Intention-based therapy for autism spectrum disorder: promising results of a wait-list control study in children.

BACKGROUND: Autism is a complex neurodevelopmental disability that usually manifests during the first three years of life and typically lasts throughout a person's lifetime. The purpose of this study is to investigate the efficacy of NeuroModulation Technique (NMT), a form of intention-based therapy, in improving functioning in children diagnosed with autism. METHODS: A total of 18 children who met the study criteria were selected to participate. All children completed baseline measures. The children in the experimental group (n = 9) received two sessions a week of NMT for six weeks. Then, children in the wait-list control group (n = 9) received two sessions a week of NMT for six weeks. Primary efficacy outcome measures included the Pervasive Developmental Disorder Behavioral Inventory Autism Composite Index, the Aberrant Behavior Checklist-Community Total Score, and the Autism Treatment Evaluation Checklist Total Score. Our hypotheses were that children in both groups would show significant improvement over their respective baseline scores following NMT treatment, which would reflect an improvement in adaptive behaviors as well as a decrease in maladaptive behaviors. RESULTS: Statistical analysis indicates a significant improvement in both the experimental and wait-list control group on all primary outcome measures following NMT treatment. The wait-list control group demonstrated no significant improvement on test measures over baseline scores during the wait period. No adverse reactions were reported. CONCLUSIONS: These findings suggest that NMT is a promising intervention for autism that has the potential to produce a significant reduction in maladaptive behaviors and a significant increase in adaptive behaviors within a relatively short period of time.

2010 Bruno Klopfer Distinguished Contribution Award. Some considerations for enhancing psychological assessment.

The field of psychological assessment appears to be bogged down in recent decades on refining existing measures and techniques to the detriment of real change. This article attempts to highlight some of the changes that need to take place in psychological assessment in the next few decades if real progress is to be achieved: (a) developing guidelines for psychological tests and measures; (b) establishing explicit criteria for training; (c) establishing guidelines for competencies; (d) recognizing the impact of marketing; (e) embracing electronic technology; and (f) implementing computer adaptive testing.

What do the MMPI-2 restructured clinical scales reliably measure? Answers from multiple research settings.

The Restructured Clinical (RC; Tellegen et al., 2003) scales were developed to improve measurement of the core constructs of the MMPI-2 (Butcher et al., 2001) Clinical scales by removing "demoralization," hypothesized to affect these scales adversely. Using 25 samples with MMPI-2 responses from 78,159 subjects across diverse clinical settings, we found that each RC scale was highly correlated with a Supplementary, Content, or Personality Psychopathology 5 (PSY-5; Harkness, McNulty, & Ben-Porath, 1995) scale: higher, in fact, than the correlation between the RC scale and its parent scale. Furthermore, for over half the RC scales (i.e., RC1, RC3, RC7, RC8, and RCd), the correlations were strong enough to conclude that the RC scales replicate MMPI-2 scales with rich empirical foundations; the remaining RC scales were not redundant. Next, we examined reliability estimates using alpha coefficients and interitem correlations and did not reveal superior reliability for most of the RC scales over existing MMPI-2 scales.

Evaluating the latent structure of the MMPI-2 F(p) scale in a forensic sample: a taxometric analysis.

P. A. Arbisi and Y. S. Ben-Porath (1995) originally proposed that the Infrequency Psychopathology scale, F(p), be used as the final step in an algorithm to determine the validity of a Minnesota Multiphasic Personality Inventory-2 (MMPI-2) protocol. The current study used taxometric procedures to determine the latent structure of F(p) among examinees with profiles that would necessitate the interpretation of F(p) when using Arbisi and Ben-Porath's proposed algorithm. Participants included a subsample of 289 consecutively referred pretrial forensic examinees adjudicated incompetent to stand trial with high Infrequency (F) scale scores, thereby providing a sample that would be expected to have a high base rate of persons with bona fide psychopathology and persons with incentive to overreport psychopathology. Using MAMBAC and MAXEIG, F(p) produced a taxonic latent structure within the subgroup of examinees who obtained raw scores on F of greater than 17. These results support Arbisi and Ben-Porath's original proposal to use F(p) to identify a distinct subgroup of overreported MMPI-2 protocols within forensic psychiatric examinees with high elevations on F. Implications and suggestions for future research are provided.

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation.

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample. The Fake Bad scale (FBS) was the only validity measure that produced acceptable TPR and FPR or a significant correlation with malingering status.

Use of the MMPI-2 in American Indians: I. Comparability of the MMPI-2 between two tribes and with the MMPI-2 normative group.

The comparability of the MMPI-2 in American Indians with the MMPI-2 normative group was investigated in a sample of 535 Southwestern and 297 Plains American Indian tribal members with contrasting sociocultural and historical origins. Both American Indian tribal groups had clinically significant higher T scores (> 5 T points) on 5 validity and clinical scales, 6 content scales, and 2 supplementary scales than did the MMPI-2 normative group. There were no significant differences between the 2 tribal groups on any of the MMPI-2 clinical, content, or supplementary scales. Matching members of both tribes with persons in the MMPI-2 normative group on the basis of age, gender, and education reduced the magnitude of the differences between the 2 groups on all of these scales, although the differences in T scores still exceeded 5 T points. It appears likely that the MMPI-2 differences of these 2 American Indian groups from the normative group may reflect their adverse historical, social, and economic conditions.

