Development of VM-REACT: Verbal memory RecAll computerized test

When tracking the progression of neuropsychiatric or neurodegenerative diseases, assessment tools that enable repeated measures of cognition and require little examiner burden are increasingly important to develop. In the current study, we describe the development of the VM-REACT (Verbal Memory REcAll Computerized Test), which assesses verbal memory recall abilities using a computerized, automated version. Four different list versions of the test were applied on a cohort of 798 healthy adults (ages 20-80). Recall and learning scores were computed and compared to existing gender- and age-matched published norms for a similar paper-and-pencil test. Performance was similar to existing age-matched norms for all but the two oldest age groups. These adults (ages 60-80) outperformed their age-matched norms. Processing speed, initiation speed, and number of recall errors are also reported for each age group. Our findings suggest that VM-REACT can be utilized to study verbal memory abilities in a standardized and time efficient manner, and thus holds great promise for assessment in the 21st century.

The Computerized Perceptual Motor Skills Assessment: A new visual perceptual motor skills evaluation tool for children in early elementary grades

Visual perceptual motor skills have been proposed as underlying courses of handwriting difficulties. However, there is no evaluation tool currently available to assess these skills comprehensively and to serve as a sensitive measure. The purpose of this study was to validate the Computerized Perceptual Motor Skills Assessment (CPMSA), a newly developed evaluation tool for children in early elementary grades. Its test-retest reliability, concurrent validity, discriminant validity, and responsiveness were examined in 43 typically developing children and 26 children with handwriting difficulty. The CPMSA demonstrated excellent reliability across all subtests with intra-class correlation coefficients (ICCs)≥0.80. Significant moderate correlations between the domains of the CPMSA and corresponding gold standards including Beery VMI, the TVPS-3, and the eye-hand coordination subtest of the DTVP-2 demonstrated good concurrent validity. In addition, the CPMSA showed evidence of discriminant validity in samples of children with and without handwriting difficulty. This article provides evidence in support of the CPMSA. The CPMSA is a reliable, valid, and promising measure of visual perceptual motor skills for children in early elementary grades. Directions for future study and improvements to the assessment are discussed.

Computer-Based Methods for Collecting Peer Nomination Data: Utility, Practice, and Empirical Support

New technologies have led to several major advances in psychological research over the past few decades. Peer nomination research is no exception. Thanks to these technological innovations, computerized data collection is becoming more common in peer nomination research. However, computer-based assessment is more than simply programming the questionnaire and asking respondents to fill it in on computers. In this chapter the advantages and challenges of computer-based assessments are discussed. In addition, a list of practical recommendations and considerations is provided to inform researchers on how computer-based methods can be applied to their own research. Although the focus is on the collection of peer nomination data in particular, many of the requirements, considerations, and implications are also relevant for those who consider the use of other sociometric assessment methods (e.g., paired comparisons, peer ratings, peer rankings) or computer-based assessments in general.

Validity of the Comprehensive Test of Nonverbal Intelligence (CTONI)

This study examined the construct validity of the Comprehensive Test of Nonverbal Intelligence (CTONI) in two separate investigations. The first study examined criterionrelated evidence of validity across racial/ethnic groups on the CTONI and the Woodcock-Johnson Psychoeducational Tests of Achievement (3rd edition). The second study examined the comparability of the standard and computerized forms of the CTONI. Results of the first study revealed that the CTONI overall score did not correlate significantly with reading achievement and correlated moderately with math achievement. The CTONI also showed significant racial/ethnic group differences, despite the absence of these differences on achievement. Results of the second study revealed that average scores on the standard form of the CTONI were significantly higher statistically than those on the computerized form. Correlations between raw scores on the computerized form of the CTONI and age were statistically significant, although generally low. In sum, results of this research raise concerns and questions about the validity of the CTONI. The CTONI should be used with caution, if at all, until further research is conducted.

