Introduction to the special section on incremental validity and utility in clinical assessment

This special section focuses on the incremental validity and utility of clinical assessment data. The lack of replicated incremental validity research limits the ability of psychologists to establish their assessment practices on a solid empirical footing. The articles in this section deal with conceptual, methodological, and content issues in the development and use of clinical measures. The authors addressed several aspects of incremental validity research, including (a) the evaluation of the magnitude of validity increments, (b) the use of incremental validity data for test development and validation, (c) the costs of assessment, (d) the use of multi-informant and multimethod assessments, and (e) the treatment utility of assessment. Obstacles limiting the use of incremental validity research to inform and guide clinical practice are also emphasized.     

The utility of the spatial span in a clinical geriatric population

Spatial Span subtest of the Wechsler Memory Scale has been viewed as an indicator of working memory and visuospatial processing. The current study examined the impact of cognitive impairment and its severity on Spatial Span performance. A neuropsychological battery including Spatial Span was administered to 538 individuals (65-89) who were grouped by consensus into Alzheimer's disease, Vascular Dementia, Amnestic Mild Cognitive Impairment, Non-Amnestic Mild Cognitive Impairment and cognitively normal. Increase in level of impairment resulted in a decrease in Spatial Span Total Score. A weak relationship between age and Spatial Span Total Score was found. Spatial Span Forward remains relatively stable regardless of level of impairment. Spatial Span Backward was more sensitive to severity. No significant differences were found between individuals diagnosed with Alzheimer's disease and those with Vascular Dementia suggesting similar deficit patterns in the cognitive abilities measured by the Spatial Span. Mild Cognitive Impairment groups and normals did not differ suggesting visuospatial processes are not affected early in the dementing process.     

Surviving Deadness in the Analytic Experience

The transference/countertransference (third space) analysis is considered to be central in the therapeutic effectiveness of the analytic process. Less emphasis has been placed on the actual experiences of analyst and analysand in the conflictual reenactment of third space experience and its resolution. This paper recounts the shared experience of a patient who was silent throughout most of the analysis, and my reaction, in fantasy and enactment, to this disturbing experience—both for him and for myself. I argue that it is the affective re-experiencing of past repressed trauma in the analytic space that has a therapeutic impact, leading to growth in the patient and also the therapist. I contrast Freud’s emphasis on insight, making the unconscious conscious, with Ferenczi’s suggestion that the therapeutic impact lies in the repetition of past traumatic experience in the analysis but with the possibility of a different outcome with a more benign object, leading to symbolic representation of repressed trauma. Re-experiencing and symbolization, in the third space, of past traumatic experience can be an exit point from the endless repetition of trauma in internal and external object relations, leading to a new beginning in the patient’s life. Immersed in the experience of deadness in the analysis, which had become a dead womb, the struggle to remain alive and thinking led to a rupture out of the dead womb, like the Caesura of birth, into aliveness and the ability to mentalize what had previously remained unmentalized.     

The Children's Automatic Thoughts Scale in a clinical sample: psychometric properties and clinical utility

The aim of this study was to examine the psychometric properties and clinical utility of the Children's Automatic Thoughts Scale (CATS; Schniering, C. A., & Rapee, R. M. (2002). Development and validation of a measure of children's automatic thoughts: The Children's Automatic Thoughts Scale. Behaviour Research and Therapy, 40, 1091-1109) in a large sample of anxious youth. The participants were 891 referred children and adolescents. Participants completed the CATS and a wide range of symptom measures, and were assessed via a structured diagnostic interview. Previous community-based psychometric properties were confirmed. The scale was highly sensitive to treatment change, and showed evidence of cognitive specificity with reductions in threat and failure beliefs, but not in hostility beliefs following treatment. The CATS demonstrated good convergent validity with related anxiety and depression scales, and moderate discriminant validity was found across anxious, anxious-depressed and anxious-oppositional groups. Implications for the assessment of child anxiety, and difficulties around children "faking good" on anxiety measures are discussed.     

The clinical utility of the Rey Auditory-Verbal Learning Test in medical rehabilitation

Recent research has reported the Rey Auditory-Verbal Learning Test Trial V (RAVLT-V) score to be a sensitive indicator of global cognitive functioning, not merely verbal learning skills. The concurrent validity of the RAVLT-V relative to other neuropsychological measures frequently utilized in medical rehabilitation was investigated in a sample of 64 outpatients diagnosed with traumatic brain injury (TBI). The sample was predominantly male (77%), white (97%), youthful (31.4±11.5 years), high school educated, and an average of 53 months postinjury. Using stepwise multiple regression analysis, a three-variable model consisting of gender, Wechsler Memory Scale-Revised Delayed Memory Index, and Trailmaking Part B (time) accounted for 61% of the variance in RAVLT-V scores. These findings suggest that in TBI patients, the RAVLT taps not only specific verbal learning and memory, but also global cognitive functions. Sensitivity to diffuse neuropsychological changes and ease/speed of administration make the RAVLT a valuable tool in medical rehabilitation settings.     

