What Are Your Favorite Assessments?

[Therapist4Chnge]

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I was just talking with my supervisor about favorite assessments, and I thought this would be an interesting discussion on here. We seem to have a nice mix of foci on here, so it may be interesting to hear what forensic folks use compared to school psych folks, etc.

Pleas be aware not to share any copywrited material or information that would compromise the assessment, though talking about what it measures and the various validities are all fair game.

As a personal aside, I am most interested in what flexible batteries people use in their particular areas and why, though this may not be applicable to most of what people discuss on here unless you are farther along in your training/career. I'm starting to incorporate more malingering assessments into my flexible batteries, though I'm still poking around to identify the best ones for a variety of circumstances.

 

[Therapist4Chnge]

One of my favorites is the Rey Auditory Verbal Learning Test (RAVLT). I use it frequently, mostly due to the relatively quick administration and useful data it provides. I do a lot of evaluations involving TBI/CVAs/etc. so being able to look at encoding, retreiving, and related areas is quite useful.

 

[erg923]

A CVLT and a MMPI....what more do you really need?🙂

 

[bmedclinic]

WRAT
MCMI -III
Always love the MMPI-II
Wisconsin Card Sort (from my neuropsych days). Just LOVED to play it with pts.
Not really a kid person, but I loved giving the WPPSI- giving IQ tests to little ones (regardless of what you can infer from the test as people disagree on that) was always fun. Make it a game. Give stickers.
KAIT (love watching people go through the fluid intelligence tasks)
hate admin. SB5
Liked the WRAML.

 

[AcronymAllergy]

Another vote for liking the Rey pair (RAVLT and complex figure) and CVLT, and for being a huge non-fan of administering the SB-5.

I always enjoy giving COWA as well.

 

[krisrox]

WRAT
MCMI -III
Always love the MMPI-II
Wisconsin Card Sort (from my neuropsych days). Just LOVED to play it with pts.
Not really a kid person, but I loved giving the WPPSI- giving IQ tests to little ones (regardless of what you can infer from the test as people disagree on that) was always fun. Make it a game. Give stickers.
KAIT (love watching people go through the fluid intelligence tasks)
hate admin. SB5
Liked the WRAML.

The WRAT is so boring : P

I like the CASL for social reasoning. Some of the answers that kids give are so cute!

 

[erg923]

Like the NAB, wish it got more widepread use. Prefer it to the RBANS.

Like WRAML's story memory better than WMS's. And...the recognition part is actually useful!!! The WMS's is poorly designed/thought out, if you ask me.

Love DKEFS, especially their version or trails, fluency, and stroop.... although I love 20 questions and their version of Hanoi Tower too.

PASAT

More obscure ones:
Ruff-Light Trail learning Test (RULIT) is neat, although often frustrating for pts.

Benton's Serial Digit Learning Test

 

[erg923]

I'm starting to incorporate more malingering assessments into my flexible batteries, though I'm still poking around to identify the best ones for a variety of circumstances.

Paul Green's WMT, MSVT, and NV-MSVT are outstanding and really have unbeatable senstivity and specificity. Plus, I think his addition of mutliple comparison groups for people who both failed and passed the test is really what needs to be considered to rule out false positives, and was what the SVT science prior to this was really lacking. The WMT programs include data from more than 80 comparison groups (although one could argue that there may be some sampling bias/limitations since most of the data set come from him and Garvis). The program makes it easy for you to contrast scores in a single case with any of the comparison groups, using graphs and report tables.

PS: I have no financial investment in Green's test, I just really like them.

 

[Therapist4Chnge]

Another vote for liking the Rey pair (RAVLT and complex figure) and CVLT, and for being a huge non-fan of administering the SB-5.

I always enjoy giving COWA as well.

I like the complex figure, though it doesn't seem very sensative to mild/moderate impairment. I had someone the other day with moderate impairment, but s/he scored in the low-average range because they got the outside structure relatively intact. Of course, Visual Reproduction I & II using some quesitonable norms, so it isn't like that is much batter. At least with VR-I&II I can see a number of figures.

I enjoy a couple different tests for verbal fluency. I deal with a good bit of word finding problems, so the COWA, Boston Naming, and a couple other assessments are rather useful.

Prefer it to the RBANS.

I'm not a big fan of the RBANS either. I try to avoid the SLUMS too. The CogniStat is what I use for a basic screen, though if they are going to see me anyway, I may just skip it if I have a basic idea of their issues.

Love DKEFS, especially their version or trails, fluency, and stroop.... although I love 20 questions and their version of Hanoi Tower too.

I've been meaning to try out the DKEFS. I use trails, a couple diff. fluency tests, sometimes a Stroop...so it may simplify things a bit for me.