Bilingual Computerized Speech Recognition Screening for Depression Symptoms

The Voice-Interactive Depression Assessment System (VIDAS) is a computerized speech recognition application for screening depression based on the Center for Epidemiological Studies–Depression scale in English and Spanish. Study 1 included 50 English and 47 Spanish speakers. Study 2 involved 108 English and 109 Spanish speakers. Participants completed demographic and acculturation scales, Beck Depression Inventory–II, Beck Anxiety Inventory, Composite International Diagnostic Interview–Short Form, and VIDAS (aural or visual). Both studies examined the psychometric properties and participant comfort ratings for VIDAS. Study 2 also examined psychometric sensitivity and specificity, and participant selection of digitized gender for VIDAS. Both studies found that VIDAS generally demonstrated adequate interitem reliability, convergent validity, sensitivity, and specificity. However, the aural modality displayed lower reliability and validity. Participants in both language groups rated each VIDAS modality favorably; however, the visual modality received higher positive evaluations. Participant comfort ratings of digitized gender revealed an interaction, such that the visual female and the aural male were rated more favorably.

Computer-Based Test Interpretation in Career Assessment: Ethical and Professional Issues

The use of computer-based test interpretation (CBTI) in career assessment raises numerous ethical and professional issues. For example, how do current testing standards apply to tests on the Internet? What are appropriate and inappropriate uses of CBTI in career assessment? How can CBTI be successfully integrated into the career counseling process? Who is qualified to use CBTI? What are the potential benefits and problems with CBTI? In an attempt to answer some of these questions, this article examines the nature of CBTI and the use of CBTI in career assessment. Strategies for establishing and communicating the validity of CBTI are also presented. By proactively addressing potential ethical and professional issues, it is more likely that this technology will contribute to positive outcomes for individuals, clients, and practitioners.

The Structured Trauma-Related Experiences and Symptoms Screener (STRESS): Development and Preliminary Psychometrics

The Structured Trauma-Related Experiences and Symptoms Screener (STRESS) is a self-report instrument for youth of age 7-18 that inventories 25 adverse childhood experiences and potentially traumatic events and assesses symptoms of post-traumatic stress disorder using the revised criteria published in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The STRESS can be administered by computer such that questions are read aloud and automatic scoring and feedback are provided. Data were collected on a sample of 229 children and adolescents of age 7-17 undergoing a forensic child abuse and neglect evaluation. The purpose of the current study was to examine preliminary psychometric characteristics of the computer-administered STRESS as well as its underlying factor structure in relation to the four-factor DSM-5 model. Results provide initial support for the use of the STRESS in assessing adverse and potentially traumatic experiences and traumatic stress in children and adolescents.

The 20-item prosopagnosia index (PI20): a self-report instrument for identifying developmental prosopagnosia

Self-report plays a key role in the identification of developmental prosopagnosia (DP), providing complementary evidence to computer-based tests of face recognition ability, aiding interpretation of scores. However, the lack of standardized self-report instruments has contributed to heterogeneous reporting standards for self-report evidence in DP research. The lack of standardization prevents comparison across samples and limits investigation of the relationship between objective tests of face processing and self-report measures. To address these issues, this paper introduces the PI20; a 20-item self-report measure for quantifying prosopagnosic traits. The new instrument successfully distinguishes suspected prosopagnosics from typically developed adults. Strong correlations were also observed between PI20 scores and performance on objective tests of familiar and unfamiliar face recognition ability, confirming that people have the necessary insight into their own face recognition ability required by a self-report instrument. Importantly, PI20 scores did not correlate with recognition of non-face objects, indicating that the instrument measures face recognition, and not a general perceptual impairment. These results suggest that the PI20 can play a valuable role in identifying DP. A freely available self-report instrument will permit more effective description of self-report diagnostic evidence, thereby facilitating greater comparison of prosopagnosic samples, and more reliable classification.

Interpretive Reliability of Six Computer-Based Test Interpretation Programs for the Minnesota Multiphasic Personality Inventory-2

The reliability of six Minnesota Multiphasic Personality Inventory-Second edition (MMPI-2) computer-based test interpretation (CBTI) programs was evaluated across a set of 20 commonly appearing MMPI-2 profile codetypes in clinical settings. Evaluation of CBTI reliability comprised examination of (a) interrater reliability, the degree to which raters arrive at similar inferences based on the same CBTI profile and (b) interprogram reliability, the level of agreement across different CBTI systems. Profile inferences drawn by four raters were operationalized using q-sort methodology. Results revealed no significant differences overall with regard to interrater and interprogram reliability. Some specific CBTI/profile combinations (e.g., the CBTI by Automated Assessment Associates on a within normal limits profile) and specific profiles (e.g., the 4/9 profile displayed greater interprogram reliability than the 2/4 profile) were interpreted with variable consensus (α range = .21-.95). In practice, users should consider that certain MMPI-2 profiles are interpreted more or less consensually and that some CBTIs show variable reliability depending on the profile.

