In your initial post, begin with a paragraph briefly summarizing the main information about the case you selected.
The following case was chosen from the DSM-5 Clinical Cases by Barnhill (2014):
After being diagnosed with autism and mental retardation for most of her life, 17-year old Ashley was referred for a reevaluation. Ashly has been recently diagnosed with Kleefstra syndrome, thus her family feels it is important to confirm her diagnosis of autism, mental retardation, and Kleefstra syndrome and the genetic risk for her sisters. In order to focus on functioning skills, Ashley attended a special school as she could not be left alone due to causing self-harm and was unable to perform certain tasks such as bathing. An informal IQ testing was done at the time of reevaluation. Beginning at 9 months of age, Ashely’s parents began noticing developmental delays. During the evaluation, there was a possible diagnosis of facial dysmorphology. Her vocabulary consisted of hundreds of single words and several simple phrases and was interested in license plates from different states, and would spend many hours drawing. She had a strong attachment to her parents and sisters, but very little interest in other individuals her age. A family history of Asperger’s syndrome, epilepsy, and dyslexia runs in her family. While being examined, Ashley made inconsistent eye contact, minimally laughed, often ignored others talking to her, and spoke many words and few simple phrases in a high pitched tone. When requesting an object, Ashley would rock her foot. When given an object, Ashley would examine it with her nose and lips. Her recent medical examination indicated urinary tract infections in which was believed to cause Ashley to become apathetic. During the medical examination, Ashley was diagnosed with Kleefstra syndrome, which is a rare genetic defect correlated with several medical issues. The parents both tested negative for this disorder.
Evaluate and describe the ethical and professional interpretation of any assessment information presented in the case study.
Based on the information provided, it appears a proper interpretation of the assessment information has been presented. Pertinent information within the case study was presented while maintaining privacy and confidentiality. For example, Ashley’s first name was stated, but not her last. The use of the assessment was deemed appropriate and useful in order to make a diagnosis of the patient. The variety of information gathered such as the patient’s history, family medical history, medical evaluation, and an observation of the patient were collected in which is essential and will contribute to making a diagnosis. A better understanding of the patient assists in interpreting assessment results as several factors are taken into consideration.
When conducting a psychological evaluation, it is essential to collect data using a variety of techniques in order to ensure the professional has a wealth of information to complete a detailed evaluation.
The first step when devising an assessment battery is conducting a clinical interview. The clinical interview is essential in order to gain a better understanding about the individual and assists the psychologist making a diagnosis and creating a treatment path. The first step would be to have Ashley’s parents fill out a simple questionnaire about Ashley. Although there are many types of clinical interviews, using the information presented in the case study as background knowledge and guidance, this interview would contain open-ended questions related to Ashley’s mental and physical health. The interview would be conducted in a safe and confidential environment. Even though some background knowledge about Ashley has been received, it is essential that I get to know her and her parents personally by engaging in conversations and observing her behaviors. It is essential that there is trust built between the psychologist, patient, and her parents. Since Ashley only uses simple words and phrases, it may be essential for Ashley’s parents to be in the room during some of the interview process as they may be able to provide some first-hand knowledge related to Ashley. It would also be essential to collect medical records, school reports, and all prior assessments that have been conducted.
Mental Status Exam
Since Ashley is a new patient, a mental status exam (MSE) will be conducted. Observing Ashley will assist in gaining answers to interview questions as it appears Ashley will not be able to communicate about her behaviors. The MSE will allow the psychologist to review the personal and intellectual functioning and watch for signs and symptoms that will assist in making a diagnosis (Gregory, 2014). There is some flexibility when conducting a MSE, but there are some common areas that are examined. The areas that will be examined include appearance and behavior, processes related to speech and communication, thought content, insight and judgement, orientation, as well as cognitive, memory, and emotional functioning (Gregory, 2014). Observing and careful interviewing skills are essential during this process.
An intellectual assessment is a vital part of the evaluation process. The purpose of the intellectual assessment is to examine Ashley’s general intellectual functioning and cognitive abilities. The Stanford-Binet: Fifth Edition (SB5) Intelligence Test is one of the most common types of intelligence tests that will be used. The SB5 measures five factors of intelligence including fluid reasoning, knowledge, quantitative reasoning, visual-spatial reasoning, and working memory (Gregory, 2014). In addition, these five factors are assessed under two domains; verbal and nonverbal. Using this assessment will provide a better understanding of Ashley’s IQ and cognitive abilities, which will assist in making a diagnosis.
Client observations are another critical part of the evaluation process. Observing the client’s behavior and emotions is an important process that provides the psychologist additional information that may not have been obtained otherwise. Observing the client in a variety of areas including social interaction as well as repetition of behaviors is important ((Volkmar et al., 2014)). Observational data will assist in making a diagnosis and developing a treatment plan that will meet the client’s needs.
Although Ashley was diagnosed with severe intellectual disability and Autism Spectrum Disorder (ASD) when she was younger, it is essential to continue assessing as individuals change along with their needs changing. ASD is a broad category and requires gathering information from a variety of sources. Although there are a variety of assessments to use when diagnosing ASD, two assessment instruments that are recommended include the Diagnostic Interview for Social and Communication Disorders (DISCO) as well as the Autism Diagnostic Observation (ADOS). The DISCO can be used for a variety of ages ranging from children through adulthood. The DISCO is a semi-structured interview that collects a variety of information related to skills, weaknesses, and behavior without focusing on ASD alone, but relates to other disorders as well. The ADOS is also a semi-structured assessment focusing on social interaction, imagination, and communication. This is a useful instrument that can be used for assessing autism as well as other developmental disorders. In addition, the Leiter International Performance Scale-Revised (LIPS-R) would also be an important assessment tool. This instrument can be used to assess adolescents with suspected autism and may provide useful in order to assess characteristics such as speech delay associated with Kleefstra syndrome.
Pros and cons of instruments
Gathering a variety of data is essential when conducting a psychological assessment. While the use of instruments are tools that assist in the assessment process, clinical judgement should not be replaced (Volkmar et al., 2014). The DSM-5 used by the referring professional is used to classify mental health disorders. While this diagnostic instrument is helpful, it is necessary to obtain information from a variety of sources. In addition to interviews, observations, intake forms, history of patient and family, medical history, results of prior assessments and tests, it is essential to conduct assessments using assessment instruments as well. The SB5 is a good intelligence test to conduct as it covers 5 domains that measures general cognitive ability. In addition, the LIPS-R is helpful when conducting an intellectual assessment of individuals when their language skills are weak (Gregory, 2014). Measuring cognitive ability and adaptive skills is an essential part of the assessment process as it helps create a treatment plan and is relative to overall development (Volkmar et al., 2014). The DISCO assessment will assist in providing a variety of information including adaptive skills. Adaptive skills can also be measured using the ADOS as it related to social interaction and communication, which is an essential part of every day functioning. ASD has a broad range of syndrome expressions and is challenging for clinicians to manage (Volkmar et al., 2014). While these assessments provide valuable information amongst a broad range of categories and are essential when evaluating disorders, no single assessment or test should be used to diagnose a disorder, but rather a wide range of assessments should be conducted.
Barnhill, J. W. (Ed.). (2014). DSM-5 Clinical Cases. Washington, D.C.: American Psychiatric Association.
Gregory, R. J. (2014). Psychological testing: History, principles, and applications (7th ed.). Boston, MA: Pearson.
Volkmar, F., Siegel, M., Woodbury-Smith, M. King, B., McCracken, J., State, M., & the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site. [PDF]. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237-257. doi:10.1016/j.jaac.2013.10.013
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