Rorschach intercoder reliability for protocol-level comprehensive system variables in an international sample

This study examines the intercoder reliability of Rorschach Comprehensive System (CS; Exner, 2001) protocol-level variables. A large international sample was combined to obtain intercoder agreement for 489 Rorschach protocols coded using the CS. Intercoder agreement was calculated using an Iota coefficient, a statistical coefficient similar to kappa that is corrected for chance. Iota values for the variables analyzed ranged from .31 to 1.00, with 2 in the poor range of agreement, 4 in the fair range, 25 in the good range, and 116 in the excellent range of agreement. Discrepancies between variables are discussed.     

MMPI-A structural summary variables: prevalence and correlates in an adolescent inpatient psychiatric sample

This study examined the prevalence and correlates of Archer and Krishnamurthy's MMPI-A Structural Summary (SS) dimensions in a sample of 632 adolescent psychiatric inpatients through a series of correlational analyses. These analyses examined the relationship between factor dimensions and categorically defined dimension elevations and external criterion measures that included chart review data, therapist ratings, chart diagnoses, and cognitive test performance. The SS dimensions provided additional interpretive yield for some within-normal-limits profiles. An examination of the pattern of correlations revealed small to moderate relationships between all SS variables and external criterion measures.     

The Social Phobia Inventory: validity and reliability in an adolescent community sample

Social anxiety disorder and social anxiety are highly prevalent psychological conditions in youth. Because of the known risks associated with the spectrum of social anxiety in youth, early detection with valid and reliable assessment measures is imperative. Self-report measures have become the most widely used method of assessment for child and adolescent social anxiety. Because research to date on self-report measures of social anxiety disorder in adolescents is limited, the primary objective of the present study was to contribute to the literature by examining the validity and reliability of a new self-report measure, the Social Phobia Inventory (SPIN), in a community sample of adolescents. The SPIN is a 17-item measure purported to assess the full spectrum of social anxiety disorder symptomatology. Previously, psychometric research on the SPIN in adult populations has demonstrated its validity and reliability. In the current psychometric examination, results revealed strong support for the temporal stability, internal consistency, and construct validity of the SPIN, suggesting it is an appropriate screening measure for the assessment of social anxiety disorder in adolescents.     

Three factors of the comprehensive system for the Rorschach and their relationship to Wechsler IQ scores in an adolescent sample

Principal axis factor analyses of the Rorschach Comprehensive System (CS) in a clinical sample of 152 adolescents yielded three clearly defined factors: Synthesized Complexity (defined by Zf, DQ+, and F%), Productivity (defined by R, D, and Dd), and Form Quality (defined by X+%, F+%, and X-%). Variables on the Synthesized Complexity and Form Quality factors were generally correlated with Wechsler Full Scale IQ, Verbal IQ, and Performance IQ scores. Overall, the factors in this adolescent sample replicated factors identified in earlier studies with adults. Implications for clinical practice are discussed.     

MAPI code types in an inpatient crisis-unit sample

Limited data is available concerning the use of the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) and high-point code combinations of its personality style scales. Our study reports on the frequency of high-point codes in an inpatient crisis-unit sample. Data analyses comparing personality style codes using MAPI expressed concerns scale elevations and Rorschach data are reported. Results comparing the personality style codes and expressed concerns scales were consistent with the findings of Millon et al. (1982). Analyses comparing Rorschach and MAPI data revealed only the presence or absence of vista responses as having any appreciable relationship to MAPI codes or personality scales.     

Comparison of the WISC and WISC-R on a psychiatric adolescent inpatient sample

The present study compared the WISC and WISC-R on a group of psychiatric adolescent inpatients. The results indicated high intercorrelations between the two test versions but with the correlations linearly related to the changes in content and administration rules of the WISC-R. Analyses of variance indicated that, on the basis of the Full Scale IQ, the WISC is an easier test than the WISC-R.The authors gratefully acknowledge the assistance of Ms. Kathleen Lennox for her aid in data analysis and computer programming.     

Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample

The authors developed the Self-Injurious Thoughts and Behaviors Interview (SITBI) and evaluated its psychometric properties. The SITBI is a structured interview that assesses the presence, frequency, and characteristics of a wide range of self-injurious thoughts and behaviors, including suicidal ideation, suicide plans, suicide gestures, suicide attempts, and nonsuicidal self-injury (NSSI). This initial study, based on the administration of the SITBI to 94 adolescents and young adults, suggested that the SITBI has strong interrater reliability (average kappa = .99, r = 1.0) and test-retest reliability (average kappa = .70, intraclass correlation coefficient = .44) over a 6-month period. Moreover, concurrent validity was demonstrated via strong correspondence between the SITBI and other measures of suicidal ideation (average kappa = .54), suicide attempt (kappa = .65), and NSSI (average kappa = .87). The authors concluded that the SITBI uniformly and comprehensively assesses a wide range of self-injury-related constructs and provides a new instrument that can be administered with relative ease in both research and clinical settings.     