Challenges in software applications for the cognitive evaluation and stimulation of the elderly

Background

Computer-based cognitive stimulation applications can help the elderly maintain and improve their cognitive skills. In this research paper, our objectives are to verify the usability of PESCO (an open-software application for cognitive evaluation and stimulation) and to determine the concurrent validity of cognitive assessment tests and the effectiveness of PESCO’s cognitive stimulation exercises.

Methods

Two studies were conducted in various community computer centers in the province of Granada. The first study tested tool usability by observing 43 elderly people and considering their responses to a questionnaire. In the second study, 36 elderly people completed pen-and-paper and PESCO tests followed by nine cognitive stimulation sessions. Meanwhile, a control group with 34 participants used computers for nine non-structured sessions.

Results

Analysis of the first study revealed that although PESCO had been developed by taking usability guidelines into account, there was room for improvement. Results from the second study indicated moderate concurrent validity between PESCO and standardized tests (Pearson’s r from .501 to .702) and highlighted the effectiveness of training exercises for improving attention (F = -4.111, p < .001) and planning (F = 5.791, p < .001) functions.

Conclusions

PESCO can be used by the elderly. The PESCO cognitive test module demonstrated its concurrent validity with traditional cognitive evaluation tests. The stimulation module is effective for improving attention and planning skills.

Computerized sociometric and peer assessment

A systematic analysis and comparison was conducted of the psychometric properties of standard (paper-and-pencil) and computerized sociometry and peer assessments. The standard assessment took place with 817 children (47.5% boys) in 34 fifth- and sixth-grade classrooms of 28 elementary schools. The computerized assessment took place with 893 children (52.3% boys) in 35 fifth- and sixth-grade classrooms of 30 elementary schools. The computerized method yielded more nominations given and received and fewer missing data. Correlations among behavioural and relational constructs followed similar patterns in both methods, but were generally stronger in the computerized method. Voter agreement was the same in both methods. The computerized method resulted in higher internal consistency of sociometric and peer assessment constructs. The methods were validated by predicting preference and popularity from behavioural and relational characteristics. The two methods yielded the same pattern of results. The advantages and disadvantages of both assessment methods were discussed.

Computerized cognitive testing in epilepsy (CCTE): a new method for cognitive screening

PURPOSE

Optimized therapy in epilepsy should include individual care for cognitive functions. Here we introduce a computerized screening instrument, called "Computerized Cognitive Testing in Epilepsy" (CCTE), which allows for time-efficient repetitive assessment of the patient's cognitive profile regarding the domains of memory and attention, which are frequently impaired due to side effects of antiepileptic medication.

METHODS

The CCTE battery takes 30min and covers tasks of verbal and figural memory, cognitive speed, attention and working memory. The patient's results are displayed immediately in comparison to age-related normative data. For evaluation of psychometrics and clinical correlations, data from patients of a tertiary referral epilepsy center (n=240) and healthy subjects (n=83) were explored.

RESULTS

CCTE subtests show good reliability and concurrent validity compared to standard neuropsychological tests (p<0.01). Adverse cognitive effects of antiepileptic medication can be detected (p<0.05), e.g. significant negative effects of increasing drug load. Specific epilepsy subgroups, e.g. focal versus primary generalized epilepsy or right versus left mesial temporal lobe epilepsy, showed different CCTE profiles.

CONCLUSION

CCTE appears valuable for early detection of individual cognitive alterations related to medication. In addition, it displays interesting differences between epilepsy syndromes. The CCTE battery provides a standardized, time- and personnel-efficient assessment of cognitive functions open to a large number of patients and applicable for clinical and scientific use in epilepsy.

Neurobehavioral assessment in forensic practice

There is a growing awareness among mental health practitioners that many mental disorders previously believed to be primarily behavioral in nature, reflecting character and environment, are actually grounded in brain mal-development or brain disorder. This growing awareness, influenced by the advent of new diagnostic procedures and measures, is also found among forensic practitioners. In this paper, we describe some of the elements involved in conducting a neurobehavioral assessment of cognitive functioning, particularly in capital cases, organizing this material in terms of the professional disciplines - social work, mitigation investigation, psychological, and medical - with which these methods are mainly identified. The paper concludes with a brief discussion of how to integrate the multiple areas of expertise to create an accurate understanding of the neurobehavioral functioning and capacity of the subject. This is the basis from which civil and criminal forensic opinions must emanate.

