Chapter Fourteen

Chapter 14-
Guidelines for MMPI-A Interpretation

The interpretative strategy recommended for the MMPI-A is based on the scales descriptor interpretive approach described in Chapter 9. An important change is the use of T scores derived from adolescent samples rather than raw scores used in the interim scale descriptor strategy.

When interpreting the results, authors do not suggest that clinicians use the recently suggested structural summary that was designed to integrate and interpret information from MMPI-A scales and subscales (Archer, 1997a, b). The reason for this is that the summary is based on some faulty assumptions such as the arbitrariness in the distinctions between the MMPI-A basic, content, and supplementary scales. Moreover, its development is atheoretical as no theoretical rationale is presented to explain how the eight factor groupings reflect the basic dimensions of overall importance in describing adolescents’ functioning. On page 317, there is a Table with questions that guide the MMPI-A interpretation. The difference between MMPI-2 and MMPI-A interpretation is that the latter considers the developmental issues and characteristics. Specifically, adolescents are growing and changing in a substantial way, which should encourage clinicians more cautious in making long term predictions about adjustment, severity of the disorder, or trait-based personality characteristics. On page 318, there is a sample form of the interpretative report that presents the categories where the information pertaining to the interpretative questions should be grouped.

Extratest characteristics:
clinicians should take care in selecting the version that is appropriate given client’s linguistic abilities and reading level
slightly different descriptors apply depending on the client’s gender and setting
clinicians should make sure to verify whether client’s responses are influenced by substance abuse or a recent traumatic experience

Validity considerations:
some response styles are so problematic that they should not be interpreted
the interpretative report should begin with a description of the individual’s response attitudes as revealed by his or her scores on the validity scales and indicators.

Assessing symptoms and behaviors:
descriptors associated with high and moderate scale elevations provide the sources for this section of the report
confidence that a descriptor applies to the individual is greatest for those descriptors coming from highly elevated scales, scales with the strongest evidence for their validity scales rather than subscales, and those descriptors that replicate across MMPI-A scales. In cases in which differing correlates cannot be resolved, they should be noted in the report.

Sexual or physical abuse:
elevations on several MMPI-A scales are associated with sexual or physical abuse in clinical boys and girls. However, the elevations should not be taken as evidence of abuse. Instead, it is a suggestion that further evaluation is needed.
Boys with histories of sexual abuse show elevations on scales measuring internalizing symptoms (Pt, Sc, A-dep, A-ang, A-lse, A-fam, and A-sch).
Sexual abuse in girls is related to elevations on Pd, Sc, and A-fam.

Suicidal behaviors
Scale descriptors can range from suicidal ideation to serious attempts with more lethal methods.
There is a series of 7 items (Depression/ Suicidal Ideation) that can indicate which, if any, MMPI-A items suggesting suicidal risk have been endorsed by a given adolescent.
Both boys and girls with elevations on standard scales 2,4, and 9, as well as the Harris-Lingoes D1, Pd5, and Ma3 subscales had an increased risk of suicidal behaviors.
For boys, elevations on A-aln and A-anx, as well as the Pd4 Harris-Lingoes subscale were also predictive of suicidal risk.
For girls, elevations on the A-fam, A-dep, and A-sod content scales made independent contributions to the predictions of suicide risk.
Elevations on these scales cannot be interpreted as a definitive indicator of the presence of the problem for an individual adolescent. Rather, elevations on scales associated with higher probability of suicidal risk suggest that a careful evaluation is needed.

School problems:
Two scales: A-sch and A-las.
Both academic and behavioral problems are covered.
Since youth may underreport school problems, elevations on Pd and A-con should be interpreted even in the presence of low scores on A-sch or A-las.

Problems with alcohol and other drugs:
There are three scales developed to determine whether the adolescent has substance abuse problems. In addition, several elevations on some clinical and content scales are associated with alcohol or other drug use.
Scores on the MAC-R, ACK (acknowledging substance abuse), and PRO scales should be examined for elevations. If scores on two of the scales are elevated, the results may be interpreted. However, if the elevation shows up on only one of the scales, then the clinician should indicate in the report that the evidence is equivocal.

Interpersonal relationships:
The primary sources of information are Si, its subscales, and A-sod. Several of the content scales describe characteristics that are relevant to an individual’s relationship with others (A-aln, A-ang, A-cyn, and A-fam). An elevation on PRO may suggest the possibility of belonging to a negative peer group.

Strengths:
Some of the Harris-Lingoes subscales offer examples of possible strengths (e.g., Hy1 (Denial of Social Anxiety), comfortable around others, finds it easy to talk with others, Pd3 (Social Imperturbability), confident in social situations, willing to defend his or her strong opinions).

Diagnostic considerations:
In formulating a diagnosis, the clinician should integrate the information from the MMPI-A to form an overall picture of the client’s symptoms, behaviors, likelihood of alcohol or drug problems, interpersonal relationships, and strengths.

Treatment implications or recommendations:
An elevation on the A-rtr scale should be interpreted as an indication of the presence of negative attitudes toward mental health treatment that may interfere with building a therapeutic relationship.

An MMPI-A feedback session:
The young person can be encouraged by the therapist to engage in problem solving and deciding whether the interpretation applies to him or her.
After providing individual interpretations to each family member, the therapist can meet with the family as a group.