Psychopathological

Screening and
Support Planning
Presented to the
Secondary School Student Support
Service Department
At
Yokohama International School
By
Adam Clark
July 20th, 2010
Theoretical Rationale
(as if presenting to my colleagues at work)
 Up until this point much of our school counselling and related
support work have focused on externalizing disorders characterized
by behavioral excesses or undercontrolled behaviors including
hyperactivity, impulsivity, aggression, and conduct disorders.

 While these are undoubtedly relevant to our student population, it is

important that we do not overlook the less overt internalizing
disorders characterized by overcontrolled behaviors including
anxiety disorders, obsessive compulsive disorder, and somatic
disorders such as anorexia and bulimia.

 Perhaps most concerning within internalizing disorders is the

presence of suicidal behaviors in adolescent populations

Internalizing and externalizing behavior descriptions

adapted from Reynolds (1990).
Adolescent Psychopathology Scale
The very nature of internalizing disorders, consisting of
relatively covert, often unobservable symptoms, results in
difficulty in diagnosis. - William Reynolds, PhD

 The Adolescent Psychopathology Scale (APS) is a Level C self-report rating

that is considered particularly useful in identifying internalizing behaviors.
This is beneficial as behaviors are more difficult to observe as students move
from class to class within the secondary division and adolescents become
more self-managing and independent at home (Conners et al., 1997)

 The Adolescent Psychopathology Scale is theoretically based on the

conceptual distinction between internalizing and externalizing disorders
(Merrell, 2003).

 The APS is designed to be consistent with DSV-IV Axi1 1 and Axis 2

symptom classification (Hilker & Kelley, 2004; Merrell, 2003; Reynolds,
1998; Weiner, Freedheim, Graham, & Naglieri, 2003)
Overview
 The APS is available in two formats. The standard version includes
346 items, and is a broad-purpose instrument that requires
approximately 60 minutes to complete. The short form involves 115
items and requires approximately 20 minutes to complete. The APS
is unique in that different response formats and temporal dimensions
are used depending on the characteristics of the symptom or the
problem under consideration (Hilker & Kelley, 2004; Merrell, 2003;
Reynolds, 1998, Weiner et al., 2003).

 The APS is computer scored and items are converted into one or
more of 40 scales using a T-score system – Clinical Disorder (20
scales), Personality Disorders (5 scales), Psychosocial Problem
Content Areas (11 areas), and Response Style Indicators (4 scales)
(Merrell, 2003).
Current Applications
 Designed for use with adolescents age 12 to 19 to evaluate
symptoms of psychological disorders, personality disorders, social-
emotional problems, competencies and distress in adolescents
(Hilker & Kelley, 2004; Merrell, 2003; Reynolds, 1998, Weiner et
al., 2003).

 Consistent with the DSM-IV symptom classification but not

intended to provide formal diagnosis or classification (Reynolds,
1998).

 Used for screening the severity of symptoms associated with specific

DSM-IV disorders and treatment planning (Hilker & Kelley, 2004;
Merrell, 2003; Reynolds, 1998).

 Utilized with young offenders to establish the prevalence of

diagnostic categories in juvenile detention centers (Bickel &
Campbell, 2002; Drew, 2009).
Proposed Application
(as if presenting to my colleagues at work)

 Over the course of the school year we occasionally

observe behaviors in students that raise concerns
regarding social-emotional problems, competencies and
distress. Inclusion of the APS among our counselling
assessment resources would enable us to evaluate for
symptoms of psychological and personality disorders
without making premature outside referrals.
Test Development and Norming
 The APS was developed in the US to assess specific content areas. An
item pool of DSM-IV symptom specifications was created by a panel of
expert practitioners using feedback from 2,834 adolescents in school
settings and 506 in clinical settings (Reynolds, 1998).

 The developers created the 40 scales of the APS through a combination

of a rational-theoretical approach for content validity and statistical
item analysis for scale reliability (Merrell, 2003).

 The final normative sample consisted of a group of 1,827 seventh to

twelfth grade students selected from the larger sample to reflect the
mixed gender, ethnic, and age percentages of the 1990 U.S. census
(Merrell, 2003). Specific age and gender score conversions are
available (Weiner et al., 2003).
Test Development and Norming
 With regard to ethnicity, the normative sample was 72%
Caucasian and 18.3% African-American. Adolescents
from Asian and Latino groups were represented (Weiner et
al., 2003).