A Comparison of Paper-and-Pencil and Computerized Forms of Line Orientation and Enhanced Cued Recall Tests

The purpose of this study was to assess whether a computerized battery of neuropsychological tests could produce similar results as the conventional forms. Comparisons on 77 volunteer undergraduates were carried out with two neuropsychological tests: Line Orientation Test and Enhanced Cued Recall Test. Firstly, students were assigned randomly across the test medium (paper-and-pencil versus computerized). Secondly, the groups were given the same test in the other medium after a 30-day interval between tests. Results showed that the Enhanced Cued Recall Test–Computer-based did not correlate with the Enhanced Cued Recall Test-Paper-and-pencil results. Line Orientation Test–Computer-based scores, on the other hand, did correlate significantly with the Line Orientation Test–Paper-and-pencil version. In both tests, scores were higher on paper-and-pencil tests compared to computer-based tests. Total score difference between modalities was statistically significant for both Enhanced Cued Recall Tests and for the Line Orientation Test. In both computer-based tests, it took less time for participants to complete the tests.

Personality subtypes in adolescents with panic disorder

This study examined personality subtypes of adolescents diagnosed with Panic Disorder (PD). As part of an NIMH-funded study of adolescent personality and its relation to psychopathology, randomly selected experienced licensed psychologists and psychiatrists used a Q-sort instrument to describe adolescents in their care, of whom 57 had been diagnosed with PD. Q-factor analysis yielded three personality subtypes: High Functioning/Dysphoric, Emotionally Dysregulated, and Avoidant. The subtypes differed on axis I and II pathology, adaptive functioning, and developmental and family history variables. Personality constellations showed substantial incremental validity in predicting adaptive functioning above and beyond DSM-IV axis I diagnoses. The results resemble subtypes recently identified in adults and suggest that adolescents who present with panic symptoms are a heterogeneous group, whose personality needs to be considered in understanding and helping them clinically.

Does the weather make us sad? Meteorological determinants of mood and depression in the general population

It is a common and well-spread belief that people feel more depressed when the weather is bad. However, whether meteorological factors such as temperature, sunshine and rainfall can actually account for variations in the prevalence of depression in the general population has yet to be investigated. We aimed to assess the influence of weather conditions on the seasonal variation of depression observed in the general population. We used data from a large-scale depression-screening programme in the south of the Netherlands. Seasonal prevalence of DSM-IV classified major depression and sad mood in a sample of 14,478 participants from the general population was calculated, and linked to mean daily temperature, duration of sunshine and duration of rainfall in logistic regression analyses. The prevalence of major depression and sad mood showed seasonal variation, with peaks in the summer and fall. Weather conditions were not associated with mood, and did not explain the seasonal variation we found. We conclude that, contrary to popular belief, weather conditions and sad mood or depression do not seem to be associated. Future studies might use daily measures of well-being as outcome.

Minor and major depression in the general population: does dysfunctional thinking play a role?

BACKGROUND

Although most research suggests that minor depression is part of a depression continuum, conflicting results have also been found. Moreover, little is known about dysfunctional thinking in minor depression and how this varies along the continuum. Especially, research on the form of dysfunctional thinking (ie, extreme responding) is lacking. We have addressed these issues by reporting results from a large community sample.

METHODS

Demographic, clinical, and cognitive factors (ie, content and form of dysfunctional thinking) were compared between minor depression (ie, 2-4 symptoms), major depression with 5 to 6 symptoms, and major depression with 7 to 9 symptoms. A large community sample (N = 1129) was used. Differences between the 3 subgroups were examined as well as linear relations between number of symptoms and factors marking the severity.

RESULTS

Most demographic variables did not distinguish the 3 depression status categories from each other. Clinical and cognitive factors acted in synchrony with the depression continuum.

CONCLUSIONS

Minor depression should be considered as part of continuum together with major depression. Not only the content but also the form of dysfunctional thinking seems to play a major role in depression. Extreme positive responding is more prominent in mild depression, whereas more severely depressed individuals have a general tendency toward extreme negative responding. This finding, if replicated, may have important implications for the cognitive theory of depression.

The Relationship Between Diabetes Mellitus, Depression, and Missed Appointments in a Low-Income Uninsured Population

Purpose

The purpose of this project is to identify rates of depression and document mental health needs of adults with diabetes who obtained care in free clinics. Data were collected to determine if there is a relationship between diabetes and depression and missed appointments in a sample of patients who were low-income, uninsured, and represented a variety of racial groups.

