Activation (RC9): impulsiveness, grandiosity, and high energy
The MMPI-A-RF yields other scores designed to assess adolescents’ test-taking attitude and specific psychological problems. For example, the test contains several validity scales that detect inconsistent responding or a tendency to over- or under-report symptoms. The test also contains specific problem scales that assess concerns such as substance use, negative attitudes toward school, and conflict in family relationships.
Figure 4.3 ■ Sara’s MMPI-A-RF Profile
Note: Compared to other adolescents, Sara reports significant problems on the Emotional/Internalizing Dysfunction (EID) scale. Her primary concerns are physical health problems (RC1) and anxiety (RC7).
The MMPI-A-RF yields scores (called T scores) with a mean of 50 and standard deviation of 10. Scores of 60 or greater indicate clinically significant problems in social–emotional functioning compared to other adolescents. Clinicians usually plot the adolescent’s T scores on a profile to graphically represent the most salient aspects of the adolescent’s functioning (Handel, 2016).
Sara’s MMPI-A-RF profile showed elevations on the broad emotional/internalizing dysfunction domain compared to other adolescent girls her age (Figure 4.3). Her scores were particularly high on scales assessing physical health problems (RC1) and negative emotions like anxiety and worry (RC7). In contrast, her scores on the demoralization scale (RCd) and the low positive emotions scale (RC2) were not elevated, indicating that Sara may manifest psychological distress through physical complaints and insomnia rather than through feelings of depression and hopelessness.
Parent, Teacher, and Self-Report Rating Scales
Many clinicians ask adults to evaluate children’s behavior and social–emotional functioning using checklists or rating scales. Older children and adolescents will also be asked to evaluate themselves. The most widely used rating scales include the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach, 2015), the Conners Comprehensive Behavior Rating Scales (Conners, 2019), and the Behavior Assessment System for Children, Third Edition (BASC-3; Reynolds & Kamphaus, 2015).
For example, the BASC-3 can be administered to parents, teachers, and older children and adolescents across home and school settings. Each informant independently rates multiple aspects of the child’s behavior and social–emotional functioning on five broad dimensions: (1) externalizing behavior, such as aggression and hyperactivity; (2) internalizing behavior, such as anxiety and depression; (3) school problems, such as attention and learning difficulties, (4) adaptive skills, such as communication and social functioning; and (5) an overall behavioral symptoms index.
The clinician can compare the ratings of each informant to the responses of other parents or teachers with children of the same age and gender. Similarly, an adolescent’s self-report ratings can be compared to the reports of other youths of the same age and gender. The results are shown as T scores that reflect the degree to which the child’s functioning deviates from other youths. Problem scores two or more standard deviations above the mean (≥70) or adaptive skill scores two or more standard deviations below the mean (≤30) indicate clinically significant difficulties that may merit treatment (Kamphaus & Dever, 2018).
Sara’s mother and homeroom teacher completed the BASC-3 to assess Sara’s functioning at home and school, respectively (Table 4.3). Her mother’s ratings suggested that Sara is experiencing significant anxiety and somatic complaints at home compared to other girls her age. In contrast, her teacher reported few problems at school. These data indicate that Sara might manifest anxiety in terms of physical problems, like headaches and stomachaches, and that she might be worried about her family.
Specific Symptom Inventories
Clinicians can also administer other tests to assess specific disorders. For example, the Autism Spectrum Rating Scales (ASRS; Goldstein & Naglieri, 2013) are widely used to screen children suspected of autism. Clinicians administer the scales to parents and teachers who rate DSM-5 symptoms of the disorder. The ASRS also assess the child’s communication and socialization skills; tendency to engage in rigid, repetitive, or stereotyped behaviors; sensitivity to sensory stimuli (e.g., certain textures or sounds); and capacity for self-regulation. The ASRS are norm-referenced; scores allow clinicians to compare the child to other youths of approximately the same age as well as to children previously diagnosed with autism.
Table 4.3
Note: Compared to other girls her age, Sara shows clinically significant internalizing problems at home characterized by anxiety and somatic (i.e., physical health) problems. Her teacher reported no significant problems at school.
*Problem scores ≥ 70 and adaptive skill scores ≤ 30 suggest clinically significant problems.
The Conners 3 (Conners, 2015) is a behavior rating scale used to screen children for ADHD and disruptive behavior disorders. The test assesses DSM-5 symptoms of ADHD and can be administered to parents, teachers, and older children to provide multi-informant data regarding the child’s functioning at home and school. The test also assesses other potential problems such as oppositional behavior toward adults, learning difficulties, and peer rejection. The test yields T scores that allow clinicians to compare children to youths of the same age and gender.
The Revised Children’s Anxiety and Depression Scale (Weiss & Chorpita, 2011) might be administered to girls like Sara who show internalizing problems. This self-report questionnaire assesses five DSM-5 anxiety disorders as well as symptoms of depression. The scale yields T scores, which allow clinicians to compare a child’s ratings to other children of the same age and gender. Sara reported significant problems with separation anxiety compared to other girls her age (Figure 4.4). She experiences intense anxiety or panic when she must leave her parents and worries about them when she is away from them for extended periods of time.
Figure 4.4 ■ Sara’s Scores on the Revised Children’s Anxiety and Depression Scale
Note: Clinicians administer specific symptom inventories, like this one, to assess particular psychological problems. Sara reported significant (T ≥ 70) fears of separation compared to other girls her age.
Altogether, data from the diagnostic interview, observations, and norm-referenced tests indicate that Sara’s somatic symptoms and school refusal are caused by underlying anxiety about separating from her parents. Sara’s symptoms developed shortly after her father’s stroke. Because of her mother’s busy work schedule, Sara cared for her father over the summer as he recovered. As the academic year approached, Sara became preoccupied by thoughts that he might experience another stroke if she left him to attend school. Her anxiety about her father and fears of separation increased until she began to develop physical symptoms. By allowing Sara to stay home from school, her mother inadvertently reinforced these symptoms, which maintained Sara’s school refusal over time.
