Chapter Thirteen

Chapter 13
Interpreting MMPI-A Supplementary Measures

Alcohol & Drug Problem Scales

A. MacAndrew Alcoholism Scale-Revised (MAC-R)

-Developed from original MMPI item pool using adult subjects
-Revised with 4 original items deleted because of objectionable content and
replaced with other items that empirically separated individuals in clinical
settings with alcohol or drug problems from individuals without such problems
-Assess drug and alcohol problems
-Original raw score cutoffs were 24 (T 60) for girls and 26 (T 61) for boys
-Now use linear T scores-if T score 60 suggestive of drug and alcohol problems
-T score of 65 or greater-more certainty presence of drug and alcohol problems
-Criterion group: adolescents with history of alcohol or drugs
-Normative group: psychiatric group without drug or alcohol problems and normal sample of adolescents
-Elevations on MAC-R suggestive of persons who are sensation seeking (e.g. likes wild parties, doing things a little frightening or illegal things, being around others who like to party), acting out problems, unable to anticipate consequences of their actions, being neither perfectionistic nor planful

B. Alcohol and Drug Problem Acknowledgment Scale (ACK)

-Newly developed measure for MMPI-A
-Similar to adult AAS
-Assess willingness to acknowledge having problematic alcohol or drug use, with
its associated symptoms
-Developed using combined rational-empirical scale construction strategy
-Items contained obvious references to alcohol and other drug problems
-Then items were correlated with remaining MMPI-A items to uncover any other
items that improved discrimination of individuals with known alcohol-drug problems use from those without those problems
-Elevations on ACK indicate extent to which adolescent has admitted having alcohol or drug problems
-ACK related to therapists’ ratings of alcohol and drug use problems
-Adolescents seem to be more open in acknowledging alcohol and drug problems on MMPI-A than to their therapist
-Concern if T score greater than 60, with increased confidence placed on T scores greater than 65
-High scores report problem alcohol or drug use, having harmful habits, relying on alcohol or drug use to express true feelings or as coping strategy; others may tell them they have a problem and they might get into fights when drinking
-Incarcerated delinquent boys with high ACK scores show internalizing and externalizing problems-depression, irritability, anger about incident leading to incarceration, attempts to resist depression and irritability, fatigue and lack of energy, restlessness and excessive running and climbing, psychomotor retardation and slowed movements, hopelessness and helplessness, suicidal ideation with greater lethality, grandiosity, aches and pains, obsessions and compulsions, blaming of others, temper tantrums, oppositional behaviors, cruelty towards animals and people, fire setting and acting before thinking

C. Alcohol and Drug Problem Proneness Scale (PRO)

-Empirically derived
-Assess likelihood of adolescent developing an alcohol or drug problem
-Similar to adult APS
-Criterion group: adolescent boys and girls in alcohol and drug inpatient treatment
units
-Normative group: adolescents without alcohol or drug problems who were in
psychiatric inpatient treatment and normal adolescents at school
-Include specific items about negative peer group, behavior problems at home and school
-Does not contain obvious items about problematic alcohol or drug use
-Concern if T score greater than 60, with increased confidence placed on T scores greater than 65
-Elevation suggests proneness to develop problematic alcohol or drug use
-PRO related to therapists’ ratings of substance abuse problems, aggressions, sensation seeking (see MAC-R), does not anticipate consequence of their actions, unlikely to be planful or perfectionist
-Incarcerated delinquent boys with high PRO scores likely to be restless, shout and complain, have insomnia, self pity, poor judgment, and blame others; they may have a history of breaking and entering

Factor Scales

Two scales were derived from a factor analysis on basis of MMPI-A scales:
1. Anxiety scale (A) -35 items, measure of maladjustment, incarcerated delinquent boys with high score on A likely feel depressed about incident leading to incarceration, have excessive guilt, experience generalized anxiety, fatigue and lack energy, restlessness and excessive running and climbing, pacing and agitation, suicidal ideation with serious lethal attempts
2. Repression scale (R)-33 items, no research with adolescent samples

Immaturity Scale

-Provide objective measure of ego development
-Item content includes lack of self-confidence, externalization of blame, lack of insight and introspection, interpersonal and social discomfort, alienation, limited future orientation, hostile and antisocial attitudes, egocentricity and self centeredness
-Correlates in sample of psychiatric inpatients include poor reading ability, possible limited capacity to think in abstract terms, being less likely to identify with values and beliefs of their social group, having poorer perspective taking, being less likely to have completed or be engaged in process of identity formation

Personality Psychopathology 5 Scales (PSY-5)

Measures constructs of:
1. Aggressiveness-correlate with assaultive, aggressive, delinquent behaviors
2. Psychoticism-related to therapists’ ratings of psychotic behaviors
3. Disconstraint-related to acting out, drug use, sexual activity, delinquent behaviors
4. Negative emotionality/neuroticism-related to symptoms of anxiety, worry, guilt and excessive reliance on adults
5. Introversion-related to social withdraw, shyness, and few friends

Emphasis on specific traits or dispositional differences rather than major psychopathological classes

MMPI-A Critical Items

-Developed using combination of statistical steps
-Normative group: MMPI-A normative sample
-Criterion group: new clinical sample of 404 adolescents in 2 groups
a. residents of locked intensive care facility
b. residents of open facility and outpatient program
-Also used rational procedures with 11 doctoral-level clinicians familiar with MMPI-A or adolescent development
-15 critical item groups:
1. aggression
2. anxiety
3. cognitive problems
4. conduct problems
5. depression/suicidal ideation
6. eating problems
7. family problems
8. hallucinatory experiences
9. paranoid ideation
10. school problems
11. self denigration
12. sexual concerns
13. somatic complaints
14. substance use/abuse
15. unusual thinking
*For specific examples of each critical item group, see Table 13-5 on page 309
-MMPI-A critical items can be used for generating hypotheses about adolescent’s behavior that can be followed up in a clinical interview
-Young people may endorse critical items about problems they initially reluctant to admit in an interview
-Clinicians use item responses to open up discussions about difficult problems