Use of the MMPI-2 in American Indians: II. Empirical correlates.

R. W. Robin, R. L. Greene, B. Albaugh, A. Caldwell, and D. Goldman (2003) reported that members of 2 American Indian tribal groups had statistically significant higher T scores on several MMPI-2 clinical, content, and supplementary scales than did the MMPI-2 normative group. The present study investigated the empirical correlates of the MMPI-2 scales in these American Indian tribal members. There were a large number of significant correlates reflecting antisocial symptoms with Scales 4 (Psychopathic Deviate), 9 (Hypomania), Anger, and Antisocial Practices. There were even a larger number of significant correlates reflecting generalized distress and negative affect with Scales 7 (Psychosthenia), 8 (Schizophrenia), Anxiety, Obsessions, Depression, and Welsh Anxiety. The rationally derived MMPI-2 content scales generally had larger correlations with these constructs than the clinical scales. Thus, the differences reported by R. W. Robin et al. (2003), appear to reflect behaviors and symptoms that American Indians participants were experiencing rather than test bias.

Sensitivity and specificity of MMPI-2 neurologic correction factors: receiver operating characteristic analysis.

A number of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items have been hypothesized to reflect neurologic symptomatology, rather than psychopathology, among closed-head-injury (CHI) patients. Some investigators have proposed a correction factor interpretive approach, which involves the deletion of such items from the MMPI-2 profile, as a method of reducing the probability of artificial clinical scale elevations due to the symptoms of CHI. The present study employed receiver operating characteristic (ROC) analysis to evaluate the sensitivity and specificity of three correction factors. All three factors demonstrated strong sensitivity when discriminating CHI patients from normal individuals but demonstrated poor specificity when discriminating CHI patients from psychiatric patients. These findings suggest that caution should be applied in using MMPI-2 neurologic correction factors, particularly with patients who might have comorbid psychiatric conditions.

Using the WMS-III faces subtest to detect malingered memory impairment.

The current study evaluated the utility of the WMS-III Faces I subtest (Faces) for the assessment of malingering. Thirty nonlitigating traumatic brain injury patients and 30 control participants were administered Faces under standard administration and instructed malingering conditions. Although the two groups obtained similar scores when taking the test under standard instructions, both groups produced significantly lower performances when instructed to malinger, indicating that Faces is sensitive to malingering, but less sensitive to traumatic brain injury. The total raw score provided stronger classification accuracy than an empirically weighted combination of the five easiest items (i.e., floor effect items). A raw score cutoff of 31 yielded the maximum classification accuracy with 93.3% sensitivity and 80.0% specificity.

A taxometric analysis of the MMPI-2 Depression scales.

The MMPI (Hathaway & McKinley, 1943) and MMPI-2 (Butcher et al., 2001) have long been used as measures of psychopathology. Both clinicians and researchers have noted the widespread existence of negative affectivity on the MMPI and MMPI-2 that may elevate scale scores and eclipse the tests' ability to differentiate depression from other clinical disorders. Using taxometric analyses, in this study we sought to test directly whether the MMPI-2 depression scales could differentiate patients with depressive symptoms from patients with other disorders. A large psychiatric sample (N = 2,000) was utilized and analyses were run separately for men and women. Taxometric analyses did not find a MMPI-2 Depression scale cut point that categorizes patients with depressive symptoms from other patients. Rather, these findings support previous studies finding an underlying dimensionality of depression. We discuss implications for MMPI-2 scale use and depression nosology in light of these findings.

Narcissism and depression: MMPI-2 evidence for the continuum hypothesis in clinical samples.

According to one hypothesis, self-report measures of narcissism help describe a psychological continuum related to self-esteem. Most of the previous support for this idea appeared in studies of undergraduates responding to the Narcissistic Personality Inventory (NPI; Raskin & Hall, 1981) along with other self-report instruments. In this project, results consistent with the continuum hypothesis were obtained when Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) narcissism scales were correlated with depression in adults receiving treatment for alcoholism. Essentially identical outcomes emerged in a second sample of state psychiatric hospital patients. A third study upheld the hypothesis when narcissism scales were correlated with clinical assessments rather than self-reports of depression. None of these findings were easily explained in terms of alternative interpretations of self-reported narcissism, and these data demonstrate that empirical support for the continuum hypothesis was not limited to the NPI, undergraduates, or self-report measures.

Taxometric analysis of impression management and self-deception in college student and personnel evaluation settings.

The typology of impression management (IM), a deliberate attempt to create a positive social image, and self-deceptive positivity (SDP), an overly positive bias in self-description, was examined using taxometric procedures with Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) underreporting scales and Balanced Inventory of Desirable Responding (Paulhus, 1988) impression management and SDP scales in a sample of college students. MMPI-2 underreporting scales were then examined in a personnel evaluation sample. IM was found to be taxonic in both student and personnel settings. Given support for the IM taxon, taxometric procedures allow the estimation of the base rate of IM and the classification accuracy of MMPI-2 IM scales in the absence of a separate criterion. Using taxometric procedures, the mean base-rate estimates were .16 and .25 for student and personnel settings, respectively. Overall classification rates ranged from .80 to .94 for MMPI-2 IM scales in the personnel setting.