A comparison of two mental status examinations in an inpatient psychiatric sample

This study compares the psychometric properties and clinical use of the Mini-Mental Status Exam (MMSE) and the Modified MMSE (3MS) in patients admitted to an acute medical-psychiatric inpatient unit. Internal consistencies were .56 for the estimated MMSE and .72 for the 3MS. Regression analyses revealed that the 3MS was a significant predictor of both length of hospital stay (LOS) and the need for additional services postdischarge. Regressions were also used to evaluate the contribution of the four new items contained in the 3MS: Word Generation, Similarities, Second Recall, and Date and Place of Birth. The 3MS was a significant predictor of LOS and the need for discharge services, whereas the MMSE did not contribute to any regression model. Word Generation was found to be a significant predictor of patients' needing posthospital services. Results support prior findings of the 3MS's superiority over the (estimated) MMSE and help to demonstrate the continued importance of cognitive screening in psychiatric samples.     

Sleep normalization and decrease in dissociative experiences: evaluation in an inpatient sample

We conducted a longitudinal study to investigate the relation between sleep experiences and dissociative symptoms in a mixed inpatient sample at a private clinic evaluated on arrival and at discharge 6 to 8 weeks later. Using hierarchical regression analyses and structural equation modeling, we found a link between sleep experiences and dissociative symptoms and determined that specifically decreases in narcoleptic experiences rather than insomnia accompany a reduction in dissociative symptoms. Although sleep improvements were associated with a general reduction in psychopathology, this reduction could not fully account for the substantial and specific effect that we found for dissociation. Our findings are consistent with Watson's (2001) hypothesis that disruptions in the sleep-wake cycle lead to intrusions of sleep phenomena into waking consciousness, resulting in dissociative experiences. Accordingly, sleep hygiene may contribute to the treatment or prevention of dissociative symptoms.     

Factor structure of the Depression Self-Rating Scale in an Iranian adolescent sample

Previous research showed concurrent validity for the Depression Self-rating Scale for Iranian adolescents, so the present purpose was to evaluate construct validity. The scale was distributed to 2012 school students in Grades 5 to 10. Factor analysis using varimax rotation yielded four factors interpretable as depressed mood, hopelessness, lack of pleasurable activities, and physiological symptoms. These factors accounted for 44% of the variance and provide some support for construct validity of the scale in Iranian adolescents.     

Enhancing accuracy in observational test scoring: the comprehensive system as a case example

Inaccuracies in administration and scoring can potentially compromise the validity of any standardized psychosocial measure. The threat is particularly pertinent to methods involving behavioral observation, a category that includes many intelligence tests, neuropsychological measures, personality assessment instruments, and diagnostic procedures. Despite evidence and conjecture that errors in testing procedure are common for at least some of these measures and that these errors are often severe enough to influence interpretation, the topic has received relatively little attention. In particular, the absence of any safeguard against inaccurate test use in clinical situations can put the respondent at risk and violates ethical standards for the use of tests. In this article, I review some issues surrounding accuracy in testing procedures, including a discussion of what is known about the problem, an evaluation of several approaches to improving testing practices, and a review of recommendations for the statistical evaluation of rater accuracy. In this article, I use the Rorschach Comprehensive System (Exner, 1993) to demonstrate the concepts discussed.     

Test-retest reliability and construct validity of Contour Drawing Rating Scale scores in a sample of early adolescent girls

Test–retest and construct validity of Contour Drawing Rating Scale (CDRS) scores were examined in 1056 Grades 7 and 8 girls. Questionnaires were completed four times, including retests at 2, 6 and 14 weeks. Test–retest reliability for current size, ideal size and current–ideal discrepancy mostly exceeded 0.70 (0.65–0.87, for the full sample, with higher rs for shorter retest periods). Ideal and current size ratings increased slightly over time. High correlations between perceived current figure and measured body mass index; moderate rs between current–ideal discrepancy and body dissatisfaction and restrained eating; and very low or no significant correlations with social desirability supported construct validity in this group. The study supported the use of the CDRS in early adolescent girls.     

Personal problem-solving system for scoring TAT responses: preliminary validity and reliability data

Personal problem solving has emerged as an important construct in the cognitive-behavioral literature, yet there is a lack of clinically useful, performance-based measures practitioners can use to assess the personal problem-solving skills of their clients. Two studies evaluated the validity and reliability of a scoring system for measuring personal problem-solving processes via the Thematic Apperception Test (TAT; Morgan & Murray, 1935). In Experiment 1, undergraduate students (N = 87) completed two measures of personal problem solving, as well as three TAT cards, which were scored using the Personal Problem-Solving System (PPSS; Renan, 1990). In Experiment 2, an additional group of undergraduates (N = 56) responded to three TAT cards on two separate occasions and also completed a different measure of personal problem solving. Results from both studies supported the use of the PPSS for scoring TAT responses to assess personal problem-solving processes. Suggestions for future research are highlighted.     