Methods

A sample of 183 adults with diabetes participated by completing paper and computerized questionnaires. Instruments included the Patient Health Questionnaire 9 (to measure prevalence of depression), the RAND 36 Health Survey (to measure quality of health), the Audit of Diabetes Dependent Quality of Life (to measure diabetes-dependent quality of life), and the Diabetes Empowerment Scale (to measure self-efficacy).

Results

The prevalence of depression at a moderate or greater level in the sample was found to be 30.1%. Levels of quality of health and self-efficacy were found to be reduced among those with the presence of depression. A significant increase in the rate of depression was found among those who had attended the free clinic for a longer period. No significant differences were found in diabetes-dependent quality of life and missed appointments among those with depression compared with those without.

Conclusions

Rates of depression among adults with diabetes in a free clinic setting were found to be comparable with the highest rates reported by other studies of insured populations. Results of this study support the need to develop mental health treatment programs for free clinic settings.

Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial

BACKGROUND

Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression.

AIMS

To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care.

METHOD

Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period.

RESULTS

No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses.

CONCLUSIONS

Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.

Personality subtypes in patients with panic disorder

OBJECTIVE

This study examined personality subtypes of adults diagnosed with panic disorder (PD).

METHODS

As part of a National Institute of Mental Health-funded study on personality in a clinical population, randomly selected psychologists and psychiatrists used a Q-sort instrument to describe 96 adults diagnosed with PD.

RESULTS

Q-factor analysis yielded 4 personality subtypes: high functioning, emotionally dysregulated, inhibited/avoidant, and somatizing. Within the sample, the subtypes differed on Axis I and II pathology, adaptive functioning, and developmental and family history variables. Personality constellations in the sample showed substantial incremental validity in predicting adaptive functioning and treatment response above and beyond the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I diagnoses.

CONCLUSIONS

These distinctions may elucidate the high rates of comorbidity among patients with PD and are important in understanding treatment choice and outcome.

Measuring Dysfunctional Attitudes in the General Population: The Dysfunctional Attitude Scale (form A) Revised

The Dysfunctional Attitude Scale (DAS) was designed to measure the intensity of dysfunctional attitudes, a hallmark feature of depression. Various exploratory factor analytic studies of the DAS form A (DAS-A) yielded mixed results. The current study was set up to compare the fit of various factor models. We used a large community sample (N = 8,960) to test the previously proposed factor models of the DAS-A using confirmatory factor analysis. The retained model of the DAS-A was subjected to reliability and validity analyses. All models showed good fit to the data. Finally, a two-factor solution of the DAS-A was retained, consisting of 17 items. The factors demonstrated good reliability and convergent construct validity. Significant associations were found with depression. Norm-scores were presented. We advocate the use of a 17-item DAS-A, which proved to be useful in measuring dysfunctional beliefs. On the basis of previous psychometric studies, our study provides solid evidence for a two-factor model of the DAS-A, consisting of ‘dependency’ and ‘perfectionism/performance evaluation’.

Status of computerized cognitive testing in aging: a systematic review

BACKGROUND

Early detection of cognitive decline in the elderly has become of heightened importance in parallel with the recent advances in therapeutics. Computerized assessment might be uniquely suited to early detection of changes in cognition in the elderly. We present here a systematic review of the status of computer-based cognitive testing, focusing on detection of cognitive decline in the aging population.

METHODS

All studies purporting to assess or detect age-related changes in cognition or early dementia/mild cognitive impairment by means of computerized testing were included. Each test battery was rated on availability of normative data, level of evidence for test validity and reliability, comprehensiveness, and usability. All published studies relevant to a particular computerized test were read by a minimum of two reviewers, who completed rating forms containing the above mentioned criteria.

RESULTS

Of the 18 test batteries identified from the initial search, 11 were appropriate to cognitive testing in the elderly and were subjected to systematic review. Of those 11, five were either developed specifically for application with the elderly or have been used extensively with that population. Even within the computerized testing genre, great variability existed in manner of administration, ranging from fully examiner-administered to fully self-administered. All tests had at least minimal reliability and validity data, commonly reported in peer-reviewed articles. However, level of rigor of validity testing varied widely.