Considering the clinical utility of performance-based measures of childhood anxiety

Examines general issues regarding the clinical utility of performance-based measures and specifically considers the utility of performance measures relevant to childhood anxiety and fear. First, we discuss the limitations of questionnaire and interview measures of childhood anxiety and the ways in which performance-based measures may compensate for or augment the use of such measures. Second, we review the major groups of performance-based measures that are potentially relevant to childhood anxiety and discuss evidence regarding their reliability and validity. Third, in the context of a general discussion of the various ways in which an assessment procedure may have clinical utility, we discuss the extent to which the performance-based techniques reviewed possess utility. Although many of these measures show promise of one or more types of clinical utility, none currently possess sufficient documented utility to warrant their dissemination for clinical use. We conclude by recommending directions for future research to demonstrate and improve the utility of such measures.     

Evidence for the criterion validity and clinical utility of the Pathological Narcissism Inventory

In this study, the authors evaluated aspects of criterion validity and clinical utility of the grandiosity and vulnerability components of the Pathological Narcissism Inventory (PNI) using two undergraduate samples (N = 299 and 500). Criterion validity was assessed by evaluating the correlations of narcissistic grandiosity and narcissistic vulnerability with established indices of normal personality traits, psychopathology and clinical concerns, and pathological personality traits. Overall, the pattern of correlations supported the convergent and discriminant validity of grandiose and vulnerable conceptualizations of pathological narcissism as measured by the PNI. Clinical utility was assessed by evaluating the extent to which clinicians without specific training in pathological narcissism as well as clinicians with expertise in pathological narcissism could accurately predict the correlates of PNI grandiosity and vulnerability with normal and pathological personality traits and psychopathology. The r(contrast-cv) coefficient provided a global index of accuracy in clinicians' predictions that was more fully elaborated by examining systematic discrepancies across groups. Overall, novice and expert clinicians were generally able to predict criterion correlations, with some exceptions (e.g., counter to predictions, pathological narcissism was negatively associated with treatment resistance). These results provide further evidence regarding the validity and utility of the narcissistic grandiosity and narcissistic vulnerability constructs as measured by the PNI.     

The validity and clinical utility of the MMPI-2 Malingering Depression scale

In this study, we examined the validity and clinical utility of the MMPI-2 (Butcher, Graham, Tellegen, Dahlstrom, & Kaemmer, 2001) Malingering Depression scale (Md) in relation to the MMPI-2 F scales (F, F(B), F(P)) to detect feigned depression. Overall, the F(B) scale and the F/F(P) scale combination were the best single predictors, although the Md scale did discriminate successfully cases of feigned depression from patients with bona fide depression. The Md scale added predictive capacity over the F scales, and the F(B) scale and the F/F(P) scale combination added predictive capacity over the Md scale; however, the actual increase in the number of cases predicted was minimal in each instance. In sum, although the Md scale is able to detect accurately feigned depression on the MMPI-2 (predictive validity), it does not confer a distinct advantage (incremental validity) over the existing standard validity scales-F, F(B), and F(P).     

Dimensional models of psychopathology: research agenda and clinical utility

This commentary emphasizes the implications for a mental health research agenda that stem from the papers in this special section on dimensional models of psychopathology. These include the need to extend dimensional models to a wider range of psychopathology; the relationship of the dimensions described in these papers, largely based on symptom and self-report measures, to findings from current research in genetics, neuroimaging, and other domains of neuroscience; the need for new scales that can assess the entire range of relevant dimensions with modern psychometric techniques; and ways to employ these dimensions in applied clinical situations. It is concluded that hierarchical dimensional models offer powerful ways of organizing our thinking about psychopathology and will serve to guide many promising avenues of future research.     

The utility of the AusEd driving simulator in the clinical assessment of driver fatigue

Several driving simulators have been developed which range in complexity from PC based driving tasks to advanced "real world" simulators. The AusEd driving simulator is a PC based task, which was designed to be conducive to and test for driver fatigue. This paper describes the AusEd driving simulator in detail, including the technical requirements, hardware, screen and file outputs, and analysis software. Some aspects of the test are standardized, while others can be modified to suit the experimental situation. The AusEd driving simulator is sensitive to performance decrement from driver fatigue in the laboratory setting, potentially making it useful as a laboratory or office based test for driver fatigue risk management. However, more research is still needed to correlate laboratory based simulator performance with real world driving performance and outcomes.     

The clinical utility of the MMPI-2 Antisocial Practices Content Scale

This study explored the ability of the MMPI-2 Antisocial Practices Content Scale (ASP) to correctly classify DSM-IV Antisocial Personality Disorder (APD). ASP scores and scores on the MMPI-2 Psychopathic Deviate (Pd) scale were compared in an APD group (n = 10), a Borderline Personality Disorder group (n = 16), a Narcissistic Personality Disorder group (n = 9), an Other Personality Disorder group (representing personality disorders from Clusters A and C; n = 14), and a nonclinical population (NC; n = 67). The ASP exhibited an ability to differentiate APD from other personality disorders and was significantly correlated to DSM-IV diagnostic criteria for APD while the Pd was not. Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power, negative predictive power, overall correct classification rate, and kappa) were calculated under four different conditions in a clinically relevant manner (Kessel & Zimmerman, 1993. Psychological Assessment, 53, 395-399). The results of this study illustrate the usefulness of the ASP as a tool for the assessment of antisocial attitudes, beliefs, and behaviors in individuals suspected of having APD. This information may be valuable to clinicians who are planning treatment or assessing treatment outcome for clients with APD.