Clinical Assessment of Child and Adolescent Personality and ...

chapter 10 projective techniques235the number of active movement responses,and the use of shading features for makingdepth and dimension responses.The modest stability of Rorschachscores is not unique to this type ofassessment, but is characteristic of mostassessment techniques in children (e.g.,McConaughy, Stanger, & Achenbach,1992). In fact, this is probably a positiveattribute of the scores because it suggeststhat the scores capture the rapid developmentalchanges experienced by childrenand adolescents. However, there is a tendencyto equate Rorschach responses withpersonality assessment, and to equate personalitywith stable dispositions. Thesefindings on the low stability of Rorschachscores clearly argue against making strongdispositional statements based on a child’sRorschach protocol.One common use of the ECS has beento assess childhood depression. Exner(1983) initially developed a DepressionIndex (DEPI) based on six scores froma child’s protocol. Unfortunately, theDEPI, based primarily on research inadults, showed very poor agreement withother measures of depression in children,which led Exner to revise the DEPI(Exner, 1990) in an effort to increase itscorrespondence with other measures ofdepression. Tests of the revised DEPIindex have also failed to find consistentassociations with other measuresof depression (Archer & Krishamurthy,1997; Ball et al., 1991; Carter & Dacy,1996). These findings could be a functionof inadequate methods of assessingchildhood depression in general, whichresults in the failure to have an appropriatestandard with which to judge the Rorschach.Alternatively, Weiner (1986) hasargued that the Rorschach: “is a measureof personality processes, not diagnosticcategories… it can help to identify formsof psychopathology only to the extentthat they identify personality characteristicsassociated with the types of disorder”(p. 155). However, these findings suggestthat users of the DEPI from the ECSshould not expect the scores to be highlyrelated to other indexes of depression.An even more extreme caution is inorder for the Suicide Constellation forChildren, a set of scores based on an indexused to assess for suicidal tendencies inadults (Exner, 1978). The suicide constellationwas developed by selecting the eightbest predictors of suicide from the ECSin a small sample (n = 39) of children whohad attempted or committed suicide withinfewer than 60 days after the Rorschach wastaken (Exner & Weiner, 1994). Unfortunately,the predictive validity of this indexhas not been replicated in other samples,making the interpretation of this indexquestionable at present (Allen & Hollifield,2003).Another common use of the Rorschachis in the detection of cognitive and perceptualirregularities that could be associatedwith schizophrenia (Weiner, 1986). Exnerand Weiner (1994) outline four sets ofRorschach scores that can aid in this detection.First, disordered and illogical thoughtprocesses are the focus of several specialscores in the Exner system. For example,the Incongruous Combination score identifiesresponses that condense blot detailsor images into a single incongruous perceptin which the parts or attributes do notbelong together: “a person with the headof a chicken” (Weiner, 1986, p. 217). Second,perceptual inaccuracies are suggestedwhen the child has a protocol with manyresponses that do not correspond closelyto the form structure of the blot (i.e., poorform quality) or protocols with few commonor popular responses. Third, interpersonalinadequacies that are often associatedwith schizophrenia can be assessed inresponses involving human movement.Movement responses with poor form qualityare considered indicative of inaccurateor unrealistic interpretations of interpersonalsituations (Exner & Weiner, 1994).