CONCLUSION

All test batteries exhibited some of the strengths of computerized cognitive testing: standardization of administration and stimulus presentation, accurate measures of response latencies, automated comparison in real time with an individual's prior performance as well as with age-related norms, and efficiencies of staffing and cost. Some, such as the Mild Cognitive Impairment Screen, adapted complicated scoring algorithms to enhance the information gathered from already existing tests. Others, such as CogState, used unique interfaces and subtests. We found that although basic indices of psychometric properties were typically addressed, sufficient variability exists that currently available computerized test batteries must be judged on a case-by-case basis.

Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: design of a randomised trial

Background

Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care.

Methods/Design

In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65) will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life.

Discussion

Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed.

Trial registration

The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).

A new Brief computerized cognitive screening battery (CompCogs) for early diagnosis of Alzheimer's disease

Screening tests for early diagnosis of dementia are of great clinical relevance. The ideal test set must be brief and reliable, and should probe cognitive components impaired in Alzheimer’s disease (AD).

Dissociative symptom disorders in advanced nursing practice: background, treatment, and instrumentation to assess symptoms

Less well-known among the psychiatric disorders, dissociation is one of the most common underlying symptoms of individuals seeking mental health care (Maldonado, 2001). Closely associated with post-traumatic stress disorder, dissociation characteristics may include inconsistent consciousness, autobiographical forgetfulness, difficulties in self-regulation, regressions, alternate identities, disorganization in the development of a cohesive sense of self, depersonalization, and derealization (Trickett, Noll, Reiffman & Putnam, 2001). The major constructs and dimensions of the dissociative symptom disorders in adults are introduced. Several of the most prominent psychometric instruments that nurses and other mental health clinicians may use as adjuncts to diagnosis and treatment are described.

Comparability and reliability of paper- and computer-based measures of psychosocial constructs for adolescent fruit and vegetable and dietary fat intake

BACKGROUND

This study investigated the comparability and reliability of computer- and paper-based measures of psychosocial constructs related to fruit and vegetable and dietary fat intake among adolescents.

METHODS

An ethnically diverse sample of 76 adolescents was studied (mean age 13 years). Scales measured use of change strategies, self-efficacy, decisional balance, family influences, and peer influences separately for the two dietary outcomes.

RESULTS

Comparability analyses indicated that responses for each of the 12 diet-related scales were not significantly different between the computer- and paper-based surveys. Internal consistencies were generally high (alpha from .61 to .97) with slightly better reliability on the computer- vs paper-based surveys. Test-retest reliabilities were adequate to good for most multiple-item scales (interclass correlation coefficients from .43 to .85 and .48 to .90 for paper and computer formats, respectively).

CONCLUSIONS

Computer- and paper-based measures of psychosocial constructs are appropriate and ready for use in either format for studies of dietary behaviors in young people.

Affect regulation in borderline personality disorder

Although difficulty with affect regulation is generally considered a core component of borderline personality disorder (BPD), surprisingly little research has focused on the nature of affect regulation and dysregulation in BPD. A random national sample of 117 experienced clinicians provided data on a randomly selected patient with BPD (N = 90) or dysthymic disorder (DD; N = 27). Clinicians described their patients using the Affect Regulation and Experience Q-sort-Questionnaire Version, a psychometric instrument designed for expert informants to assess affect and affect regulation. BPD and DD patients appear to differ in both the emotions they experience and the ways they regulate or fail to regulate them. Whereas DD patients are characterized by negative affect, BPD patients are characterized by both negative affect and affect dysregulation, which appear to be distinct constructs. BPD patients also show distinct patterns of affect regulation, and subtypes of BPD patients show distinct affect regulation profiles of potential relevance to treatment.

Ethical considerations in writing psychological assessment reports

In this article, the author addresses the ethical questions and decision evaluators associated with the writing of psychological assessment reports. Issues related to confidentiality, clinical judgment, harm, labeling, release of test data, and computer usage are addressed. Specific suggestions on how to deal with ethical concerns when writing reports are discussed, as well as areas in need of further research.

The psychological report: a review of current controversies

A summary of the most frequent controversies in report writing is covered. These include length, readability, acknowledging use of poorly validated measures, use of computer-based narratives, inclusion of test scores, degree of integration, inclusion of client strengths, and development of a feedback report. Available research is summarized along with suggestions for future research.

