves identifying the
story’s “hero” and evaluating the intensity, frequency, and duration of needs, environmental press,
themes, and outcomes in each story. Research indicates that the TAT is less useful for assigning
specific diagnoses but may be useful for identifying gross diagnostic distinctions and/or to serve as
a broad measure of personality.

The next topic is clinical assessment, and tests in this category include the Bender Visual-Motor
Gestalt test, the Mini Mental State Exam, the Wisconsin Card Sorting Test, the Stroop Color-Word
Association Test, and the Beck Depression Inventory. Let's start with the Bender Visual-Motor
Gestalt Test, second edition, or Bender-Gestalt II, which was designed for individuals ages three
and older as a brief measure of visual motor integration and screening tool for neuropsychological
impairment.

The test consists of 16 cards that each contain a different geometric figure, and administration
involves two phases. In the copy phase, the examinee copies each design from the stimulus card on
a blank sheet of paper. Then, during the recall phase, the examinee is asked to reproduce as many
designs as possible from memory. Research has confirmed that performance on the Bender-Gestalt
is affected by education but not by drawing ability in that up to age 10, scores correlate with
intelligence. There's also evidence that the test is useful for assessing school readiness and first
graders’ predicted academic achievement, as well as for identifying learning disabilities. This test is
considered a valid screening tool for brain damage, but to avoid false negatives it should always be
used in conjunction with other sources of information.

The Mini Mental State Exam or MMSE is used to identify cognitive impairment in older adults. It
should not be used as a substitute for a thorough clinical assessment in diagnosing dementia. The
MMSE assesses six areas of cognitive functioning including orientation, registration (immediate
recall), attention and calculation, delayed recall, language, and visual construction. It relies heavily
on verbal responses, therefore should be used with caution for individuals who have limited English
skills or communication impairments. For the MMSE, the maximum score is 30 and a score of 23
or 24 is ordinarily used as the cutoff, with scores below the cutoff suggesting cognitive impairment.

Limitations of the MMSE include its lack of sensitivity to cognitive impairments that occur in the
earliest stages of major neurocognitive disorder and the fact that performance is affected by
educational and cultural background. For example, there's evidence that use of a cutoff score of 23
produces a significantly higher rate of false positives for African-American and Hispanic American
adults than for white adults, even when scores are adjusted for educational level.

Next is the Wisconsin Card Sorting Test, or WCST, which is used to assess executive cognitive
functioning in children and adults. The WCST is sensitive to frontal lobe damage, and impaired
performance has been linked to alcoholism, autism, schizophrenia, depression, and malingering.
The test includes four stimulus cards and 64 response cards that each contain one to four symbols—
a triangle, star, cross, or circle—and the examinee is asked to sort the response cards under the four
stimulus cards using a sorting strategy that has not been explained to him or her; however, the
examiner provides the examinee with feedback about whether the examinee’s strategy is right or
wrong. After 10 correct sorts, the examiner changes the strategy without warning the examinee. The
examinee’s responses are scored in terms of the number of trials required to identify the correct
sorting strategy.

The Stroop Color-Word Association Test is another assessment tool that you want to be familiar
with for the exam. It assesses the degree to which an examinee can suppress a prepotent or habitual
response in favor of an unusual response and is considered to be a measure of cognitive flexibility
and selective attention. The test presents the examinee with a list of color names that are printed in
ink colors that differ from the name. For example, the word red might be printed in blue ink and the
examinee is asked to say the ink color of each word rather than read the color name, which is the
prepotent response. The Stroop Test is sensitive to frontal lobe damage, and poor performance has
been linked to ADHD, mania, depression, and schizophrenia.

Finally, the Beck Depression Inventory, Second Edition, or BDI-II, can be used with examinees 13
through 80 years of age to assess severity of depression. It contains 21 items that address mood and
cognitive, behavioral, and physical aspects of depression. The examinee rates each item on a four-
point severity scale from zero to three in terms of how he or she has felt in the last two weeks. A
total score of zero to 13 indicates no or minimal depression; 14 to 19, mild depression; 20 to 28,
moderate depression; and 29 to 63, severe depression. The BDI-II is often re-administered
periodically during the course of treatment to monitor changes in symptom severity and guide
treatment decisions.

This concludes my lecture on Psychological Assessment. Please note, this is not an exhaustive list
of the content within this domain. I encourage you to also study our written materials on
Psychological Assessment as this will expand your understanding of the most important topics on
the EPPP. Good luck on your exam!