Clinical Assessment of Child and Adolescent Personality and ...

chapter 15 integrating and interpreting assessment information347agreement for younger children than foradolescents. As noted above, part of thisage trend may be due to adolescents spendingless time with teachers and parentsand, as a result, these informants may haveless complete information on the adolescent’sadjustment. However, Achenbachet al. also suggest that younger children’sbehavior may be more cross-situationallyconsistent. Importantly, however, theseage related findings have not always beenconsistently reported across samples (DeLos Reyes & Kazdin, 2005).Informant Discrepancies: OtherFactorsIn addition to type of behaviors and age ofthe child, there are other factors that mightinfluence the report of various informantsand which therefore should be consideredwhen interpreting discrepant information.In a previous chapter we discussed factorswithin the family, such as parental adjustmentand marital conflict, which may affectthe information provided by the parent on achild’s adjustment. For example, Foley et al.(2005) reported on a sample of 2,798 twinsages 8–17. They found that maternal alcoholismand marital difficulties were characteristicof cases in which an anxiety disorderwas reported by mothers but not children.Also, informants might have differingmotivations, both conscious and unconscious,that can affect the informationthey provide (Karver, 2006). For example,a child may not want to admit to problembehavior or a teacher may be interested ingetting a child placed outside of his class.Several rating scales discussed in previouschapters include validity scales that attemptto detect such response sets and aid in theinterpretation of information provided.It is also important to note testing conditionswhen interpreting the report of differentinformants. For example, a childmay have been administered a self-reportquestionnaire after a long testing sessionand it is obvious in watching him completethe questionnaire that he is not reading theitems carefully.SummaryFrom this discussion it is clear that,although the simple scheme of equallyweighing the report of different informantsusing an either/or approach is a good startingpoint, a clinical assessor cannot use thisapproach blindly. There are numerous factorsthat must be considered in trying toexplain seemingly discrepant informationfrom different sources.The previous discussion outlines someof the more important issues that havebeen uncovered in research that can helpguide clinical decision making. However,the final case formulation that results fromthe integration of multiple types of assessmentinformation involves a number ofcomplex clinical decisions. To aid in thisprocess, in Box 15.3 we provide a summaryof an article by Nezu and Nezu (1993) thatoutlines (1) some of the common cognitivestrategies that are used by people inmaking decisions but which could lead toerrors in clinical reasoning and (2) a generalorientation to clinical reasoning thatcan minimize the effects of these errorsin clinical judgment. Using this generalproblem orientation as a basis, the followingsection outlines a step-by-step strategythat can help to guide the clinician in theintegration of assessment information.A Multistep Strategy forIntegrating InformationThe following strategy assumes one hasconducted a comprehensive clinical evaluationof the child or adolescent. The prerequisitesare (1) having information ona child’s adjustment from various sources