Scaling clinical judgments of symptom pathology by means of the psychophysiological method of magnitude estimation

Summing scores across heterogeneous symptom items without consideration of their differing psychopathological significance has been criticized as producing an inadequate picture of an individual's clinical status. The purpose of this study was to derive symptom item weights representing clinically judged seriousness of each symptom through the application of Stevens's psychophysical method of magnitude estimation. A nationwide sample of 129 clinicians rated the pathological significance of 221 symptom items in a design such that every rater rated 121 items, 21 of which were rated by all raters and 100 of which were rated only by the A or B subgroup to which each rater was randomly assigned. Each item was rated as to the seriousness of the pathology it would represent if manifested by either a boy child, girl child, boy adolescent, or girl adolescent, with one-fourth of the raters assigned to each condition. The results of 211 two-way analyses of variance revealed that age and age and sex in interaction, but not sex alone, significantly influenced the clinical ratings. The resulting magnitude estimation ratings of symptom pathology ranged from 1.0 to 9.9. They were demonstrated to have satisfactory reliability and convergent validity and to have the psychophysical characteristics of a prothetic continuum.A preliminary version of this paper was presented at the 85th Annual Convention of the American Psychological Association, San Francisco, August 1977. The research was supported by HEW grant MH24886. The authors wish to express appreciation to Walter W. Wengel for his work in developing the median quotient ratings used in the study, to Terrance Auger for making available unpublished raw data, and to Merton S. Krause for helpful suggestions regarding the interpretation of results.     

FUNCTIONAL ASSESSMENT,CURRICULAR REVISION,AND SEVERE BEHAVIOR PROBLEMS

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and auricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the auricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate “psychotic” speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.     

Ecological interventions and the process of change for prevention: Wedding theory and research to implementation in real world settings

Considers a preventive intervention effort designed to modify the characteristics and regularities of the school environment so as to enhance the expectations conveyed to high risk students. Employing this case effort (Weinstein et al., 1991) as a base, several issues are highlighted that deserve greater attention in the design, implementation, assessment, and reporting of other preventively-focused social interventions. These issues include: (1) the degree of program implementation fidelity, (2) the impact a lack of attainment of program fidelity may have on arriving at erroneous evaluation conclusions about social programs, (3) the ways in which the theory and basic research employed in the program rationale is appropriate to and reflected in the program as designed, (4) issues of program potency and dosage, (5) the ways in which quantitative and qualitative evaluation data can enhance each other, and (6) the import of evaluability assessments of programs prior to moving to outcome evaluations. In addressing these issues, the importance of developmentally- and ecologically-informed program formulations is underscored. Finally, the critical role that program reports such as the Weinstein paper, with its careful discussion of both the process of implementation and outcome assessments, can play in the development of more effective prevention program implementation efforts is highlighted.