 Four t-score threshold scores were used to depict the

deviation from the normative mean and clearly identified
the level of clinical severity represented. Descriptive
categories range from normal to severe clinical range. This
provided for straightforward identification of youth with
potentially clinically important responses (Drew, 2009).
Technical Specifications
 Reliability
 Internal consistency scores for the clinical disorders,
personality disorders, and psychosocial problem content
domains ranged from .69 to .95 for the total normative
sample (Hilker & Kelley, 2004). Scores in this range are
suitable for screening and for generating hypothesis
(Erford, 2007).
 Item total correlations indicated consistent item content
for each scale (Hilker & Kelley, 2004).
 A 2 week interval test-retest reliability indicated greater
than .76 for the the majority of coefficients (Reynolds,
1998).
Technical Specifications
 Validity
 As mentioned, initial content validity was obtained
through a rational-theoretical review of the item pool by a
team of expert practitioners (Bickel & Campbell, 2002;
Merrell, 2003, Reynolds, 1998).
 Statistical item analysis affirmed the construct validity of
the APS and the hypothesized distinction between
internalizing and externalizing symptoms (Hilker &
Kelley, 2004; Reynolds, 1998).
 Overall the discriminant validity of the APS was also
supported in that no significant correlations between the
scales of the APS and IQ were found (Hilker & Kelley,
2004; Reynolds, 1998).
Technical Specifications
 Concurrent criterion-related validity was supported by moderately
strong correlations between the relevant scales of the APS and the
Minnesota Multiphasic Personality Inventory (Hilker & Kelley,
2004; Reynolds, 1998).

 More specific measures were also used to calculate concurrent

validity including the Beck Depression Inventory, Suicide Ideation
Questionnaire, and the Reynolds Adolescent Depression Scale
(Hilker & Kelley, 2004; Reynolds, 1998).

 Generally speaking, concurrent validity was supported (Hilker &

Kelley, 2004).

 Lastly, clinical validity was found by demonstrating significant

difference between the APS scores for the school and clinical
samples (Hilker & Kelley, 2004).
Current Research
 The APS featured prominently in a 2002 study regarding
the mental health of adolescents in custody in Tasmania,
Australia. It was selected because of the compatibility
between the APS and the DSM-IV and because it yields a
measure of ADHD. The utility beyond the United States
suggests the APS may have international applicability
(Bickel & Campbell, 2002).

 In 2009 the APS was evaluated as potentially a “useful”

more cost-effective alternative for juvenile justice
facilities in place of costly in-depth evaluations
conducted by highly trained clinicians (Drew, 2009).
Current Research
 The 2009 study examined the validity and utility of the
short form of the APS (APS-SF) by the accuracy with
which scores identified youth offenders who had already
been determined to meet one or more DSM-IV diagnosis
by highly trained masters level clinicians with extensive
experience administering the Structured Clinical
Interview or DSM-IV Childhood Diagnoses (KID-SCID).

 The utility of the APS-SF was assessed by Receiver

Operating Curves (ROC) and a broad range of diagnostic
efficiency statistics. The ROC was used to report how
well the instrument identified high risk adolescents for
further evaluation (Drew, 2009).
Current Research
 A basic premise of this study was that the diagnostic
sensitivity of the tool must be accurate enough (at least .
70) to identify all juvenile offenders who would be
identified by a more thorough diagnostic evaluation for
follow-up (Drew, 2009).

 Drew (2009) found the APS useful in identifying which

youth offenders didn’t need follow-up evaluation,
moderately accurate in predicting mental health
disorders, and less accurate with mood spectrum
disorders.
 Limitations and Critique
As identified previously the APS has a number of unique
strengths and has received favorable reviews. It is
generally believed to hold promise but...
 there is not a large body of research in support of the instrument
beyond the psychometric and technical manual.

 because of the range of internal consistency t-scores for clinical

disorders additional study is needed to determine the relationship
between scores on the APS and diagnosis and clinical description.

 it is recommended for use with treatment planning, yet no

indication on how treatment planning would follow is indicated in
the manual (Hilker & Kelley, 2002).
Limitations and Critique
 Low but significant correlations were found between social desirability
and the APS Scales (Hilker and Kelley, 2002). This potentially reduces
the objectivity of the measure.

 Connected to the desirability bias, adolescents in the Tasmanian study

were able to underrepresent their criminal behavior to better make use
of APS in court. In those instances a combination of information,
including other reports, was compiled (Bickel & Campbell, 2002).
This may decrease the efficiency of using the APS and raises questions
about possible manipulation of data.

 Lastly, while the cut-points or threshold scores of the APS clearly

identify the level of clinical severity, as Clarke and McKenzie (1994)
warn, it is advisable to carefully review item responses so that the
unique combinations that contributed to the scores are not overlooked.
This may be particularly challenging given the purported complexity
of marking the APS and may limit the insights of the examiner.
 References
 For a complete list of references
click through to

http://clark-ref.notlong.com

Photo by Adam Clark