Paul Green's WMT, MSVT, and NV-MSVT are outstanding and really have unbeatable senstivity and specificity. Plus, I think his addition of mutliple comparison groups for people who both failed and passed the test is really what needs to be considered to rule out false positives, and was what the SVT science prior to this was really lacking. The WMT programs include data from more than 80 comparison groups (although one could argue that there may be some sampling bias/limitations since most of the data set come from him and Garvis). The program makes it easy for you to contrast scores in a single case with any of the comparison groups, using graphs and report tables.

I use some of the typical ones (TOMMS, Rey 15, etc) though they are mostly to see if further assessment should be done to evaluate for malingering or malingering related issues. I would like to have the ability to look at false positives more closely, so this may be a good solution. Malingering is a consistant consideration at my hospital, but I have yet to actually use it in a report. It seems to be like the scarlett letter. I'd like to find a good set of assessments I can use specifically for malingering concerns, particularly since I am considering doing some forensic work on the side.

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How about personality testing preferences....anything new worth considering? My go to are the MMPI-2, MCMI-III, and PAI. I have pretty much tossed out all projectives (outside of therapeutic use), with the exception of a Rotter...but I'm not that big of a fan.

 

[erg923]

I use some of the typical ones (TOMMS, Rey 15, etc) though they are mostly to see if further assessment should be done to evaluate for malingering or malingering related issues. I would like to have the ability to look at false positives more closely, so this may be a good solution. Malingering is a consistant consideration at my hospital, but I have yet to actually use it in a report. It seems to be like the scarlett letter. I'd like to find a good set of assessments I can use specifically for malingering concerns, particularly since I am considering doing some forensic work on the side.

Well thats what the WMT and MSVT were designed for. I would recommend checking it out. The software has to be leased from Green himself.

I have found a wide variety of approaches to assessing and reporting of test taking effort/symptom validity....whatever name you wanna call it, within this profession. Within my own VA last year there was person widely known to be "on the look for it" in EVERY CASE. Another one who would bluntly reported it if found, but whom despised the "gotcha" attitudes of many who specialize in research on the topic. Yet another always incorporated effort measures into every eval, but would never ever write malingering or intentional exageration in a report. he always preferred to simply to say that testing was "invalid" and never commented on the possible intentions or on purposeful exagerrations.

How about personality testing preferences....anything new worth considering? My go to are the MMPI-2, MCMI-III, and PAI. I have pretty much tossed out all projectives (outside of therapeutic use), with the exception of a Rotter...but I'm not that big of a fan.

MMPI-2 almost always. Geriatric cases get a GDS and maybe a CASE-SF.

 

[Therapist4Chnge]

I have found a wide variety of approaches to assessing and reporting of test taking effort/symptom validity....whatever name you wanna call it, within this profession. Within my own VA last year there was person widely known to be "on the look for it" in EVERY CASE. Another one who would bluntly reported it if found, but whom despised the "gotcha" attitudes of many who specialize in research on the topic. Yet another always incorporated effort measures into every eval, but would never ever write malingering or intentional exageration in a report. he always preferred to simply to say that testing was "invalid" and never commented on the possible intentions or on purposeful exagerrations.

It is really frustrating to see the range of approaches surrounding the treatment of suspected or pronounced malingering. The documentation is paramount in how to handle the case. I have yet to explicitly write, "malingering", though I have written a number of reports that outline the data and provide rationale and a possible explanation for the data, so that any clinician reading it can draw their own conclusions about possible under/over-reporting and related motive(s).

It is my belief that you are defeating the purpose of the malingering assessments if you do not speak to the data and possible implications. I understand if someone doesn't want to label someone as malingering, but it is frustrating if a clinician leaves the rest of us in the dark. It is pointless to write an assessment is invalid, and not explain WHY it is invalid. A quick sentence or two about the data can provide the necessary information without putting a label out there.

I do thorough differentials and often my Dx would be quite different than the chart, but I'd always explain my differentials in the report. Having supportive data from multiple sources is the responsible way to conduct differentials, and when a Dx is made lacking supportive data, it should definitely be noted as a R/O or at least under-consideration and not a firm Dx. This then brings us back to having enough data to make a diagnosis, and how to attain that data if you are not doing formal psychological/neuropsychological testing. I'm always concerned if the diagnosis is based solely on self-report and/or a 5 minute MMSE and interview.

 

[erg923]

Agreed. But just to comment that there seems to be a notable difference in approach to the assessment of effort and malingering taken by the Division 40 types vs the Division 22 types. In my own VA, there was notable skizsm betwen how suspected malingering/exagerrating patients were viewed in Psychology Service and how they were viewed over in the Polytrauma Clinic...even though both clinics' assessments were done by neuropsychologists....just very different types of neuropsychologists (both in orientation/approach and in personality).