Comparability and reliability of paper- and computer-based measures of psychosocial constructs for adolescent physical activity and sedentary behaviors

This study assessed the comparability and reliability of paper-based and computer-based administration of psychosocial construct measures related to adolescents engaging in physical activity and sedentary behaviors. Adolescents (n = 76; 55% girls, 49% Hispanic, 18% non-Hispanic-white; M age = 13 years) completed measures of behavior change strategies, self-efficacy, decisional balance, family and peer influences, enjoyment, activity choices, and environmental influences. Overall, the adolescents provided equivalent responses on paper and computer formats. Reliability estimates were generally good for the multiple-item constructs, but single-item measures tended to demonstrate low reliability. Average scale internal consistency was significantly higher for measures administered with the computer format compared to the paper format, but test-rest reliability estimates were not significantly different between formats.

Validation of a Computerized Adaptive Version of the Schedule for Nonadaptive and Adaptive Personality (SNAP)

This is a validation study of a computerized adaptive (CAT) version of the Schedule for Nonadaptive and Adaptive Personality (SNAP) conducted with 413 undergraduates who completed the SNAP twice, 1 week apart. Participants were assigned randomly to 1 of 4 retest groups: (a) paper-and-pencil (P&P) SNAP, (b) CAT, (c) P&P/CAT, and (d) CAT/P&P. With number of items held constant, computerized administration had little effect on descriptive statistics, rank ordering of scores, reliability, and concurrent validity, but was preferred over P&P administration by most participants. CAT administration yielded somewhat lower precision and validity than P&P administration, but required 36% to 37% fewer items and 58% to 60% less time to complete. These results confirm not only key findings from previous CAT simulation studies of personality measures but extend them for the 1st time to a live assessment setting.

Computer utilization and clinical judgment in psychological assessment reports

The process of assessment report writing is a complex one, involving both the statistical evaluation of data and clinical methods of data interpretation to appropriately answer referral questions. Today, a computer often analyzes data generated in a psychological assessment, at least in part. In this article, the author focuses on the interaction between the decision-making processes of human clinicians and the test interpretations that are computer-based. The benefits and problems with computers in assessment are highlighted and are presented alongside the research on the validity of automated assessment, as well as research comparing clinicians and computers in the decision-making process. The author concludes that clinical judgment and computer-based test interpretation each have weaknesses. However, by using certain strategies to reduce clinicians' susceptibility to errors in decision making and to ensure that only valid computer-based test interpretations are used, clinicians can optimize the accuracy of conclusions that they draw in their assessment report.

Computers in clinical assessment: historical developments, present status, and future challenges

Computerized testing methods have long been regarded as a potentially powerful asset for providing psychological assessment services. Ever since computers were first introduced and adapted to the field of assessment psychology in the 1950s, they have been a valuable aid for scoring, data processing, and even interpretation of test results. The history and status of computer-based personality and neuropsychological tests are discussed in this article. Several pertinent issues involved in providing test interpretation by computer are highlighted. Advances in computer-based test use, such as computerized adaptive testing, are described and problems noted. Today, there is great interest in expanding the availability of psychological assessment applications on the Internet. Although these applications show great promise, there are a number of problems associated with providing psychological tests on the Internet that need to be addressed by psychologists before the Internet can become a major medium for psychological service delivery.

Sexuality, personality, and eating disorders

To assess sexuality, personality, and eating pathology in women with eating disorders (EDs), we asked a random sample of 234 clinicians to describe an ED patient (age 16-65). Restricting AN patients tended to be childlike and prim/proper, while BN patients tended to be flirtatious and promiscuous. A constricted/overcontrolled personality predicted a childlike sexuality independent of AN diagnosis, and an undercontrolled, emotionally dysregulated personality predicted impulsive sexuality above and beyond BN diagnosis. Constraint and impulsivity are not isolated to the domain of eating in women with EDs. Personality provides a link between eating and sexuality in at least a subset of women with EDs.

Practitioner review: computerized assessment of neuropsychological function in children: clinical and research applications of the Cambridge Neuropsychological Testing Automated Battery (CANTAB)

BACKGROUND

Computers have been used for a number of years in neuropsychological assessment to facilitate the scoring, interpretation, and administration of a variety of commonly used tests. There has been recent interest in applying computerized technology to pediatric neuropsychological assessment, which poses unique demands based on the need to interpret performance relative to the child's developmental level.

