Do you believe assessment tools are a hindrance (user error, false positives), or do they enhance a clinician’s ability to diagnose correctly? To support your response, provide an example of an assessment tool, and describe the tool’s benefits and challenges.
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Do you believe assessment tools are a hindrance (user error, false positives), or do they enhance a clinician’s ability to diagnose correctly?
In my opinion different assessment tools have different advantages and disadvantages. For this week’s discussion I have chosen to focus on the Beck Youth Inventory (BYI) which is an assessment tool for youth depression. The BYI is a self-report assessment that contains 5 different inventories: depression, anxiety, anger, disruptive and self-concept (Pearson, 2020). These inventories can either be used independently or together. Pearson (2020) notes that an individual inventory contains “20 statements about thoughts, feelings, and behaviors associated with emotional and social impairment in youth. Children and adolescents describe how frequently the statement has been true for them.” Self-report assessments can be a hindrance when it comes to diagnoses because sometimes people tend to answer in the way that they think the clinician will want them to answer or they answer to make themselves look better (halo bias) thus potentially leading to false positives or false negatives. However, I do believe that when this assessment tool is used by a professional, and potentially with other assessments (e.g., behavioral), then it can truly enhance a clinician’s ability to diagnose correctly.
Validity numbers can help someone understand how a certain assessment tool might be more beneficial than others. Test-retest validity is defined as “the degree to which similar items within a scale correlate with each other,” and it has been found that the BYI has “excellent internal consistency” (CORC, 2017). This tells us that if an individual takes the assessment multiple times, they are likely to score similarly every time. It has also been found that the BYI has “good discriminant validity and has been found to reliably discriminate between internalizing disorders, with the exception of depression” (Measure Profile, 2012; CORC, 2017). This is important in diagnosing mental disorders, especially in adolescence, because misdiagnoses can impede an adolescent’s development based on various medications that could be prescribed or the social factors that sometimes occur when a diagnosis is received.
It could be the fact that it has been shown to work, and maybe some newer assessment tools are not as widely accepted. If a clinician is every not sure of an assessment tool, they should try a different one to see if they receive similar results before giving a diagnosis. Overall, I believe that the BYI enhances a clinician’s ability to diagnose correctly.
CORC. (2017). Beck Youth Inventory. Retrieved from https://www.corc.uk.net/outcome-experience-measures/beck-youth-inventory/
Pearson. (2020). Beck Youth Inventories™ – Second Edition For Children and Adolescents (BYI-II). Retrieved from https://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildMentalHealth/BeckYouthInventories-SecondEditionForChildrenandAdolescents(BYI-II)/BeckYouthInventories-SecondEditionForChildrenandAdolescents(BYI-II).aspx
I believe that assessment tools enhance a clinician’s ability to give correct diagnoses. Assessment tools allow the clinician to gain better insight into specific behaviors and symptoms thereby allowing them to provide a more informed diagnosis. One assessment tool that is used to assess ADHD is the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). The VADPRS is used to measure the severity of ADHD symptoms in children aged 6-12. Parents rate severity of each behavior on a 4-point scale rating using never, occasionally, often, and very often. Academic performance and relationships are also rated on a 5-point scale ranging from problematic to above average. The VADPRS includes all 18 of the DSM-IV criteria for ADHD along with 8 criteria for ODD, 12 criteria for CD, and 7 criteria for anxiety and depression.
There are several benefits to using the VADPRS including cost efficiency, easy to complete, easy to score and it includes core symptoms and rating of performance along with screening for comorbid conditions. In a study by Wolraich and colleagues (2003), the psychometric properties of the VADPRS was evaluated and the results suggested that factor structures and internal consistency were consistent with DSM-IV and other measures of ADHD. The study also showed a good reliability under different conditions and severities.
While there are benefits to using the VADPRS, it is not without limitations. One limitation is the fact that parents rate the behaviors which can lead to under or over rating of symptoms. A parent who is set on their child receiving medication or other services may rate behaviors at a higher severity, while parents who may view their child as perfect may be more likely to give lower ratings on their child’s behaviors. The effectiveness of the VADPRS to determine comorbid disorders has also been brought into question. One study examined the VADPRS comorbidity screening scales. The results showed that none of the optimal VADPRS comorbidity scale thresholds had adequate levels to determine which participants likely met diagnostic criteria for CD, ODD, depression, or anxiety but alternative thresholds on existing scales can be used to determine which children do not likely meet the criteria for those disorders (Becker, Langberg, Vaughn, & Epstein, 2012). Although it is suggested that the VADPRS cannot determine likelihood of meeting diagnostic criteria it can be a useful tool to identify who may or may not be at risk for diagnoses of comorbid disorder.
Becker, S. P., Langberg, J. M., Vaughn, A. J., & Epstein, J. N. (2012). Clinical utility of the Vanderbilt ADHD diagnostic parent rating scales comorbidity screening scales. Journal of developmental and behavioral pediatrics, 33(3), 221-228. doi:https://doi.org/10.1097/DBP.0b013e318245615b
Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K. (2002). Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in Referred Population. Journal of Pediatric Psychology, 28(8), 559-568. doi:https://doi-org.ezproxy.snhu.edu/10.1093/jpepsy/js…