 

[lexicon]

Agreed. But just to comment that there seems to be a notable difference in approach to the assessment of effort and malingering taken by the Division 40 types vs the Division 22 types. In my own VA, there was notable skizsm betwen how suspected malingering/exagerrating patients were viewed in Psychology Service and how they were viewed over in the Polytrauma Clinic

That's really interesting. Can you elaborate?

 

[TenaciousGirl]

Aside from some assessments that were already mentioned in this thread, I really like the PPVT (I forget which version... 3? 4?) When I worked with kids we used the Kaufman cards as a part of their battery workup and I found those to be fun. And finally, I'll just say it ... I like the projective assessments. Specifically the Rorschach, RISB, and the TAT. I don't want WWIII to start because I mention this. I think they can provide interesting and useful information/insight into personality and coping styles.

 

[erg923]

That's really interesting. Can you elaborate?

Eh..that was a pretty broad generalization actually. This was basically just the case at 2 places I have worked at thus far.

 

[IT514]

For adult neuro, CVLT-II and MMPI-II (FBs and subtle/obvious are my favorite scales). Love the WCST as well (full only...the 64 card norms suck). As for the RBANS...I've used it in Parkinson's and Huntington's referrals and the cortical/subcortical differential has been useful (although I'd argue that the same thing can be done using other measures). Havent used the NAB yet, but I like the Dementia Rating Scale-2 and HVLT/BVMT over the RBANS for older patients. Definitely prefer the DKEFS stroop task over others. Cant leave out Trails B...especially with the stuff from U of Florida showing a relation to driving. And who can forget the Clock drawing? Neglect, vis/construction, and some executive function all in about 3 minutes. I'm over-stating its usefulness but I guess I'm attached to it.

As for peds neuro, the NEPSY-II is always fun. I like the Dyslexia Screening Test combined with the CTOPP for reading referrals. For personality assessment, the PIC/PIY 2 is a very well thought out instrument, having a known malingering group and the fact that you can get validity scales in the parent form is great. I hate the BRIEF for the same reason (no validity scales and every kid is rated either as perfect or the worst case of ADHD ever).

 

[Therapist4Chnge]

I almost always do a Trails A & B, as well as a clock. Both are quick and easy and rather useful. Good additions.

 

[IT514]

Agreed. But just to comment that there seems to be a notable difference in approach to the assessment of effort and malingering taken by the Division 40 types vs the Division 22 types. In my own VA, there was notable skizsm betwen how suspected malingering/exagerrating patients were viewed in Psychology Service and how they were viewed over in the Polytrauma Clinic...even though both clinics' assessments were done by neuropsychologists....just very different types of neuropsychologists (both in orientation/approach and in personality).

Interesting. I've seen the same thing in the VA I'm at right now. I wouldnt say that any neuropsychs who have supervised me would make a formal diagnosis of malingering, but there are definitely some who play up the feigned cognitive impairment language...especially in C&P evals. Most of the department, I think, would lean toward the "this test is invalid, but I'm not going to speculate the 'why'" camp.

 

[krisrox]

As for peds neuro, the NEPSY-II is always fun. I like the Dyslexia Screening Test combined with the CTOPP for reading referrals. For personality assessment, the PIC/PIY 2 is a very well thought out instrument, having a known malingering group and the fact that you can get validity scales in the parent form is great. I hate the BRIEF for the same reason (no validity scales and every kid is rated either as perfect or the worst case of ADHD ever).

I agree on the NEPSY. And as for the BRIEF- I hate SCORING it.

 

[Therapist4Chnge]

Interesting. I've seen the same thing in the VA I'm at right now. I wouldnt say that any neuropsychs who have supervised me would make a formal diagnosis of malingering, but there are definitely some who play up the feigned cognitive impairment language...especially in C&P evals. Most of the department, I think, would lean toward the "this test is invalid, but I'm not going to speculate the 'why'" camp.

The biggest issue I have with this scenario (in addition to the reason I previously gave) is that the most capable person to make an interpretation of data often leaves it up to everyone else, and that is a recipe for disaster. Most physicians aren't comfortable with anything but reading the summary paragraph (not a knock on them, as it isn't their area of expertise). Providing no interpretation is often worse than a conservative interpretation because the reader may approach the data very differently. Being a C&P it is even worse because if it is appealed it may or may not go to a neuropsychologist, so the reviewer may feel even less able to make a firm Dx if they saw the neuropsychologist didn't even take a stab.

Yes, this is a pet peeve area of mine. 😀

 

[Therapist4Chnge]

*bump*

 

[erg923]

A Model to Approaching and Providing Feedback to Patients Regarding Invalid Test Performance in Clinical Neuropsychological Evaluations

Dominic A. Carone, Grant L. Iverson, and Shane Bush

http://www.informaworld.com/smpp/content~db=all~content=a922328119~frm=titlelink

 

[Therapist4Chnge]

Thanks!

I need to dig up a copy, as the first database I checked didn't have this included yet.