FINDINGS

However, pediatric neuropsychologists have tended to implement computers in the scoring, but not administration, of tests. This trend is changing based on the work of experimental neuropsychologists who frequently combine data obtained from test batteries with lesion or neuroimaging data allowing descriptions of brain-behavior relations to be made with increasing confidence. One such battery is the Cambridge Neuropsychological Testing Automated Battery (CANTAB), and current studies in which the CANTAB has been used to measure executive functions in children are reviewed.

CONCLUSIONS

Computerized batteries of this type can record aspects of performance that are difficult for psychometrists to achieve, and these may reflect activity in developing neural networks with more sensitivity than can be achieved with traditional tests. However, before computerized test administration becomes a routine part of pediatric neuropsychological assessment, several obstacles must be overcome. Despite these limitations, it is concluded that computerized assessment can improve the field by facilitating the collection of normative and clinical data.

Discontinuities, side steps, and finding a proper place: an autobiographical account

In this invited autobiography, I present an account of some influential events and experiences in my life that led me eventually, after some false starts, to a career in personality assessment psychology. The psychological research and applied areas (self-report personality assessment and cross-cultural research) with which I have been identified for over 40 years can, however, be seen in early interests, although their impact and their direction were not always apparent at the time of occurrence. Several people who were influential in my career development are noted and a number of important collaborators who helped sustain my efforts in personality assessment research and practice over the years are highlighted.

Touch-screen system for assessing visuo-motor exploratory skills in neuropsychological disorders of spatial cognition

A new computerised test adopting touch-screen technology has been developed to assess the visuo-motor exploration of extra-personal space. The test was derived from well-known paper-and-pencil cancellation tasks used widely in the diagnosis and quantitative assessment of unilateral spatial neglect (USN), a neuropsychological syndrome that is more frequent and severe after damage to the right cerebral hemisphere. A main component deficit of USN is the defective visuo-motor exploration of the side of space contralateral to the side of the lesion (contralesional), namely, in right-sided brain-damaged patients it occurs on the left side and vice versa. The computer-based paradigm consisted of a visuo-motor spatial exploratory task: the subjects were instructed to touch, in any order they wished, all the targets they detected on a computer touch-screen. This measured the time of occurrence and the spatial co-ordinates of each touch event and forwarded the data to the computer for storage; the computer provided feedback to the subject by 'tagging' the touched target. The paradigm allowed the calculation of accuracy and latency indexes and recorded the exploratory pathway taken by each subject. A pilot study was performed in ten normal subjects and 15 brain-damaged patients, with and without psychometric evidence of USN; the results showed that the equipment was able to provide quantitative indexes related to the spatial-temporal aspects of exploratory ability, which are useful for diagnostic purposes, and revealed significant differences between the controls and patients with USN: the overall average values of latency and crossing indexes increased in patients with USN, compared with the controls (latency from 0.77 to 1.90s; path crossing index from 7.0% to 59.5%), and the significantly negative USN patient latency gradient (-2.79 against a null control value) evidenced a worsening of performance towards the left side.

Clinical assessment

Are clinical psychologists' assessment practices cost-effective? Are they scientifically sound? Are they fair and unbiased? Financial pressures from managed care interests, recent developments in the law, and multicultural issues are forcing the profession to confront these hard questions regarding accountability. Our review discusses the important changes that have begun to alter the field of personality assessment and describes recent research on clinical judgment and its implications for the future. We conclude that clinical psychology can adapt to future conditions by developing assessment strategies that are economical, scientifically sound, and culturally sensitive.

Body Morph Assessment: preliminary report on the development of a computerized measure of body image

OBJECTIVE

To develop a prototype of the Body Morph Assessment (BMA), and to test the reliability and validity of this new measure of body image. The BMA is a realistic and relatively simple procedure that uses computer morphing for the assessment of body image. For the purposes of this preliminary study, a prototype of the BMA was developed for usage with white women ranging from very thin to obese.

RESEARCH METHODS AND PROCEDURES

A total of 72 subjects participated in tests of reliability, content, and convergent validity of the BMA.

RESULTS

The reliability and validity of the BMA was supported by the results of this study. In a test of convergent validity, the measures of current, ideal, and reasonable body size were positively correlated with their equivalents from a similar body image assessment procedure. In addition, reliability coefficients were found to be satisfactory for all variables. Participants found the human figural stimuli to be realistic.

DISCUSSION

These preliminary findings support the reliability and validity of the BMA with white women. Given these positive findings, we plan to extend the procedure to males and to other racial and ethnic groups.