TEOFILO O. PALSIMON JR.

MA in CLINICAL PSYCHOLOGY

Journal Critique On
Beyond the Score: Clinical Evaluation Through Formal Psychological Assessment

I. Summary

This paper has shown how the FPA highlights each self-report questionnaire’s strengths and
weaknesses in terms of correspondence to a set of diagnostic and clinical criteria. The FPA
details the relations between objects (items) and attributes (decomposition of clinical and
diagnostic criteria). This eliminates useless redundancy and increases efficiency. FPA also allows
for the pinpointing of the relations among sets of items and attributes by analyzing the
presence or absence of diagnostic criteria in the items. Flexibility is another crucial advantage of
FPA: the set of attributes could be easily modified or updated according to new versions of DSM
or to different theoretical approaches, while the methodology remains equally effective and
reliable. Moreover, it has been shown that FPA could actually be used to provide clinicians with
the specific diagnostic information endorsed by the set of responses of a patient to a
questionnaire. In FPA the score becomes somehow useless given that even smallest sets of
items may endorse more critical situations in terms of clinical symptoms. All this information
could be provided by means of the output of the adaptive algorithm that carries out the
administration of the items.

II. Relevance

Broad-spectrum questionnaires administered in the assessment are deemed to be time-

consuming to complete and interpret. These types of questionnaire were also found resulting to
redundant information and inconsistent response patterns. Extending this to clinical diagnosis
means that individuals could be grouped under the same diagnostic category (because they
meet sufficient criteria) even though they present different clinical features and are motivated
by different underlying psychological mechanisms. The critical point is that clinicians do not
have readily available a formal objective method to interpret the clinical picture presented by
the combination of a patient’s responses to a questionnaire. In fact, they are usually unaware of
potential problems when scores resulting from different patterns are compared to a cutoff. To
fill these gaps, the authors have developed a method that is potentially capable of maximizing
the advantages of both semi-structured interviews and psychological tests while overcoming
some of their limitations, namely, formal psychological assessment.

FPA indexes provide opportunities to use information from a questionnaire. First, probability
estimates for an attribute could allow consideration of retaining or removing an attribute if it is
not informative. Second, the false positive and false negative rates for each item are important
when evaluating the plausibility of a specific, observed response pattern. This could lead to
reformulating the item, modifying the attribute assignment, or splitting the item in two or more
parts to correct poor formulation. Finally, the global fit indexes allow for an overall evaluation of
the goodness of the hypothesized model.

III. Recommendation, Comments and Suggestions

FPA can be used as a formal method to remove redundant items from a given set of
questions investigating a specific disorder. The possibility of mapping all the clinical attributes
investigated by the items might allow the removal of items that provide the same information
over and over again. Furthermore, the proposed approach also could be used to identify
attributes that a set of items misses. FPA might also represent a viable methodology with
questionnaires containing less face-obvious items