Adolescent depression and externalizing problems: testing two models of comorbidity in an inpatient sample

Differentiating between additive (quantitative) and interactive (qualitative) effects of comorbidity has important treatment implications. This study illustrates the heuristic superiority of a multifactorial approach over simple group comparisons in testing quantitative versus qualitative models of comorbidity. Analysis of variance was used to compare 266 adolescent inpatients identified as depressed, externalizing, both, or neither on self-report measures of personality, school problems, and substance abuse. The results support quantitative rather than qualitative models of comorbidity. Depressed status related most strongly to group differences in interpersonal and self-critical concerns. Externalizing status related most strongly to group differences in school problems and drug use. Main effects for the two statuses together explained especially elevated levels of reactance and alcohol abuse among the comorbid adolescents.     

Hub Group: an innovative approach to group therapy in a short-term inpatient adolescent unit

Two and one-half years of Hub Group have shown that short-term, ward-based, heterogeneously mixed adolescent groups can work. Backed by a behaviorally based privilege system, Hub Group contracting methods facilitate rapid investment in group therapy, are flexible enough to accommodate change, and provide a meaningful ritual that involves all group members in promoting change for the individual. Hub Group's method of self-rating and rewards promotes objectivity in self-evaluation. The contracts' images are compact, but all encompassing, providing a continuum along which to move in developing greater responsibility and productive functioning for the adolescents. There are distinct advantages and disadvantages to mixed levels of functioning within the same group. The nurturance and tolerance for others fostered by Hub Group is a primary advantage. Despite the obvious disadvantages of rapid turnover, common issues such as acceptance, attachment, and separation are ever present to be addressed. Leadership must be either supportive or confrontive, but always active in these groups. Hub Groups have shown that with the support and supervision of IDTU's administrative staff, diversely trained staff can comfortably perform multiple roles within the unit and be effective as group leaders.     

Three traditional and three new childhood anxiety questionnaires: their reliability and validity in a normal adolescent sample

The current study examined the psychometrics of three traditional [i.e., the trait anxiety version of the State-Trait Anxiety Inventory for Children (STAIC), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Fear Survey Schedule for Children - Revised (FSSC-R)] and three new childhood anxiety scales [the Multidimensional Anxiety Scale for Children (MASC), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Spence Children's Anxiety Scale (SCAS)] in a large sample of normal adolescents (N=521). Childhood anxiety scales were generally found to be reliable in terms of internal consistency. Furthermore, evidence was obtained for the convergent and divergent validity of the various anxiety questionnaires. That is, anxiety questionnaire scores were found to be substantially intercorrelated. Particularly strong associations were found between total scores of the STAIC and the RCMAS, total scores of the SCARED and the SCAS, and between subscales that intend to measure specific categories of anxiety symptoms. Childhood anxiety questionnaires were substantially connected to an index of depression, although correlations among anxiety questionnaires were generally higher than those between anxiety scales and a measure of depression.     

The criterion validity of the Borderline Personality Features Scale for Children in an adolescent inpatient setting

The purpose of the current study was to examine the criterion validity of the Borderline Personality Features Scale for Children (BPFS-C) by assessing the performance of the self-report and a newly developed parent report version of the measure (BPFS-P) in detecting a borderline personality disorder (BPD) diagnosis in adolescent inpatients. This study also examined parent-child agreement and the internal consistency of the BPFS subscales. An inpatient sample of adolescents (n = 51) ranging from ages 12-18 completed the BPFS and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD) by trained clinical research staff. ROC analyses revealed that the BPFS-C has high accuracy (AUC = .931; Se = .856; Sp = .840) in discriminating adolescents with a diagnosis of BPD, as measured by the CI-BPD, while the BPFS-P has moderate accuracy (AUC = .795; Se = .733; Sp = .720). Parent-child agreement on total scores was significant (r = .687; p < .005). Cronbach's alphas suggested internal consistency for the four subscales of the BPFS. These findings support the criterion validity of this measure, particularly the self-report version, in adolescent inpatient settings.     

The prevalence of personality disorders in a Kenyan inpatient sample

DSM-IV Axis I and II comorbidities and the pattern of Axis II diagnoses in patients admitted at Mathari (Psychiatric) Hospital, Nairobi, Kenya are unknown. To determine DSM-IV Axis I and II comorbidities and patterns of Axis II diagnoses in patients admitted at Mathari Hospital. Cross-sectional study on 148 randomly sampled patients. Twenty percent of the patients were confirmed for an Axis II diagnosis. Eighty-seven percent of the Axis II disorders were Cluster B Personality Disorders of various types. Using chi2 tests, significant associations were found between Axis I and II diagnoses and substance use/dependence (p < 0.001; 66.7%), mood disorder (p = 0.002; 46.7%) and schizophrenia (p < 0.001; 23.3%). The prevalence of personality disorders was lower than that reported in psychiatric patients in USA and Europe. The results are likely to be a true reflection of the actual epidemiological situation, but cannot be generalized to outpatient or general populations.