Clinical Assessment of Child and Adolescent Personality and ...

CHAPTER 6 SELF-REPORT INVENTORIES129Box 6.4A Sample Case Using the MMPI-AMichael is a 16-year-old high school juniorHe was referred for an evaluation becauseof recently increased anxiety symptoms thathave interfered with his social interactionsand functioning at school. More specifically,Michael has experienced some increasedconcerns with cleanliness or organization athome, and he has has begun to avoid socialsituations for fear of experiencing noticeableanxiety in front of others. Michael also has ahistory of depression, according to his mother,which has included a trial of antidepressantmedication about three years ago. Medicationwas discontinued after a couple of monthsbecause his symptoms had diminished.Michael currently lives with his parentsand his 11 year-old brother. He reportedlygets along well with his family, and he has historicallyperformed well academically until thecurrent school year when his grades have gonefrom “As” and “Bs” to “Bs,” “Cs,” and “Ds.”Michael was cooperative and attentivethroughout the test session. He appearedmotivated to do well. No speech, visual, auditory,or motor abnormalities were noted.Michael demonstrated tendencies towardperfectionism and anxiety during intelligencetesting. During the arithmetic subtesthe began to tremble and remarked, “I feelnervous.” He was visibly nervous (i.e., handsshaking, voice cracking) when faced withrelatively difficult items. He also seemed perfectionisticin his response style as evidencedby his unwillingness to give up on difficultitems. Michael also displayed depressed affectduring a clinical interview, although he didsmile on occasion. Michael’s intellectual testfindings were all within the High Averagerange. Likewise, all of his achievement subtestscores were in the High Average range.These findings are consistent with his educationalhistory.On the MMPI-A, Michael indicatedmoderate levels of depressive symptoms anda tendency to isolate himself socially. He wasself-described as shy, which is consistent withhis mother’s report. Content scale elevationson the Social Discomfort and School Problemsscales are consistent with referral concerns.More specifically, he reported beinguncomfortable in social situations, has difficultyinteracting with others, and avoids socialevents. In regards to problems at school,Michael indicated that he does not careabout doing well at school and that school isboring. Structured interviews with Michaelindicate that these issues are relatively recent.However, his mother expressed concern thatMichael has had a tendency to lose interestin activities such as school and social outingsover the last few years.The Depression (D) clinical scale wassomewhat elevated. Michael indicated that hehas feelings of inadequacy and worthlessness.Also, on the MMPI-A, Michael acknowledgedhaving lost interest in activities andlosing sleep due to worry. The reports ofMichael and his mother on structured interviewsindicate that he meets diagnostic criteriafor Dysthymic Disorder. Since childhood,Michael reportedly has had periods of cryingeasily, difficulty making decisions, feelings ofinadequacy, a lack of enjoyment from praiseor rewards, and feeling that he is not as goodas other people. He recently has experiencedincreasingly depressed mood, difficulty sleeping,and avoidance of activities.His social anxiety and negative attitudesabout school have apparently been recent developmentsthat do not warrant a diagnosis at thistime but should receive clinical attention.The findings of this evaluation support theneed for intervention at this time. Michaelcontinues to demonstrate depressive symptoms.In addition, he is beginning to exhibitsome anxiety in social situations which areinterfering with his desire to interact withothers and his enjoyment of school. A possible(Continues)